 
## Grand Rounds:

### Healing Wisdom for a Complex World

### By William Sutherland, MD

### Foreword by Bradford Keeney, PhD

### Grand Rounds: Healing Wisdom for a Complex World

### By William Sutherland, MD

### Copyright 2015 William Sutherland

### Smashwords Edition

### ISBN 9781311977236

### Smashwords Edition, License Notes Thank you for downloading this ebook. This book remains the copyrighted property of the author, and may not be redistributed to others for commercial or non-commercial purposes. If you enjoyed this book, please encourage your friends to download their own copy from their favorite authorized retailer. Thank you for your support.

### Published by the

### Institute of Complexity & Connection Medicine

### www.complexitymedicine.org

### First Edition: July 2015

### Forward by Bradford Keeney, PhD

### Cover Design by Andrew McClure

### Copy Edit by Roger Sumner
Acknowledgements

### Dedicated to all of my Grandmothers and Grandfathers

In indigenous ceremony it is common practice to put the Creator first in one's acknowledgement and in one's gratitude. Let me start then by acknowledging with humble thanksgiving that Great Mystery. As well, let me take this moment testify to the fact that the unifying principles and verities of the Baha'i faith and its founder Bahá'u'lláh have been the silent source of inspiration behind the writing of this work as I looked within and without to better understand what a medicine grounded in the truth of unity could become. This process in investigating Health has been profoundly healing for myself – Such is the way of Spirit.

It is said that the basic block of human unity is the family and all other aspects of human society are built on that foundation. The writing of this book was only possible because of the unconditional support of my family. The love of my wife Lisa and my four children William, Alura, Grace, and Nate was what pushed me to start this endeavor and what pulled me to finish. My hope is these words, with whatever wisdom that may lay within will be something they my children can carry throughout their lives, passing it on to my family's future generations. As well, let me gave thanks to my mother Rosalyn and father Bill Sr. along with my brother Ryan and Sister Steph; my family of origin and the source of my lineage. My mother's enthusiasm and support for my projects in life has known no bounds, and if it wasn't for my father's dedicated tutelage and editing throughout my schooling, I would never have succeeded in becoming a physician.

There is the family we are born into, nevertheless there is also the family we create through our own choosing. In this way I want to express gratitude to some of the primary mentors in my life including Brad Keeney, Clem Courchene, Fabian Morisseau, and Takemasa Okuyama. Sadly, there is not enough space to list all of my dear and cherished brothers and sisters that have been a part of my walk, but you all know who you are as you live in my heart and I in yours

As a final note, I would like to thank all of my editors in this work. My appreciation goes to Roger Sumner, Dad, Andy McClure, and Brad Keeney for all the help and patience you gave in helping me clarify my thoughts and ideas. You have helped put that swarm of crazy bees to rest!

With Love

Bill

**" The laws of Nature are written by man. The laws of Biology must write themselves" **

### **Heinz von Foerster**
Table of Contents

Foreword: by Bradford P. Keeney, PhD

Introduction to the Concept

Invitation to (a) Play

Act I – Scene I (Night Rounds): The Master of the Game (The Glass Bead Game as a metaphoric pedagogy and guidebook for an exploration into the nature of Mind and Holism)

Act I – Scene II (Day Rounds): On the Nature of Service

Act II – Scene I (Night Rounds): The Ancestor (Disease, Health, the nature of change, and the tyranny of language in the modern world)

Act 1I – Scene 1I (Day Rounds): On the Nature of Sensuality

Act III – Scene I (Night Rounds): The Professor (Cybernetic Circles, Virtue and Viciousness, and a return to ecological grace through the patterns that connect)

First Intermission: Confection Infection – You are what (and how) you eat

Act III – Scene II (Night Rounds): The Professor (continued)

Act III – Scene III (Day Rounds): On the Nature of Performance

Act IV – Scene I (Night Rounds): The Wizard (Hypnotic Wizardry, Tantalizing Trance, and why every day is best served up with a good breakfast)

Act IV – Scene II (Day Rounds): On the Nature of Aesthetics

Act V – Scene I (Night Rounds): The Philosopher (Chaos, Complexity, and the cacophony of creation brought forth when Life lives itself)

Second Intermission: Refreshments – Re: Fresh Mint

Act V – Scene II (Night Rounds): The Philosopher (continued)

Act V – Scene III (Day Rounds): On the Nature of Ceremony

Act VI – Scene I (Night Rounds): The Physician (The Hippocratic Oath Revisited)

Act VI – Scene II (Day Rounds): On the Nature of Love

Act VII (Night Rounds): Jazzman (Finding the rhythm of one's life, so one may find the Rhythm of Life)

Encore: The Garden (Sowing seeds, reaping the bounty)

Appendix A

Appendix B

Endnotes

References

Back Matter – Book Description

Help with the Vision of a Complexity Medicine

Contact

Thank you

About the Author
Foreword

It has been fashionable for several decades to argue for an alternative and/or complement to conventional allopathic medicine. Whether they call them "holistic," "mind-body," "complementary," "integrative", or by some other metaphor, proponents of these approaches promise a revolution, or at least an expansion of the beliefs and practices that may legitimately address sickness and wellbeing. In spite of the proliferation of best-selling authors and popular medical gurus in the whole health marketplace, it is seldom asked if any paradigmatic change has actually been enacted. For a paradigm to truly change, the premises that define "legitimacy" first must be altered in a discernible manner. It is time to question whether any of the calls for a new medicine have actually delivered an alternative, or simply a new fad or business venture, masking what is actually more of the same old medical way of thinking and behaving.

One primary example is the replacement of synthetic pills with plant-based (presumed more natural) pills. This offers no exemplification of a change in what legitimizes medicine. The only difference introduced is that between "natural and synthetic" and the marketplace in which they are sold. Both forms of pill are argued to be effective for the same reason and through the same means of validation: socio-statistical outcome studies determine whether a chemical bullet hits the pathogen target or triggers the body's defense against sickness. Here there has been no shift in paradigm or Weltanschauung, as the same authority that determines what is valid medical treatment remains intact. The result is that any claimed alternative offered by "natural" treatments is now held inside the paradigm of allopathic medicine. The latter becomes even more all-encompassing, now appropriating even that which formerly promised to be different.

Similarly, when a non-material intervention such as "prayer," "meditation," or "positive thinking" is treated as if it were a pill, the same established court of legitimacy rears its head and conducts an outcome study to see if it is effective. Then a doctor can write a prescription for prayer, suggesting that it be administered once, twice, or three times a day as if it were aspirin. What has been missed by so-called medical science is that its idea of science promotes a self-verifying protocol that first and foremost validates its own version of the scientific model.

Here we find a hidden circularity: medicine applies its own premises about science to prove that its premises deliver a true science, blind to the way this recycled bias transforms belief into presumed fact. Alfred North Whitehead's critical lesson is ignored; namely, the primary premises that organize any system of thinking, including science, are first invented beliefs that require faith, rather than hypothesis-free facts that constitute an objective means of description and analysis. Subsequent activity inspired and limited by these beliefs only serves to maintain the beliefs and their accompanying invented means of legitimacy.

As a consequence of medical science's blind spot to the way its clinical trials participate in self-producing its version of evidentiary discourse, few scholars have critiqued the particular choice of science that medicine has wed. There exists more than one model of science and the methods of mainstream medicine, along with its proposed alternatives and complements, are more often than not organized by a lack of relationship with more recent advances in what constitutes knowing, science, or their formal means of legitimacy.

This holding back of the evolution of medicine is perhaps most easily recognized in the way "diagnosis" remains an archaic means of categorizing and reifying what should be better understood as dynamic process rather than frozen stasis. The latter is better encountered through interactional knowing; that is, seeing how our interactions with the patient contribute to bringing forth their experience of health and sickness. Here we find both western and eastern medicine stuck in diagnostic naming rather than being more attuned to interaction, relationship, and ecology. Many schools of medicine, throughout diverse cultures, are in need of treatment for 'hardening of the categories'.

Finally, a book has arrived that brings an authentic paradigmatic difference to the understanding and practice of medicine. Dr. William Sutherland's Grand Rounds marks a noticeable difference that can make a difference in medicine. His call for a circularly organized systemic logic that challenges the simple cause-and-effect lineal thinking of outcome-based evidence handling. Beware the implications of this shift from flat line to rounded thought; the guardians of legitimacy are now subject to challenge.

Dr. Sutherland comes to his subject with the kind of training and background that few, if any, physicians are fortunate to have accrued in their formative years. He has been well-schooled in the circular sciences and circular arts, the ways of knowing and practice that are based on interaction rather than blind allegiance to reified construct and fossilized oath. As a cybernetically-organized physician, he is able to bring medicine back to its earlier wisdom, when so-called empirics, inspired by the ancient Greek empeirikos doctor, have relied on experience alone. Here the unique here-and-now interactions between attempted treatment and observed, immediate outcome guide subsequent intervention, rather than unquestioningly following a manual that treats conceptual categories while blind to the patients, each inside their own unique treatment-interaction circularity.

What is fascinating from the history-of-ideas perspective is that the contemporary advances of complexity science, initially voiced by cybernetics, mirror ancient epistemologies inherent in many indigenous healing practices. Both prior to and following the reign of Newtonian billiard-ball science, circularity and paradox were regarded as indications of a more complex wisdom, pointing to the ecological nature of all living processes, including doctor-patient communication and performance. An African healer, jazz improvisationalist, systemic therapist, martial arts master, and postmodern complexity scientist shares more understanding than anyone equipped only with the present conceptual tools of medical science. Suffice it to say that early cybernetic thinkers like Gregory Bateson long ago lamented the sorry state of the science, and its non-complex machinery of legitimacy, that underlie medicine. With Dr. Sutherland's wake-up house call, it is no longer necessary to continue down that dead-end course.

Fear not throwing out the Newtonian baby with its muddled water for the new complexity science holds on to whatever works – in spite of its having been right for the wrong reason – while expanding the ways in which we are able to go further with both understanding and practice. Complexity medicine, in the able hands of Dr. Sutherland, enables medicine to have a more complex science that has no fear of healing wisdom, art, or imagination. Here prayer is not treated like a pill nor is a plant medicine regarded as necessarily different as that produced by a pharmacological industrial plant. Complexity is the name of a vaster context that is able to host a garden of either-ors, both-ands, both, either, or neither. It cares not to colonize cultural healing paradigms outside its own, but holds a variety of ways of practice and diverse means of legitimacy.

Dr. William Sutherland's many years of being involved in painting, storytelling, comedic performance, as well as being a friend to numerous indigenous healers throughout the world, have uniquely prepared him to convey their circular truths, and readied both himself and the future of medicine to become well-rounded. In his remarkable presentation of ideas in the conversations of this book, we find the tributaries of circular medicine. In the virtuous pursuit of health we move past being lost in the vicious circles of pathological focus and perception.

I have known Dr. Sutherland for many years, beginning when he asked to have a conversation with me when he was a teacher of the martial-arts. I have watched him make his life more complex by immersing himself in the arts, cybernetic thinking, ancient healing culture, and contemporary medical practice. I can testify that he is a damn good doctor and that his good doctoring is held inside a deeper holding than outcome studies based on simplistic probability theory. He stands on wisdom and fears not to encourage his colleagues to be more human and more healing in their manner and being. He goes past primum non nocere (first, do no harm) and moves toward praescribens vitae (prescribing life), acting so as to expand both the medical universe and the choices for action that may arise whenever doctors and patients face the mysteries of how life and death, as well as wellness and sickness, dance together.

Dr. Sutherland deserves to be the next important leader of medicine, bringing it out of the dark ages of overly-simplistic causality and the kind of arrogance that a paucity of complex knowing/know-how breed. He stands for the whole that can make medicine holy. His Grand Rounds is an invitation to return to Hippocratic aesthetics, the art of fostering healthy personhood rather than merely attacking any dis-ease with disease. Welcome to the complex age of medicine, as medical doctors return home to embrace ancestral ceremonial ground and make room for reawakened wisdom.

Bradford P. Keeney, PhD

www.keeneyinstitute.org

Author of Aesthetics of Change & Way of the Bushmen

Back to the Table of Contents
Grand Rounds: An Introduction to the Concept

Grand Rounds:

(noun)

1. An organizationally closed, circular, recursive or reiterative system. A complete cybernetic circuit versus a partial arc. Necessary feedback.

2. An observer observing his own observing.

3. Dogs chasing their own "tales". Snakes eating theirs.

4.Physicians attending to their patients accompanied by their charges for the purpose of teaching, lecturing, and exhibiting to junior doctors.

In your hands you now hold an odd sort of a book: an alchemical text of a kind. Specifically, it is a collection of tales that, ultimately, are both a reflection and critique of some of our deeply held cultural myths, including those of our medical practices. It may strike you as a heretical statement for a Western trained physician to speak of modern medical thought in terms of a mythology. Mythologies, after all, are anachronisms of primitive, preliterate, and irrational people; aren't they? Simple legends told around campfires, and ancient sacred rites that brought a sense of control and meaning to what often seemed like an uncontrollable and unpredictable world, full of uncertainty and ambiguity. Certainly, in this meta-modernistic age, mythologies must be considered a vestige of a bygone era. But regardless, whether we are aware of it or not, all practitioners of the healing arts – physicians included – must subscribe both to a guiding ethos through which to make ethical decisions, and some mode of body-mind relations. By entering into this contract, they invariably must construct their own collective mythos. It is through our mythologies, and the fundamental organizations that underlie them, that all of us order our environment through the biological process of difference making, thus creating a world. Mythologies are part of what defines us as living. That being said, however, all mythologies are not created equal. Having a choice, I personally would want to live in a rich world of perceived enchantment, mystery, reverence, and awe, rather than a disenchanted one, impoverished and imprisoned by its own hand such that it even forgot it had a mythology to begin with.

This book, then, serves as a compendium of mythologies, legends, parables, and fables. Contained within, you will find a number of different body-mind schemas and ethical stances that, I believe, are infinitely richer than our present societal modus operandi, thereby setting a stage for an invitation, invocation, and initiation into our collective holistic coming of age.

Before going further (you can still turn back!), I must give you a proviso; a wayfarers warning if you will for the world you are about to enter. While writing the early chapters for the book, I was in the habit of reading my initial drafts out loud to my family. My somewhat precocious son, Nathaniel, who was seven at the time, was listening closely and attentively. After I had finished reading Nathaniel spoke up in true Socratic fashion: "Dad," he said, "Is your book going to be for sale in a bookstore someday?"

"That would be nice if it happened, wouldn't it?" I replied.

"Will I have to buy a copy or will you give me one?" he asked with his impish grin.

"Of course I will give you one," was my answer.

"Good" he said, "Someday I am going to take that book you give me, and read it to my wife, and when I am finished reading I am going to say to her; 'who is the crazy man who wrote this?' and then throw it out!" Advice out of the mouths of babes...Consider yourself sufficiently warned, and now to the subject at hand.

Within the field of medicine it is a truism to say that, as a patient, you neither want to be known as "interesting" or "complicated." Both of these are euphemisms for "there is nothing else left that I can do." At this point it is common (if unspoken) medical practice to blame the patient for his predicament. It was said once that a surgeon coming out of the operating room was asked by the next of kin how the surgery went. The surgeon replied that, "It was a flawless operation, a perfect textbook procedure. It was just a damn shame that the patient had to go and die"...anyway, you get the gist. These interesting and complicated patients are, of course, the ones that make it into case-studies in journals, or become the fodder for medical students, interns, and residents in patient rounds. Students and residents make a point of searching out this population of patients while practicing physicians avoid them at all costs, for they are sure to make a busy day busier, and they guarantee that the doctor will not be making it home for dinner on time...again.

Now patients are placed on the hierarchy of "interesting" based on the severity, voracity, virulence, complexity, or quantity of their disease processes. Disease, after all, is the focus of orthodox medical practice. It is the object of the physician's gaze. There is, however, a truth to the idea that in medical practice, doctors can only see what they know to look for; to the rest they are blind. With this being said, Western physicians are very good at finding disease, and Western patients are very good at accepting the veracity of their diagnoses. But what are these things we call "diseases" that stalk us from cradle to grave, and that we work so hard to avoid, prevent, treat, and cure lest we fall victim to their ravaging? They are like so many imps, trolls, goblins, giants, and witches, of our fairytales and myths that frighten children at bedtime, and make us hesitant to venture into the dark woods – no matter our age.

In fable and myth, there is no end to the nastiness and viciousness that can befall a hero in his moment of darkness, but all of these adversities are nothing when compared to the unified focus of his heart and mind: the hero's quest. Although the hero's enemy may be legion in number, there is only one "Holy Grail" or a singular "Golden Fleece" to draw him onward in his journey. For a moment, let's imagine – as a physician or as a patient – how our story could be different if we shifted our gaze from the monsters and mayhem of disease to the collective holistic metaphor of the hero's journey. With this in mind, I put forth the question to you: how would our medicine (and, indeed, our world) be different if we turned the attention of our shared medical mythology away from disease and instead towards health? Would this be a more interesting and compelling story than the one we presently possess? What if patients were found to be "interesting" and "complex" because of the nature of their health, rather than their disease? Would we all celebrate such an encounter? Would our conception of our very selves in relation to each other and to the world at large transform? I don't know the answers, but these questions form the beginnings of a noble quest for those of us who dare to brave such things.

During the writing of this book, people would often ask me: what kind of book is it? I would tell them it is part personal manifesto, part philosophical meditation, part intellectual primer, and part performance art-piece. It was a significantly vague enough answer that most people would stop their inquiry right there, nevertheless, the occasional few would push on, and for them I would continue with my response.

This book, at its heart, is an expression of a set of morphing, internal tensions that have run throughout my life as a type of theme, shaping my decisions and thus creating the course of my path. These tensions have always been held by a polarity of thought and feeling (at times, creative, at others, destructive) in how they played out in my life.

Over the years, in response to these pulls, a movement began within me. In my younger days it led me to take up the Japanese martial arts. This culminated in my first trip to Japan when I was 17 years old. Over the two years in total that I lived in Japan, I had an opportunity to study their martial, meditative, and healing ways. Again, in the search born of these polar tensions within myself, I was drawn to the world of indigenous and traditional healing. Consequently, I have lived and worked with traditional elders and healers from North America, South America, Asia, and Africa. Ultimately, through these relationships, I began to see the focus of my personal longings: the place to which my internal tensions were driving me. All of this movement was generated by an impulse, not ever fully conscious, to embrace and be embraced by wholeness. Thus there was always a meta-polarity, if you will, of wholes/parts or unification/separation that was both the source and the subject of my quest. This was what I was being drawn to.

Ironically, it was through these traditional healers, under their direction and guidance, that I found my way back to orthodox Western medicine. As a child, until the age of 14, there was nothing else that I wanted to be other than a doctor. At 14, however, my life changed with the discovery of karate. Through the trajectory set in motion by this passion, I left behind the idea of being a physician. Over the course of my life, I travelled abroad, studied at the side of traditional martial art masters, healers, and elders, started university twice, and dropped out twice, married, had four children, worked as a karate instructor, and once again I found myself back at school. I finished a Bachelor of Science and an additional Bachelor of Science in Nursing, after which I worked as a rural emergency department nurse.

Through all of this, however, my old dream to become a physician reemerged, and with the urging of my elders, mentors, parents, and my wife Lisa, I made the decision to apply to medical school. As the Fates would have it, right after the auspicious birth of my fourth child, the acceptance letter came, and I once again found myself back in school, soon to complete my MD with a subsequent residency in Rural Family Medicine. My first job was as a solo physician working as a general practitioner on a Mi'kmaw Indian Reserve in Cape Breton, Nova Scotia: circles completing circles.

Of late, I find my musings have turned to contemplating the nature of the underlying foundation that supports and holds these tensions in my life. I find myself asking: is there a unified stance in all of this, in Life as a whole, and how do we grow in our learning in such a manner that we may embrace paradoxical positions?

I am often asked by friends and colleagues on both sides of the traditional healing/ Western medicine spectrum how I can be comfortable on either side of these apparently contradictory or adversarial worlds. I tell them I have never seen it as a conflict, because for me it has never been a question about modalities or explanatory frameworks; rather it is about the quality and pattern of relationships, and the rightness of what is required in a given moment. With this frame in place, I have only ever seen a unity between the two positions.

Nevertheless, through the experience of daily living, issues of congruence do come into play. A movement towards wholeness, and a reverence for the complexity found in Life has become my guiding ethos (of course I recognize the paradoxical nature of this statement, as we are all already intrinsically whole). Consequently, not all aspects of traditional healing or Western medicine are resonant with this adopted ethic or world-view. In my practice as a physician, I have always loved emergency and acute care medicine. Why? Because such an undertaking with the acutely suffering is congruent with my thoughts on wholeness. Broken bones, dislocations, trauma, heart attacks, raging infections, life-threatening illness, and pain: all of these things need to, and often can be dealt with in a timely manner. Addressing and treating them is what is most appropriate, and is the needed "holistic" care of the moment. It is what is required to maintain the integrity of the whole person in light of their immediate trauma.

Unlike the ER, the structure and organization of the family medicine office was often a source of frustration, limitation, and incongruency for me. Now, don't misunderstand me in this; I treasure the doctor-patient relationship, and the inherent trust when people place themselves and their families under my care. The source of my dis-ease, however, was in the reductionist model through which I was being asked to view my patients. Chronic diseases, multiple ailments, numerous medications, limited results, side-effects, treatment without meaningful personal context, along with many other nagging thoughts hiding at the edge of my mind, made me question my role in family practice. To be sure, there were many successes as defined by both myself and the patients, but never enough to push away the feeling that what I was doing was in separation from the spirit of wholeness.

That being said, these thoughts and ideas were born of a sense of dissatisfaction within me, and they are not meant to be a commentary on or a maligning of the practice of other physicians. Doctors work very hard in difficult, and often limiting circumstances. There is an ever-increasing burden of illness putting almost impossible demands on their time, and the medical system itself is fraught with difficulties. Furthermore, I want to unequivocally state that the family doctor's office has been a source of healing for me during some of the hardest times in my life, and I have been blessed with the care of a great family physician, along with the support of the remarkable men and women whom I am happy to call my colleagues.

This book, then, is a personal manifesto. It is my public statement affirming the principles of wholeness and healing in medicine as I have experienced them. It is a declaration of my life-stance on the matter at hand. Hopefully the reader – whether physician or lay-person – will find sympathy in their own experience with the words herein, for this work, first and foremost, is about the nurturing of relationship. Medicine, in the greatest attribution of that word, is a part of all of our lives, as wellbeing and illness is inextricable from the human experience. In this spirit, it is my hope that there will be some appeal in these ideas for all readers regardless of their background.

Beyond a manifesto, this book is also partly a philosophical meditation. Before we can even begin to critique our medicine, we have to first understand its philosophical underpinnings, initial premises, assumptions, axioms, presuppositions, and first principles. Although we often take the validity of modern science and medicine as a given, it always strikes me as interesting that we would just blindly accept this as so. It is said there is no work for philosophers any more (with artists often equally unemployable), and this seems to me to be a real shame, for without the scrutiny of their questioning, we lose a source of needed wisdom to rein in our ever-burgeoning knowledge and technology. In the pages that follow, we will begin to explore such branches of philosophy as epistemology (the nature of knowing), ontology (the nature of reality), metaphysics (the nature of being), aesthetics (the nature of beauty), and ethics (right action), as they apply to holism in medicine, and more broadly to the position of holism in our lives.

Next, the book also acts as an intellectual primer. In a search for a medicine of holism verses one of reductionist orientation, we find a potential ally in the emerging scientific paradigms of cybernetics, complexity, complex adaptive systems, and the mathematics of chaos. These are vast fields of specialist expertise. Being neither a specialist nor an expert (as a family doc I am a true generalist at heart), I have prepared herein a hopefully humorous "Fool's Guide" (where I am the fool, and this is my guide) as a working introduction to this field of exploration, with thoughts on how it is relevant to our conceptions of medicine. This is an emerging area of inquiry full of intellectual giants, grand ideas, and discovery. The shoulders available for us to stand on are broad. My perspective in all of this, of course, is that of a physician's; that is to say it is informed through my actions and experience as an applied physiologist and anatomist. In this fashion, my gaze is necessarily grounded in our living biology. As a practicing clinician, I am neither a professional scientist, nor philosopher. I apply science to my work, yet I am obliged, in doing so, to also reflect on the lives of my charges as they transition from cradle to grave. In this way, I am both a practitioner of the natural sciences, and of a natural philosophy. Nevertheless, my own experience and curiosity withstanding, know that I stand with you throughout this exploration in our collective "not-knowing" rather than engaging in the fallacy of forcefully imparting my "knowledge" to you. It is my humble hope that as a small introduction to this paradigm of thought, this book will whet your appetite for more, and serve as a starting point for your own fruitful investigation as you apply these understandings to your own life and practice.

Finally, this work is an artistic endeavor. As I initially struggled to find my voice, after many false starts, I realized that this book had playfully and unintentionally taken on the form of a play-script, and although it is not meant as a stage production, the metaphor is a useful one. One of my mentors in the writing of this story, Dr. Bradford Keeney, sagely advised me that when you start a piece, no matter what you think it will be in the beginning, the story will take the shape it needs to, surprising you along the way. As authors, we inevitably write the book we need to read, as long as we remain true to our process. This introduction is one of the final chapters that I have composed, as for most of my time writing I have been unsure about what I would be introducing. Like a friend, I had to develop a relationship with the ideas before I could formally introduce them. That being said, in hindsight, I also realize that the work has been whole in its entirety from its inception.

In introducing the writing as an art-piece, it would seem reasonable to look at the body of the work's form and function from an aesthetic stand-point. The book centers around a character called The Doctor, part autobiographical and part fictional, with the boundaries between these two aspects intentionally blurred. This approach has allowed me to draw on both theory and experience in the creating of the structure and process of the work.

The telling is centered in and around the institution of Grand Rounds in medicine. Traditionally, Grand Rounds have been an essential part of the teaching pedagogy in medicine, as well as an important ritual in a physician's coming of age. Originally, staff physicians, residents, and students would gather at a patient's bedside to examine the patient, review the diagnosis, and discuss the relevant medicine of the case for the purpose of teaching. Over time, however, Grand Rounds have changed, and more often than not are likely to be delivered in a lecture style in an auditorium, with the patient no longer present. Grand Rounds differ, then, from the daily rounds of the doctor in hospital where he visits all his patients on the ward individually for the purpose of monitoring and treatment.

You will find the chapters of this book divided into two alternating sub-divisions: Day Rounds and Night Rounds. The Day Rounds are presented in the format of modern Grand Rounds; a lecture where The Doctor, in this case, presents reflective and introspective ideas around the role of complexity science in medicine in the hope of challenging his audience to think more deeply about these topics, with a vision for the future always in mind. The Night Rounds, however, are very different. During the Night Rounds, The Doctor has a series of dream visitations. In these dreams, he receives tutelage in the intricacies of Complexity Medicine from his visionary mentors. The characters he encounters in the Night Rounds are based on the historical personages of my paternal Grandfather, William Sutherland the 1st (The Master of the Game), my maternal Grandfather, James Swann (The Jazzman), Gregory Bateson (The Professor), Milton Erickson (The Wizard), Pythagoras (The Philosopher), and Hippocrates (The Physician), along with a fictional Bushman tribesman (The Ancestor). Similar to The Doctor, the presentation of these characters, along with their bodies of work, is part biographical and part fictional. Their spoken passages are not necessarily literal and unadulterated reconstructions of their ideas. Instead, as characters, they held the frames required to direct my raw inspiration, and as such, gave form to my expression. They became mirrors of my own learning reflecting it back to me in a way that I could never have accomplished in isolation. In my involvement with them, I found the needed voice in my writing to convey the thoughts and relationships of ideas that I was exploring. As such, each of these character's voices should not be considered a scholarly presentation of their collective ideas, as I have mixed their thoughts with my own, further adding the voices from other scholars farther afield whenever I felt it was appropriate. These characters represent a focal synthesis of a number of concepts, and are holders of the spirit of the material that is being presented to The Doctor. Throughout the book, you will find a series of citations and references that I drew upon, and I would encourage you to further delve into the primary sources listed if you are so drawn.

Unlike traditional story writing, there is no emphasis on character or plot development in this book. Rather, the primary focus is the creation and nurturance of metaphor, not just as a literary device, but as a central mode of communication. Likewise, there are varied themes and symbols found throughout these pages, but they are not laid out in a linear fashion. Instead, we experience them vis-à-vis their non-linear and recursive nature; at times, like waves crashing back on themselves, at others subtle undercurrents that pull the reader into deeper waters.

The metaphorical nature of the book provides for us the necessary aesthetic ground through which the content and the themes of our inquiry are planted, nurtured, and grown. As I have mentioned, the writing of this book quickly took on the quality of a play or a theatrical performance. As such, it would be good for you to consider each chapter as a separate act within the play. The acts, within the book, alternate between The Doctor lecturing during his Day Rounds, and then subsequently receiving an education of a highly different order in his Night Rounds. The form and presentation of these acts shifts formally between a monologue in the Grand Rounds of the Day, and dialogue in the Grand Rounds of the Night. Despite these stylistic distinctions, however, the spirit of the monologues and the dialogues is meant always to be that of a dialogic dance. Lastly, even though this "play" is more involved than most, don't worry, for there are also s and intermissions to stretch your understanding, breathe fresh air into your imagination, and to refresh your spirit.

Relationships are interesting things. No two are exactly the same, and they are always changing. Ironically, change is the only true certainty in this world. Because of this, you will need to chart your own way forward in the reading of this book, forging your own relationship with the spirit of its contents. You may decide to take my son's advice of reading it out loud to your significant other, and then throw it out, or perhaps you will read it many times until the pages are tattered and ear-marked. I will say, however, that I didn't write the book for fast consumption. It is designed to be savored slowly. There is admittedly some difficult language and concepts to wrestle with. I know, for I have had to do so myself. Moreover, despite its conveyance in prose, the material in hand is better experienced as poetics. I continue to enjoy the feel, the flow, texture, and rhythmicity of the language on these pages. In truth, this writing at its core, has been first and foremost a sensual act, that is to say an aesthetic as much as an intellectual one. Language can be a rich thing if we allow it.

The form of the book is challenging in that it is, by necessity, non-linear. It weaves, and twists, and turns, and often leaves the reader hanging. Many questions are eventually answered, but just as often they are not. No doubt further questioning will be generated through your investigative process. Hopefully I have found the right balance between imagination and rigor in the work. I encourage you to remember Aristotle's wisdom that, "The whole is more than the sum of its parts." This is the core of the book's pedagogy. In that regard, I encourage you to hold the diverse ideas herein even if you don't fully grasp them at first, or even necessarily agree with them. Give them time to ferment. Return back to them as need be. Let them mix with your own experiences, thoughts, and emotions. In time, they will create their own unique connections and relationships, forming a seamless whole that is representative of your individual understanding, character, and outlook, further embedded in the context of your life. This is the essence of learning within the human experience. If you stay the course on this winding road, and complete the reading of this tale, you will realize that you were not simply chasing after your own tail, but have actually caught it, and are now feasting on its rewards.

Early in the writing process, my father commented that although some would come to embrace this work, many would no doubt find the content uncomfortable, and perhaps even threatening. Truthfully, I hope this is so, for if it isn't, I have failed in my pursuit. Fundamentally, all that is within these covers is about change; not change of a trivial sort, but a deep foundational transformation of embodied thought and action. As we probe our perceived relationship to the living world, and question our deeply held and cherished views, feelings of discomfort and dis-ease are bound to arise. Nonetheless, we must ask the questions, who are we in relation to a world, and what is a world that we may have a relationship with it? These are, perhaps, the most fundamental questions before us at this juncture of not only historical, but indeed, geo-evolutionary time.

At times, the writing of the work has flowed from my typing fingers effortlessly, almost without conscious thought. At others, I struggled terribly for the words and ideas, certain that all was at a loss, and the way forward futile. Many times, I walked away from the computer for days taking up other passions and pursuits, allowing ideas time to incubate, only to come back and find my creativity renewed. In other moments, when meaningful progress was fleeting, I would return to the cybernetic dictum, "Act to know," letting each word I put on the page guide the next. These, I think, are natural and needed parts of the creative and artistic process. Likewise, in the reading of this work, if I have done my job properly, I imagine you will be challenged similarly; at times, the flow will be smooth and settled, at others turbulent. When your exploration becomes tough, or overly burdened, I recommend that you change things up. Put the book down. Inspire yourself in other ways, both aesthetically and intellectually, and then bring that new feeling and understanding back into the relationship. Let your interests guide you. Read the Endnotes to expand the context of your understanding. Look at the primary sources at the back of this book to pursue a line of thinking, and increase your knowledge, or use the dictionary or the internet for clarification (my own 70-year-old mother pushed on in this way). If you don't understand something, or even if you think you do, change the frame that you view the writing through frequently. For example, recite the lines as poetry; see it all as metaphor, thereby letting go of your understanding so as to be able to feel the words. Perhaps you could try out different accents as you read it aloud, or buy a second copy for the shower so you may sing the parts, thus escaping the tyranny of the left side of your brain, and thus facilitating a new kind of understanding! If all else fails compost this book, and with its remains, plant a garden, and see what springs up. I assure you that what is contained in these pages is more fertile than the best manure!

First, there was an unconscious inclination, impulse, or stirring towards change within the field. This was followed by recognition of the need to name the emerging understanding of medical complexity, medicine in its complexity, and medicine as a complexity. Nevertheless, as of yet, no one has put forth a comprehensive articulation elucidating the nature of this revolutionary change. The time, then, is ripe to put forth the key, complex ideas required for the elaboration of a complexity-based medicine, and, ultimately, a medicine of complexity (i.e. Complexity Medicine). Grand Rounds, Healing Wisdom for a Complex World is to be viewed, then, in filling that void as that greater articulation of that holistic paradigm, and, as such, holds the promise of immense possibility at this critical juncture that we find ourselves in medicine today. In many ways, what is old is new again, but with an important difference! Complexity suggests to us that our path to understanding is rooted first in our actions, and that paradoxically the stability that we search for as physicians is to be found in the dynamics of never ending change. This book, then, is to serve as guide for physicians and patients alike throughout these ambiguous and uncertain terrains (and times), as we traverse the landscape of Health in our lives.

Ostensibly, this is a book about medicine. Specifically, it speaks to a way to hold the complexities of medicine in generative and embodied ways. But it also speaks deeply and more generally to the food we eat, the houses we build, the way we educate our youth and ourselves, the way we birth our children, and any of the other myriad expressions found in our collective universal human life. How could it be otherwise in our exploration of the mystery and majesty of wholeness? Nevertheless, as a physician, medicine is what I know best, and it is the source of my richest and most often repeated stories. In hearing these stories, try to listen to them in an open and childlike way. Like all the good fairytales and fables of youth, regardless of its monsters or heroes, what is most important to retain is the moral of the story.

William Sutherland, MD

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An Invitation to (a) Play

Herein lays an extraordinary sequence of events that occurred in my life. Interspaced between my hectic days of office, teaching, and hospital duties, I experienced a series of dream-like visions that I can think of no other word than visitations to describe them. They were, in their completeness, to comprise a teaching. I have not been able to see medicine or the world in the same way since. I invite you to join me now in the telling of this tale of crazy wisdom...

Sincerely,

The Doctor

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Act I - Scene I: Night Rounds - The Master of the Game

Doctor's Narration: I was in hospital on a 24 hour in-house call covering a small town emergency room and in-patient department, away from the family again. Throughout the evening things had been busy, mostly minor complaints. Nevertheless, the day had been a long one.

Around one o'clock in the morning, I had managed to fall into a fitful sleep on my uncomfortable pull-out couch with its over-bleached sheets and plastic pillows that crunched every time I moved; their sanitary mandate masquerading as comfort...

Ahhh, the good life.

Despite the lack of home comforts, I found my way into sleep, and eventually, into a dream. But this was no ordinary dream. It was so vivid, so real that, only in the hindsight that waking affords, was I able to identify it as a dream at all. Indeed, it was more along the order of a vision, or perhaps more exactly: a visitation. Such was the clarity and impact of the experience on me...

I am standing on the grass outside of University College, on the main campus of the University of Toronto. It is oddly silent and still. Although the grounds normally bustle with student noise and activity, no one else is to be found. The College looms before me in its grandeur. With its massive stone-faced exterior replete with elegant carvings of continental European design, the building, even with the maturation of time, remains magnificent and rich with grandeur. The South Wing, which I am facing, is a full 400 feet in length, the central tower 120 feet in height. Built in the Victorian era in the Romanesque style, its immaculate craftsmanship beckons to a bygone time. Every side of the college is unique in form, with no one style dominating.

I walk up to the College's main entrance. With a lead-up of stone stairs worn with use, flanked by six-foot wrought iron gates, the wooden doorway is set within a series of receding rounded stone arches supported by columns, each covered in a stunning array of carvings, intricate in both detail and diversity. Above the innermost arch is the coat of arms of the University of Toronto and University College. Below the shield, the University of Toronto's motto: Velut arbor ævo - as a tree through the ages \- is etched deeply in stone. On the right of the emblem is an inscribed tree representative of the University: on the left a lit oil lamp, a symbol of the College.

Stepping through the large wooden doors, I find myself in the main entrance hall. In front of me is an arcade of high, elaborate Norman arches. Beyond the arches lays the two-^story rotunda with its beautiful multi-coloured tile floor and yellow brick walls: the College's original meeting place. To either side of me are two stone stairwells, also worn with the many generations of feet that have passed here. Ascending the stairs to my left, I arrive on the gallery level that overlooks the Rotunda. Here I have a choice to either enter the East Hall or the West Hall. Although both halls are magnificent, I find myself with an inextricable pull to the West Hall that, prior to the great fire of 1890, served as the University's museum. Going through the wooden doors into the hall, I am overwhelmed by the detail and craftsmanship of the architecture within. Inside the door are carved heraldic animals, bearing the College and University arms. Crafted oak paneling covers the lower aspects of the walls in their entirety. Set into the panels are a multitude of round carvings, each adorned with faces, creatures, animals or abstract designs. They circle the hall, forming a frieze of 267 unique masterpieces. Above, the ceiling rises high, arched with thick wooden beams, numerous chandeliers, and rows of stained glass windows set in stone arches to either side. At the front of the hall there is an incredible work of stained glass on the west wall, a traditional rose design proportionate in size and majesty to this great room. Light shines through into the space muted into blues and reds, both inviting and soft.

The hall is empty with the exception of a massive, solitary oak table on a raised dais at the far end of the room. Across the table hunches a lone figure in his chair: academic- like, thoughtful and astute in his posture. In front of him lies an enormous ancient hardwood board, rich in its grain, along with two small wooden chests, one on either side of the board. The chests lay open, revealing antiquated Asian calligraphy brushes inside.

As I approach, I note he wears an odd set of apparel: traditional British legal court dress. Underneath he wears a bar jacket. Over top is a black court gown. Around his neck there is a stiff wing collar, and at his wrists, a set of elaborate cuffs emerge from the gown. When I move closer the dignified man looks up. To my surprise and great joy, I see it is my paternal Grandfather.

With his baritone voice and a twinkle in his eye, he greets me. In his presence, I feel like I am seven years old again.

Magister Ludi: "Parum claris lucem dare" my Grandson.

Doctor: Grandfather, you're teasing again, you know I never studied Latin.

Magister Ludi: "To shed light on that which is obscure," the motto of our Alma Mater, to which it seems you and I have been called back.

Doctor: I had hoped I would be finished with my higher education.

Magister Ludi: There is higher education, and then there is education of a higher type. But from here on, I no longer want you to learn degree by degree. And although I am proud that you are now a man of letters, from this point forward, I want you to shed that too. This is a different kind of classroom.

Doctor: Once again, Grandfather, I don't understand what you are telling me. Why can't you, for once, get directly to the point of things?

Magister Ludi: Fear not, all will become clear in good time. For now you must exhibit some patience. Our time together is short, and we have work to do. Sad though, I would rather fancy taking a stroll to Varsity Stadium to catch a football game. Forgive me, I digress. What we have here in front of us is the Game of Games, the Glass Bead Game.

Doctor: What is the Glass Bead Game? I have never heard of it.

Magister Ludi: You have been too busy with your nose in medical books to learn either Latin or to read good literature it would seem. The novel, The Glass Bead Game, was penned by the Nobel Prize laureate, Hermann Hesse, and before you on this table, lays the masterpiece of his creativity.

Doctor: Why have I been brought here to learn about a game? Aren't games rather trivial indulgences?

Magister Ludi: Trivial? What is a great game, Grandson, other than metaphor? Is chess not, in itself, war? Yet the Glass Bead Game holds so much more promise than that.

Doctor: Alright, your point is taken. Then what is this Glass Bead Game a metaphor for?

Magister Ludi: Relational complexity.

Doctor: Complexity?

Magister Ludi: Yes, and wholeness. The Glass Bead Game is a pedagogical method of sorts. It is a system to understand systems; that is also to say: mind. In that way, it is appropriate that we are back here at the academy. Yet, at the same time, it is first and foremost an aesthetic endeavor through which its participants can come to express, and be expressed by, wholeness. It is designed to help you transcend your illusions of separation and the paradoxes formed by distinctions.

Doctor: So where does the game originate Grandfather?

Magister Ludi: The answer you seek is really a matter of perspective. Obviously it is a creation of Hermann Hesse's literary genius. Equally, it is a product of the mythopoetic realm, while alternatively it is also a direct metaphor for mind itself. Truth or fiction, then, becomes a product of your specific gaze. Regardless of your stance, the history and play of the game remains the same.

Doctor: How does an imaginary game have a history?

Magister Ludi: It has an imaginary history I would expect — but a real imaginary history, nonetheless.

Doctor: You are not making sense.

Magister Ludi: Paradoxes rarely do, but they serve to encourage you to return to your senses.

Doctor: Tell me more about the history of the game, then, imaginary or not.

Magister Ludi: Very well, the game originated within the various schools of music. At that time it was, as its name suggests, played with glass beads on an abacus of sorts. The strings were laid out as a musical staff. The various colored beads represented various notations, time scales, rhythms, and the like. It originated as a tool of memorization and improvisation. One player would start with an initial bar or refrain, and the second player would counter with a continuation of the piece or with a contrasting theme. In this manner, the players mutually developed in the shared aesthetic of their craft.

Doctor: It sounds like an enjoyable way to learn both theory and practice, and at the same time develop expertise.

Magister Ludi: It was, and it proved so popular that it began to spread to other scholarly disciplines. Initially, mathematics was the first to adopt the game from its music colleagues. Mathematics with its formulas and logic was a good fit for the game, and its students quickly developed their own symbols and abbreviations for the game to express their own concepts. From there, the game quickly spread to the faculties of philosophy, visual arts, and architecture.

Doctor: So each specialty had its own version of the game that they applied to their field?

Magister Ludi: Initially, however over time there was a growing aesthetic impulse developing in the world of academia for a game that would cut across the divide of disciplines; for an expression that was truly interdisciplinary in both thought and artistic expression. At that time there was a revival of the ideal of a universitas litterarum: the teaching of knowledge in its universality. Consequently, the early developers of the Glass Bead Game searched for an expression that would encompass arts, mathematics, philosophy, jurisprudence, medicine, theology, and the humanities in its play. The aspiration was to couple the natural beauty, imagination, freedom, and complexity of artistic expression with the rigor and exactness of theoretical and applied sciences.

Doctor: Did they succeed in their goal?

Magister Ludi: Yes they did succeed, but in more than a simple end-point of a specific goal. It was an organic process born of the collective vision of all the participants in the greater academy. Their hope was the unification of arts and intellect, a unio mystica of all the member schools of the universitas litterarum. The early trail blazers originally coined their visionary ideal as the "Magic Theatre," capturing the ethos and pathos of inspired performance, improvisation, and spirited expression in the early days of the game. With a concerted effort over time, the game spanned gulfs and chasms between the disciplines. From each school's formulas, abbreviations, and operational definitions, a secret encompassing language, understandable to the scholars of the world, emerged for this new universal Glass Bead Game. With its own rules and grammar, it had a structure of sufficient complexity to bridge the various concepts and create new understanding by analogue, correspondence, and metaphor.

Doctor: And what of the original glass beads?

Magister Ludi: They remained in memory and name only. In lieu of the beads a different expressive order was required to convey this new language. Over time an international script of symbols and hieroglyphs, not unlike ancient Chinese characters, but far greater in number, was developed along with an associated sign language. This was rigorous and disciplined enough to express its theoretical complexity, but flexible in a way that it did not exclude imagination, creative expression, and improvised thought. Although the framework and rules of the game are fixed in form, an infinite number of expressions and combinations are open and available to each player. In theory, the game is capable of reproducing the entire intellectual and artistic content of the lived human experience. No two games are ever alike.

Doctor: So that is how the present day Glass Bead Game came into being?

Magister Ludi: Not entirely. Early in the game's history, it was hijacked by a select group of gifted savants: mnemonists with prodigious memory. With their skill and virtuosity, they were able to blaze through games with incredible speed powered by their rapid recall of countless ideas. Although remarkable in skill, their play lacked depth as the aesthetic spirit of the game was absent.

Doctor: What did the early players of the game do to combat this?

Magister Ludi: They introduced the idea of contemplation or meditation to the game. By changing the focus, they introduced a feeling of religious spirit to what was threatening to become a degenerative, intellectual, and egotistical pursuit. Adding the element of contemplation, allowed players to reflect on the deeper meaning of the characters and symbols, and most importantly, the relationships between them. In time this inward, as well as outward, harmony became the most important aspect of the game. The language of the game became a lingua sacra, a divine language.

Doctor: How is the game played Grandfather? Can you teach me?

Magister Ludi: Telling you how to play the game is an easy task, but teaching its play is an entirely different matter. Like Life itself, learning the game's complexities and nuances is non-linear. An understanding of it is acquired only over a life-time. Indeed, learning continues until the very moment of our last breath, if our minds remain open to such a possibility. That being said, let me explain the basic structure and function of the game.

Doctor: Yes Grandfather, please do.

Magister Ludi: As you now know, the game is based on a complicated grammar, and is composed of a multitude of characters, symbols, ritual gestures and sign language. The concepts are drawn from each discipline, and as a result the game goes beyond disciplinary boundaries. Hence, as a quality of its essential unity, the game is of a transcendent nature. The game's symbols and characters are drawn in finely brushed calligraphy, and the artistic rendering is very much part of the aesthetics of the game. A game can be sketched out on paper, or composed and displayed on a large game board such as the one before us.

Doctor: It seems that aesthetics plays a very important role in the Glass Bead Game. The presentation of the play is as important as the play itself.

Magister Ludi: The two aspects are inseparable. The merger of intellect and aesthetics, along with the contemplative element, helps to combat purposefulness and pragmatism in the players. Beauty of expression, and contemplation of such beauty, is the transformative crux of the game at all levels of abstraction. It is both the means and the end.

Doctor: Please continue, I am absolutely fascinated by the concept of such a game.

Magister Ludi: The game can be played by one player privately, or it can be played by many. It can be played cooperatively or competitively. One theme or multiple themes are chosen as starting points, either by the players themselves or by a game director. A theme could be drawn from scientific theory, a musical composition, a quote from a philosophical treatise, or a verse from a great religious text. The sources for such themes, of course, are endless, as are the possible combinations, but ultimately they are a reflection of the players' deep interests, passions, and emotions. The game is to connect these various themes through relational pathways or correspondences into a conjoined intellectual and artistic expression. Players, depending on their ability, can further explore, elaborate, enrich, or weave ideas through allusions, metaphor, and parables. Or they could present competing or dualistic ideas central to the theme, and after giving appropriate weighting to each position, unify them through a harmonious composition.

Doctor: So the idea is to bridge the various themes through a series of connecting ideas to show how they relate to each other?

Magister Ludi: No, not exactly, the game is much more interesting and nuanced than that. It is not an action of linear thought or reductionism. Nor is it about showing how things relate objectively; rather, it is a manner of eloquent expression that shows the intrinsic relational wholeness, in and of itself. Themes link and feedback through labyrinthian, dendritic paths culminating in a recursive totality. Mapping occurs in series or parallel, directly or indirectly, linearly or non-linearly, by point and counterpoint, divergently or convergently, through thesis and antithesis, through harmony and dissonance, competitively or cooperatively. Ultimately, the players transcend these dualisms if they are successful in their play, exemplifying the totality of a unified expression at the completion of the game. The great masters, however, transcend even this with the ability to express holism at any stage of the game through the understanding of paradox.

Doctor: It sounds as if the participants must be Olympian in their intellect and understanding.

Magister Ludi: Certainly they must be well-grounded in many fields, as well as carry the spirit of inter-disciplinary collegiality. That being said, book knowledge is a very different thing from engaging in Life itself. Life shapes us just as we shape it, and as the game is an expression of Life, our play likewise becomes an expression of our very selves. If the game is a mode of expressing and acting on incipient possibilities, how could we expect anything less from our own lives? Just as important as intellect in all of this, so too is intuition, expressed in form through posture, rhythm, breath, movement, stillness, and spontaneity. In this engagement, players express themselves through bold and daring new associations and relationships between themes, birthing a new creativity in thought.

Doctor: You mentioned the use of meditation after each symbol is constructed to allow the players time for reflection on the origins and deeper meaning of the characters. Can you elaborate on this?

Magister Ludi: I am afraid I can't.

Doctor: Are you being secretive? Are these teachings only for initiates into the game?

Magister Ludi: No, quite to the contrary, I am being wide open and forthcoming in my declarations. There are origins and meaning. Equally there are no-origins and no-meaning. Just as the Zen Masters of old asked their students, "What was your face before you were born?" In the same way the game can challenge our understanding of the world. Certainly, the majority of players stay in their heads, with the game being a reflection of intellectual accomplishment and prowess, but the true glory of the game is in the magic of its inner alchemy. Through deep meditation and naturally arising expression, the game is a vehicle to allow for the opening of the transcendent mind which goes beyond all images or multiplicities into the heart of oneness. The game with its outward characters and expressions, coupled with its interior meditations and contemplations is the straight road that traverses the holy ground between the earth and the heavens. You need only to look at the space between your breaths to find it.

Doctor: But Grandfather, how is such a game won?

Magister Ludi: Now that is a very good question, but not an easy one to answer.

Doctor: Will I be able to understand the answer? You do have a way of complicating things.

Magister Ludi: If you don't understand the answer now, then hold what I give you, for it is a part of the wholeness you are seeking. The answer emerges when the game is complete.

Doctor: Grandfather, I can't even understand your answer to my question about whether I will be able to understand your answer to my question, and you have still yet to answer my question!

Magister Ludi: Very well then, let's discuss "winning" the game. As you by now realize, the game has many diverse forms, yet they are all entirely unified. Although we call it a game, unlike other games, there is ultimately no intent or purposefulness, however that is not to say that the game is without purpose.

Doctor: So you are telling me it that it is a non-purposeful purpose-filled game?

Magister Ludi: That's correct. The nature of the game is to engage wholeness. The game's "purpose" then, is to immerse one's self in the whole so that the whole can express both its aesthetic and intellectual completeness. The result is that playing the game becomes both a conscious and unconscious act, yet the weighting of the ratio shifts to the unconscious as mastery is acquired. Thus although the game is full of purpose, as a result of the player's experience over time, it becomes progressively more non-purposeful.

Doctor: But Grandfather, what does that have to do with winning? You're speaking in riddles.

Magister Ludi: Yes, I have always loved that rich aspect of language: its playfulness, that is. So let us return to your question about winning. Winning in the game depends on your point of view. If the game is played by a solitary player, in one sense you could say he is competing against himself, but that it is an internal competition where one becomes less over time, rather than more. If players are playing a game together in a cooperative fashion, winning could be seen as a collective subordination of the ego, like jazz musicians who strive to find the greater improvisatory mind. As no one player has control of the course of the game, each player must work towards releasing their hold on outcomes. When done artfully, the group finds a way to utilize everything, even its "clunker" notes, and, in this manner of play, even wrongs are made right in the aesthetic of the completed game. Next, there is the idea of competitive games where players play against each other. Nevertheless, the spirit of the game is correctly that: play. A winner, then, is chosen for a completed game that is most art-full in its merger of aesthetics and intellect. Acting as an agent of wholeness within the system, the finished game becomes a fulcrum for change and transformation, and hence the whole community wins, including all of the players. There are no zero-sum games in the Great Game, only win-win. But the final aspect of winning is the most important to realize.

Doctor: But Grandfather, you have already outlined all the ways to play and "win" the game: singularly, cooperatively, and competitively.

Magister Ludi: Grandson, you have become so fixed on what is spoken that you forgot to listen to what is unspoken. You are seeing each game as a solitary event or undertaking; however, in truth, the game is far more than that. The sum of the games a player performs in his lifetime becomes a reflection of his total embodied experience, from cradle to grave. Each game is contextual in its own right; nevertheless, when viewed as a whole, together they form a new context greater than all the singular games a player has played. And still there are greater levels of understanding, as we begin to conceive of all the games, in all of their creativity, that have been played throughout the history of the Glass Bead Game; their collective expression and experience are woven into a solitary unified Great Game. Further still, there are even greater games that, in their expression of wholeness, transcend the tongue's ability to speak, where thought of winner and loser no longer hold meaning: all duality extinguished.

Doctor: I think I am beginning to see now. The game is not a simple thing neither is it complicated, yet it is complex, living somewhere on the edge between order and perceived chaos.

Magister Ludi: Indeed, that is true, and it is that way for all endeavors in Life when one commits to a sacred undertaking. One needs patience, perseverance, an open mind, and an indomitable spirit to become an adept of the game.

Doctor: The rules are so deceptively simple, yet the outcomes are so complex. How can I ever hope to learn such a game, much less master it?

Magister Ludi: But my young master, you have already engaged in the game; you have just never known it as such.

Doctor: I am confused... I am not sure what you mean.

Magister Ludi: It is time now to silence our talk. Both you and I have always had a predilection for too much of it. Certainly we have never been accused of too little. It has been a hazard of our characters and our professions. Sit down now with me at the table. Pick up the brush, dip it in ink, and with each breath in and out, open up your mind and your heart, and let what pours out of you be an expression of your love, and our love for each other.

With these words, I begin to draw each character: stroke by stroke. My hand simply knows each motion and passing of the brush against the board; its contact firm in my hand, the lines sure. The themes also emerge with each passing character as if spoken from Grandfather's unmoving lips. As for my Grandfather, he sits in silent repose, deep in meditative reverie across the table. There is no passing of time; each moment is complete, in itself. In this way, the game both starts and finishes. As I end my last stroke with the brush, I realize the game is complete, and in truth always had been. In our mutual and shared solitude, we quietly reflect on the game in its aesthetic wholeness. It has a certain perfection about it. It is not an idealized sort of absolute perfection in which all degrees of freedom have been exhausted, and further action is barred. Instead, it is a quality of perfection born of gentleness and generosity of spirit where even that which is wrong is embraced and made right: a perfection where we are free to make mistakes, so as to more fully understand ourselves and the world of our creation. In time, we slowly come back to ourselves...

Doctor: I have missed you Grandfather.

Magister Ludi: I have never left you. All you have to do is look, and you can see that I am woven throughout your game, in so many ways.

Doctor: Where do we go from here?

Magister Ludi: Well it is a university, so it only seems right that you finish this course of study.

Doctor: What is it exactly that I am studying?

Magister Ludi: Comparative Uncertainty, A necessary pre-requisite for your understanding of Complexity Medicine.

Doctor: As always you are frustratingly obtuse, but I have missed that in my life.

Magister Ludi: Let me then say something razor-sharp in its clarity. I love you always, and you must keep alive your love for me so that the rope between us remains strong. Know that I will be with you at each stage of your learning as you take steps towards your mastery of the Glass Bead Game...

Oddly, as my Grandfather's voice trails off, I no longer find myself in the West Hall, but in the College's Junior Common Room on one of those big comfy couches that are always so easy to nap on, rather than study...

Gently, I awake in the dark of the night, and find myself in my own bed. Not yet fully awake, I note characters and unknown symbols swirling like wisps in the dark air, I hear my grandfather's voice reciting a limerick:

There was once a man who played games

When he penned he forgot his own name

With each stroke of delight

He gained new insight

And from that point was never the same

Back to the Table of Contents
Act I - Scene II: Day Rounds on Service

Welcome to the first of a series of Grand Rounds that I will be presenting. Our topic is complexity, and more specifically, the embodiment of complexity, so that we may collectively start to enter into a process of meaningful change in both our medical practices and our lives. This is not a light or trivial undertaking; rather, it is a profound kind of metamorphosis that I am proposing.

As much as this presentation today is the first installment in our series of talks, in many ways it can also be considered the last. As we start here in this place, you will find that we inevitably come full circle ...but with an important difference, I hope. Consequently, this first lecture may prove conceptually to be the most difficult in this series of presented rounds. Be gentle and patient with yourselves as you consume these new ideas. Chew on them. Accept the new flavors they present. Take time to acquire the taste. Let them digest a while inside of you. Allow them to ferment in your gut. Savor this process of transformation, and in time it will nourish your being. Remember, there is no need to rush anywhere, and there is no place other to be than here, now.

Before we proceed let's take a moment to define the often misunderstood discipline of cybernetics8 as its core concepts and central precepts will keep emerging throughout these rounds, and are essential to our developing understanding. The word "cybernetics" originates from the Greek word kybernetes, meaning to steer, and embraces the metaphor of an oarsmen, helmsmen, or ship's pilot.

Cyberneticists study systems with inherent self-corrective mechanisms that appear to exhibit goal directedness, in the same way a ship's pilot makes moment-to-moment corrections navigating into a harbor despite constantly changing conditions and externalities. In a cybernetic circuit, a specific action causes some related change in the internal or external environment, and the outcome of that change is fed back into the system as the new input or stimulus. This creates a closed loop or iterative circuit. As a consequence of this recursive circuitry, a system is able to alter its behavior in a responsive way. The study of cybernetics, then, is a trans-disciplinary approach investigating the effects of feedback: circular causation in regulatory systems.

At its core, our exploration is about the nature of change. But underlying that change, if we care to examine further, we will discover what many in the fields of philosophy, mathematics, and science find to be a messy truth: the appearance of paradox.

With paradox, no matter how hard we try to steer clear, this disruptive logical storm, inevitably pulls us into its center of the tempest; dragged and battered by our simultaneous confrontation of mutually exclusive and opposite states. What is true is shown to be false, and what is false, true! What are we to do with this perplexing conundrum that assaults our self-reflection, pulling us from the stable moorings of our denotative reasoning? If we can navigate the fierce winds and gales of self-reference, the strong currents of circular reasoning, and the relentless waves of propositions that crest and crash back on themselves, we find ourselves suddenly at rest amongst the stillness in the eye of the storm. It is here, having survived our journey of self-discovery, we become witness to the truth that stability is a dynamic state based on unending and ceaseless change. From motion comes stillness, and from stillness we find revealed the dynamic organization that underlies it. There is no hurricane without its eye.

Circularity is at the root of paradox. As complexity theorists, we must come to terms with the condition that all reference is ultimately self-reference. An acceptance of this position defines the terms of our study; namely that through the dynamics of change we discover that which is stable. As the great cybernetician Heinz von Foerster noted in his examination of the phenomena:

Clearly when cyberneticians were thinking of partnership in the circularity of observing and communicating, they were entering into the forbidden land. In the general case of circular closure, A implies B; B implies C: and (oh horror!) C implies A! Or in a reflexive case A implies B, and (oh, shock!) B implies A! And now the devil's cloven-hoof in its purest form, the form of self-reference; A implies A (outrage!)

The very thought is anathema to the orthodoxy of science, and this should be of no surprise, as the orthodox and paradox share a related etymology where the former claims the straight path of the "inside teaching" while the later claims edification from the "outside."

The irony of this is that the orthodoxy dictates to us a world formed from the outside-in while the "paradoxy" necessarily conceives of a world birthed from the inside-out. Although the inquisition continues inside, there may yet be hope for the heretics, witches, and other outsiders among us.

As physicians, we must pay close attention to the state of change, for it is a great ally in our work. In Von Foerster's words, it provides the "therapeutic force" that we require to evoke further change. However this advice comes with a proviso, for in the penultimate moment before we try to apprehend, understand, capture, or control change, it offers us up something entirely different than our expectation. Of course: how could it be otherwise? Why should we expect change to yield to us something different than itself? In this, however, we can take comfort in the stability of our recognition that change itself is ceaselessly changing. From our perspective as physicians, change is necessarily equated with hope, for as purveyors of transformation, both physicians and alchemists rely on the promise of change to continue to ply their trades.

Alright...paradox, change, stability; this to me looks like a promising start to our exploration as we try to catch a fleeting glimpse of this thing we call Health. As a parting gift on this maiden voyage of ours, Heinz von Foerster presents a protective talisman, or what he has coined the "therapeutic imperative": "If you want to be yourself, change!" Luckily for us, this imperative comes with a set of self-referential instructions. Such, then, is our declared starting point.

In the upcoming days you will come to see that each of these rounds has its base in story-telling. A story will always say more than an explanation, and furthermore may say things to you that I could never have imagined, for in the hearing of a story you create your own unique relationship with it, bringing all of your history and lived experience to this new partnership. Heinz von Foerster once observed that a chance to use language was nothing short of an "invitation to dance." Language is co-inventive. In dialogue we each suggest what rhythmic steps we would like, and then each respond and engage in kind: "...the hearer and not the speaker determines the meaning of an utterance."

Going forward, you will need to be patient as we explore some theoretical material around complexity and its other academic brethren. Although these ideas are important and interesting in their own right (for those of us who have such interests), they are most valuable for the transformational frame that they create. Every good raconteur knows that no story can exist without context, and indeed, contexts of contexts; the structure of every myth having both internal contextual intricacies, as well as external ones, thereby forming the basis of its organization. That is to say it has set of relationships that it holds (pattern), and others which it is further embedded in (matrix). If any wisdom is to be gleaned from a story's telling, it is to these relationships that we must look, for ideas are dynamic, continually transforming, immaterial processes, and not reified, static, material forms. No story can ever be told (or heard) the same way twice.

Minstrel, minister, ministrations, administer: all four of these words share the same Latin root, ministrare – to serve. Performers, poets, priests, and physicians share a common origin in the language that denotes their work, and a common work through the language of their stories. Etymologically, these terms also share a relation with the word minus, meaning less. "Less" can never mean "more" in any quantitative sense; it is only through the quality of our service that less is paradoxically more. Embracing the bardic tradition, and in remembrance of the lyrical offerings of the minstrels of old, I would like to recite to you a quote from the palliative care physician and author, Rachel Remen:

Service is not the same as helping. Helping is based on inequality, it's not a relationship between equals. When you help, you use your own strength to help someone with less strength. It's a one up, one down relationship, and people feel this inequality. When we help, we may inadvertently take away more than we give, diminishing the person's sense of self-worth and self-esteem.

Now, when I help I am very aware of my own strength, but we don't serve with our strength, we serve with ourselves. We draw from all our experiences: our wounds serve, our limitations serve, and even our darkness serves. The wholeness in us serves the wholeness in the other, and the wholeness in life. Helping incurs debt: when you help someone, they owe you. But service is mutual. When I help I have a feeling of satisfaction, but when I serve I have a feeling of gratitude.

Serving is also different to fixing. We fix broken pipes, we don't fix people. When I set about fixing another person, it's because I see them as broken. Fixing is a form of judgment that separates us from one another; it creates a distance.

So, fundamentally, helping, fixing and serving are ways of seeing life. When you help, you see life as weak; when you fix, you see life as broken; and when you serve, you see life as whole.

When we serve in this way, we understand that this person's suffering is also my suffering that their joy is also my joy and then the impulse to serve arises naturally - our natural wisdom and compassion presents itself quite simply. A server knows that they're being used and has the willingness to be used in the service of something greater. We may help or fix many things in our lives, but when we serve, we are always in the service of wholeness.

When I found this writing, it was the perfect articulation of the unspoken thoughts and feelings I had about patient care and my role as a physician in that care. Indeed, it has become my guiding ethos in terms of my medical practice, and it is something which I believe to be vitally important to the profession as a whole.

In truth, I think Dr. Remen's beautiful prose stands complete entirely on its own merit. Nonetheless, I want to draw your attention to certain aspects of her assertions, as they echo sentiments that will repeat themselves in various forms throughout these rounds. First, let's look at the idea that helping, fixing, and serving are ways of seeing Life. This, at first glance, is a peculiar statement as helping, fixing, and serving are verbs; affectors, calls to a specific type of action. What, then, does this have to do with our effective perception of Life, the world, and our place in it?

To understand this question, I suggest we turn to the two philosophical branches that deal directly with the investigation of knowledge, that of ontology and epistemology (note: these are terms you want to put to memory, as we refer to them frequently throughout these discussions). Ontology is the philosophical study of reality; the nature of existence, or in other terms, what can be known. Epistemology, on the other hand, is concerned with how we know, how we know we know, and how we acquire and act upon knowledge. Obviously, the two branches are intimately connected. Thus when we speak about our ontology or our epistemology, we reference our collective presuppositions about the nature of reality and our ability to comprehend that same reality.

Our individual lived experiences certainly influence our perspective of such things, but we must not forget that epistemologies (i.e. knowledge frameworks) self-inform our culture as a whole, via their firmly entrenched position within that culture. As such, our deep ontological and epistemological structures come to birth our worldview, and hence provide the framework for the ideas and beliefs that we, as individuals, groups and cultures, use to navigate, interpret, and engage our worlds. In this way, our ontology and epistemology can create blind spots.

As our culture continually reinforces one particular set of perceptions, knowledge, belief, and actions, we lose sight of the fact that there are other ways of perceiving and acting; that there are other ways of knowing. As our habituated perceptive lens continues to hide the interactions of our ontology and epistemology from our conscious mind, we inevitably become blind to our blind spots.

Now, we see many references to wholeness in the aforementioned passage. What is wholeness? This is an ontological question, and a vitally important one at that. Words like wholeness and holistic are often used as a critique of orthodox medicine, but what do we mean by those words? Without a thorough reflection of our ontological notions, wholeness and its derivative concepts risk being trivialized and co-opted into more of the status-quo; the appearance of change unaccompanied by any meaningful transformation. Dr. Remen, in the articulation of her experience, is already nudging us towards a deeper understanding and embodiment of these concepts.

In addition to our ontological query, we also find a guide map for our epistemological inquiry. Dr. Remen offers three choices; three alternative ways of engaging the world and seeing life: helping, fixing, and serving. We see emerging here the suggestion of recursivity, where how we act and behave in the world informs how we perceive it. What does she mean, then, when she gives us the choice of seeing life as "weak", "broken" or "whole"? This is of course an epistemological question, in the spirit that we will see reflected again and again in these lectures as we learn to "Act to know so that we may know to act." The unconscious, inaccessible, and consequently, unexamined foundational presuppositions of ontologies and epistemologies are, at times, treacherous things to navigate, but we have little choice.

Individuals claiming to have no epistemology either have a "bad epistemology" in as much as they avoid responsibilities for specific actions predicated on a set of perceptions and ideas, or to quote cybernetician/healer/family-systems theorist and Jazz musician Bradford Keeney, they "... reveal an epistemology that does not include a conscious awareness of itself." Many of us no doubt fall into the latter category, but as physician-scientists, we must doubly guard against the former, as ownership of our actions is the ethical core of our profession.

All of this brings us to a problematic place. Are all ontologies and epistemologies equal? Are some better than others? Is there such thing as a pathological epistemology with its resulting aberrant worldview? Dr. Remen implies that a worldview centered in service is fundamentally more integral and whole than one of helping or fixing. But when we consider every alternative worldview, with their differing underlying epistemological foundations, inculcated through individual, family, and cultural traditions, we run the risk of falling into a post-modern relativism. When specific points of view have no absolute validity, but only contextual and subjective value in accordance with their differences of perspective, we are left with no way to evaluate differing ontological and epistemological stances. Considering the present state of affairs in the world, I think many of us would agree that there is such a thing as a "bad epistemology." Is this position a defensible one, however, under the specter of relativism?

Let's go back for a moment and look at the paradigms of serving, helping, and fixing as they apply to medicine. We require a basic understanding of both the ontological and epistemological underpinnings that construct the philosophical foundation of our present system of scientific inquiry leading to modern, "evidence-based" medical practice. These various philosophical positions provide the necessary presumptions required for a philosophy of science. They form the theoretical groundwork upon which the scientific method is built, the framework on which to contextualize and validate our scientific pursuits, and the bridgework for their further application to the practice of medicine. Certainly, over the course of history, elaborate and robust philosophical schemas within the philosophy of science and medicine have been put forth and elaborated upon. But all of these varying schools of thought with their different historical proponents have their roots in the following basic philosophical first principles, collectively known as scientific orthodoxy:

 Realism: where objects of scientific knowledge and scrutiny exist independently of the minds and actions of the observers themselves. In other words, the belief in objective, mind-independent existence, ontologically separate from subjective observation.

 Materialism: whereby valid existence is limited only to forms of matter and energy. All "things" are thereby composed of material and energy, with all secondary generated phenomena (or epiphenomena) being the direct result of material and energetic interactions. In this way, "reality" is considered identical with the appearance of objectively occurring states of matter and their corresponding physical forces or energies. In the materialistic view, all physical causes with their resultant effects are, in theory, reducible to fundamental physics.

 Positivism: where discrete data from the sensory-independent objective world (but derived from sensory perception) are the only admissible basis of knowledge and exacting thought. Building upon this positivist assumption, we see such philosophical considerations as representationalism: the idea that the world we see in conscious experience is but an internal representation or mapping of the "real world" as it truly is.

 Empiricism: the epistemological view that true knowledge comes to us through our sensory experience. Empiricism emphasizes the primacy of repeatable and reproducible evidence as the foundation of proof, especially as discovered by experimentation. It forms a fundamental part of the scientific method in that all hypotheses and theories must be tested against observations of specific phenomena, rather than through the logic of a priori reasoning. In empiricism, we also find embedded the doctrine of falsifiability or refutability, wherein the core element of a scientific hypothesis or theory must, in principle, be capable of being proven false through empirical means.

 Reductionism: the belief that the nature of complex objects or processes can be fundamentally understood by reducing them to the specific interactions of their component parts. Reductionist thought is predicated on the notion of the overall uniformity of all matter and energy, therefore there is no uniqueness to the fundamental constituents forming the physical universe. In this way, complex systems are never seen as anything more than the measured sum of their parts, and any summary of a system can, in principle, be understood by a complete accounting of the individual constituents.

 Dualism. In a philosophy of science, a fundamental dualism is the dichotomy between the subject (the observer) and the object (the observed): the observer and the observed. We see a similar explanatory divide between mind and body.

We must realize that all of these postulates speak to the specific ontological and epistemological positions that form the foundation of all Western orthodox science. The keystone principle, implied and unspoken, behind all of these orthodox ideologies is that there exists an objective reality of material things that exist independently of our subjective experience. Humberto Maturana, one of cybernetics' elder expounder's, has referred to this as the "metaphysics of a transcendental reality." There is an accepted premise and belief in a world as it really is, "the thing-in-itself" (Kant's, ding an sich), a fundamental or ontic existence of real things, as opposed to phenomenal existence.

The metaphysical presupposition underlying such a position is that there are fundamental objects in the world of existence, defined by a set of object-specific properties that may be subjectively distinguished owing to their observer independence and privileged status as unique material entities in and of themselves. As a primary axiom, scientific orthodoxy accepts ontic existence as a fundamental verity, the validity of which is rarely questioned by our societal collective, as the position of material realism is so deeply entrenched in culture and reinforced in our noun-dominant language.

As a necessary extension of this externalized ontology, mental processes equate with physical processes, all of which are felt to be adequately accounted for by the fundamental laws of the physical world. Epistemologically, the orthodox scientific frame defends the premise that we are only able to perceive limited aspects of the "real world" indirectly using our neuro-biological machinery, collecting objective sensory data generated by the material universe. In this way, we create a representation or mapping of the physical world allowing us to interact with and navigate through our environmental terrain. Finally, reductionism further advances our epistemological understanding of object material reality by breaking down complexity into its component parts. Neuro-cognitive theorists would have us believe we are cognitive map-makers and map-users, thereby simplifying the complexity inherent in the external, environmental terrain so as to be able to navigate the world.

One of the many issues with this ontically-derived worldview and logic is, unsurprisingly, the resultant inability to adequately deal with paradox. If we hold to the belief of an absolute and transcendent existence, then the experience of objective truths must categorically be either "yes" or "no." Orthodox logic is unconsciously premised on such a fundamental stability. An understanding of paradox, however, requires a position that encompasses the dynamism-of-state in its operation. To explore paradoxical positions requires a shift in awareness from a passive, reified "ontology" towards an engaged, dynamic "ontogenesis"; from observing a world of "being" to engaging and participating in an existence of "becoming." This is a vitally important distinction that will be emphasized throughout these lectures.

So: we have laid out our basic position, and assuming that after a lengthy presentation with multiple iterations of exchange utilizing varied metaphors to convey our arguments, we convince a few of the more intellectually enlightened followers of the cult of materialism to loosen their dogmatic metaphysical reins enough to consider the validity of our thesis. But to our surprise and chagrin we find out that they are in actuality covert, liberal post-modern materialists, and hitting us with a relativistic counter-punch, they write off our entire argument, justifying their material-rationalist beliefs as a type of cultural equivalency. The horror of it all! If our proposed epistemology is taken to be just another idiosyncratic metaphysical proposition, we quickly find ourselves in a relativistic trap without the ability to critique, impotent to advocate for change.

For example, I may critique my realist/ materialist/ positivist/ reductionist friend, and say something like: "Fine mess you have got us in with global warming, climate change, and the like."

To which he could respond: "True, but once we break things down a bit more, and get a better grip on the world as it really is, we will come up with a new technology that will correct our miscalculations...just a few growing pains."

And where I reply: "What are you crazy? How do you expect to right things with the same kind of thinking that caused the problems in the first place?"

When he responds: "Have you got any better ideas?"

And I impishly reply: "Yah...relatively better anyhow..." What are we to do?

Don't worry. All is not lost to the churning of a relativistic sea like so much flotsam and jetsam. What if we were to consider for a moment the possibility that the ontological and epistemological foundations of an alternative ecological or holistic worldview were rooted in something basic and universal to all human beings, and indeed to all life, thereby transcending any cultural relativism? A cybernetic/complexity approach to science and medicine, I propose, does just that. In a broad sense it offers up the possibility that our ontology and epistemology can be fundamentally grounded, not in our diverse culture frames, but instead in our shared biology, and it is in this way that we can break free of the tyranny of metaphysical relativism.

Complexity is a new and emerging science and still a fluid and dynamic field. Perhaps, then, we should model our thinking similarly, and resist our cultural penchant to rigidly classify, compartmentalize, and name things; at least when we converse about complexity. With this spirit in mind, let's examine the ontological and epistemological considerations born out of a biological approach to complexity: an approach that I (ironically) refer to as an epistemology of wholeness.

An epistemology of wholeness is grounded in the integral nature and primacy of relationship in the living world. Consequently, its view and actions are necessarily ecological and holistic. It is immersed in an exploration of pattern, thus its nature is aesthetic; its expression relational, recursive, and dynamic. This of course stands in contrast to the materialist view, or what may be conversely thought of as an epistemology of separateness, that is functionally reductionist, a-contextual, object-centered, and lineal in form and process: qualities reflected in its pragmatic intentions and utilitarian outcomes.

In attempting to articulate a frame for an epistemology of wholeness, I ask us to consider four distinct, yet interrelated domains or differing levels of abstraction. In this way, through the interaction of our observation and the power of our language, we can choose to speak of the physical, biological, systemic, and holistic domains. They pragmatically remain differentiated in as much as they highlight certain emergent properties present in our experience of the world. Nevertheless, they hold no independence or privilege separate from their relationship to each other. Aesthetically, however, we must never forget to acknowledge that these four domains in truth are only separate emergent facets of an unbroken, unified whole of which we are a part.

Furthermore, a cybernetic dialectic holds that knower and known remain paradoxically distinct, yet simultaneously related. Thus, by necessity, we shall conflate the separate, traditional philosophical investigations of epistemology and ontology under a new meta-definition of what has been called a cybernetic epistemology. Equally, we could change our focus from a reified ontology proper, to that of the dynamic organic process of ontogenesis, that is to say the process of "how things become". This stands in stark contrast to the representationalist view, and by its very nature is radical constructivist in its stance.

So, in contrast to the philosophical foundation of orthodoxy in science and medicine, let us suggest the following first principles as an initial mental scaffolding to support an emerging understanding of an Epistemology of Wholeness:

 The observer can never be separated from the observed. What can be understood about the world is equivalent to what is understood to exist in the world.

 Emergence , a process whereby novel larger systemic patterns, regularities, behaviors, and complexity are generated as a product of the interactions and processes of less complex systems that themselves do not exhibit such properties, drives the process of ontogenesis. Emergent transformations producing evolving ontogenic domains of organization represent order for free and are indicative of greater levels of systemic complexity supporting new states that did not and could not be known or causally deduced to exist a priori to the manifestation of such order.

 Emergence, as a self-organizing principle is paradoxical. We simultaneously view local to global determinations (upward causality) where the local interaction of components/nodes/parts/agents spontaneously form a network of relationships resulting in novel properties representative of a new global organizations that could not have been predicted in a deterministic fashion (i.e. "The measure of the whole is greater than the sum of the measures of its parts"). That being stated, through a circular causality, we also note global to local determinants (downward causality), where the emergent organization exercises constraint or control (organizational parameters), thereby limiting the possible behavioral freedoms (variables) the components could have potentially exercised prior to their interweaving into a greater pattern. Thus, although the whole that emerges is a product of the constitution of its parts, similarly parts are constituted by their relation or position to one another within the whole. Emergence is thereby a self-referential phenomenon.

 A cybernetic epistemology, such as we are proposing, acknowledges the existence of a physical domain (i.e. material world) in which all the physical forces, interactions, and reactions generated apply. In this way, our philosophy is not solipsistic in its stance (note).

 The process of feedback is the condicio sine qua non (i.e. essential condition or essentiality) of the physical, material world. Within a material and energy rich environment, feedback provides the foundation for the spontaneous formation of non-linear, dynamical, far-from-equilibrium states that are supportive of emergent changes that underlie the formation of complex systems.

 The physical domain, primordially, remains a place of circumstance, happenstance, and unboundedness. A cybernetic epistemology recognizes no intrinsic objects, orders, states, or patterns within the physical phenomenology itself. The ability to distinguish such is not a property of this ontogenic domain.

 Distinction or the ability create and recognize pattern is an emergent property central to the biological ontogenic domain and did not exist a priori to the generation of primordial life. The act of distinguishing is synonymous with the emergence of mind and the genesis of observation (including self-observation).

 The emergence of living, self-creating systems through a process of molecular and metabolic self-organization is the genesis of distinction. Consequently, we observe that the act of distinction is both formative for and representative of living things. For the first time, ontogenically, we view both complexity and adaption within the presenting form and process. This is accomplished by a paradoxical and recursive organizing principle, where the primordially distinguished organism is the source of the genesis of its own distinction.

 As autonomous unities, biological entities are requisitely self-organizing and self-referential systems, having both organizational and operational closure. Their domain is specific to their internal dynamics free of the observership of others. They are autonomous by virtue of their property to distinguish. They are unities by the fact they have self-referentially distinguished themselves as such.

 The criteria defining a living organization as a unity (i.e. autonomy and closure), brought forth as a product of self-reference and resulting in self-organization, is sufficient in itself as a fundamental definition for Life. A listing of biological properties (such as reproduction, metabolism, growth, response to stimuli, order, adaption, etc.), as viewed by an observer, is not sufficient as a primary definition of Life, as it is the observer-independent or intrinsic organization of the living which in itself defines the living.

 In the biological domain we see the incipient beginning of a mutually specifying form and function, or structure and organization, creating the biological foundation through which we may extrapolate a universal, non-relativistic ontology (ontogenic) and cybernetic epistemology, rooted in our shared biology.

 Biological organisms are necessarily coupled to their environment (including other organisms) through a history of recurrent interactions leading to a state of structural congruence. Coupling allows for the creation of a paradoxical situation where operationally closed systems can be viewed as materially and energetically open.

 Coupling allows for the emergence and creation of a systemic domain that cannot be strictly characterized as biological. Via the process structural congruence, mutually coordinated behaviors are established thus forming systems, and as a result of their circular trains of causation, are able to maintain the integrity of certain propositions about their own organization that can be thought of as living and thereby supportive of a type of systemic mind of sorts. These larger systemic entities may be entirely composed of living organisms, or be a composite of the living and the physical environment. Examples could include such things as species and ecosystems, or societies and cultures, or an artist with brush and pallet in hand and canvas on the easel.

 These systemic organizations, unlike biological organisms proper, are not necessarily bounded and topologically distinct. Yet from the perspective of the observer who draws the distinction, appear to maintain their own identity. As observers of such systems, we may make additional distinctions of sub-systems.

 The holistic domain (i.e. the summation of all sub-systems within the biosphere), is synonymous with the Whole, and representative of a new emergent ontogenic domain.

 Although the biosphere satisfies the ontological criteria of the biological organizational domain (i.e. autonomy, closure as a product of self-reference, and self-organization), it is nonetheless a product of a fundamentally distinct emergent ontogenic organization.

 We note that each of these domains forms alternating open and closed systemic interactions (i.e. physical/open, living/closed, systemic/open, and holistic/closed). This forms the basis for a type of cybernetic dialectic were we can observe an alternation of "classification of form" (i.e., closed) and "description of process" (i.e. open) throughout these interactive domains (note)

 Each ontogenic domain (physical, biological, systemic, holistic) springs forth unheralded from its antecedent domain together informing yet being informed by the self-organizing and self-referential whole that together they look to create yet are simultaneously created by.

 Circularity in its myriad guises is the fundamental mechanism leading to the recursive (i.e. paradoxical) logic driving a cybernetic epistemology. All previous elucidated principles are predicated on this understanding. Recursion can then be thought of as the first principle of the first principles in an epistemology of wholeness.

Another thing we must consider in exposing an epistemology of wholeness is the role of language and an understanding of its use and limitations. I would propose that language is innately paradoxical. On the one hand, language is a self-verifying, self-substantiating, closed logical system. Through metaphorical injunction and analogy, the user of language creates a recursive web of syntactical and semantic structure. Language shapes our conscious thought, giving direction to both our perceptions and actions.

On the other hand, language by its very nature serves to parse, divide, distinguish, and provide indication, thereby constructing a narrative of our apprehensions of 'reality.' Furthermore, although language is a "holism," it is only a very partial representation of the "whole," which far transcends all limitations that language (and by association, the conscious mind) would look to impose. In this light, it is important to realize that our embodied experiences of wholeness are similarly not limited to the linguistic domain.

With this understanding in hand it is essential to maintain a proper accounting of how we make abstraction through language. We must remember that our linguistic parsing is directly attributable to our view point: our position as observers. Likewise, we must take responsibility for eventual re-integration of our ideas into a unified conceptual understanding, as well as committing to an a-linguistic, embodied participation within the whole.

To help us start exploring our new found cybernetic epistemology, the science of cybernetics ("the original science of complexity") inevitably challenges our modern conventions around causality. Our traditional scientific approach, grounded in the Newtonian tradition, focuses on the causality of motion: stops and starts; causes preceding effects, or what was termed by Aristotle, a causa efficiens. Cybernetics, with its investigation of circularity and feedback-driven systems, challenges this conventional perspective. Goal-directedness and self-correction suggests the possibility of a causa finalis or final cause (telos) where the action in the present is pulled by a future cause (i.e. purpose, aim, goal, destination or endpoint), or the existence of some ideal that the very action is meant to accomplish. In other words, a final cause's precedent effect is circular in form (e.g. predators predate, and prey evades being preyed on). It should be no surprise that the orthodoxy, with its processes of inquiry founded on linear causal forces, is not a fan of such a view. Likewise, our recursive view, with its self-reference and closure, predicated on the existence of final causes in nature, forces upon us a teleology (i.e. the philosophical account that nature inherently tends toward definite ends), the truth or falsehood of which cannot be elucidated by reductionist means.

The first generation of cybernetic thought, or first-order cybernetics, worked from a traditional scientific paradigm where the observer was felt to be able to observe a system from outside with impartiality. Second-order cybernetics followed as a critique and response to this first-order stance. Recognizing that Life is the product of Life engaging itself, second-order scholars approached cybernetics with the awareness that investigators are always part of the system they investigate, and consequently the very act of their investigation impacts its outcomes. They termed this thinking second-order-cybernetics or the cybernetics of cybernetics. Beyond the idea of a simple, single, closed feed-back loop, they envisioned a loop within a loop where the feed-back mechanisms of interest were contained within the greater loop of the observer-interacting-with-the-system. More poetically, as Von Foerster once highlighted: "Life cannot be studied in vitro, one has to explore it in vivo." It is only through our participation with Life, rather than our investigation that we succeed in producing, creating, and bringing forth Life, which we too are a part of. Our immersion into this cyclic dynamic allows us to become part of the organization and ordering, and allows us to be ordered and organized. The study of second-order cybernetics helped advance an understanding of many ontological and epistemological issues, and has had widespread applicability to the natural sciences and the humanities. The contributions from second-order-cybernetics will be what we are most interested in throughout these lectures.

Now, as I mentioned, and I hope that you agree with me that Dr. Remen's passage is explicitly epistemological. Nevertheless, that being stated, I remain unsettled by a certain feeling that there is more to it...a certain something that I can't quite put my finger on. In the course of preparing these rounds, I realized that her wisdom is also implicitly ethical. As professionals with our professional organizations, that is to say our governing bodies, I believe we have become confused about the nature and relevance of ethics to our profession, and this confusion springs from what I believe to be a lack of clarity in understanding the role of first and second order cybernetics. What do I mean by this? In the profession, we are quick to profess the importance of an ethical code of practice. I would argue that what we have, however, is not an ethical code of medicine, but instead a moral one. Ethics and morals, at least cybernetically, are not synonymous. Morals invoke the position of sanctified observership. They are first order in their orientation. As an "independent observer," I pass judgment and pronounce value on others; the "thou shalts" and "thou shalt nots." Morals, as a product of the observer's first-order positioning, are necessarily other-directed, and hence proclamatory or accusatory in nature. Conversely, if I work from the interdependence of a second order embrace, I can only decide for myself how I should think and how I should act. It is from this position, and more importantly, action, that we find a direction towards an ethical understanding.

Unlike morality that prescribes reward and punishment for determined behavior, in ethics, as Von Foerester reminds us, the reward and punishment reside within the individual action itself; they remain distinct, but at same time inseparable from each other. Once again, we are confronted with self-reference, as our action is not separable from our knowledge of how to act. Morality is dependent on its grounding in an ontic existence, for only through situating ourselves in an observer-independent milieu, where objects exist separate from our position as observers, can we begin to judge actions as right or wrong. Authoritativeness, expertise, validity, universality, hegemony, ideology; all of these notions contain moral elements, and as all are predicated on a notion of the externality of ontological truth, they create a justification whereby certain modes of experience and knowledge are discredited and labeled as false, while others receive sanction, and are deemed to be true. A "mistake," when similarly objectified, is held as a failure in an absolute sense when deemed as a transgression against some objective measurement of truth. Through this measure against the "truth," we are able to find fault, and justify punishment of the transgressors. This is the passing of a moral judgment.

Conversely, when we situate ourselves such that our reference is not an external objectified world, but instead is grounded in the primary self-reference of our biology, we find that we are alone, as an outcome of the organizational closure that defines our autonomy. From this internality, there is no privileged access to a reality separate from our own internal organization. The Emperor, we are surprised to find, is wholly without clothes, and we can no longer subjugate, convince, cajole, coerce, or castigate others to our view. Instead, we must strive for common ground, and negotiate mutual needs.

Mistakes appear very differently from an ethical perspective when compared to the moral paradigm. Here we realize that all mistakes, whether our own or others, were in the moment of their doing conceived as wholly valid actions from the perspective of our self-organizational response, and were undertaken in good faith. It is only in hindsight that we may, as observers, deem something as mistaken, and then only by contextualizing the specific action within the successive series of related events that follow. A mistake is never absolute, but is derived only as a construct of its contextual framing.A different framing, or constructed abstraction from the perspective of the observer may show a specific action not to be a mistake at all, but instead a moment of potential opportunity or even wisdom. This conceptualization is epitomized in the following Chinese folk tale of the Daoist Farmer:

There was once a farmer who lived close to the borderlands who worked diligently, and lived a righteous and ethical life. One day, however, his prized mare escaped its fencing taking off into the wilds. His neighbors consoled him, while at the same time pitying the situation the farmer found himself in. However the farmer's reply to them all was: "Good thing, bad thing, who is to know?"

Several months later, to everyone's surprise, the mare returned, pregnant and accompanied by a majestic wild stallion from the Steppes. Everyone celebrated his good fortune, but his reply was still the same; "Good thing, bad thing, who is to know?"

Having the new stallion, the family's wealth and local prestige increased, but sadly the man's eldest son fell from the spirited horse while riding one afternoon, breaking his hip. The community was grief-struck. How would the old man manage on his own? Yet the farmer's reply remained the same; "Good thing, bad thing, who is to know?"

A month later the clarion call came, as news had spread that the barbarians had swept across the borders in a wave of sacking and pillaging with only destruction and despair left in their wake. The Imperial army came to each village conscripting all the young men to come and fight the approaching hoards. The old farmer's son, however, was spared on account of his injury. He was the only working youth left in the village. Amongst the tears of crying mothers and sobbing grannies, a small grin came across the farmer's face; "Good thing, bad thing, who is to know?"

Because of the circular and reiterative process of an organization structured on feedback, a mistake holds equal validity to any success, in that both serve to inform our next action. Although, from our perspective, a mistake is not deemed to be an ontological transgression against an established truth, it does not follow that our actions are without consequence. Instead, we come to realize that consequence is inseparable from any action, whether in the form of a perceived reward or punishment. Ethics, in this sense, is the intrinsic recursive unity formed between the two. Acknowledgement of a second-order epistemology, and embodiment of the ethical position, frees us from the fetters of moral judgments. Nevertheless, we must recognize that it binds us to owning the responsibility for the consequence of both our actions and non-actions.

Before proceeding, there is something, however, that I want to caution you about. We must be wary and vigilant, for if ethics is to remain a source of continued transformation, it must remain fundamentally implicit, covert, and in a functional sense, unconscious to us. To expose ethics to the eye of first-order observation is to risk its degeneration into moralizations, at which point it ceases to subsist as an ethical, aesthetic expression. The power of ethics to inform and govern change lies in the closure of its paradoxical self-reference. Ethics flows like an underground river directing us on its unerring current. Only at our own peril do we give up the direction of its ancient course to guide our way by replacing it with a moral compass of our own making.

Any attentive, ethical practitioner of the healing arts should be feeling considerable consternation at present. Paradox, of course, creates that kind of internal tension. We want to be ethical, but to act ethically in an explicit, conscious sense is to create something inherently unethical. The conscious judgment of the other determines that this self-fulfillment is inevitable. What do you do?

The genius of Von Foerster lay in realizing that none of the philosophical pursuits live independently of each other. Epistemology and ontology mutually specify each other. Epistemologically, to act is to know. To be ethical is to embody "right action," yet to try to act rightly is to end up with moralization. The way out of this conundrum then, according to von Forester, is rather than focusing directly on ethics, instead to let our gaze fall on metaphysics.

Physicians are also meta-physicians, whether we realize it or not. To be a meta-physician we need not agree about what metaphysics is about, for this is at its heart the very nature of metaphysics. As Von Foerster suggests, metaphysics is the decision to agree, in principle, on the answer to unanswerable questions. An easy, non-technical, example of this would be the perennial origin question of how the universe began: Big Bang, act of Creation, no beginning no end, monkeys banging away on type-writers...who's to know? It is all mythology. Von Foerster says, "Tell me how the universe came about and I will tell you who you are." This to me sounds strangely like the dialogical dance of epistemology and ontology.

Metaphysics is the process of deciding to answer what are ultimately unanswerable questions. To do so is to create a resultant mythology, but aren't mythologies archaic vestiges in our modern world? This, of course, is the Achilles heel of modernity, where with our arrogance and linguistic trickery, we have convinced ourselves that our rational, logical, enlightened, scientific worldview is not mythological. Yet that hasn't stopped us putting answers forth, in our striving to answer the fundamentally unanswerable. As scientists, to forget our active decision to myth-make is to create a type of un-reflected dogma, the culmination of which results in an untenable and inherently unethical position; a position whereby we abdicate responsibility for our actions to some other outer authority of the "truth."

So why bother with metaphysics at all? As separate individuals and cultures, can we not just leave the unanswerable questions unanswered? To answer only the trivially answerable questions is to forgo any of our freedom to be able to create. Questions with answers, whether they are arrived at quickly or after a number of irrefutable logical steps, will ultimately be "yes" or "no" answers. This is the real digital world. We have created icons and idols of technology that reflect back to us our image of ourselves. It is only in answering the unanswerable questions that we discern our freedom to choose. The unanswerable is, by analogy, analog. There are no external parameters that force us to answer these questions in a specific way. It is left to us to draw the distinctions that bring meaning forth. We are free to choose, and in this, accept the responsibility that comes from such a realization.

Gregory Bateson, another of our cybernetic elders, shared a story:

There once was a man who had a computer, and he asked it, 'Do you compute that you will ever be able to think like a human being?' And after assorted grindings and beepings a slip of paper came out of the computer that said, 'That reminds me of a story'...

Enchantment, it would seem, is a necessity of the living.

Oh yes, I almost forgot; what does this have to do with ethics? Metaphysics is the gateway to Heinz von Foerster's cybernetic ethical imperative; "Act always so as to increase the number of choices." For in that it would seem that the diversity of our mythologies are important considerations after all.

And what of aesthetics? On this Von Foerster shares with us his aesthetical imperative; "If you desire to see, learn how to act." To help with this, let's take a moment to contrast aesthetics with pragmatics. In a broad cybernetic sense, aesthetics is the attendance to context and context of contexts, while pragmatics implies a preoccupation with outcomes; circular self-reference and closure in contrast to a linear cause and effect. In this way, ethics as a relational manifestation is more akin to a dance, or a conversation. Through aesthetic engagements and interplay, both ethics and language escape from a denotative reductionism that would choose to disenchant them. As Remen reminds us, we can see the world as weak, broken or whole, and we come to know this through our helping, fixing or serving. Two of these actions are pragmatic, one is aesthetic. I leave it to you to decide where ethics is to be found. "Our natural wisdom and compassion presents itself quite simply."

In conclusion, I want to talk about the primacy of relationship to wholeness. It is an essential idea forming the foundation for all of these rounds, and what they propose. It is an ongoing theme that will present itself again and again. It is relationship, or as Gregory Bateson says, "The patterns that connect"; that form and are formed by the matrix of the living world. Only through mutual and reciprocal acts of service do we see the true nature of our relational connectivity. The call to service naturally generates the virtues of compassion, gratitude, and love. Acts of service in turn bring us into an awareness of a state of wholeness. Through our action, we are made more humble in the same moment that we find ourselves more whole. Paradoxically, we become expansive through our smallness.

Before finishing this morning, I would like to share a short personal story. While in medical school, I was completing an Internal Medicine rotation at a busy downtown city teaching hospital.

During that rotation, I found myself sorely vexed with a certain existential woe. I was battling feelings of being inauthentic in my work. I was tired and worn out with school, late-night call, and travel. When talking and caring for patients, I gave them all the attention I could muster, but it always felt like I was constructing and concocting what I knew they wanted to hear. There were no great feelings of connection or reward. It certainly did not seem to me to be the type of experience of service that Dr. Remen was talking about. In truth, I felt like a charlatan, a con, a fraud. Ironically though, the patients would report back to my supervisor positive critiques of my ministrations. Despite what I felt about my performance, they felt genuine care, empathy, and improvement in their health. Their comments only succeeded in making me feel all the worse, and did nothing to bolster my spirits.

My preceptor in the rotation was an Irishman: Dr. O'Donnell. Now, whenever Dr. O'Donnell talked or waxed poetic, always with a sparkle in his eye and an impish grin on his face, he was prone to the more than occasional tirade of profanity. Of course, with his Irish lilt, it sounded nothing other than pure poetry. He was wise in his ways, and quick to offer up an opinion. He once encouraged me to "always serve up every compliment with a thin veneer of shit," as that's the Irish way, and the source of their cultural humility.

When I shared my angst with Dr. O'Donnell, he paused, looked me straight in the eyes, and with a mischievous grin said:

I think you are a sham, but not for the reasons that you think. You are expecting a return from the encounter; you are wanting and waiting to feel something good from it. You are looking for a personal reward or satisfaction. It's your wanting that taints your actions from being a true service. Now you find yourself being tired and burnt-out. However, you continue to serve and strive in the best way you can, and your patients are benefitting from that service despite what you feel or covet. Truthfully, it would seem to me, that you are being your most authentic when you are feeling your most inauthentic by just doing what is asked of you. You have gotten out of the way, and are just serving for the sake of serving with nothing more added to the mix.

Ah yes, Von Foerester's therapeutic imperative; "If you want to be yourself, change!"

As we continue through these Grand Rounds, I encourage you to frequently go back to Dr. Remen's beautiful and wise words. They will help you unlock what is to come. Let us then take our newly discovered cybernetic wisdom and use it as a platform to act boldly in service to our patients, to each other, to ourselves, and to the whole. Let what emerges from our participation in Life be a remarkable surprise to us all.

Thank you

Back to the Table of Contents
Act II - Scene I: Night Rounds - The Ancestor

Doctor's Narration: After an exhausting day of work, I laid down on my couch in my living room. This couch was a veteran of many naps like this. It's soft embrace, although hell on my back, was always quick to lull me into sleep. With the addition of an eiderdown comforter, despite any protestations from my post-shift adrenalized body, unconsciousness was always the inevitable winner. This evening was no different...or so I thought...

At first there is only blackness. Then, from the depth of my dark slumber an incredible dreamscape gradually comes into lucid focus. I am in a desert, a desert not only of sand, but of thorny scrub and bushes. In the background is a giant Baobab tree at rest, weathered and etched with the passage of heat, winds and droughts over inestimable time. It is dusk; the sky a mix of brilliant pinks, purples, blues, and grays. The first stars are just starting to appear. Birds are in the air, flying home in synchronous masses to rest for the evening. Animal sounds punctuate the night stillness with their wildness. A deep ancestral memory of this place stirs within me.

In the middle of a clearing is a lone grass hut. It is utterly simplistic in its dome-like design and construction, and blends perfectly in both time and place with its surroundings. There is nothing to distinguish whom the occupant might be other than a simple haunting melody coming from within. Its sound is of such sweetness, it is as though I am bewitched. I have no choice but to follow its pull inside.

Once through the opening of the hut, I am startled by the contrast of the scene outside and the scene within, for here I find myself in a room far too large, and completely foreign to the outer environment. Unbalanced at first by what I see, I stare in disbelief at a modern hospital room; tiled floors, sterile white walls, and a hospital bed, complete with patient.

In the corner of the room is an old man. He is of short stature, barely coming above the height of my umbilicus. He is dark, his skin a mixture of rich pigments: brown, ochre, and yellow, like a living soil. His hair is short, black, and curly like peppercorn. His features are sharp, angular, and delicate. His whole countenance, and, indeed, his entire being seems to smile. His face shows off a toothy and somewhat impish grin. Oddly, he is wearing a white lab coat beaded with intricate designs. His feet are bare, and thick with callous. His legs are wrapped with a string of cocoons that rattle when he steps. His only other clothing is a minimal loin cloth of leather hide.

With my entrance, the man puts away a small single-stringed bow that he has been using as a mouth harp. With his eyes, he motions towards the center of the room. Then he stands and begins to walk towards the bed, and with a glance and a nod, directs me to the bedside. Joining him, I look down to view the most interesting patient of my career. In the bed lies a creature with the head of a zebra, the body of a man, and the legs of an eland (for the sake of both modesty and humility, the elephant parts shall largely go unmentioned, but needless to say they, too, are impressive).

In the very moment I look at this chimerical creature, a strange oddity occurs. A thundering voice in my head says, "Prepare to return to First Creation." In the next instance, I find myself unable to remember the names of the animals before me. Then, following in quick succession, I am unable to remember that I am unable to remember, as all words leave me. Then things began to get really strange...

The room disappears; space and time itself seem to retreat as I find myself bathed in a world of manifest light, pregnant with possibility, yet void of any specific elements. Looking down, the patient and I are all that remain. His appearance begins to fluctuate. Human anatomy continually morphs into animal imagery, causing his overall appearance to constantly transform. As this is happening my body, too, begins to undergo these same changes. In a singular moment, I have become a shape-shifter with all of existence passing through my form. I become the patient, the patient me, and together we become all things and nothing. In this place that is no place, in this time that is no time, First Creation dances itself.

An awesome voice booming with authority then announces: "The Great Naming has commenced, so begins the Second Creation". In this singular instance, or perhaps over eons, everything stops. From the constant flux, chaotic motion, and never-ceasing change that is First Creation, there comes forth from the void a single creative possibility amongst infinites: the idea of difference. Paradoxically, through this single action, everything that was previously formless and limitless is frozen into form, thereby limiting the possibilities of future change, and ushering Second Creation into existence.

From the infinite void springs all manner of being, each with a name, thus filling Second Creation. Amongst the creatures, there I stand: Primordial Man, and with my birthing comes the dawning of conscious thought, and with this: time, separateness, illness, and death. From the one there is now two, and from two...many. Here I stand anew, my form again recognizable. I return to myself. The power of language is once more mine. I look down; my patient has disappeared. Before me is an empty bed and the old man is at my side, his small hand holding mine. He begins to speak:

Ancestor: You have completed your training as a Doctor of Medicine; this begins your training as a Doctor of Creation, or in other words, how to be more creative in your doctoring. It seems fitting to start at the ending of the beginning, or the beginning of the ending, depending on your perspective.

Doctor: Are you even speaking English? Strange, all the words you are uttering somehow seem new and less binding. The relationships between the words seem more important than the words themselves.

Ancestor: We are both speaking the language of the Ancestors, and more correctly, we are singing our words into being; singing is sacred, speaking profane. In becoming your ancestor, as he was birthed from First Creation you were a witness to the Great Distinction. As your eyes, ears, nose, mouth, and skin are once again fresh, you are still able to perceive the webs and weaves of interconnection. It is this net that bridges us back to First Creation.

Doctor: I am still confused. I am unsure of what you mean by First Creation, but those words somehow stir something inside of me.

Ancestor: It is the same for all of us who have had the Ancestral Dream, for in First Creation there is no you or I to do the remembering, and no this or that to be remembered. All we retain in the returning to self is a pull back to wholeness; like the resonate sound that fades after a lion's roar...

Doctor: So when you say First Creation what you mean is wholeness.

Ancestor: No, that would be wrong, since the First Creation is neither captured by the words "First Creation" or "wholeness" – rather, it is a unity that transcends any description that tries to capture it. But I am glad that it decided to swallow you up and shit you out.

Doctor: Swallowed me up and shit me out?

Ancestor: Yes, from and back into Second Creation.

Doctor: I am confused.

Ancestor: Yes you are very confusing. How have you managed that so quickly after returning from First Creation?

Doctor: Are you insulting me?

Ancestor: Absolutely. Therapeutic isn't it? You have only been in the world of Second Creation again a short time, and you are already becoming rigid again. By insulting your meat, I hope to keep you tenderized.

Doctor: Now I really am confused.

Ancestor: Good, then we are able to proceed.

Doctor: Let me try to understand what has happened: First Creation was the un-formed state of existence that, with its demise or ending, formed Second Creation, or in other words, the universe as we know it?

Ancestor: You make me laugh. I get a Big Bang out of what you're saying. Nevertheless, you are wrong in your thinking. First, the universe as you know it is not how it wants to be known. Just ask It. Secondly, even though we are taking about firsts and seconds, you need to loosen your addiction to straight lines, linear causality and rational logic, and embrace a world view that lets circles truly be circles, until you're absolutely dizzy with your head spinning. Then, and only then, can seconds come before firsts, and vice versa.

Doctor: If the First Creation is about a transcended original wholeness, then what is the Second Creation about?

Ancestor: Wholeness obviously!

Doctor: What?!

Ancestor: The First Creation is a singularity that, in its wholeness, embraced its formless multiplicity which it expressed through never-ending change, flux, and motion. Then, as an act of creativity amongst the infinite acts of creative possibility, it birthed the idea of difference, and that is when Second Creation came into being. What the First Difference was is not known, but we know that from this first distinction came the birthing of all other dualities.

Doctor: Wait, so if First Creation was the time of wholeness, then Second Creation was the start of our separateness?

Ancestor: Remarkable! How did you manage to get through medical school anyway? I want you to pretend that what I am going to say is going to be on an examination, so listen closely. First Creation is the time of primordial wholeness. Second Creation is the impetus of our experience of separateness and individuation, but it too is utterly whole. First Creation, as the sire of Second Creation, remains alongside Second Creation. Both contain the multiplicity found within the whole. The difference between the two is exactly that: difference itself. The multiplicity of the First Creation remains undifferentiated, and therefore you call it the void, while the multiplicity of Second Creation remains differentiated (or what you in the West would call dualistic), and hence you refer to it as existence. From the difference between Second and First Creation, what one could only call a difference of difference, we begin to have in-sight into the mysteries of form and formlessness.

Doctor: What, then, does all of this have to do with me being a doctor?

Ancestor: Everything, of course. You are so lucky the board exam isn't today. How do you ever expect to be a Generalist in Complexity Medicine? Are you sure you don't want to be a surgeon with a specialty in geriatric endoscopic proctology in the chronically constipated?

Doctor: Yes, I am certain of that, but what is this Complexity Medicine you refer to? The medicine I practice, by your standards, must seem very complex.

Ancestor: Don't jump ahead, or behind. I am trying to utilize the abstractions formed by your linear mind to teach you a lesson. Indeed, your medicine is complicated, but it is an error on your part to confuse that with complexity. And yes, you do have a predilection towards complicating things, as complexity can be a very simple thing if you would just allow it to be. Now back to your question of how this is relevant to your doctoring. Let's began, shall we?

Doctor: Please do.

Ancestor: It strikes me that you are experiencing some dis-ease with this whole experience.

Doctor: Yes, I am feeling somewhat stretched in all of this.

Ancestor: Tell me, what is it that you treat as a physician?

Doctor: The patient, of course.

Ancestor: What are these "patients" you speak of?

Doctor: Well, they are individuals that come to us with sickness or disease of some sort or another, and we offer them treatment for their affliction.

Ancestor: How, then, do you perform your treatments?

Doctor: There are a variety of options depending on their aliment. I might prescribe a medication, suggest a therapy, surgery or intervention, or provide counseling or advice.

Ancestor: Where, then, do you undertake your work of healing?

Doctor: Well, similar to where we first met in this dream, I will look after my patients in the office or in the hospital. There, I have all the tools of my trade to do the work I need to do.

Ancestor: Enough! I believe I am becoming ill with all you are saying!

Doctor: I am afraid I don't understand.

Ancestor: That is exactly my point, and also the source of the distress you have caused me. You neither know, nor do you deeply not know. You have mistaken a head full of facts for knowledge, and to add insult to injury: knowledge for wisdom. I ask you: where is health? Where is disease? Are you most effective in your knowing or not knowing? You are certainly useless to me in your present state of ignorance! Let us look, then, at the impoverishment of your situation!

Doctor: Impoverishment? I am a representative of the most technologically advanced healthcare system that has ever been seen in the history of man.

Ancestor: And I come from a healing tradition that is over 50 000 years old. It is grounded in the blood and bones of my ancestors. What do you know of your tradition's pedigree?

Doctor: Sadly, a history of medicine was not much part of my training.

Ancestor: Your situation is direr than you realize. In forgetting the myths and stories of your ancestors, you have allowed the Trickster to whisper his dreams in your people's ears. Now, back to making you a rich man. Let's look at the condition of your present poverty. Please, give me a tutorial with you educating me about these "diseases" that you claim to treat.

Doctor: I am glad you asked. There are many different kinds of disease with many names such as diabetes, myocardial infarction, or pneumonia. All the diseases would be too numerous to mention in their entirety, but needless to say, they can affect any part of the body. We have specialists that deal with each part of the body, and the diseases associated with them. When I decide on what disease a person has, I refer to this as "making the diagnosis." This diagnosis then directs me towards the proper treatment of the disorder.

Ancestor: I am fascinated by what you are saying. How do you come to this diagnosis?

Doctor: Well, after taking a history of the patient's illness, and doing a thorough physical examination or mental status exam, I decide to order some appropriate testing such as lab-work or imaging. I then amass the information garnered through the history, exam and investigations, and start looking for specific signs, symptoms, and metrics. The signs and symptoms will often show themselves in recognizable patterns that we have compiled as a profession over time, and that I have also come to recognize personally through my experience with the patients I have encountered over my career. From these numerous patterns, I construct a short list of possible diseases that fit the pattern I am seeing. This is called the differential diagnoses, and from this short list, I pick the one diagnosis that is the best fit. Occasionally, however, I am wrong in my choice, as things are not always clear in their presentation, and individuals are rarely textbook cases. If I am wrong in my diagnosis, and the patient is not responding to treatment, I go back through the process of history, exam and new investigations, reconsider my differential diagnoses, and decide once more on a new operational diagnosis.

Ancestor: I have hope again in what you are saying. I had diagnosed you as an incurable idiot, but I see now that I will have to revise my diagnosis of you in light of this new information. Your process is a good one, as its inherent circularity honors the wisdom of your lineage. However, I must say that I find fault with the premise on which it is built.

Doctor: I am afraid once again that I don't understand.

Ancestor: Of course you don't, because your ancestors fell asleep, and while they slept the Trickster corrupted the language of their dreaming mind through a whisper in their ear. It was in that moment that their dreams became profane and not sacred, and the world lost all its enchantment.

Doctor: Please explain.

Ancestor: The Trickster seduced your people with promises of power. It was such a simple act by that wily Trickster. I have to give him credit. Through a quick slight-of-hand, he convinced your people of the supremacy of nouns over verbs.

Doctor: Now you are talking nonsense.

Ancestor: To the contrary, I am encouraging all-senses, rather than non-senses. Let me explain. Nouns are things that are actually non-things, while verbs are non-things that are actually things, in as much as the former is less real while the latter is much more real.

Doctor: Can you elaborate on what you are saying?

(The Bushman proceeds to dance momentarily on the spot, then recommences his talk).

Ancestor: I choose not to elaborate because that is the tyranny of nouns and the Trickster's way, but I will try to better explain my position. Let's take the noun "you." Who, then, are you? When we deconstruct you, we see, ultimately, that we fall to the default of answering the question with a string of other nouns; you are a son, a father, a brother, a doctor, a saint, a sinner, and so on. But where is the object "you" in all of that? Language, as I told you, is a tricky thing. How, then, can we better answer the question? In reality, rather than viewing ourselves as discrete objects, we are better seen as a composite of our relationships, and this is better captured by verbs. You know and are known by your son-ing, brother-ing, father-ing, doctor-ing, saint-ing, and sin-ing. The actions, captured by verbs, reflect better our relational engagement in the world. As you can see, there is no independent noun that at any level forms the foundation of who you are. You exist as a web of your relationships. The same applies to any "thing". As a verb's-eye view shows us, we are the sum of our interdependent relationships, reaching forth to and from the world. The "you" that is you should at best be viewed as a focal density, observed through the continuum of time and place, where these numerous relationships happen to intersect.

Doctor: But the world is so much more solid than that. I experience objects about me.

Ancestor: You name, therefore they are...but this is a slave mentality. All kings need their coronations: ever democracy, a despot with an election to fix!

Doctor: I am no slave!

Ancestor: But your language, once again, betrays you. Nouns are hierarchical , and every hierarchy you help to create must have a sanctified head...head of state, head of church, head over heart (the exception being head over heels); and you are its serf. If we skillfully track and follow the noun trail, we see, for example, that "horses" are "mammals," "mammals" are "vertebrates," "vertebrates" are "animals," "animals" are "organisms," "organisms" are "things," and at the pinnacle of the mountain we have climbed, we see that "things" are "objects" that we cannot or choose not to name! The trail ends, and rather than catching our quarry, we instead bow down and worship it. Now if we start with a verb, and track it, we would end up starving, as all that we would ever see of what we choose to capture are flashes and remnants. A verb is mythical "thing" for our people because we have never caught one; despite that it is circles us all the time. For example, if I start with "hunting," I'm led to "pursuing" which then takes me to "following." If I "follow," I'm "moving," and then I'm "going," and lo and behold, I find I am "moving" again, or "travelling," or some such action. I have succeeded in going in a circle, yet my prey remains elusive. Verbs are heterarchies. With verbs there are no kingdoms or serfdoms, only neighborhoods, and with verbs I am free to become in the living democracy of our relationships.

Doctor: This is truly a fascinating discussion, but I am a man of medicine and science, and I am not sure how this all applies to my craft.

Ancestor: Let me answer your question first with some questions: What is disease? What is health?

Doctor: Well, umm... disease, I guess, can be defined as a loss of health resulting from disordered structure or function from within the body, while health is a state of wellness and vitality in which an individual is free from disease.

Ancestor: I see... don't worry, addictions are hard to overcome, especially a noun addiction. From what you are saying, you are presenting health and disease as opposite and equal dualisms, in as much as they are both things. However, I pose to you that this is an illusion.

Doctor: Like you?

Ancestor: I remind you that this is your dream. Now in continuing, let me suggest to you that disease as a thing is actually a non-thing, while health, which is a non-thing, is actually a thing.

Doctor: Do you have a fever? This is sounding like the delirious babble that I hear from some of my in-hospital patients.

Ancestor: Should I take two aspirin and call you in the morning then?

Doctor: No, let's get through this. I have to work in the morning.

Ancestor: Starting with disease, I ask you: where is it to be found? You gave names like diabetes, depression, and myocardial infarction to a disease, but ultimately these diagnoses are just a specific group of nouns, and, as I argued earlier, have no ultimate separate existence or thingness. Nevertheless, disease as a grouping is interesting. As I have stated, most nouns are defined by the sum or totality of their relationships. However, in contrast, those specific nouns, representing the various disease processes, are defined by their breakdown in, or loss of, relational complexity. Hence, diseases are things (in that they are labeled events which we experience as a lived, embodied experience) which are non-things (in that they are focal but non-localizable and are, in actuality, representations of a breakdown in somatic relationship, and subsequent loss of complexity that normally supports bodily form and function).

Doctor: How is health, then, a non-thing that is actually a thing?

Ancestor: Let me ask you a question first. Where is health to be found?

Doctor: I assume inside each of us as people?

Ancestor: Point to me where.

Doctor: All over the body I guess. It's a general state of well-being.

Ancestor: That's very interesting because when you talk about disease you localize it. You will say glaucoma is in your eye, pneumonia is in your lungs, and depression is in your brain. Yet as I have argued, despite your urge to localize these things, diseases are not things to be found in space, but in truth are focal breakdowns of relationships culminating in alterations of the body's form and function which are themselves relational structures and processes reflective of the greater organization. They, in other words, are non-things masquerading as things. Health, however, is of an entirely different order. We all agree that health exists, yet none of us can localize it. Is health in the patient? Is it housed in the physician? Does it exist between the patient and physician? Is it in the family? Is it in the community or the culture? Is it found in nature or in the environment? Is it in all or none of these things? This is a vitally important question, for if we are at all to be effective healers, in some manner, we must understand how and where to engage health.

Doctor: I think I am starting to understand what you are talking about. Occasionally, when I am with a patient, there are moments where a special feeling of connection into something greater than either of us occurs. I may find myself saying or doing things that are different from my normal approach. I am nervous, but trusting at the same time. It is as though the patient and I share a certain knowing or understanding that something special has taken place. Often these encounters result in the times of my best work; what I would call healing, yet it is a humbling thing since I, too, am transformed in that same instance. It is as though I am both actor and audience in a great improvised play.

Ancestor: Yes, what you are talking about I have also experienced. Something else you should know that is relevant to your experience of these things is that my people, as well as being great healers, have always been great hunters. Before you can heal, you must be able to hunt.

Doctor: Once again, I am confused. Who exactly is the predator, and who is the prey in our relationship?

Ancestor: Don't forget that even the fiercest of hunters eventually succumbs to the returning flowers that come with the rains, feasting on his corporal remains after the vultures are done with him. Let's continue on this walk-about of ours, and see what we can see. To be a hunter, you must learn to listen deeply. When I say listen, I mean see, hear, smell, taste, and touch in a full, interconnected way. With this openness to the sensual world, one can feel the pull of the animal. The animals, through our senses, pull us to them. If they do not call, or we don't listen, our prey remains elusive. To be a healer, we must learn to hunt Health. We listen with all of our senses, and wait patiently for health to show itself, and when it does, we act.

Doctor: I am listening.

Ancestor: Good, because what I am about to tell you, you have to hear with every part of your being if there is to be any hope for you. Health is the state of complexity and variability represented by the connective sum of all relations, both potential and actual, within the whole. Although it exists at multiple spatial and temporal levels of abstraction, it is not localized to any specific one. Therefore, health is a non-thing (in that it can't be focalized or localized) that is actually, from the perspective of wholeness, a thing (in that it exists as an unbroken totality that can be experienced at multiple levels of abstraction, but not comprehended).

Doctor: All you are saying seems to contain a certain type of slippery logic that I must admit leaves me spinning. I feel as though I am in some unknown territory without a map.

Ancestor: Very good, very good...your vertigo is prognostically favorable for your present condition, and proof of the efficacy of this work.

Doctor: Where do we go from here?

Ancestor: Around and round of course, but for your sake let's get back on track again, and revisit your manner of doctoring. As I understand from what you have told me, you treat these patients. How successful are you with that?

Doctor: I am unsure how to answer that. At times, I have my successes, and at other times, my failures. Admittedly, some diseases are more amenable to treatment than others. Sometimes, the best I have to offer is management of symptoms, and not a cure.

Ancestor: Your answer betrays you, and reveals that you are yet bereft of true knowledge. Not only have you misunderstood my question, you seem to have forgotten all that we have already discussed. As I mentioned, noun addictions are not easily cured. Do not give up hope though. These so called "diseases" in their apparent thingness, are cured, fixed, and repaired. These acts, although potentially useful in the proper context, have very little to do with the language of healing. Now back to my original question, what success have you had with treating your patients?

Doctor: I am afraid I don't see what you are trying to get at.

Ancestor: My point exactly. You are myopic. I will need to refer you to one of our traditional ophthalmologists to open up your sight. Let me ask you again; where is health? The answer to this you already know, so why do you insist on always looking at the individual or your patient as the focus of your search? I would be a piss-poor hunter if I never looked outside of my hut for my quarry. I could just hear my wife's ceaseless ribbings and complaints if that was to be the case, as she so loves meat. I will say it once more; health is the state of complexity and variability represented by the connective sum of all relations, both potential and actual, within the whole. Do you see what I am getting at?

Doctor: Yes, I think I do understand. In that case, then, I have been looking for health in all of the wrong places.

Ancestor: Yes, but more correctly, you haven't been looking for health at all. You have only been looking for illness, and in only one place at that: within the individual.

Doctor: You are right. I do need a set of new glasses; ones that let me see health in my patients, not disease.

Ancestor: You are getting closer, but more importantly, your vision must be of such wide-angled acuity that it sees health in all places at all times. Make central what has been until now peripheral in your view. That means you must now see your patients differently. Individuals, families, communities, the living ecology, and the Earth Mother herself: they are all your patients now. I believe you will need a bigger office.

Doctor: This is overwhelming. I am feeling faint. How do I tackle the enormity of this task?

Ancestor: Certainly not by fixing, curing or helping, but rather through the action of serving. Through this pathway healing can be fostered, and you, too, will be a beneficiary of this grace.

Doctor: You have commented on the fallacy of my conception of disease. What, then, should become the focus of my healing efforts?

Ancestor: The ropes.

Doctor: Are you being metaphorical?

Ancestor: No, they are something my people truly experience in our healing, but in a verb-way, not as nouns. In regards to the ropes, to say we rope and are roped in the roping would be more accurate. This is our way.

Doctor: Are you going to show me the ropes?

Ancestor: No, but I will cut you some slack.

Doctor: Please continue. I am happy enough to trip myself up in all of this.

Ancestor: Hang on. Soon I will have you snared in this net I am weaving. Wholeness, as it holds the sum of all possible and potential relationships, can be neither poor nor rich in its connectivity, as it transcends all specific form and function. Nevertheless, our experience as creatures of Second Creation allows us, through our acts of will and volition, to feed or starve the relational possibilities available to us (that is to say the ropes) within the whole. Just as the body's metabolism has both anabolic and catabolic functions, we, too, as agents within Second Creation, can build-up or break down relational complexity and variability at various levels of spatio-temporal existence. For you to succeed in healing, three prerequisites need to be met: First, you must acquire the aptitude to be able to access the systemic wisdom or knowledge available to you within the whole. Secondly, you must possess the ability to transform this knowledge, through and not of you, into an ethical action that supports and nurtures relational complexity and evolving ecologies within the whole. Thirdly, you need to realize that the first two prerequisites are in no way separate from each other as they are ruled by the logic of circles. In other words, see the ropes of relationship, hear the ropes of relationship, smell the ropes of relationship, taste the ropes of relationship, feel the ropes of relationship, emote the ropes of relationship, and when the pull is there, take hold and weave the ropes of relationship. This is what my people have done for 50 000 years.

Doctor: You have me all tied up in knots again. Can you please go through all of that once more?

Ancestor: No, I can explain no more. I hope to cure your addiction, not enable it.

Doctor: I thought curing was part of my wrong thinking.

Ancestor: You are right, indeed, my good Doctor. I think your thinking must be infectious. It is a good reminder to both of us to dance now. The dance is my people's sacred gift to all the peoples of the world. Through the dance we are reminded that all things change, everything is in motion, and nothing is static. As the dance dances us, it shakes up our bodies and ideas so the old is new again. It is through the dance that we reconnect with our ancestors, for in the eternal present of that moment, our past and future intersect. It is at that time that the veil between First and Second Creation is most thin. Then, through the sight bestowed by our enlivened spirit, we are shown the ropes; the pathway of all our healing, and our connection to all being.

With the ending of his words, songs carried by voices on the wind drift into my consciousness, beckoning us both to follow. He reaches out, and holding his small weathered hand in mine, he leads me through the door from the hospital room. Once again outside, the stars are bright, suspended in the inky darkness. The moon is full and high in the sky. The small grass hut is behind me, a fire blazing in front. Around the fire a village has gathered: old and young alike. The women, centered in a group, are clapping polyphonic rhythms and chanting a haunting ancient melody. The men, hunched in their postures, stomp out their ecstatic beats and dance into being their timeless mythologies. Amongst these kindred spirits, I feel peace in my heart. The old man turns to me and says, "Welcome to your new office, doctor; these are your assistants. Look out from here, for that is where your patients await. This is your initiation into Complexity Medicine". With that, there is the roaring of a lion out of the darkness beyond the light of the flames. As the old man starts to dance, the young man again falls into the formless void of sleep...

Back to the Table of Contents
Act II - Scene II: Day Rounds on Sensuality

Let me start this morning's rounds by saying that I believe sensual experience to be a very different thing from sensory experience, although the latter is often given as a definition for the former. Now admittedly, on the surface, these two words appear similar, but I would argue that they contain important differences; one leads to division and reduction, while the other is connective, generative, and is in itself a path into wholeness.

Now when we talk about sensory experience, at least from a scientific perspective, we are referring to psychophysics: The quantitative study of relationship between a physical stimulus and a corresponding sensation mediated by the sense organs. It is a data-driven experimental model that looks at measuring detection and distinction through the determinacy of perceptual thresholds. It sheds light on how a signal is differentiated from ambient noise. In this way, the sensory experience becomes a scientific derivative, or what I call the "scientification" of the sensual experience.

I would argue that our experience of sensation is of a different sort than the data-driven quantitative model of psychophysics. As embodied creatures, we are interested not just in difference, but in "differences that make a difference". To be certain, our experience of the world is mediated by physical stimuli (or the absence thereof), but our experiencing of the world is always relational in nature, with relationships being qualitative interests. While we perceive stimuli, we engage in relationships. Through our perceptive faculty we differentiate signal from noise. However, through our relational interactivity, we note patterns of patterns or the deeper patterns that connect. This acknowledgment of pattern is an aesthetic act, and what I would term sensual. In this way, through our engaged and embodied sensuality, we define ourselves as a member of the community of the whole. By necessity, such a membership binds and interweaves us into the complex web of life, and just as a vibration on a spider's thread is felt throughout the whole web, sensual acts have reverberations felt throughout the whole.

Interestingly, the idea of sensuality has a bad reputation in our culture. At once, we see it as taboo, using descriptions like "appetites," "carnal," "fleshy," and "titillating" to define it. We further confine it with our moral judgment, applying it with derogations such as "lewd" and "unchaste." Finally, we eroticize sensuality, limiting its conception to the physical act of sex and thereby profaning it. Generalized pornography has been an inevitable result. Now, as a taboo, we see sensuality as dangerous, through our dichotomization of good and evil, we view it as immoral, and through its sexualization, we reduce it to profanity. In any event, whether through scientification, taboo, morality, or sexualization, we distance and insulate ourselves from the experience of the sensual. By extension, then, we cut our connections or threads to the relational web of wholeness. This inevitably becomes a self-alienating act.

Perhaps we could take a moment to reflect on what the consequences of shunning sensuality as a culture has had on the individual, the family, our society, and the natural world. If we look around and take honest stock of the world we live in, we begin to recognize the consequences of this unexamined position. In contrast, we could try imagining another culture where sensuality is embraced. Where art is not viewed as separate from life. Where wholeness is experienced, not alienation and where the nurturing of relational integrity is the norm. In such a society, we may not even need the word "sensuality" to describe the experience, for it would be so completely integrated into the fabric of individual and communal life as to become blind to the conscious mind.

Why then, as individuals and as a culture, do we have such a resistance to, and fear of the sensual? The answer lies, once again, in an investigation into our underlying epistemology. To help us with that, let's turn to the thoughts of the great cybernetic thinker Gregory Bateson once more. Just as there is a physical ecology, Gregory Bateson proposed that there is also and "ecology-of- ideas." Like evolution, where the creatures of a particular ecosystem co-evolve, we see within our collective ideas an analogous process. In both cases, there is a need for continual adaption as the context of organisms-in-environment, and by extension, ideas-in-environment change. To see this analogy through to its conclusion, we must acknowledge that fitness is an evolutionary imperative, and like species responding to changing environmental pressures, ideas, too, must adapt and evolve in response to social pressures, or become extinct in relation to the greater mental ecology.

Nonetheless, ideas come in a variety of forms and levels of abstraction. For example, just as for the living world, where we have erected the taxonomical hierarchy of species - genus, family, order, class, phylum, kingdom, and domain - perhaps we could construct a similar structured abstraction for a taxonomy-of-ideas. For example, one equivalent hierarchy for modern scientific ideas could be that of data, hypothesis, theory, meta-theory, scientific method, and reductionist epistemology. In continuing our evolution/ecology metaphor, we should note by similarity, that the higher the order of taxonomical abstraction, the more resistant it is to extinction within the ecology, by reason of the fact that it has more subordinate classes in its membership, giving it greater redundancy and resiliency. Just as species come and go in a given ecology over time so too, do ideas. Higher hierarchical orders of ideas are similarly much more resilient and resistant to change. Through the course of the planet's natural history, individual extinction of solitary species is a rather common thing, but mass extinction, thankfully, is a rare although not unheard of event. A radical change of an embedded epistemology, I would think, is of the same order as the latter.

What then does an ecology-of-ideas have to do with my thoughts on sensuality? As we saw, it is a curious thing that we have largely cordoned off sensuality through taboo, morality, and sexuality, as well as scientification. What is the basis of our fear of the sensual? To answer this, let us again consider the concept of our underlying epistemology.

When we reflect on a given epistemology, we can examine the diverse outcomes of this meta-mental process, and observe, in a very real sense, the signs and symptoms or markers of its vast and deep underlying organization in thought. Its underlying premise is reflected in the ideas it births into collective consciousness through language, and into the collective unconsciousness through our behaviors and habits. For example, in our culture, we see such things as the mind-body split, the ideology of reductionism, the division of self and other, the supremacy of rational ways of knowing, and linear logic systems as evidence of the epistemological structure. Furthermore, we see the active (and sometimes brutal) suppression of other ways of knowing, accompanied by the oppression of others that hold those views. Although we can see the outcomes of our actions, and at times can be self-reflective of those consequences, we never have direct access to our epistemology as such. Epistemologies are deep sorts of immaterialities. They are beyond the purview of language and direct analysis. By systemic design, they are unconscious to us, both as individuals and as a culture, and it is from this deep cover that they exert their influence over our perceptions, thoughts, and actions. They are a meta-mental process, and as much a part of the collective mind as the individual one.

Returning to our metaphor of an ecology-of-ideas, we can begin to start thinking about ecological niches supportive of such ideas. Now, our present collective environment is supporting largely one type of dominant epistemology, but that does not preclude other epistemologies from living at the fringes of our collective mind. Nevertheless, there are only enough mental resources for one epistemology to hold dominance in our individual and collective thought. However, just as there is an ecology-of-ideas in the mental environment, we can postulate that there must also be a process akin to an evolution-of-ideas. Based on its evolutionary fitness over time, an idea may continue on, or become extinct within the informational cybernetic circuitry of the systemic mind. When we see two epistemologies vying for the same niche within the greater organization of mind, we will see conflict or adaptive pressure; a process which could be seen as analogous to the evolutionary process. For the sake of discussion, let's dichotomize these competing epistemologies, returning once again to consider an epistemology-of-separateness and an epistemology-of-wholeness.

This brings us back to the question regarding our fear of the sensual. As I have suggested, it is through our sensuality that we perceive our relational wholeness and integrity in the world. However, despite this promise, we continue to defensively rear up against the sensual at the cost of a deep separation from our embodied experience. Furthermore, in our insulation from the sensual, we find themes of separateness, otherness, dominance, control, and banishment from the natural world as integral to our cultural myth. We just have to look at the loss of ecological habitat, the rate of extinction, the loss of domestic agricultural breeds and cultivars, the suppression of indigenous culture and the oppression of their people to know this is so. The sum of such actions and insults allows us to make inferences about the flawed nature our guiding epistemology. As a result of our exodus from the embodied world, the quality of our planetary stewardship has fallen into question, and our very survival in the world is now at stake.

We can begin to understand now why sensuality is such a powerful expression that evokes such a strong reactionary stance in our society. As a relation-generating experience, it is a promoter of a more holistic engagement in the world, and it remains transformative through its ability to integrate us into the total weave. It is an instrument of wholeness, and presents a threat to the dominant reductionist epistemology. From the perspective of separateness, sensuality needs to be guarded against, for an epistemology-of-separateness can only exist in a disenchanted world.

How then does all of this relate to medicine? These after all are medical rounds. When we look at emerging progressive scientific and medical literature over the last two decades, we see increasing reference to such things as systems theory, chaos theory, complexity science, complex adaptive systems, non-linearity, and the like, and their role in our developing understanding of physiology and disease. With these theoretical inquiries, we are given the promise of a new "holistic science" that will better serve us as we go forward. Now admittedly, I believe these advances in scientific understanding are important steps towards embracing an epistemology-of-wholeness. They are holistic enclaves of thought, born of a paradigm of holism, that are now starting to show themselves throughout mainstream life. There are, however, a couple of issues that need to be acknowledged. First, we are only in the infancy of this exploration, and that makes these new concepts vulnerable to trivialization and relegation to the fringe. We continue to be unsure at this time how such ideas could translate into a medical practice or expression. At this juncture in history, these diverse studies remain an incomplete science. Secondly, these same ideas, although reflective of wholeness and holistic thought, risk being co-opted by the dominant epistemology. Why is this? The dominant epistemology, in separating mind from body, has succeeded in disembodying us from our thought. We have become "stuck in our heads", uncoupled from the guiding and instinctual influences of our "hearts" and "guts". Without grounding our ideas in the sensual body, we alienate ourselves from the visceral relationships available to us in the living world, and thus inadvertently succeed in propagating the status quo.

To theorize and abstract ideas and models about wholeness or systems thinking is not enough. To truly begin to change our epistemology from one of separateness to wholeness, we have to consider how to embody these emergent ideas into the lived experience of our collective lives. If this is to happen, these concepts need to migrate from individual and collective conscious thought into unconscious experience. Once again, in this vein, we come back to the necessity for sensuality in our lives as one possible gateway into wholeness. How then can we approach the topic of sensuality so as to avoid the defenses of the separateness epistemology, with its enforced prohibitions, taboos, and judgments around the sensual?

Let's start to explore this question with a set of imagery from the natural world, in this case that of jelly-fish and slugs. Consider the jelly-fish from the ocean deep. In them we see the graceful undulating and pulsating of their fluid bodies, at home in their liquid ambience within their watery milieu. We can view the trailing and intertwining of their tentacles amongst the ebb and flow of the ceaseless oceanic currents. They are the very image of embodied water, at ease in our ancestral home-world. To see these creatures in their magnificent form and color within the muted light of the ocean blue is to encounter a manifest sensuality.

Next, I want us to turn our attention to the exotic and erotic world of slug sex. I should warn you in advance; this next portion of our discussion is going to get a little steamy. Now to begin with, you should know that slugs are hermaphrodites. When it comes time to mate, slugs search each other out amongst the rich, decaying vegetative matter, humus, and moist soil. Inching their way towards each other with their oozing, slim covered bodies, they begin to feel for their would-be mate; cephalic stalks sensing the presence and position of the other. When the time comes to conjoin, our molluskian couple intertwines in a writhing, copulatory mass, secreting a large store of mucous-like exudates. Many species of slug will then suspend themselves in a cord-like fashion from this gooey string, thereby allowing them to freely dangle, sway, and move in three-dimensional space. Then, in a bizarre display of nature's choreography, they will project their penises from the side of their heads. In many cases, these Herculean phalli can extend as long as or longer than the slug's own body. Their bodies thus aligned in a spiral, they will initiate a search with their penises, continuing to explore their mate until that juncture whereupon their male reproductive organs finally wrap and merge. Their translucent phalli engage each other, further intertwining in a double helix in a form reminiscent of Hermes' staff. And when the union is complete, the coupled organs rhythmically undulate into a flowering, bell-like structure. It is at this point that sperm is reciprocally released and shared between the pair. In the moments after this reproductive climax and exchange, if all goes well, the penises are gently and slowly untwined and retracted back into the body. The sperm is subsequently released to the female sex organs within each creature's body to complete the process of fertilization. With the completion of the act, and their instinctual drives satisfied, they release each other from their slimy viscous tendrils and fall to the ground, each to go on their merry way holding the residual glow of ecstatic reverie within.

Beyond the cheap thrill of eroticism in the natural world, I bring these images to your mind in a playful way because they allow us to skirt the defenses of a separateness epistemology. How is this so? First, these images transcend, by their aesthetic nature, any mere scientification that could occur by appealing only to the sensory or physiological aspects. It thus guards against reductionism and disenchantment. Secondly, by taking the sensual so far outside of the human experience (by a number of phyla I might add) we diminish our ability to label these naturalistic and sensual encounters in taboo or moralistic terms without risking blatant anthropomorphizing. This exercise allows us to recognize the deep patterns or "patterns of patterns" that connect us to our evolutionary brethren through the conservation of ancient living pathways of being.

Continuing, I would like to share with you two related stories of a sensual nature in my own life involving a Japanese karate master and a Western orthopedic surgeon. In my former career, I was a full-time karate instructor. My teacher was a Japanese karate master by the name of Takemasa Okuyama. In the practice of karate, in addition to the more commonly known punches, strikes, kicks, and blocks, we have throws, joint locks, and chokes. As his assistant instructor, it was my job to be on the receiving end of all of those techniques (a somatic education to say the least). The question, as an instructor, then, is how to teach these techniques. The obvious and more commonplace practice would be to give technical instruction by breaking a technique down into its component parts; grab here, hold here, twist like this, and move your body this or that direction, etcetera. This certainly has an important role in instruction, and I am not diminishing its pedagogical use. But proficiency comes only slowly through acts of repetition. Is there, then, another way to teach? In addition to technical and repetitive training, Okuyama Sensei was very partial to teaching in two other modes of related instruction: sensually and metaphorically. This was not a surprise as he was also a painter and a master of the Japanese brush stroke.

One specific incident still stands clear in my mind. He was demonstrating some various chokes, and was frustrated with the class's clumsy attempts. He asked us to visualize how a boa constrictor interacts with a branch in order to see the relationship between the snake and the branch, and conversely between the branch and the snake. What was the nature of the movement? What was the quality of the contact? What was the rhythm of the encounter? What feelings were evoked by this imagery? He then, proceeded to perform the choke on me twice, once with technical execution, and once with a sensual/ metaphorical application. Interestingly, although both were flawless in their precision, my experience of them was very different. The technical execution had a feeling of violence or attack associated with it, and consequently aroused in me an innate need to defend myself. I received it with a degree of struggle, eventually succumbing to the hold. The sensual approach, on the other hand, was inviting, gentle, and open. There was a feeling of harmony and union between my sensual body and his technique, delivered through his sensual body. In all ways, I could feel the essence-of-boa-constrictor in his arm as it slithered over my shoulder, across my chest and towards and around my throat and neck, and like the prey within the coils of a boa's grasp, it was too late to act by the time I realized anything had happened. I was completely and utterly locked up without any defense. There was no slack in the system available to exploit an opening. It had both technical and artistic perfection, and was a technique worthy of the moniker, martial artist.

Let's take the next moment to transition from the world of Japanese martial arts to Western orthopedics. While in medical school, we were receiving orthopedic instruction on fracture reduction from a crusty old curmudgeon of an orthopedic surgeon. I was intrigued with the proper mechanics for a wrist reduction for a Collies-type fracture. His eyes lit up with the request, and he took my right forearm and wrist in his hands. Now what was interesting about his tutorial was that he bestowed two types of teachings at one time. As he walked me through the procedure, he talked about positions of mechanical advantage, vectors of force, traction, three-point molding of the cast, and so on. However, at the same time he was talking, I had a flash back to the "boa constrictor" of my karate class. He gently embraced my hand and forearm. His touch generated trust in its knowing. I relaxed. His position was effortlessly and smoothly gained, and then, in a single moment, my arm was locked into position with no escape from his well-experienced grasp. I had no doubt that had my wrist been broken it would have been effortlessly reduced in that moment with no fight or guarding from me. Again, only surrender to the inevitable was possible. It was an experience that was both a perfect blending of the technical and the sensual. I should add however, that as time has gone on, I have forgotten his words to me, yet I have never forgotten the way he manipulated my arm, as this was a purely kinesthetic transmission from flesh to flesh. Is it any surprise that two diverse experiences such as karate and orthopedic surgery could share such a common experience? Perhaps not. They are each somatic pursuits that hold in their tradition both knowledge and perfect discipline of engagement with the body. Karate shows us how bones are broken and joints dislocated, while orthopedics deals with the restoration of the very same. They mirror each other in their mechanics and aesthetics. What is called for is different in each case, but what is called forth is the same. For certain, it was commonplace in many traditional cultures that the teachers of the fighting arts and the bone-setters were one and the same.

Continuing, I would like us to reflect on how sensuality and healing have been parts of all of our lived experience. Recall for a moment, when you as a child fell and scraped and bruised your knee. Likely your mother or father or some other caretaker was there to hold you, comfort you, and touch you where it was sore. After I became a parent myself, whenever my young children were hurt, I would pick them up, hold them close, rock them, talk or hum soothingly and gently hold or rub the offended part. Inevitably, the child would calm, relax, and surrender to the comfort of this sensual embrace. Perhaps you have shared a similar experience with a child in your life. In looking at this experience, what do we see? We have touch, we have rhythm, we have motion, we have sound, and we have breath. Sound familiar? They should because these are reflections of our experience in the womb; the recapitulation of our in-utero sensuality. When framed this way, the wisdom, comfort, and healing found in the sensual touch seems self-evident. Yet as we move through childhood, towards adolescence and adulthood, this connection is gradually suppressed. Sadly, what we are inevitably left with in our society is largely only the sexual frame through by which to understand our sensuality.

I invite you now at this moment to go on a journey of remembrances back to the ancestral homeland of all of us, Africa, and more specifically, to the Kalahari Desert, home of the Bushmen. As modern medical practitioners, a look at the Bushmen's healing tradition should be a humbling encounter, for in them we see the world's oldest healing tradition, going back tens of thousands of years. Why then is this important to our discussion? In the Bushmen, we see a culture in which an embodied sensuality is central to all aspects of their life, whether it be healing, hunting, gathering, crafts, dance, music, or any one of a myriad of other common place social encounters. This sensual and deeply embedded existence in the natural world is reflected in the fact that their epistemology evidences wholeness. Consequently, we see circularity and an honoring of relationship in the various expressions found throughout the totality of their lives. In our ancestral home, we find an exemplar of wholeness, living and dancing itself. As healers interested in exploring the nature of healing, let us then look at the healing-dance and ceremony of the Bushmen.

In the ancient rock art of Southern Africa from time immemorial, we see evidence of the Bushmen's healing-dance going far back into the annals of pre-history, capturing the cultural memory of an experience that is still enacted to this very day. Sadly, the Bushmen have not remained hidden from the gaze of modernity, and with onslaught of pressures from the modern world, this ancient road is in real danger of disappearing. Nevertheless, some elders of the ancestral tradition remain, giving us time yet to take stock of their wisdom.

I would like to share with you my experience of the Bushmen's healing-dance. Imagine, if you will, a clear, crisp, star-filled night in the Kalahari Desert. The people's village lies amongst the thorny bush, in landscape dotted with Baobab trees. Early in the evening, young boys start a fire in the center of the village with the firewood that the villagers collected during the daytime. As the evening progresses, young women make their way to the fire to enjoy some singing together. The young men soon follow to show off their dance skills with flirtatious vigor. The start of the night is full of playfulness. As dusk turns to dark, the elders, both men and women, make their way to the circle to engage in the spirit of open communal play. Naturally however, throughout the course of the night, the rhythm and tension of the dance builds, and at some unspoken point the level of absorption and excitement takes on a new intensity. The community's healers begin to feel a vibration and heat in their bellies that slowly spreads throughout their bodies with each new step. Soon, they begin to shake and pulse with spontaneous improvised expression. Their eyes take on a distant look. An unbroken synchronous, polyphonic, and rhythmic interplay between singers and drummers pushes all deeper into an ecstatic and spirited state. In this place, the Bushmen doctors are pulled to each other. With shaking hands, dancing feet, sweating bodies, and spontaneous shouts and breaths, they blissfully fall together further into their joyous and sensual ecstatic reverie. The veil between self and other starts to dissipate like breath itself, and through the sacred acts of touch and song, they step into the timeless state of wholeness: vibration, movement, rhythm, flow, flux, and opening – the sensual body surrendering in love to the tides of Life itself. In this way, they become instruments and agents of change, and a source of creativity and transformation for the members of their families and community. Healing for them is not an act of intentionality, but the natural outcome born of an improvised performance orchestrated by the living spirit. From a Bushmen's perspective, healing is not about the banishment of illness in the individual; rather, its focus is the restoration and nurturing of relationship in all aspects of life. To be a healer is to be a master of the sensual; enlivened touch, pulsing body, and both feet deeply rooted in the living soil of an ancient land. Armed with trembling hands and a sacred song they perform their calling. Theirs is the blessing of the Ancestors.

Let's take a moment to review what we have heard so far. First, we all, as a culture, share a collective underlying epistemology that shapes how we know, perceive, and interact with the world. Secondly, epistemologies are deep things. We can see the ideas that are born of our epistemology, but we are blind to the underlying structure of such things within the ecology-of-ideas. Thirdly, there are different kinds of epistemologies. For the sake of our discussion, I have created a dichotomous categorization of epistemologies-of-wholeness versus epistemologies-of-separateness. Implied in this is that an epistemology-of-wholeness is life-sustaining, while one of separateness is pathological, thereby unintendedly cutting a tear across the fabric of the living world. Fourthly, epistemologies (to borrow the evolutionary metaphor) compete for limited resources and dominance within the ecological niche of the cultural mind. Fifthly, to maintain its position within the ecology-of-ideas, an epistemology will, through the evocation of entrenched cultural views, habits, and traditions, defend itself against novel ideas or perspectives that are a threat to its supremacy. Finally, sensuality is a gateway into an epistemology-of-wholeness, and so is seen as subversive, disruptive, and threatening to an epistemology-of-separateness and its reductionist paradigm. The response from the separateness camp (reflected in the views and actions of its individuals) is a predictable one, where the sensual is pitted against the tired old vitriol of scientification, taboo, moral judgment, and sexualization.

With this foundation laid out, we are now in a place to start thinking what a medicine of wholeness, what I have referred to as Complexity Medicine, may look like. Medicine, like all other ideas and concepts, is directed and informed through its circular relationship with its underlying epistemology. In other words, it is self-fulfilled, self-validated, self-generated, and self-reinforced by the very same epistemology that orders it. Remember, it is vitally important to continually remind ourselves that we are "blind to our blind spots" in these matters; we only know what we know to know. As a profession, then, we find a ready vehicle in the sensual to aid us through this reflective voyage into new epistemological territory as we collectively answer the unspoken call of wholeness and begin the process of reinventing medicine.

To further our investigation of this topic, let us start with the examination of one of the traditional cores of medicine, the physical exam, and work outwards from there. Sadly, in recent times, the physical exam (along with the patient's history, I might add) has progressively taken a back seat to laboratory, radiological and nuclear investigations. It's not that these things don't give us essential information, but as they begin to surpass history taking and a thorough physical exam in their perceived importance, we begin to lose sight of our patients in their lived context. We reduce the patient to a mere collection of self-referential data points. This same trajectory in medical practice also seeks to disembody us as practitioners, as we move away from the concrete intelligence of our senses into the abstractions of our overly purposeful professional agendas and frameworks.

Let's reflect for a moment on what the act of the laying on of hands brings to us. First, it is recursive: act, listen, and respond, then act, listen and respond again, this time with a difference. Now what do I mean by listening? I don't entirely know that this is answerable, yet in my experience there seems to be a deep exchange of understanding between the embodied touch of the one, and the embodied soma of the other. In the moment of recognition of flesh to flesh there is the unveiling of a relational wisdom, whole in type that is at once both diagnostic and therapeutic. Interestingly, this is not a unidirectional experience, and the doctor as well as the patient can find himself healed in this moment of relational exchange.

Listening, acting, and responding deeply is not a trivial skill set. It is something that is developed with years of experience of working with the suffering and those in need. It is more art than intellect, but like any performance art, expertise initially begins as a learned skill. However, for true mastery, at some point there has to be a letting go of learning and conscious knowledge in order to fall effortlessly into the free-flow of inspired improvisation. In this moment, a performer does not play, but is played. From the position of an embodied and therapeutic sensuality founded in both deep touch and listening, the perceived separation between physician and patient, or by analogy, performer and audience, begins to shift, morph, and fade. To attend to your own sensation is to attend to the patient's, with the opposite also being true. Often this experience induces a type of synesthesia, as the experiences of the senses merge such that we can listen, touch, see, taste, and hear in a poetic, integrated form.

Why should all of this be important to us? Quite simply, because patients expect it in their care! I can't tell you how many times I have heard as a complaint from patients that, "The doctor didn't even touch me." One of our unspoken roles as physicians in society is that of sanctified touch. It is a sacred act between physician and patient, the very evoking of which can be therapeutic in itself. The doctor becomes the medicine, and the physician's touch the healing balm.

As we focus more and more on the modern tools of medicine, whether it be diagnostics or drugs, we lose focus on the integral relationship between doctors and patient that is the well-spring of healing. As an act of rediscovery, the next time you lay a stethoscope on someone do it in a reverent way, and realize anew that someone is listening back.

In further exploring the sensual world as it pertains to medicine, let's continue to expand our gaze outwards from the body to the doctor's office with its sterile white walls, the blood pressure cuff mounted on the wall, the small, ridged examination bed covered with paper, and the revealing patient examination gowns. The physician completes this staging, replete with tie and white lab coat, his diploma of expertise hanging on the wall. All of this accoutrement offers up the prescribed sterility, professionalism, and proper utilitarian outcomes that we have come to expect from our visit to the doctor. This is of course a traditional setting, and I am not arguing the pragmatics of it. Nevertheless, for the sake of discussion, let's change the frame of how we view things, and imagine for a moment that the doctor's office is a set from a stage play. With this new perspective, the examination room can be seen as a stereotypical scene that we all immediately recognize. As we watch from our theatre seats, this set on the stage may evoke feelings of hope or dread depending on our past experiences. Just by seeing this scene, all of us in the audience will no doubt experience a pre-set and predictable understanding of how the general encounter between the actors on the stage will play out. I know, as a family doctor, that it doesn't take young children long to associate the office with the dreaded immunization needles. And any office nurse or parent will tell you that some of their protest cries are traumatizing for all within ear-shot.

The Bushmen, in contrast, situate their most scared rite at the very edge of the wild. Their dance occurs at the interface between communal life and the natural world. Now for a traditional Bushman in the Kalahari Desert viewing our theatrical set, the doctor's office would hold no past association for him. Conversely, however, a scene of ecstatic dancing, inspired singing, and improvised touch from the village's healers around a fire under a star filled sky, all with full community participation, would arouse strong feelings, not only setting the stage for unexpected and novel possibilities of healing, but also evoking a sense of deep, unspoken, and sacred mystery full of surprise.

In our role as connoisseurs of fine theatrical performance, I would like us to compare these two scenes. I am personally struck by the impoverishment and starkness of the physician's square-walled office, compared to the abundance and richness of the Bushmen's healing circle. On one hand, we have the two actors, physician and patient (and if the performance budget allows it for it, you can throw in a nurse or a family member or two) in a small isolated cubicle, likely without windows, and with uncomfortable furniture where the actors engage in a lot of talking. Contrast this, if you will, with the scene containing a visceral experience of the wild accompanied by the full participation, support, and involvement of friends and community, and the use of dance, song, and touch, and a rich connection to the community's unbroken lineage of Ancestors.

Furthermore, what also strikes me in the juxtaposing of these scenes is their difference in perceived novelty. In the doctor's office, outcomes of the encounter are of a generally predictable set. Meanwhile, the Bushmen's healing dance holds promise of an encounter with the potentialities of healing, all of which are unexpected, unanticipated, and unintentional, yet complete in their outcome. The examination room is conservative, the healing dance is innovative. If we remember from our lecture on service, the ethical imperative of a complex or cybernetic epistemology is to, "act always so as to increase the number of choices." A sensually rich setting is one manner to accomplish this. In our upcoming rounds, we will look further at the concept of performance as another gateway into wholeness.

Finally, if we let our gaze drift to the horizons of Life's experiences, we can look to Nature as the ultimate sensual field in which to ground our practice. Jellyfish and slugs are natural beings. Our bodies in all of their liminality and muckiness, too, are natural things. Embracing this truth, as we have already seen, it should be no surprise that wildness and complexity are, in some sense, kindred metaphors, both of which evoke uneasiness in their unpredictability from the perspective of our tame and linear conception of the world with all of its predictability. This perceived stability, born of our epistemological bias, comes at a price, as we self-limit our possibility for accessing the fluid and self-corrective change that is part of the processes found within the relational complexity of the natural world. Traditional healers and shamans have always lived on the edge between culture and the wild, for in the crack between order and chaos lays the fertile ground of transformation and healing.

Like rivers returning to the ocean, the sensual journey will no doubt take us down many meandering waterways, but at some point it inevitably brings us back to ourselves. How, then, does this journey start? Simply act to know. Act to create change. Act to create diversity. Act to create possibilities. Sensual acts will invite you into an epistemology-of-wholeness without the need to purposefully try to create such a change. Paradoxically, a directed effort will only lead us back to more of the status quo.

Although this lecture could be read as a critique against our dominant epistemology, it is not meant to diminish our Western medical tradition. Physicians come from a proud lineage, and what we have brought into the world is not trivial. The Bushmen are happy to have access to antibiotics. No one enjoys the paroxysmal ravaging of a tuberculosis-induced cough with its life-limiting consequences. Nevertheless, I would suggest that our medicine should not ultimately dissect and reduce, but rather embrace and utilize.

What I ask of you is to consider whether our present-day medicine could be more than it is? Can the cognitive, rational, and linear live in unity with the sensual, intuitive, and non-linear? Can our conscious knowledge be informed and framed by the deeper systemic wisdom of the greater whole?

To be sensual in our world, and in our profession at this time is without doubt a deeply subversive act. Who, then, would like to join me as agents of change within the mysterious organization of this complexity? Who would like to become vanguards of a new Complexity Medicine? In concluding this morning, I would like to leave you with the juxtaposition formed by two final stories: one from a busy modern emergency room, the other from the Kalahari.

One night while working in the ER, I had the privilege of meeting three women octogenarians over the course of the evening. One was Canadian-born, one was born in Greece, and the third in a French colony in North Africa. At one point in their histories they had all spoken English, but as they all developed advanced dementia, they had progressively given up the use of that language. The Canadian-born lady had given up speech all together, and the other two women had reverted back to their birth-tongues exclusively. Now, beyond the basic medical examination that each required, I had nothing else to do other than wait for their investigation results to come back. There was no point in taking a history (my Greek and French were never that good), so I took the liberty of just holding their hands throughout the evening as time allowed, being present with them. It wasn't difficult, as I had no expectations and no investment in outcomes, yet what happened with each of them was amazing. With each encounter, they all held my hand firmly with both of theirs, and in the stillness of those simple moments, I felt a miraculous exchange. In a singular instance there was a feeling of deep neediness or longing on their part for the intimacy of touch, while they simultaneously radiated a feeling through their being and presence that I can describe as none other than love. It was the kind of feeling you get when you know you have walked into a sacred or hallowed space. It was nothing short of a silent blessing; a benediction of the type that only an elder can bestow. With each encounter, their agitation would quickly settle, and a warm smile would come across their face.

I have shared this story with many friends, family members, and patients when they have confided their angst with me of progressively losing a loved one to the unrelenting throes of dementia. It is amazing to me how many times after I have told them of my encounter with these remarkable women that I have heard reflected back my same experience, for in each instance, beyond language and naming, they have each sensed and entered into a profound communication and deep recognition born of wholeness. It would seem that when the faculties of cognition and higher order mental functioning have greatly diminished, that there still remains a deeper place of sharing, understanding, and intimacy. It is a true mystery that has to be experienced, rather than understood.

Finally, I would like to share a final story from my time with the Kalahari Bushmen. After my dances with the Bushmen concluded, we drove two of the elder-healers back to their villages in a pickup truck on the dusty bush pathways. The younger son of one of the elders, a village headsman, was present to translate the click-language of these ancient tribal peoples. I told the elders that when I went home that I would try to practice what they had imparted to me in conjunction with my training as a medical doctor. Hearing this, they became very happy and excited, and began talking rapidly amongst themselves. They then said, "Yes, yes, that is the way. You should have a foot in both worlds. That is best." More than their words, however, I will always remember the warmth and enthusiasm of their smiles and grins, and the deeply etched laugh lines around their eyes. Just before we departed, one of the old men reached up and pulled my head to his, kissing me on the forehead. This small moment in the back of a pick-up truck on the back paths of the Namibian Kalahari with two lineage holders from the world's oldest healing tradition was, in itself, a great blessing, and an encapsulation of all that I learned from them. They have forever changed me through their spirited expression, their smiles, and their open hearts.

These elders, whether we find them in a busy emergency department or in the remote corners of our planet, challenge us, through the wisdom born of their years, to embrace complexity. Life, at times, is messy, and not without scarcity, struggle, and suffering. But it is equally full of bounty, blessing, and bliss. As we reach out to these venerable old ones as physicians, they are also reaching out to us. In their own way, they encourage us to embody complexity in our medicine in the same way that they have navigated complexity throughout their life: at times successfully, at others not, but always with humility. This is the heart of mentorship, and the way in which we learn through relationship. Such is the teaching of our elders, grounded in the context of their lives and shared with us freely so that we may integrate their wisdom into the fabric of our own.

Thank you.

Back to the Table of Contents
Act III - Scene I: Night Round - The Professor

Doctor's Narration: Sunday night insomnia...As a victim of shift-work, my circadian rhythms were not keeping step. With each toss and turn my anxiety increased; the digital clock peering at me like a malevolent re eye from the dark. Minute by minute, seven o'clock was approaching. I was dreading my impending morning patient rounds. There was no pardon or reprieve coming for my sleep deprivation, as the Monday morning sun was always ruthless in its punctuality. I last remembered a time of 3:00 a.m. on the clock, as I fitfully succumbed to unconsciousness...

With a startle, I lucidly awake to a fresh dreamscape. I find myself amidst an old-growth redwood forest. Giants loom above me in their enormity, ancient in their guise. The woods teem with life. The odor of a fresh morning rain still hangs in the air with its rich, organic dampness. In the midst of the grove stands a Zen temple, surrounded by its serene gardens and ponds; its wind chimes gently move in the breeze.

The temple doors are locked. Nonetheless I somehow just know, as if reenacting a memory, to wait patiently on the steps, sit mindfully, and watch my breath. With the ringing of a great bell, I come back from my self-absorbed reverie. One of the temple acolytes emerges from the great doors and greets me. He ushers me through the temple threshold, taking me to a great hall. He says, "The Master will see you now." With that, he quietly closes the doors behind me.

In the middle of the hall stands a large man, imposing in his stature, just shy of six and half feet. He appears disheveled, sporting a wild frock of silver-white hair. He is hunched at the shoulders, reminding me of my own grandfather bent from years of writing at the desk. In front of him is an easel with a large canvas. Beside the easel stands an old wooden table with the artist's resting paint wells and brushes, along with, of all things, a dead lobster. He wears an old lab coat as an artist's smock. It is speckled with multicolored paint splashes, the armpits yellowed with sweat stains.

As I enter, he looks up at me. There is warmth and hope in those eyes, yet his gaze holds an authority born of years of a practice; full of a mixture of discipline and rigor. In this moment, I feel strangely uncomfortable in myself. He beckons me over with a motion of his hand. His first words to me are: "You have five minutes," and so our conversation begins.

Doctor: What are you painting?

Professor: Differences.

Doctor: Differences?

Professor: More specifically differences that matter, or in other words, differences that make a difference. It is one of the things that define us as biological beings. As the Laws of Form shows us, "a Universe comes into being when a space is severed or taken apart." Through the living, we celebrate and continually reenact the Mystery of the "original act of severance."

Doctor: I am afraid I don't understand.

Professor: That much is obvious. Luckily, not understanding is also another biological necessity. Come now, let's paint this together. One mind is more than two in these endeavors as you shall see.

Doctor: I am not much of painter.

Professor: Neither am I. I suspect, however, it is the process that matters most, and not the product. I am hoping that this painting can teach us a better way in which to view the world, not as it is of course, but as we would wish to know it.

(And with that he dips his fingers in the paint and starts to color the large canvas. I hesitantly join him, doing the same).

Doctor: What's with the dead lobster on the table?

Professor: That crustacean is there to remind me that, despite the importance of differences, it is through the patterns that connect us that we are brought face to face with a type of deep symmetry that ultimately informs us of our essential sameness. In other words, it is there to keep me humble, as I am here to do the same for you.

Doctor: A way to embrace your inner crabbiness?

Professor: Yes, quite. Now getting down to business, I understand that you are a physician?

Doctor: It's my day job.

Professor: Good, then, you should realize by this point that you are here on professional matters. I have a medical consult for you if you are open to such things.

Doctor: A consult, here?

Professor: Perhaps the most important of your career, but certainly you must be use to atypical patients by now. Let us then proceed. My question to you is how are climate change and type 2 diabetes part of a greater pattern of connectivity?

Doctor: What an odd sort of clinical question. What if I am unable to adequately answer?

Professor: No concern, trust that the system through its organization is self-corrective.

Doctor: System?

Professor: "Systems", "processes", "ecologies", "aesthetics", "patterns", "a painting"... Lexicons are often a matter of context or taste, nevertheless, we are talking about the self-referential relationship or organization shared by minds and bodies. Although your trust in both appears quite shaken; a hazard of the profession I would presume.

Doctor: Once again, I fail to follow.

Professor: What are they teaching you lads in school these days? Have you not heard of Rene Descartes? This is something every school-boy should know, and certainly every physician. Sadly, inculcation without rigorous examination is nothing less than mere propaganda! Multiple choice is no choice at all, it would seem.

Doctor: I think I know what you are ranting about. Are you referring to the mind-body dilemma?

Professor: Dilemma? In the world I live in there is no dilemma, but you are certainly welcome to live in whatever world you choose, even if it is a hopelessly muddled one. Nevertheless, let us take this moment to revise our understanding of such things.

Doctor: I hope you don't mind. I realize that in saying this, I keep going around in a loop, but I am still having trouble comprehending any of what you are saying.

Professor: Yes, yes...you are absolutely correct in saying that we should talk loops before we talk about minds, and in that you're very astute in observing that your understanding is the problem.

Doctor: Certainly, one of us is loopy.

Professor: Very complimentary and quite right again. Now, the loops we are interested in are ones that generally feed-back, yet upon occasion will also feed-forward. This type of reflexivity comes with a variety of names including recursions, reiteration, and circular causation. Regardless of your syntactical preference, all of this is ultimately about a snake eating its own tail. In going around, it finds its way forward. Recursion too, you see, is a biological necessity, the science of which we refer to as the cybernetics of cybernetics.

Doctor: Now as a physician, I understand feedback. It is the foundation for homeostasis. Its breakdown forms the basis for the pathophysiology for disease.

Professor: Tell me then; what is static in homeostasis? Homeodynamic would be a more appropriate terminology, I would think, as Life is always to be found at the edges. Nevertheless, I digress; feedback, although certainly the cornerstone of physiologic process, has a biological universality. Non-linear causality, with its vast relational interconnectivity, is the foundation of the rich complexity of Life that we find in the world.

Doctor: What are you getting at with all of this?

Professor: My dear boy that is the problem with your generation. You are always trying to get at or to something. Biologically speaking, the shortest distance between two points is never a straight line. In a word, Life is circuitous. Now, the answer to your question is information, or in other words: difference that makes a difference, and that brings us back to where we started, but with an effective difference! Before we go around again, let me ask you, what is wrong with the statement: "function follows form?" Come now, you fancy yourself a physiologist after all.

Doctor: By your reasoning, function indeed follows form, but equally form follows function. Each continues to shape the other, structure and process chasing one and other in a recursive union. In light of this, you will probably want me to reconsider the relationship of anatomy to physiology and vice versa.

Professor: Yes, as well as reconsidering your relationship to your anatomy and physiology through the process of your reconsidering.

Doctor: A reconsidering of my reconsidering?

Professor: To take this further around, allow me to borrow an economic metaphor. If difference acts as the currency of biology, then feedback is its system of exchange. Life is built on this fundamental framework, a primordial form and function of sorts. All other manner of biological engagement, in a sense the form and function of form and function, springs from this ground.

Doctor: If I may be so bold as to direct us back to Descartes, what does all of this have to do with minds and bodies?

Professor: Just as nature is full of bodies, I would also argue it is also full of minds. Together, through a cybernetic dialectic of form and process, they form ecologies of various kinds. Your confusion of minds and bodies comes, as did Descartes, from your error in logical typing. Tell me doctor, what would you think of a man who went to a restaurant, and mistook the menu for the main course?

Doctor: He could have saved himself a trip by simply standing on the spot on the map.

Professor: Exactly, a lesson in the importance of logical types will no doubt serve as a stimulant to your appetite. Logical typing is a useful tool in discourse, as it allows us to keep account of various levels of abstraction throughout this circular rollercoaster; that is to say, it is a structuring that allows for ordering of our names and names of names. For example, mustangs belong to the greater class of horses; horses are members of equines; equines of mammals; mammals of animals; animals of living things; and living things to material things in general. Likewise, mustangs are members of the Ford brand of cars (not to be confused with horse branding, of course) which in turn belong to automobiles in general. Then, in a line of further abstractions; automobiles belong to vehicles of transportation, vehicles to mechanical things, and mechanical things to material things in general. In our ordering this way, we must always honor the unidirectional arrow of abstraction. In other words, the class of horses may belong to the class of mammals, but the inverse is always prohibited. Furthermore, we must keep in mind that the name is never the thing named. In other words, the fundamental constitutive nature or organization of a subject or unity that exists within the greater relational ecology is not to be mistaken for or by the labels we apply, nor the symbols we use to represent such a unity, either in its concreteness or in its abstraction. This being said, mustangs are both material things, but horses are certainly not cars except in the metaphorical sense.

Doctor: Why is it that your clarifications seem to make things less clear?

Professor: My clarifications are clear enough; I would argue that your mind is cloudy, but we will remedy that in short order.

Doctor: All right then, continuing with our train of thought in our attendance to logical types, what happens if you break the rules of logical typing?

Professor: Humor, artistic expression, dreams, metaphor, spiritual experience, psychosis, and the like.

Doctor: Psychosis, that doesn't sound healthy.

Professor: Of course, as a medical professional you would view it that way. You are like a gardener that sees weeds as separate from his vegetables. Yet to eradicate the processes underlying madness is to doom us to a world without humor, without art, and without religious expression, as these things appear to be woven in a continuum of experience. This statement is not to satirize or stigmatize the suffering of the psychotic, but to highlight that an approach of purposeful remedial action, whether it be an herbicide or a therapeutic intervention to cure is, at its best, manipulative, and at its worst, an act of violence. Furthermore, the use of such an action (therapeutic, corrective or otherwise) is full of folly, considering that it is derived from the same paradigm underlying the cause of the disorder, whether weeds or psychosis. In the garden, one finds oneself stuck between a rock and a hard place, while an individual in the throes of psychosis has a mind bound with double binds. What is needed, by my estimation, is not more of the status quo, but an underlying change of ecologies both in the garden and of the mind.

Doctor: Are you telling me I should not tend to my own weeds?

Professor: I fancy a solution, like an intervention, is a rather purposeful, and hence dangerous. Although we talk about cybernetic systems as exhibiting purpose (i.e. goal-directedness) this is a very different than purposefulness. Instead, I choose to offer up a joke.

Doctor: Which is?

Professor: A horse walks into a psychiatrist's office. The psychiatrist says, "Why do you look so long in the face?" To which the horse condescendingly replies, "Obviously you know nothing about logical types."

Doctor: ...uggh.

Professor: All right then, let us proceed, shall we? First, we'll start with the proposition that there is body (i.e. individual living material systems exhibiting autonomy and closure), bodies (i.e. micro/macro subsystems observed in co-relational interaction) and Body (i.e. wholeness; concrete summative reality of all abstracted subsystems), that we embody and are embodied by, depending on the level of abstraction we choose to focus our gaze. Likewise, to my mind, there is the corresponding immaterial mind, minds, and Mind in conjunction with the aforementioned bodies. Bodies, then, are substantive, space-occupying materialities. They are aggregates of recursively interacting material parts or components of ever increasing levels of complexity that form structures capable of supporting increasingly complex or emerging functions; single cells, multi-cellular collectives, autonomous organisms, families, communities, societies, species, ecosystems, upwards towards the ecological climax that supports us in its totality. Through this wonderment, we encounter bodies of various orders in a stunning and miraculous array of diverse and abstracted forms.

Doctor: ...and of minds?

Professor: Yes, minds are of an entirely different order, aren't they? Bodies, due to their material nature are rather obvious sorts of things. Admittedly, there is the issue of minimal complexity in the organization of bodies. For a body be considered a body, the aggregate of relationally interactive parts must be significantly complex to support the mental processes intrinsic to mind... but hold that for now as I am jumping ahead of myself. Nevertheless, following that rich vein of thinking, I would think of cells as a type of body in their own right, but I would be far less inclined to think of proteins in that way, and certainly not molecules or atoms. Now what do I mean by minds? The Cartesian model proposes that minds and bodies are distinct substances or things. Whether they are different substances, or they are the same substance is irrelevant, of course, if the initial premise of the theory is incorrect. This proves problematic for modern science, as its reductionism, materialism, and positivism has been founded in response to the Cartesian model. As much as this worldview has led to the development of powerful scientific and societal advances, it has also been rife with a multitude of dire unintended consequences, the legacy of which we are living with today. This position forces us to ask the question: Is there a better way to know the world that we are intrinsically and intimately a part of, and what would be the corrective actions generated by such a change in our underlying epistemology?

Doctor: I see we cannot fix the symptoms of this Cartesian illness. So how do you suggest we heal this epistemological blight of ours?

Professor: The answer, I believe, lies in thinking about the nature of mental processes, and the relationship of such things to the physical world. Let me put forth to you a question. When you think of mental processes, what comes to mind?

Doctor: Certainly, thought, learning, memory, attention, and the like...

Professor: That is all very well; nevertheless, your answer betrays your anthropocentric view of a body.

Doctor: Body? I thought we were talking about minds.

Professor: Exactly, but it would seem you are still possessed by Descartes' ghost. The question one needs to ask is what would mental processes look like in bodies of all temporal and spatial scales, whether it is your individual body or that of the ecological whole?

Doctor: I am not entirely sure what you are getting at, but I bet it is about to make a difference in my understanding of all of this.

Professor: Difference indeed. What you require is a new tool of understanding, one I refer to as abduction. Through a process of abduction, we look for recognizable similarity in systems of varying orders and scales, then reasoning by analogy we can develop new insights into both systems of interest.

Doctor: So what ideas are we going to kidnap to help us understand mental processes in the natural world?

Professor: We should probably start small as you are new to all of this. How about we abduct evolution as analogous to learning, and view it is a type of mental process in its own right?

Doctor: Now you are driving me towards my own extinction I fear.

Professor: That is exactly what I am trying to prevent in all of this. Let's look back for a moment. Mental processes are about what a system does in the face of difference. What is an appropriate accommodation or adaption, thereby allowing for the maintenance of organization? Our sense-organs note change in our internal and external milieus, including the absence of stimuli. These perturbations impinging on our sensory apparatus trigger a cascade of changes in our closed nervous systems, as dictated by our structural mechanics and underlying constitutive organization, thereby initiating complex processes of feedback with its corresponding computations. Thus, differences that make a difference initiate ever greater levels of contextual distinction within the system via comparison of state. In this way, a behavior is generated in response to maintaining the organization and stability of the organism, completing the greater sensory-motor loop. By analogy, self-similar processes of responding to difference go on at all temporal and spatial levels of abstraction in the living world. These are the patterns that connect the entirety of the biosphere into a unified whole, and it is this reality that provides for us the necessary ground in which to root a new life-affirming epistemology.

Doctor: If information is a difference that makes a difference, what is learning?

Professor: The process of feedback.

Doctor: Once more please?

Professor: Feedback. When the difference computed by the process of feedback is carried forward, becoming the generator of change in systemic parameters and patterns of performance within the closed cybernetic circuit, we can, in the most fundamental sense, say that a process of learning has occurred. This conception points us towards a greater dynamic process where learning can be viewed as a continually reiterative process of feedback, as well as feedback of feedback, and the feedback of feedback of feedback. Similarly, we can posit that feedback forms the basis for a dynamic organization of memory, for in any feedback system a history of state must be in principle maintained if a system's "output" is to be carried over as the next "input" within the given cybernetic circuitry, all with the "purpose" of achieving systemic "goal directedness."

Doctor: Can you backtrack for a moment, and with these newly garnered insights explore this similarity you pose between learning and evolution? Are you saying that evolution, like learning, is a mental process?

Professor: Yes, and if you apply your understanding of logical types, the relation and pattern between these two great stochastic mental processes becomes apparent.

Doctor: How is learning related to logical typing? It does, after all, seem like a fairly straight forward act without abstraction. I mean isn't learning simply learning?

Professor: But is it? All learning is contextual you see. In addition to learning, there is the learning of the contexts that learning takes place in conjunction with, or what may be thought of as a meta-learning. It is the context, and context of context in which learning occurs that forms the basis for a recursive hierarchy of logical types.

Doctor: When you refer to learning within a hierarchy of logical types, which is to say there exist higher and lower learning, are you implying that some contexts of learning are superior to others?

Professor: No, quite to the contrary. This is one of the limitations of language in trying to explain logical typing from a cybernetic position. Higher and lower in the hierarchy of logical types does not refer, in any imagining, to thoughts of superior or inferior. All orders of logical typing are recursively interconnected, and thus serve to self-define each other. In considering the nature of such a hierarchy intrinsic in logical types, rather than turning to a metaphor of a ladder, it is perhaps more appropriate to think of an experience in a fun-house hall of mirrors, where the reflection of one mirror in another creates the image of multiple embedded mirrors: one within the frame of the next. Higher or lower logical types are not dialectically opposed in the traditional Hegelian sense or dualistic in the Cartesian manner, but instead are viewed as mutually specifying, and therefore can never be compared in the sense of superior or inferior, or better or worse.

Doctor: How then is learning to be understood from the perspective of logical types?

Professor: To answer that, let's consider an analogy. It would be helpful to reflect on a similar hierarchy of logical types in physics, namely that of "changes in motion" or "derivatives of position change", as reflected in their mathematical ordering of a position of zero motion (m), constant velocity (m/s), acceleration (m/s2), and the rate of change of acceleration (i.e. jerk) (m/s3). Similarly, I have come to order learning as zero-learning, Learning I, Learning II, and Learning III.

Doctor: Still, my own ideas about learning continue to hold a good deal of momentum for me.

Professor: Ahh...that is an easy fix: just stop being a jerk.

Doctor: Are these to be understood as different types of learning?

Professor: Yes and no in that "yes" they are different, but "no" in that their differences are predicated on their fundamental shared relationship. For example, just as velocity, acceleration, and jerk are different "derivatives of motion", so too are Learning I-III different "derivatives of learning". Another way to categorize these classes of learning would be response to stimulus, context of the response to stimulus, context of the context of the response to stimulus, and so on. Each new order becomes a meta-message classifying the order below it.

Doctor: So what you are saying is that we respond, learn to respond, learn to learn to respond, and learn to learn to learn to respond, and the summation of all of these contexts are what constitutes learning as a whole.

Professor: Exactly.

Doctor: At this point what you are talking about is just a word game for me. Could you better explain what each level of learning on the hierarchy of logical types would look like?

Professor: Most certainly I can. To begin, zero-learning constitutes the simple acknowledgement of difference of a repeated stimuli or perturbation to which an organism responds in the identical way 100% of the time. This is exhibited as either a highly stereotypical behavioral response, or by no response at all if the organism has habituated to the disturbance. Seen this way, zero-learning could be thought of as perceived differences that don't make a difference. Often, these are genetic or hardwired effects, and by and large are not determined by experience. Zero-learning is highlighted by the fact that there is no trial or error involved in the process. It lacks novelty of response, and is inherently a-contextual. It is only the higher orders of learning that we see exhibited accommodation and adaption to novelty and perceived randomness.

Doctor: That is to say learning I-III.

Professor: That's correct. Learning I, or learning to respond, would be related to what we think of as conditioning, either in the classical or operant sense, and it is what we generally mean by the term "learning" in the colloquial or standard use of the word. Through repeated stimuli, an organism begins to create new associations with its environment. This coupling of stimuli and response forms a basic context for the organism. The context, being a set of temporally related events, which tell an organism, as per the limitations established by its present structure (ontogeny), what set of behavioral alternatives are available on which to base its next action. Learning II, then, necessarily entails a transformation in the process of Learning I or what we could think about as learning about learning to respond.

Doctor: Learning about learning?

Professor: Yes, you could imagine that having to address each successive context individually would become cognitively burdensome and highly inefficient. It therefore is in an organism's best interest to develop a set of heuristics or algorithms in which to classify like contexts, or in other words: to create contexts of contexts or meta-contexts. Learning II provides needed economy for the thought process. It allows us to carry on without thinking about all the generalities of relationship that remain constant in our environment. It is this level of learning that a psychiatrist would be most interested in, as this context of contexts is the stuff of our personality. They are the schemas through which we interpret our engagement of self with others and the world. This is the learning that forms our habits of cognition and behavior, and reflects them in our embodied being. They are generally unconscious, or at least below the threshold of overt consciousness, and to varying degrees are resistant to change once formed due to their self-validating nature. Ironically, through the process of learning about learning, individuals unconsciously manipulate their perception of their environment to fit their expectations of what they will perceive, thus biasing future learning opportunities or shutting them down all together. If the individual's Learning II schemas are impoverished or overly rigid, they may also become the source of psychopathology. For all these reasons, the transformation to the order of Learning III, or the leaning about learning about learning to respond, is a rare and difficult thing.

Doctor: Zero Learning and Learning I and II sound like the general human experience. What would then constitute a third level of logical typing in human learning?

Professor: Learning III is a relatively rare event in the collective human experience. It would be akin, perhaps, to what is reported as a profound mental or spiritual experience where a subject undergoes a complete reordering and reorganization of their identity. Although this experience is beyond their purview of language, for the sake of scientific scrutiny we can see that as a higher ordering of Learning II, there must be a process of greater flexibility or freedom from the constraints of Learning II, and that this freedom from habit must in turn lead to radical redefinition of selfhood. It is the aggregate of habits acquired in Learning II that shape the characteristics of self. They form the sense of "I": the sum of our recurrent cognitive, emotional, and behavioral responses acting in context. Through this process, "I" become an active shaper and interpreter of the very same contexts in which "I" act. In this way, Learning II becomes a rigid container, as it eschews a process of deep self-reflection. To enter into Learning III is to expose the contextual and habitual relativity of Learning II for what it really is, and through doing so, we observe that the idea of "self" becomes outmoded, as a personal sense of nodal subjectivity separate from the continuum of experience falls away. Only the expansive living of the present moment, as an expression of greater mind, remains in its stead. Learning III is the pale of experience in human learning, as defined by our present ontogeny, beyond which we must necessarily shift to the evolutionary realm if we wish to further conceptualize our develop-mental identity.

Doctor: Step by recursive step we come closer to our goal it would seem.

Professor: True, at times closer, and at others further away, as that is the nature of circuits. Yet goal making is antithetical to this process, I assure you.

Doctor: I do have a question. If we are to think of evolution, like learning, as a mental process, do we not need some equivalent, akin to mind, in which to ground this process?

Professor: Indeed, we must. Now that we have discussed our thoughts on thoughts and other mental processes, on scales small and large, we must turn our collective attention to the nature of minds and Mind. Let's start with the question of what criteria a definition of Mind would require to support such diverse mental phenomena as memory and learning at the level of the individual, embryology and evolution in the natural world, and culture and knowledge acquisition in human societies?

Doctor: You have my whole attention.

Professor: Good, as long as it is not your whole intention, as this would be much too purposeful for our purposes here. A non-dualistic theory of mind, by its very nature, must be holistic. Nevertheless, for the sake of discussion, and indeed for our very ability to have a discussion, we need to view the topic (ironically perhaps) through its component parts. That being said, we must never forget that any of these divisions are arbitrary machinations of our own creation. The observer is a reductionist illusion, as that which is "observing" is never separate from the "observed." Impartiality is a myth. From the systemic perspective, all things remain subjective in their essential nature. Nonetheless, let this not hinder our investigation.

Doctor: I will try not to objectify you, nor make your words the object of my attention or affection.

Professor: Be mindful, however, of not trying in your not trying for this would no doubt be trying for both of us. Luckily, all of this will now be a review for you. Let us begin with the necessary criteria for mind. First, minds require aggregates or interacting parts, that is to say bodies of sufficient complexity so that they may enter into relationships with each other that, in turn, are supportive of mental processes. The components of mind are material, while mental processes themselves remain immaterial. Mind is composed of the relational interactions between parts, and is not located in time or space. Mind, therefore, is intrinsically empty. Mental processes, reside in the organizational architecture formed by the dynamic interactions generated by a system's multiple components. Secondly, a type of metabolism, either literal or figurative, must be present to utilize available energies that are pumped into an open system, thereby creating and sustaining the far-from-equilibrium state needed to provide the energy required for the realization of the material relations, and to further drive the physical and mental processes of the whole system. Thirdly, we need differences that make a difference to trigger interactions between connections of mind. But don't go looking too hard for these because, like mental processes, differences are insubstantial and not to be found anywhere. Fourthly, recursive or circular causality (i.e. feedback) provides the means for needed complexity, the seeding of relational organization, and for the maintenance of stable states within the face of continual change. Fifthly, with mental processes, the effects of a given difference are to be seen as transformations of the fed-back difference (input) that lead to them. A cybernetic circuit dealing with circular trains of difference on multiple scales requires the structural flexibility to hold pattern and redundancy and differentiate cause from effect. Hence the present systemic state is always predicated on, and thus a reflection of, the historical antecedent state. Finally, to make sense of the phenomena of interest within a system of circular causation, we require a nested hierarchy of logical typing, namely the mental processes immanent within the system. Such an accounting, whether implicit or explicit, helps compute our reiterative naming of differences, and thereby provides a mechanism for both learning and communication. If all of these requirements are present, I shall not hesitate to unequivocally call the system of interest a mind.

Doctor: Well there is mind, and then there is Mind, at least to my mind. What you are proposing is a radical departure from our normal paradigm of mind that goes well beyond our traditional conceptions of the human mind in relation to a physical brain housed within the body.

Professor: Quite right, what I am suggesting is that mind is not a localized phenomenon; rather, a holistic one that includes all living organisms, along with the sum of their non-living interactions and relations. It is what we are referring to, knowingly or unknowingly, when we talk about the nature of systems.

Doctor: Yet when I think of myself as a mind, in the Cartesian sense of Cogito ergo sum - I think, therefore I am \- I understand myself to be an autonomous being. I experience myself as a unity.

Professor: Likewise, by my definition for systemic mind, we must see systems as in some way possessing a degree of autonomy or control, the capacity for self-correction, self-regulation, pattern generation and recognition, and adaption, as well as having the ability to unite with similar systems so as to be able to form greater and more complex wholes. Systems, as a product of our observation, are unities. We must never forget, though, that systems in the way we are discussing them now are open dynamics, and our parsing (i.e. perception) of them remains idiosyncratic to our observational constructs.

Doctor: In your necessary criteria for mind you listed logical typing. Are systemic minds also subject to errors in logical typing then?

Professor: They would necessarily be, yes.

Doctor: And the result of such an error?

Professor: Similar to the human experience of mind, we would see either systemic creativity or systemic pathology. Systems, too, can be generative or psychotic you see.

Doctor: What differentiates, mind, minds, and Mind?

Professor: As I mentioned, the distinction of categories of mind are simply artifacts generated by our subjective experience of observership, whereby we draw arbitrary differences in relation to self and other. The totality of these relational interactions within the whole, as defined by my six criteria, is what I refer to as Mind, the Mind of Nature or, perhaps, what has been metaphorically referred to as Gaia. However, for the sake of abstraction and discussion, the sub-system aggregates, present at various scales, may too be viewed as distinct minds or sub-minds if they satisfy the same criteria of mind. Nevertheless, when we choose to view a particular mind, at any scale, we must remember that such divisions are ultimately arbitrary: vestiges of a specific perceptual mode. They are situationally or contextually relative, and not ultimate. That being stated, in considering the nature of mind, we must remember that minds are always immaterial, emergent properties of the material aggregates that support them. Minds, you see, must always be viewed as relational processes, rather than things that have somehow been dissected out from that other thing which we call the body. Minds, in truth, are patterns of interaction. They are dynamic, aesthetic interplays. Throughout their patterning, they are supportive of communication, and are dialogical. The relational architecture of mind is such that difference may evoke the possibility for change, as determined by the system's organization.

Doctor: I still don't see in all of this how we do not end up with a neo-Cartesian trap of a dualism born simply of material bodies and immaterial minds, where mind and body are still separated?

Professor: To explore that question, let's borrow a metaphor from Carl Jung; that of the Gnostic worlds of Pleroma and Creatura. As Jung states in his paper Septum Sermons ad Mortus (The Seven Sermons of the Dead)

Harken: I begin with nothingness. Nothingness is the same as fullness. In infinity full is no better than empty. Nothingness is both empty and full... A thing that is infinite and eternal hath no qualities, since it hath all qualities. This nothingness or fullness we name the Pleroma. Therein both thinking and being cease, since the eternal and infinite possess no qualities. In it no being is, for he then would be distinct from the Pleroma, and would possess qualities which would distinguish him as something distinct from the Pleroma. In the Pleroma there is nothing and everything. It is quite fruitless to think about the Pleroma, for this would mean self-dissolution. Creatura is not in the Pleroma, but in itself...The Pleroma is both beginning and end of the created beings. Yet because we are parts of the Pleroma, the Pleroma is also in us... It is that nothingness which is everywhere whole and continuous. Only figuratively, therefore, do I speak of created being as part of the Pleroma. Because, actually, the Pleroma is nowhere divided, since it is nothingness...But wherefore, then, do we speak of the Pleroma at all, since it is thus everything and nothing? I speak of it to make a beginning somewhere, and also to free you from the delusion that somewhere, either without or within, there standeth something fixed, or in some way established, from the beginning. Every so-called fixed and certain thing is only relative. That alone is fixed and certain which is subject to change...The Pleroma hath all, distinctiveness and non-distinctiveness. Distinctiveness is Creatura. It is distinct. Distinctiveness is its essence and therefore it distinguisheth. Wherefore also he distinguished qualities of the Pleroma which are not. He distinguisheth them out of his own nature. Therefore he must speak of qualities of the Pleroma which are not.

The answer for us lies in an understanding of the relationship between these two realms of metaphorical existence. It is good to think of this new recursive metaphor of "Pleroma and Creatura" as a more poetic birthing of the one of "form and function". Through the interface of Pleroma and Creatura, we find the relational dance that gives us our holistic monism, and a solution to the Cartesian legacy that haunts our present day science and medicine.

Doctor: I have heard of minding my Ps and Qs, but minding my Ps and Cs is entirely a different matter.

Professor: Exactly, you have preempted me I see. Using Jung's metaphors, we can conceive of two worlds, or two separate yet connected orders; Pleroma governs the lifeless material world, and is subject to the nameless forces of physics, while the other, Creatura, is the home of living things, distinguished by mental processes based on the notion of difference. An example may help to clarify these ideas.

Doctor: An example, yes...

Professor: Let us consider the popular image of Darwin's iconic monkey, human skull in hand, contemplating the nature of existence shall we? There are three perspectives to consider here.

Doctor: Three perspectives? I thought we were considering just the two perspectives of Pleroma and Creatura; the fundamental physicality of the skull, and the living monkey as an essentiality.

Professor: Exactly as I said, three points of view: the skull, the monkey, and the monkey/skull as a unified system. Now, if we may continue to venture forth from the skull's perspective, that of Pleroma, there can be no perspective, as inanimate objects neither receive nor generate information, that is to say differences that make a difference, or in other words: distinction. Certainly the skull, as is all materiality born of Pleroma, is subject to the forces and regularities as dictated by the physical universe. For certain, the monkey could hurl the skull across the floor, knocking over bowling pins or some other such things, as an example of a linear, deterministic, effective causality. Nevertheless, the skull remains hopelessly oblivious to it "skullness", or the forces that acted on it throughout this action, because the ability to distinguish such matters involving difference or change remains sacrosanct to the domain of Creatura.

Doctor: I knew monkeys could type, but I had no idea that they invented bowling.

Professor: Indeed, it is a strange world that we find ourselves in, and like Darwin or ourselves, the monkey is a member of Creatura, and is distinguished as a member of that class by its very ability to distinguish. The monkey names and is named. It both receives and generates information, and responds to the same in kind. The skull, of course, can do none of this, and is only a skull since it was so named by the monkey, in whatever ways monkeys are inclined to do such things. Rest assured, the skull exists in its materiality whether the monkey is there to hold it or not, but it is only differentiated into a discreet object, that is a skull, vis a vis the working of the Creatura mind. When observed as separate, the worlds are, in one sense, inaccessible to each other. Pleroma remains a place of lifeless, undifferentiated substance and forces, devoid of mental process, and hence unable to distinguish or make meaning of itself. There exists in Pleroma an infinite number of possible differences, but none that can make a difference, as Pleroma is unable to distinguish itself, in part or in whole. Expanding on this notion, we see Creatura, although composed of the material stuff of Pleroma, and subject to its laws, is the home of non-substantive mental processes. Here differences that make a difference are distinguished and acted upon through the great stochastic processes of learning and evolution, and as a consequence all the things that make Life alive are made possible this way. Yet despite Creatura's ability to distinguish, the direct experience of the material world remains inaccessible. For Creatura can only know the world through its internal and structurally determined transformations. Getting back to the monkey; the skull in its hand is not the thing in itself; rather it is what the mind makes of it. We must never forget that the name is never the thing named. Finally, unlike the fullness of the material world of Pleroma, the Creatura mind is empty; it is a non-thing that exists only as an immaterial ecology-of-ideas and thought.

Doctor: Alright, we now have an expanded template of a material body as an aggregate of substantive parts of requisite relational complexity, and an expanded operation of non-substantive mind as an ecology-of-ideas formed by multiple iterations of distinction making and pattern formation at various systemic scales and abstractions. Yet I still fail to see how we have escaped from the dualism intrinsic to the Cartesian worldview; on one hand, we have Pleroma, and on the opposing, Creatura?

Professor: Yes, while it is true that within descriptive discourse there appears to be an apparent dichotomy within our figurative creation of Pleroma and Creatura, in truth neither of these apparent states of existence is separable other than through an illusory parlor trick of language. From a recursive viewpoint, all of Creatura's immaterial existence is predicated on Pleroma in all of its rich materiality. Conversely, knowledge of Pleroma, and all of its material operations, exists only in the differential and relational mind of Creatura. For certain, the forces of physics still apply independent of the living world, but any observation, description, or differentiation of them lies only within the awareness of the living mind as determined by the structure that supports it. As you can see, Pleroma and Creatura can only ever be met as a unified whole, and never separately. Creatura will always require an aggregation of matter to create the sufficient complexity required to support mental processes. Equally, Pleroma is dependent on the mental processes emergent in Creatura, allowing it to be organized and assimilated into the greater mind of nature in such a manner that allows Pleroma to be affected by information as well as physical forces. From this standpoint, the mind/body derived from our metaphor of Creatura/Pleroma is entirely unlike the classical Cartesian dualism of mind and matter, as distinct and separate substances, or the neo-Cartesian materialism that states mind and body are composed of the same substance (i.e. are not different). What we have obtained through the recursive union of Pleroma and Creatura is the creation of a seamless whole in which physical, substantive bodies, via their organization into complex, recursive wholes, give rise to the emergent properties of non-substantive mind, which in turn, define and give meaning to their material basis. Material relations become the progenitors of immaterial thought, and thereby form the basis of our cybernetic conception of the world. In other words, mind/body must necessarily be viewed as singular in nature: a monism universally applicable at all levels of abstraction in living systems. This new conception of mind and body affords us a path towards a life-affirming, life-revering, life-supporting, life-sustaining, and life-regenerating epistemology. Its promise is one of reverence for the natural world we are part of, rather than one of dominance over a world from which we see ourselves as separate. Its overarching ethos is one of love, not alienation: wholeness and not reduction. If one truly understands the unity of Creatura and Pleroma and accepts its cybernetic premise, then we must acknowledge that all systems are living systems. Physics, since the dawning of the Age of Reason, has appointed itself "the King of Sciences." We must never forget, however, that no titles can exist in the World of Becoming separate from those bestowed by Life's livings heirs.

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First Intermission - Confection Infection

My prescription for you is to have a dinner party for your friends with a lovely three-course meal. Make sure you do it up right; candles, fancy napkins, fine china. Go the whole nine yards!

For the first-course you will need to do some advance preparation. Start by going to your local health-food store. When you get to the store, take a look at the shelves of nutritional supplements. Peruse the labels of the vast variety and cornucopia of nutraceutical products that are being offered, and pick out three of the most exotic offerings.

When you get back home, make sure you do your research on your choices because it will make for excellent dining room conversation, and you will no doubt come off as sounding like a very intelligent host. For example, for my selection, I might pick something like "raspberry ketones" (the equivalent 90 lbs. of raspberries in a single dose) for use as a weight-loss supplement, or the super crazy potent antioxidant "astaxanthin" (the stuff that makes pink flamingos pink). To finish it off, some good old fashion "salmon oil" might be nice (although I hear "krill oil" is now in vogue).

To introduce the first course, place all three supplements on a fancy, and preferably covered appetizer dish. Serve with water. Make sure to talk about all of the health benefits of these magnificent scientific and nutritional delicacies.

For the second course, go to your local farmers market, or to wherever they sell quality local organic produce. While shopping, pick out and purchase the brightest assortment of vegetables, fruits, cheeses, olives, and herbs. Make your selection entirely based on the food's sensual appeal and aesthetic merits. Give no thought as to the nutrients (you already have that covered that in the first course), but pay attention only to how your selection tickles your aesthetic sensibilities. If you were to put all of your purchases in a wooden bowl, they should make a vibrant still-life image.

After your guests have finished their first course, place all the washed, but unprepared foods on the table. Give every guest a carving board, a serving plate, and a knife, and let them choose their own color medley of foodstuffs for a salad of their choice. Encourage original form and style in the cutting and shaping of the food, stressing the importance of its orientation and position on the plate relative to the other ingredients. When your guests have finished, take a picture of each individual plate, and post the creations on a social media site. Tag them as an opening event for a progressive art installation opening called: Archaic Revival: Culinary and Medicinal Explorations of the Foodstuffs of the Post-Post-Modern-Hunter/Gatherer.

Finally, for the third course, prepare a meal of your own choosing that comes from a specific cultural/ethnic cooking tradition. Italian or Greek, Chinese or Japanese, Mexican, Mongolian or even Malagasy; whatever tickles your fancy. After choosing a dish, make sure that you are able to get most of the traditional ingredients from the region it comes from. Have the meal cooking when your guests arrive so that the aroma saturates the air.

Now, in addition to preparing this unique meal, it will also be your job to fabricate a story about your great-grandmother whose recipe it was. Make sure that you include a pedigree of the recipe's origin by divulging a snippet or two about your great grandmother's life in the "old country," and a description of the town, village or region that the recipe came from. Be utterly fictitious and fallacious in your story's details, but relish the telling of the story as much as the meal you are about to serve. If you are really brave, you will pick an ethnicity that is geographically far away from your own (did I ever tell you the story of my great grandmother from the Congo...or France...or Korea?)

Finally, as you sit down with your friends, deeply savor and reflect on the truth that food is always better shared, and that the home and hearth is the heart of all communal relations. That, my friends, is good medicine

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Act III - Scene II: Night Round - The Professor

Doctor: I see we in the West have been blinded by our cult of materialism. We have become so focused on substance that we have negatively biased our view towards the importance of the immaterial or non-substantive. Quality, relationship, difference, circularity, pattern: the essence supportive of an ecology-of- mind; all are lost when viewed through the quantitative processes of a reductionist lens. Like form and function, or structure and process, body and mind form a seamless recursive loop of mutual support and nurturing. Once more we find the snake eating its own tail.

Professor: Yes, I am now prepared to swallow what you are saying; yet Descartes' ghost may be choking on it, I'm afraid. This being said, it seems to me that you are still of two minds in all of this and that; knowing is one thing, and not-knowing another, but a mix of the two will get us nothing more than a muddle, and possibly far worse. I should also warn you before we go further that I don't actually know the way out of this particular mess we find ourselves in. Neither do I care to, for I suspect the answer that both of us are striving for is one of a highly different sort. With that out in the light of day, let us deal with this most pertinent issue of your two minds. Tell me, doctor, what do you know of hemispheric neurology?

Doctor: In regards to its form or function?

Professor: Ah well done, it appears I took that one square on the chin. Please continue. Feel free to pontificate on the matter: grey, white or otherwise.

Doctor: The brain is divided into two hemispheres: left and right, joined by a bridge of dense neurons known as the corpus callosum. By and large, the left hemisphere controls the operation of the right side of the body and the right hemisphere the left. We see the consequence of this with the deficits residual in many common forms of stroke and brain injury. In terms of neuro-psychological function, each hemisphere appears to show both specialization and lateralization. Although there are obvious divisions of function and notable differences in form between the hemispheres, it is their combined contribution that leads to our full subjective experiences of cognition and behavior. That being stated, hemispheric difference appears to be supported by both experimentation and case study. For example, the right hemisphere shows a predilection towards a holistic perspective. Its phenomenological experience is of dynamism and openness. It demonstrates integration and sees the body as a whole. It is contextual. It is the home to vividness, fullness, and the subjectivity of embodied experience. It has a penchant for the natural world and living things, and its sense of self is expanded in relation to such things. It deals in the metaphoric and understands the implicit meaning of things. Its attention is ultimately broad, sustained, open, and vigilant.

Professor: And of the left?

Doctor: The left hemisphere, on the other hand, disassembles, dissects, and disembodies; parsing the world into components that may be manipulated. It prefers the mechanical over the living. It is a user of tools. The attention of the left is narrow, sharp, and focused. It pays attention to details, and to the details of details. It values precision and explanatory clarity. It deals with the explicit. It relies on and generates denotative language. Hence, the phenomenological world of the left is composed of representations and abstractions created through its words, symbols, and maps derived from lived experience. It objectifies. Consequently, the world of the left is a virtual one in which the sense of self is separate, fixed, or closed with its particular view of reality colored similarly. That said, the brain is an incredibly complex organ, and the brevity of my explanation does it a great injustice.

Professor: Not to mind, your explanation is more than sufficient for the continuation of our circumferential line of thought, and your brevity is appreciated. Now your typing of the hemispheres provides us a perfect segue back to typing of a different sort, namely that of the logical. The role of logical types, if you remember, is to track and clarify orders of abstraction. This typing was never meant to be a truly linear hierarchy, as the membership of each order is embedded in the order above, like a set of Chinese boxes or Russian dolls. This nesting is inherently recursive you see. That being said, it is apparent that the task of logical typing belongs to the domain of the left for this is where the creating and ordering of abstractions is to be found.

Doctor: And the role of the right hemisphere?

Professor: From the perspective of the right, there is no scaffolding to support a structure of logical types, and therefore they fall like a house of cards. This collapsing or imploding of logical types becomes the source of both our creativity and our madness. The right is the domain of metaphors and dreams, and metaphors of metaphors, and dreams within dreams, although the naming of these things in that way is only of concern to the left hemisphere. To the right hemisphere, all phenomena are experienced in their essential suchness, with the left-sided convention of naming remaining at best irrelevant, if not completely incomprehensible to the right.

Doctor: What you are saying sounds very abstract; my left hemisphere is not following your line of thought.

Professor: I must give some words of admonition towards your last statement. Although as counter-intuitive as it might sound, the right hemisphere deals in concreteness and the left in abstraction. Despite what we think about artists with their abstractions and logicians with their concreteness, the inverse is actually true. And as for lines of thoughts, linearity is the specialty of the left, while the right recognizes that it is circles that ultimately create closure for the nervous system.

Doctor: Huh?

Professor: Go back and revise your understanding of logical types. They are a recursive, nested hierarchy of abstraction. They are names and names of names, but never the thing named. This ability to abstract is the domain of the left. The "like" or "as" of simile, the interpretative aspects of dreams, the causal sequencing of events in time, and the division of self and other, are mostly functions of the left and remain largely meaningless to the right. To the right however, everything is experienced directly as such and remains largely undifferentiated: situated in our present moment of experience. In our dreams a butterfly is a butterfly, a dragon a dragon; from the perspective of the right, the former is not real and the latter imagined. In other words, a cigar is concretely a cigar in the right, until the left gets hold of it and abstracts it! That reminds me of the definition of a Freudian slip.

Doctor: Which is?

Professor: When you say one thing, but mean your mother...

Doctor: Ugh...Pardon, my distraction with abstraction, but where is this conversation headed?

Professor: I don't very well know, but let's consider for a moment the relationship between psychotic phenomenology and western religious experience to further enlighten us.

Doctor: That sounds like a real jump in thought.

Professor: Not if you look for the patterns that connect. Let us start by looking at the historical Christian theological dispute around the true nature of communion. On one hand, we have the Protestants who will tell you that the bread "is like" the body of Christ, and the wine "is like" his blood; very left-brained you see. Conversely, the Catholics on the other hand will tell you that through the mystery of Communion that the bread "is" the body, and the wine "is" the blood. Here we see the left-right divide exemplified. In the left, we see separation into self and other via simile, while the right embraces union through subjective experience and metaphor. This right-brain immersion (a baptism of a different sort) is a useful skill for the religious adept, for it allows individuals or communities of believers to partake in the mysteries of their faith without the destructive scrutiny of their left-brain criticism.

Doctor: I see that the left hemisphere gives us an intellectual understanding of our religious belief, and the right an experiential or revelatory dimension of faith. I fail however to see how we make the association to psychosis.

Professor: For a psychotic individual, the "Catholic" or metaphoric mode of experience, rather than being applied judiciously to their experience of the world, becomes universal to their thought process. They regularly collapse their logical types, thereby creating a state of constant paradox. They bind themselves in double binds. For someone in the throes of psychosis, the picture of the hamburger is the hamburger, which is the cow, which is their own flesh, and they not only have to contend with the stress of their self-cannibalism as they eat the restaurant's printed menu, but they feel guilty for the need to use salt, if you see what I am getting at. Alternatively stated, the dreamer sees the wild horses of paradox, the artist rides them, the visionary tames them, but the psychotic carries the whole herd on his back. Even more so than the Catholics, peoples in the horrific throws of unrelenting madness are rather passionate about the absoluteness of their metaphors.89

Doctor: Sounds like the meaningless babble of madness.

Professor: No, despite the height of this tower, there is no shortage of meaning in a psychotic's paradoxical poetics.

Doctor: Can you give me a concrete example?

Professor: I am happy to oblige a journey into the wonderland of your choosing by saying: "My dear Maryland whose I's are blind and cannot sea. With tears he falls into the hole and not the whole me thinks; an Oedipus, he roams his barren landscape; his mother lays scarred and bleeding."

Doctor: And what is that supposed to mean?

Professor: I don't very well know, yet it is vitally important to your salvation I assure you.

Doctor: You are sure to anger the religious folk with these inflammatory statements.

Professor: Yes, inflammation is the source of many a problem, health or otherwise. Yet I don't see my thoughts on the matter as problematic. I have simply posed that, from a religious perspective, there are two ways of viewing and interpreting religious experience: from the concrete left, and the metaphorical right. Each is equally valid in its own way, and together both views work to create a unity of experience. Furthermore I have, in my comparison to religious experience, created sympathy by showing that psychosis is but part of the continuum of the shared human experience; in this case as it relates to both sacred and aesthetic existential modes. In this way, my comments are meant to unify schisms by highlighting our lived commonalties.

Doctor: Speaking of salvation: tell me more about religion as it relates to science. Is religion or the spiritual largely a right-brain endeavor, and science a left-brain pursuit?

Professor: That is a good question. Certainly religion's iconography, visions, parable, metaphor, and prophetic experience are grounded fundamentally in the right hemisphere. Nevertheless, religious laws, ordinances, and moral teachings are in general the domain of the left. My feeling is that a unity of experience of both domains is required if we are to obtain an understanding of the sacred; one extreme leads to fundamentalism, the other to madness. A study of mythology reminds us that for every Apollo there needs be a Dionysius; the prosaic balanced by the poetic. That being said, there must be a separation between the left and right; between state and religion if you will. For the light of left-brained consciousness shall surely destroy the mysteries of the fertile right, if allowed to dominate. As Christ said in parable: "Let not your left hand know what your right hand does."

Doctor: Fascinating, I have always thought of religion as opposite to science. Yet, by implication, if religion is a balance between the concrete and abstract, then so should be our science: two branches of the same tree.

Professor: Let me ask you, as scientist and a physician, do you view Life as sacred?

Doctor: Of course, but where are you going with that question?

Professor: I am not entirely sure, and for certain, I tread lightly around such explanatory principles.

Doctor: Explanatory principles?

Professor: Well, yes. From time to time in academia we are confronted with concepts whose inner workings we know nothing about. Not wanting to profess our collective ignorance, we all agree to stop explaining the thing in question beyond a certain point, by scientific convention. Of course, all explanatory principles are names, but the name is merely a black-box (to use an engineering metaphor) that identifies the concept of interest, but in truth reveals nothing of its inner workings. That being said, you should minimize your use of explanatory principles to clarify other explanatory principles, or else you will have a lot of talk about absolutely nothing at all!

Doctor: So an explanatory principle explains nothing?

Professor: That's correct, and that is how we scientists like them. Nevertheless, they are useful in letting us talk around a subject and help us organize a number of phenomena that appear to be co-related.

Doctor: So the sacred is an explanatory principle?

Professor: Yes, as are other slippery or sticky words such as "wholeness," "health," "love," "beauty," and the like. For example, in trying to explain "sacred" we might say that it refers to that which is holy; yet if asked to define "holy" we will see that it pertains to that which is sacred. It is a self-referential explanation and a very tight loop, indeed.

Doctor: As scientists, how do we investigate an explanatory principle?

Professor: You are not listening it would seem. We do not investigate explanatory principles. They are conveniences: the threads that hold our moth-eaten conceptualizations together. When they wear out, we replace them. Yesterday gravity...tomorrow dark energy. Explanatory principals are such fickle things; they will only break your heart in the end.

Doctor: Is the sacred like that?

Professor: Perhaps... it certainly remains a mystery.

Doctor: What is a scientist or a physician to do in these cases?

Professor: Wise up or give up. Although we may be unable to comprehend certain explanatory principles directly, we can examine the processes of how we engage with such things. In this way, epistemology becomes both a scientific inquiry as well as a philosophical pursuit.

Doctor: How does one begin to examine the processes of the sacred in our lives?

Professor: I hesitate to do this, but for the sake of our discussion on the sacred, I will need to evoke the further explanatory principles of wholeness and consciousness. I am loath to do so as it strikes me as overly messy. But it can't be helped, and Ockham's ghost is no doubt cutting himself with that razor of his this very moment.

Doctor: Three black boxes; the sacred, wholeness, and consciousness. Sound like a shell game to me. So how do wholeness and consciousness relate to the sacred?

Professor: Do not confuse mystery with nothingness. Remember our discussion about mind, minds, or Mind. As we can now see, this abstraction is the product of left-sided logical typing. From the perspective of the right, there exists only the experience of unbroken mind as a total relational ecology. The right dwells in the eternal present of experience and does not concern itself with the re-constitution, re-ordering, or remembering of difference. Why is this difference of fundamental hemispheric perspectives important to appreciate? Wholeness by definition transcends any label that tries to contain it. This is intrinsically understood by the right, yet remains a source of perpetual frustration or outright denial for the left. If we remember the unidirectional arrow of abstraction (unlike arrows of recursion) from our theory of logical types, the whole cannot be contained by any part of its own membership. Wholeness is trans-categorical in that it holds all other possible categories or orders, but is held by none. Paradoxically then, wholeness can simultaneously be viewed and experienced as both abstract and concrete; as both the ultimate category of abstraction and the concrete summative whole of all things and all thought. That being said, the state of wholeness necessarily transcends the mind that conceives it, and therefore must remain forever an explanatory principle.

Doctor: And consciousness?

Professor: Consciousness remains only a partial arc.

Doctor: What?

Professor: Well, as scientists, we don't really have a good handle on what consciousness is, or its role in an evolutionary sense. For that matter, we only know consciousness exists because we are conscious of our consciousness; in other words reflexively self-conscious. For this reason, I submit that consciousness remains only an explanatory principal; another black box. Nevertheless, some observations may be forwarded concerning the effect of human consciousness on the greater eco-systemic mind, and its impact on the overall health of our present world.

Doctor: Health is always one of my utmost concerns, but I should remind you that I am a physician and not an ecologist.

Professor: With your developing understanding of mind, you will begin to realize that all physicians are ecologists, and all ecologists are physicians. Now where were we... ah yes, consciousness. When we look at the total circle of mind, whether conceived as individual mind or the greater mind of nature, we see that consciousness forms only a very small part of that circle; a partial arc of the whole. It is because of this that the mental process of consciousness is presently on a runaway trajectory; an out-of-control feed-forward loop that has resulted in numerous social and ecological travesties. The problem with the limited perspective, or partial arc, afforded to us by consciousness is that it completely biases our perception of our relation to the whole. The partial arc, forming consciousness, is of such a limited span in the context of the whole metaphorical circumference of mind that it appears to us as a straight line. Through this trickery of conscious thought, we become intellectually convinced of such concepts as linear causality, object as different from subject, and a whole host of other such nonsense that is not applicable to a complex living world. Worse still, these illusions of separateness blind us to the systemic wisdom available within the whole; a wisdom that is the evolutionary birthright of all living creatures.

Doctor: But how can consciousness truly be such a bad thing? It is the source of our understanding of ourselves as Homo sapiens, and in many ways seems to intersect with our understanding of the sacred. For example, in the spiritual market place I often hear such things as the importance of our "spiritual consciousness" or our "collective evolution to a higher consciousness" or "becoming eco-conscious" or the "development of a global consciousness," and the like.

Professor: Poppycock! That is exactly the problem with conscious thought; you can spin any drivel into some pseudo-meaningful babble, and convince yourself that it has merit. It is feedback of the worst kind resulting in some pathologically closed and vicious loop. Understanding, you must understand, is not predicated on consciousness. Mind at all levels is ripe with perception and awareness, and has the ability to act on the information garnered through these processes, none of which is dependent on consciousness. Arguably, most systemic activity runs efficiently and efficaciously because of the very fact that most operations are unconscious. Despite our cultural penchant for pairing consciousness with the sacred, consciousness with its denotative language and left-brain bias has often shown itself to be the enemy of the sacred. The root of profanity has always resided in the conscious mind. Look at Adam and Eve; they are still, despite all their planning and cajoling, trying to get back into Eden's garden!

Doctor: I must say, I am conscious of the fact that you are purporting an anti-intellectual viewpoint, and this makes me somewhat wary of your assertions.

Professor: Descartes' ghost has reared his ugly head once again, I am afraid. He thinks, therefore, he is! No doubt, that would be a typical response for a conscious mind on the run, but let's try to think about the reality of mental process as it truly operates (although I realize this is a contradictory statement in light of what I am professing). Freud brought to our collective awareness the vast unconscious processes at work through the internal operations and computations of mind. Certainly, his views about these processes are open to debate. Unlike Freud however, I would argue that the individual unconscious, rather than a source of destructive impulse, is a wellspring of understanding which acts as an interface with greater subsystems of a societal or ecological nature. The "Royal Road" to the unconscious is our path into wisdom, and provides the way to our collective salvation.

Doctor: Yet the unconscious is exactly that: un-conscious. It lies beyond our ability to know, and I fail to see how such an anti-knowledge position can be useful to us, particularly as it relates to science. Certainly our conscious advances as a culture and a species must have some intrinsic worth.

Professor: Let me give you an example to help explain my position. Tell me, what was it like when you first learned to drive a car?

Doctor: Well, it was very awkward to say the least. Stopping, starting, stalling, grinding gears, popping clutches, and the incessant rebukes from my near apoplectic father.

Professor: I well understand how he might have felt! Anyway, how is your driving now?

Doctor: I don't know, I haven't really thought about it in years.

Professor: My point exactly! When you drove under the influence of conscious control, you were a terrible driver, but with practice and increased proficiency your efforts became unconscious. Now when you drive, you have perception and awareness, but no overt consciousness acting as overseer of the act. As I am sure you will agree, many actions just work better that way. The majority of life in truth operates through the deep not-knowing of mind. Conscious knowing, although admittedly not without its value, often short-circuits these greater unconscious mental processes, and at its worst undermines or destroys them. Most things are just never meant to be reflectively known, and by evolutionary design remain beyond conscious understanding.

Doctor: Despite your talk of partial arcs, linear misperceptions, and the efficiency underlying the workings of the unconscious, I still fail to fully understand the basis for your obvious passionate distrust of the conscious mind.

Professor: Two words: intention and purposefulness.

Doctor: I intend, therefore I purpose?

Professor: It goes back again to the idea of partial arcs. When we are fooled into thinking that our actions and their outcomes are linear, and hence predictable, we undermine the complex feedbacks and checks and balances woven into either the individual, societal, or natural ecologies. As a result, our intended purposes or good intentions often have a multitude of unintended consequences: some good, often bad, and some catastrophic. We see in the Cartesian legacy of Cogito ergo sum the formation of our consciousness bias. This, along with its unholy offspring of reductionism, positivism, and materialism, has created in us a disconnection from the natural mind, and consequently a disenchantment with the natural world. The results of which we are now seeing in terms of climate change, global warming, environmental degradation, as well as a whole host of other social and societal ills on both local and global levels. This path has led us to an entirely different order of madness. If our great oceans, forests, and wetlands have been driven towards ecological sickness and insanity, how can we hope to avoid the same fate? We are, ultimately, of one mind and one body. As Plato so prophetically noted, "The part can never be well unless the whole is well." If we continue to impoverish the world with our limited ideas born of unchecked conscious thought, how do we hope to avoid the same poverty? We kicked ourselves out of Eden. God would never be so wicked to do this, and that brings us back to the sacred once more.

Doctor: The dis-ease of the world is connected to the disease of my patients?

Professor: As well as the disease of your own body and mind. What is true for the mother is also true for her children.

Doctor: Then how do I become the doctor that my patients need? These issues seem so far beyond my ability to comprehend, and so far removed from the walls of my office, that I feel paralyzed. What should I do?

Professor: Under your guise of physician, become a secret shaman.

Doctor: A secret shaman?

Professor: A secret sacred shaman of the greater eco-mind. Act to know, do not know to act. Live and work at the margins and the edges. Transform the transformations. That is all you need to know.

Doctor: Is the picture ruined and beyond recovery?

Professor: I think we are just in the muddled middle.

Doctor: Will this story have a good ending?

Professor: Ask the snake how tasty its tale is.

Doctor: How do we fix this mess?

Professor: Epistemologically, you are posing the wrong question. Fixing, helping, saving: these are purposeful acts rife with intentionality. I think it is wrong thinking that the solution will come from the same source that initiated the problem. More purposefulness will not save us from the consequences of our purposefulness. Our intentionality, good or otherwise, has already delivered us to hell. No, I think our answers now must come from the wisdom of wholeness: a dose of truly holistic medicine for you, your patients, and the planet alike.

Doctor: What is the answer then? It would appear that it is five minutes to midnight.

Professor: I don't know, and even if I did, I would be averse to telling. I know my limits as a scientist. It is time to consult the artists, poets, and dreamers of our world, for they continue to see beauty when all the rest of us are jaded by the ugliness of our own making.

Doctor: And what of the art of medicine?

Professor: Look to the "good medicine" of the indigenous spirit. The answer lies in the recognition of the beauty in and of all things, and from the passionate engagement of aesthetic pursuits. Always be mindful of the patterns born of patterns, for these are the patterns that connect. By this I mean; be painted and don't paint; be sung and don't sing; be danced and don't dance. Let your choreography spring forth from the depth of your relationships. Become the very medicine you seek to practice. If you do this, I have no doubt that within the movement and stillness generated by your artistry, you will once again be led home to the sacred, oh prodigal son.

Doctor: I believe I am ready for that consult now.

Professor: Yes, I believe you are. Let's tackle it together, shall we? From the two we derive the one, if you now get my meaning.

Doctor: You wish for me to comment on the greater patterns that connect type 2 diabetes and climate change, do you?

Professor: Remember, when addressing questions relating to the patterns that connect, it is less important where you start then to just start. Jump freely in and immerse yourself!

Doctor: In looking at type 2 diabetes, why don't we begin from the structure of logical types?

Professor: Sounds very reasonable, I would think.

Doctor: Type 2 diabetes, as defined by its hyperglycemia or high serum sugars, along with obesity, hypertension, and high cholesterol, are members of a class of diseases that form a syndrome referred to in medicine as "metabolic syndrome". The disorders of metabolic syndrome appear to be a product of insulin resistance and a hyper-insulin production. Emerging evidence also suggests a further relationship between many of the chronic disease processes and the hyper-insulin state, with its pathological processes of systemic inflammation. Nevertheless, for the sake of discussion, let's refer only to the logical typing of this sequence as ((((type 2 diabetes) metabolic syndrome) hyper-insulin state) inflammation).

Professor: Very Good. We are all well acquainted with the effect of diabetes and the like on the body, but what do you have to say about it in light of your new understanding of minds and mental processes?

Doctor: Good question. At present, it would seem that there is a dissonance within the patterns that connects various scales of human learning. We live in a modern culture that promotes the consumption of high levels of carbohydrates in the diet. This is a relatively recent phenomenon when we consider that the most radical changes in our food production, processing, and distribution occurred over only the last fifty of our 10 000 years of agriculture. From an evolutionary and adaptive perspective these are insignificant timeframes. There are a variety of explanations for this change in our dietary habits, most of which appear purposeful and short-sighted in light of the partial arc of understanding they are predicated on. Historically, grain production promised a predictable source of calories ensuring consistent nourishment and freeing up time for other cultural pursuits. Much later, there was the convenience of processed food, the profit-driven motives of corporations, mass agricultural production using fossil fuels, etcetera. This newly-adopted individual and cultural dietary pattern, this learned behavior, is at odds with our evolutionary legacy. Our modern diet presents to us a clash of logical types of different orders: namely that of learning and evolution. Consequently, our cultural predilections are at odds with our evolutionary imperatives, all at the cost of our individual and collective health and well-being.

Professor: In terms of the human diet, what would our collective evolutionary process mandate, then?

Doctor: From an evolutionary medicine perspective, the human diet was primarily based on meat protein, animal fat, and the fiber from wild plants. Sources of carbohydrates were limited and seasonal, and would have included wild tubers, root plants, wild rice, grains, berries, fruits, and wild honey when available. Our individual and cultural body/minds have co-evolved with the greater ecological body/mind to adapt to this manner of eating.

Professor: So there is a conflict between the two great mental processes of individual and cultural learning, in a modern sense, and evolution.

Doctor: Yes, a conflict that has not been without casualties. The conflict has arisen from the clash between conscious thought at the individual or cultural level, and the unconscious wisdom contained within the systemic mind. The limited view of consciousness has resulted in an imbalance in both the individual body and the eco-systemic body. This disruption to evolutionary norms has resulted in a host of individual diseases present, and on another systemic level, has contributed to dysfunction in our global ecology.

Professor: Although I recognize that the recursive relationships that connect the individual to his environment are vast, please share some of the patterns of connection between the individual and the planetary ecology by way of example.

Doctor: Certainly. Let's start with an assumption that we can take two approaches to treating diabetes and the like. One would be the symptomatic approach. This is done through the promotion of lifestyle changes (largely ignorant of individual context), or through our not insignificant pharmacological armamentarium, by which we wage battle with physiologic abnormalities in the name of endpoints and evidence-based outcomes. In contrast to this reductionist road, we could opt to take a systemic approach using our evolutionary advantage: a diet congruent with the ancient rhythms and relations of our ancestors and the land which birthed them. The question is; what form would this take in returning us to balanced functioning?

Professor: Let us act so we may know!

Doctor: Well, we obviously can't go back to being hunter-gathers.

Professor: It would be foolish to even suggest such an absurdity.

Doctor: Nor can we continue to rely on the status quo for answers.

Professor: Shit in; shit out, as they say.

Doctor: And therein lays the core of the problem as well as our solution: Feces!

Professor: Quite right.

Doctor: "As above, so below."

Professor: "As in Heaven, so on earth."

Doctor: "As within, so without."

Professor: Such is the natural order of things.

Doctor: The reductionist would have us believe otherwise, framing diabetes as something limited to the human condition. This type of thinking is manure of a different order, and not the fertile organic matter we are searching out. In our search for health, we are interested in growth, not decay: transformation, not loss.

Professor: Our arrogance knows no bounds it would seem.

Doctor: Systemic wisdom reminds us otherwise. Both the root and answer to our diabetic problem lays in mending the webs of evolutionary relationship.

Professor: Sounds very reasonable. Your thinking engenders a visceral response within. I have a good gut-feeling.

Doctor: And the viscera, with its enteric brain, is where we shall start our discussion: deep within the recesses of our individual bowels.

Professor: A dark and mysterious tale no doubt.

Doctor: Yes, but a rich fruitful darkness full of wonder, for just as our bowels are at the core of our being they also support the core of our health. They too have a mind in all of this. The abiotic wars of the Pasteurian age had many successes, but the magnitude of its casualties, and long-term consequences and aftermath, are now becoming clearer to us. Antibiotics, food preservatives, and processed high-carbohydrate/low-fiber food have been anything but pro-biotic. The consequence of this culinary apocalypse is a ravished and barren landscape in our gut. What was originally a diverse rainforest of intestinal flora has been reduced to the equivalent of monocultures in our farmers' fields. Our gut diversity was a genetic treasure unbeknownst to us. It functioned to nourish and protect us, based not on principles of power, but of balance. We in turn provide internal ecological niches and environments allowing a multitude of bacterial species to survive and thrive. Together with our microbiota, we formed a veritable super-organism: a complex ecology where there is more of the "other" than of "ourselves" in terms of genetic wealth and sheer cellular quantity. In this context our ancient and communal prokaryotic brethren, with their promiscuous genomes, are able to provide a rapidity of adaption that our composite body of newer eukaryotescould never hope to achieve.

Professor: And what has been the consequence of this inner war?

Doctor: Our victories in the infectious realm have come at a great cost. The acute has been replaced with the chronic. Infectious disease has been replaced by heart disease, cancer, diabetes, and other inflammatory conditions. And even our hard-won gains in the war against infection are tenuous victories at best, as new, virulent, antibiotic-resistant pathogens emerge. The battle has left the territory ravished, leaky, impoverished, and inflamed: the rot of decay left to putrefy in the fields.

Professor: Where does our hope lay?

Doctor: What is required is a post-Pasteurian revolution. Pre-biotics, pro-biotics, and ferments; more than a truce, a peace and alliance with our micro-biota is now essential. To sustain such an effort we need to nourish this lasting and ancient evolutionary relationship of ours. This brings us back full circle to shit of a different, but not unrelated sort: that is to say of cows and their manure, and our two species' shared concern in a grain-based diet that is out of step with Mother Earth and Father Time.

Professor: You are not just chewing your cud. Let the revolution commence! I am hungry for meaningful change. There are rumblings among the masses.

Doctor: If we take just a small step backwards in time, we see in the pre-colonial world no shortage of ruminants, whether they be bison in North America or antelope on the great African plains. Throughout pre-history there has been a great co-evolution among bovids, hominids, soil, wild grasses, and the climate, not to mention a host of other organisms and physical factors, all embedded in a deep and balanced relational ecology.

Professor: The hindsight of history is keen. As we know, the Europeans arrived here in North America, and with their thoughts of Manifest Destiny, ruined the whole thing by driving the plains buffalo to needless extinction.

Doctor: Yes, and that was a true tragedy which we are still reeling from today, but luckily Mother Nature is more resilient than that. Indeed, although the wild Great Plains buffalo are almost gone, the idea of the ruminating buffalo is still immanent within the mind of the natural world. What remains important from an epistemological perspective is not the specific components of the ecological organization; rather it is the relational positions they hold in their roles, contributing towards maintaining the organizational whole. Components can be switched as long as the relational organization remains invariant, thus supporting the system's continued integrity. Although the bison are fast disappearing from the physical ecology, the thought of ruminant-in relationship within-the evolutionary ecology, is still held within the ecology-of- ideas as part of a deep pattern within the evolutionary mind. This seed idea within the ecological organization remains dormant until suitable conditions are available for its germination, at which point new components in relationship to the present context may manifest. As long as the essential organizational foundation supporting the mental ecology's systemic relationships is maintained, the physical forms may evolve, or be subject to substitution. In the modern world this substitution could be the domesticated cow-in relationship within-the evolutionary /cultural ecology acting as a surrogate and functional substitute for the deep evolutionary ideal of the wild ruminant in nature, with its assorted co-evolutionary roles.

Professor: Well and dandy in theory, however, when I look into the world, I see very little of what you are alluding to. The free-roaming buffalo have been replaced by cattle on feedlots with their manure piles reaching (and stinking) to high heaven. The land has been all but depleted of its rich soils, the water has been tainted, and the farm machines continue to belch out industrial smog.

Doctor: I concur the situation is very grave. The dire nature of external environmental destruction is obvious, and the internal environmental destruction of our bodies increasingly so, as we are exposed to herbicides, pesticides, antibiotics, heavy metals, hormones, harmful bacteria, and all the other untold horrors of the industrial food system. We say something is safe if it doesn't kill us upon consumption. If it gives cancer, arthritis or diabetes in 20 to 30 years, so be it. Yet, I believe there are seeds of hope that have been planted, and are starting to sprout.

Professor: Seeds that will become mighty oaks no doubt!

Doctor: Or resilient willows, perhaps...

Professor: How, then, do we make this buffalo-jump in thought?

Doctor: The answer still lies in the herd mentality. It is true that the great herds of buffalo, the prairie grasses, and the hunter-gatherers of legend are gone, but domesticated ruminates, grasses, and organic farmers lay in waiting to keep the evolutionary faith. We need to re-think our farming based on the deep evolutionary blueprint. A form of farming needs to emerge forth, grown from a natural epistemology and rooted in the patterns that connect: a paradigm of agri-culture based in natural aesthetics, rather than modern industrial pragmatics.

Professor: Time to round things up, and bring'em on home.

Doctor: Alright, cows, like humans, have a natural diet that is a product of their evolutionary relationship with their environment. Our choice of entrees may be different, but we need to understand that both humans and cows are eating from the same co-evolutionary menu. Cattle (like their bison predecessors) have evolved perfectly to consume grass, while grass has co-evolved for consumption, each to their mutual survival benefit. Of course, this evolutionary reciprocity is much more complex than just a two-way relationship, but it is a useful simplification to aid our understanding. So in this relationship, we note that the consistent grazing of pasture maintains grass in its growth cycle. This results in the sequestration of more carbon which contributes to climate stability and a reduction in net greenhouse gasses. In this manner soil is continually built and fertility increased. Beyond sustainability, the relationship between ruminants and grasses is a generative one.

Professor: What is the co-evolutionary role of humans in this perennial cycle?

Doctor: Humans are apex predators, like wolves. Hunting created fitness pressures on the bison by selecting out the old, weak, and infirm from the herds, while also maintaining diversity in the prairie grass ecology. The threat of predation forced the herds to roam close and circle together for protection. Consequently, they were encouraged to eat all of the grasses in a patch of prairie, and not just the best-tasting. As a result, no single grass species became dominant, and over time diversity naturally prevailed.

Professor: What, then, is the equivalent apex predator in the modern farming system?

Doctor: Remember, it is not the form of the component that needs to be maintained but the organizational relationship. In the modern world of ecological farming the wolves are replaced by portable electric fences.

Professor: Shocking! How can that be?

Doctor: It is a simple and elegant solution. Small daily paddocks constructed with portable electric fences ensure a small enough enclosure that the cattle will graze down all of the grass within the paddock. The next day the fence moves, forming a new paddock, and treating the cattle to greener pastures.

Professor: I see. The bite of the fence serves the same purpose as the nip of a wolf. Both tightly corral the beasts, ensuring the continued diversity of the grasses: beautiful!

Doctor: Of course, the keener our study of pattern and the deeper our immersion into the natural world, the better our understanding of the connective organizations and ecologies that support it. For example, farmers following the above-mentioned design will often follow the grazing cattle with chickens three days later, mimicking the role of wild prairie birds who feast on the emerging fly larva and thus control the pest population. Their scratching also spreads manure and aerates the ground, enriching soil and grass. At the same time, we cultivate access to a sustainable source of protein that we have evolved to eat just as our hunter-gather forefathers did during their time roaming on the Great Plains. By changing our productive and consumptive habits, we help to heal the environment and ourselves: aligning our learning and associated practices with these deep evolutionary organizational principles.

Professor: And of the pattern that connects?

Doctor: The problems arise (both externally in the world, and internally in the gut) when we try to feed cows or humans grain grown using fossil fuels. The tragic result of industrial grain production is the loss of the inherent feedback loops present in the eco-systemic mind. This has resulted in the loss of farming on local scales, and as a result, organic waste concentration, water contamination, aquifer and soil depletion, and an increased dependency on the fossil-fuel economy. Furthermore, grain feeding upsets the natural gut ecology of the cow, culminating in abnormal bacterial growth in the form of pathogenic e-coli (including 0157:H7), with all of its inherent health risks to human populations. And this same grain dependence, in the form of large quantities of processed carbohydrates, has analogous effects on humans, devastating our own gut health. Neither cow nor man has evolved to consume large quantities of grain, and neither has our shared ecology, judging by the present wide-spread agriculturally-related environmental atrocities. This sweet-tooth of ours is unsustainable.

Professor: And in summation...

Doctors: Heal the co-evolutionary relationships available to us using a modern form for an ancient function. My prescription is as follows:

 Agricultural models based on the local, integrated production of grass-pastured cattle and other livestock.

 Evolutionary prudent dietary changes for both humans and livestock based on the abundant production flowing from diverse methods of pattern-driven natural farming designed to support our microbiota, thereby promoting gut function and overall health.

 The rediscovery of the cultural value and wisdom to be found in the traditional culinary arts and traditions of the world: using whole foods to align cultural learning and environmental evolution.

 An elevated social status for farmers that is equal to or greater than that of physicians. Mini-van moms should be bragging about their daughter or son the farmer, and trade in soccer for 4-H.

Professor: Wonderful! A prescriptive design (rather than a prescriptive measure) that reduces the societal burden of diabetes and other associated diseases, mitigates global warming and climate change, regenerates of our soil fertility, rekindles community relationships centered around the family farm, and culturally embodies a new ecology-of -mind. It seems that you are beginning to understand the pattern that connects.

Doctor: Thank you so very much. Our time together has been transformational, but my morning at the office is coming quickly. How can I possibly integrate all of this knowing, and more importantly, all of this not-knowing into my care?

Professor: Prescribe a garden.

Doctor: And this will change the world?

Professor: Who's to say about these things? It might change your patients, but it will certainly change you.

And with this, he turns towards the painting that we have completed unconsciously. The flow and rhythm of the entirety of our conversation is captured with its lines: the passion of our dialogue revealed in the vibrancy of its colors. Just looking at our painting, I began to feel better. It contains a certain intangible rightness. The Professor reaches out, lifts the painting from the canvas and hands it to me. He says, "Hang it up in your office beside your medical degree." Then he passes me the dead lobster. "I have no doubt you'll cook something tasty. Just make sure you eat it whole." He then looks at me with his beneficent smile, his eyes revealing a touch of melancholy, or perhaps a deep sadness, and says, "Your five minutes are up". The temple bell starts to ring, and, carried on its rich tones, I find myself transported back into the darkness of slumber.

...I awake with a start. The time on my clock is 3:05. "Remarkable" I say to myself, and without another thought, I drift again into dreamless sleep.

Back to the Table of Contents
Act III - Scene III: Day Round - Performance

Historically, orthodox Western medicine, as the dominant cultural modality, has always competed with and been critiqued by alternative medical systems and viewpoints. Through the ages, we have observed a variety of counter-movements to the orthodoxy of medical practice. In its most recent incarnation, we have seen this tension playing out in parallel medical forms encompassed by such terms as alternative, complimentary, mind-body, integrative, and functional medicine. These, of course, all claim to be more holistic or systems-based in their orientation, but are they truly in the deepest of senses? These movements surely represent an impulse, yearning, or movement towards holism. I have partaken in many such approaches, and have found much comfort, healing, and solace in their methods and modalities. I can also say the same for the orthodox medical care that I have received as well. The question remains, however, are they more holistic or systemic in their approach? Do they ultimately embrace and embody complexity? Are they reflective of an epistemology-of-wholeness?

A frequent criticism of Western medicine is its reductionist underpinnings. In the categorization and treatment of disease, it has been accused of not treating the whole person, treating the symptom and not the cause, treating the disease and not the person, and so on. Of course, many alternative systems' claims on holism are rooted in their proposition that they address these perceived shortcomings, and this may indeed be fair to say, as it is a sentiment shared by many of our patients. Before responding to these claims, however, it would hold us in good stead to remind ourselves of what we know about competing epistemologies. Epistemologies are precarious terrains to navigate, and are so entrenched in our cultural mind that it is easy to lose one's way. It is very easy to delude ourselves that a superficial change in cultural form (or the annexing of other cultural forms for that matter) will truly bring about a deep change in our underlying epistemological organization. Whether we are treating symptoms, humors, imbalances, diseases, causes, energies, systems, physical/mental/emotional/spiritual bodies, the whole person (as defined by the practitioner), or any other perceived form of ill-health, we are still diagnosing and purposefully treating some dichotomous division within the locus of the individual. Ultimately, we are trading between reductionist metaphors.

To answer our question of what a holistic medicine could look like, we must turn once again to our elder brothers, the Bushmen. Interestingly, one of the Bushmen's names for us Westerners is the straight-line people, while their moniker for themselves is the people of the circle. Straight lines divide, circles encompass; straight lines go from here to there, while circles are without destination. From the Bushmen's perspective, our cultural medicines, in all of their forms, take the straight line, while Bushmen medicine remains circular and reflective of a true holistic paradigm.

It should be stated upfront, however, that it would be a misconception to say that the Bushmen never discuss potential etiologies of illness within their own cultural lens, whether it be physical cause, relations with the ancestors, issues of the spirit, or the work of sorcery. The thing is that these explanations are neither stable in place or across time, and they do not offer a reified platform or framework for basing their medical or healing expressions. The Bushmen have longed recognized that words are tricky things, and explanations even trickier. If you say something enough times you will eventually believe it to be true. At best, their explanations are constantly changing metaphors appropriate for myth or storytelling within the specific context of the moment.

I would like you to close your eyes, and for a minute think about a typical daily encounter in your own office. Imagine for a moment how it unfolds... Think of your interactions with your patients... Reflect on your discussions, investigations, treatments, plans, and follow-ups...Consider how you define your successes and failures... Let's take that experience and contrast it with a Bushman doctor's work, whether in the healing dance, or in a spontaneous healing encounter. To start, before he attends to anyone else, the Bushman doctor waits to be inspired. At the point that he is filled with the spirit, he waits for a pull or a calling to the recipient of his forthcoming ministrations. He does not know who that will be ahead of time, nor has he planned for what the encounter will entail. With a vibrating body, he lets his trembling hands naturally dowse over the patient. He may shake, sing, and shout in a complex, spontaneous, rhythmic, polyphonic choreography; each encounter different from the last. His attention during this time may be centered in the recipient's body, within his own body, within a shared sense of self, or it may reside in a distant visionary place, or take refuge in a mythic ancestral home in reunion with his forefathers. This interaction continues as he is repeatedly pulled to different individuals within the community until the movement of this improvised and spirited orchestration spontaneously comes to rest.

There are some important things I would like you to note about the Bushmen encounter. First, there is no intention to treat. The spirit arises spontaneously and subsides in the same way. Secondly, the encounter, although following a cultural form, is unique, individualized, and improvised each time. Thirdly, there is no dichotomous parsing of individual and illness. There is no disease to name or treat, only unarticulated pulls, rhythm, movement, and stillness. Fourthly, the perception of the locus of the healing work is not necessarily focal to the patient. Finally, it is a kinesthetic or embodied exchange, rather than a linguistic-rational encounter.

At this point you are no doubt saying to yourself, "This is all very interesting but what does this have to do with medicine and my practice of it?" If you are thinking this, then we are on surely on the right path, and this is a very positive prognostic sign, for if you were to comfortably recognize the Bushmen healing as akin to our own medicine, then we haven't left the confines and limits of our own epistemology. The alien nature of Bushmen healing to our Western mind, accompanied by our discomfort with its ecstatic expressions and sensual wildness, is a good metric for gauging its epistemological otherness. To find a holistic paradigm, we need to be open to the signs and tracks it leaves for us, and fearlessly follow it into the deep dark recesses of the wilderness that awaits.

In exploring the proverbial wild, it is always good to have guides. I was fortunate in this regard that, throughout my life, I've always had experienced and gifted mentors to aid me in my learning. One of the first mentors in my life was my maternal grandfather, James Swann. He was a large man, handsome, full of the Irish Blarney, and the one whom I called my Big Grandpa. I love him dearly, and every year since his passing, the seeds we planted together continue to grow, blossom, and bear fruit in my life. Now in the telling of this story, what you need to know is that my Big Grandpa was a jazz drummer. He spoke the language of jazz and carried its rhythms. It was his singular passion, and it informed his soul. Like jazz, my grandfather embodied improvisation, polyrhythm, and syncopation in his life. He was a complex man, with a complex history. Jazz is a complex art. I bring up my grandfather in the context of this lecture because jazz is an excellent western metaphor for accessing the Bushmen way of healing and may aid us in our understanding of a true medicine of wholeness. This shouldn't be a surprise, as jazz is historically a fusion of African and Western music traditions.

Improvised jazz is a manifestation of the cybernetic dictate, "Act to know, so that you may know to act." Imagine a group of "cool cats", as my grandfather used to say, all with their instruments and nicknames. One of them lays down a groove, and each player with their individual instrument, style, and feeling joins in the improvised play. Sometimes taking the forestage, and at other moments falling into the background, the players, centered in their individual personhood, begin to find the music. Then a magical transformation takes place; they get out of the way and let the music find and play them. No orchestration, no pretense. It is as though they are running through the dark forest at night with reckless abandon, yet not hitting a branch or falling in a hole (although regularly falling into wholes): avoiding all pitfalls of conscious thought. They utilize everything. All of their life experiences are left naked, open, and raw. They surrender their being as an offering so the music will pour forth and, at this crossroads, the players and audience held by the music find themselves in completeness: a collective beating of hearts and breaths present in a grand syncopation. As I said, jazz was my grandfather's passion and soul, as well as his greatest gift to his grandson.

More than jazzing up our medicine though, I truly wonder what a medicine-jazz would look like. When Africa met the West, our music forever changed, and it continues to change in an ever-shifting, responsive, dynamic, and challenging way to the continuing tensions we hold. How could it be any different, for transformation and change is the very nature of jazz. Medicine, at its core, is about witnessing and responding to suffering. How, then, do we learn to sing our collective blues, rather than medicate them away?

Jazz has the instruments of its trade, and medicine has its own set of tools. Yet when we think of jazz, it is so much more than the sum of its instruments, style, and theory. Indeed, most of the great jazz musicians of the past could not even read music, and knew nothing of verbally articulating its theory, except perhaps in a poetic manner. They have always spoken through the music itself. Jazz, at its core, is all about performance, specifically the improvised performance of the ever-present, ever-changing moment. It is an expression of wholeness: musicians, instruments, venue, audience, tradition, possibility, all coming together in a recursive union, with no one entirely sure of the identity of the mysterious conductor. This is the magic of jazz, and at its best the music itself is healing. By that I mean it tunes us, embraces us, and entrains us into a pattern of relational complexity greater than our individual selves.

The idea of tuning is a great metaphor for health. So often we turn to mechanistic, reductionist metaphors when we refer to our own health: "Doctor, please fix me," "I have run out of energy," "He had a nervous breakdown," and "She underwent a surgical repair." As a profession, do we really want to view ourselves as gas station attendants, technicians, or mechanics? I would suggest that other metaphors are more appropriate to who we are as physicians. I personally like the idea of envisioning each other as fine musical instruments of different modes and temperaments, as suggested by my friend and mentor Bradford Keeney, as even the finest of instruments fall out of tune with either use or disuse. The finer the instrument, the more likely it is to lose its tuning. Musicians know this, and this is why they are constantly tuning, even during the course of a performance. As human beings, we are elegant instruments, and constantly falling out of tune. We are already whole; we just occasionally need our tensions adjusted, so we can hear and play the music we are already a part of. Healing is fundamentally an act of re-tuning. However, the musical metaphor is more complex in that we must recognize that our roles within it constantly shift. Do we play an instrument, or are we the instrument to be played? Do we tune an instrument, or are we an instrument to be tuned? Do we conduct the music, or are we conducted in our playing, and if so, how are we being conducted?

When we look at the Bushmen dance or the improvisational jazz tradition, we see similar epistemological roots. Healing is not the goal, nor is a compositional endpoint. The Healing dance and improvised jazz are both goal-less despite what goals we may, in our Western way of observing, project on to them. Effortless, non-purposeful surrender is what unites them. Their pedagogies are not additive, but subtractive. Participants become less and less, rather than more and more, so as to allow wholeness to express and experience itself. By getting out of the way, both the Bushmen healers and the great jazz performers collectively shape-shift, thereby becoming the embodied expression of the mytho-poetic Ouroborous; the primordial manifestation of a great serpent who eternally nourishes itself through the devouring of its very own tail/tale.

How then does medicine find its jazz? How do our actions become soulful in their expression? The heart to this lies, I believe, in the act of performance. If we framed medicine as an improvised performance rather than a clinical practice or science, how would it look?

To explore this idea, let's turn our attention to another metaphor: that of the theater. When we think of a theatrical performance, we realize there are many aspects to a given show. There are the actors, the director, the audience, the script, the set, the venue, various props, technical support, lighting, and so on. There may also be music and dance accompanying the performance. The play could be drawn from many genres, including comedies, tragedies, mysteries, or from any of the other multitudes of theatrical expression. If we add improvisation, that is to say the participant's spontaneous, creative responses in the moment coupled with their inner feelings, past experience, and technical expertise, the play becomes infinitely more complex, even if one takes into account the limitations that the theatrical form places on the performers.

Seen through the eyes of a performer, medicine has become locked in the static form of its own standards. We have confused ourselves into believing that progress lies in the scientific splitting of hairs and the proliferation of information for its own sake. I would argue that, considering the state of our present affairs, our advancing medical knowledge is at times an albatross around our neck, continuing to become heavier and heavier, immobilizing us in our own epistemological inertia.

We must break free from the tyranny of our fossilized rotes and roles (doctor, patient), scripts (disease and diagnosis), sets (exam room or hospital), and props (medicines, surgery, and psychotherapy). I am not suggesting that we do away with all of this; rather, I am proposing that we embrace, and allow ourselves to be embraced by the spirit of improvisation, allowing ourselves more options and greater expression. Improvisation is about utilizing what is available to us in the moment. When we look at the relational complexity of our patients (not to mention the world as a whole), we begin to realize that medicine can take on an infinite number of expressions, each one perfect for the interaction of the moment, never to be exactly repeated. We can laugh when it is right to laugh, cry when it is right to cry, touch when it is right to touch, and be touched when it is right to be touched. Our medicine, surgeries, therapies, and evidenced-based knowledge can still be used appropriately in this context of interaction or engagement. This is not about abandoning what we know and have been trained for. We are still doctors first and foremost. I am a Western-educated physician, and proud of my profession. But the spirit of improvisation frees us to explore other expressions and other equally valid ways of experiencing the world. Performance would offer physicians and patients a way to be with our medicine that is rich and abundant.

In thinking about medicine as performance, we envision a future built on the paradigm of improvisation. We become co-authors of the present interaction of the moment, as well as visionaries of future plays. Imagine for a moment that, as a practicing physician, we have taken nothing away from you, and in return for your willingness to be open to greater possibility, you have been given wide artistic freedom. As an improvisational playwright, what sets would you begin to see? What genre would you embrace? Who are the central actors in a given encounter? Who is in a supporting role? What props are at your disposal? What venue would you choose to stage the play? Is your audience a local, national, or global one? In these rounds, I have intentionally resisted putting forth my vision of a future Medicine of Complexity. Together, we and our patients are co-authors of this production. Neither you nor I alone can envision the magnitude and complexity that such a medicine may offer up.

Through my own career, I have come to treasure the unexpected moments of performance and improvisation that have presented themselves in my practice, one of which I would like to share with you now. A young mother came to my office having endured some tragic losses in her life. It was the first time I had met her. She exuded anger when she walked in. Her jaw was locked, and her face held a harsh and unyielding countenance. Her glare was cutting and direct. As she told her story to me, there was challenge in her voice: daring me to try to do anything. It was already her expectation that any action on my part was destined to failure: yet another confirmation of the constant letdown, hurt, and disappointment that has been a constant specter in the theater of her life.

She had recently experienced the death of her estranged partner, the father of her children. The young man's life had been a conflicted one of constant battle with authority and substance abuse, and not unexpectedly, he had died a traumatic, accidental death. Suddenly she found herself alone, her children fatherless. In the time since the tragedy, she had felt that her partner's family, with the exception of the father, had pulled away from her, demonizing her and publically revising her history with the deceased in a negative light. All of these feelings she carried with her into the office in our first meeting. The complex emotion and tension in the encounter was palpable.

It was obvious from her story that, even more than the rejection of her partner's family, she was angry with him for leaving...for dying. In our initial conversation, I struggled to find a point of connection, but my efforts were rebuffed. I had no idea what I was going do, and it looked like her prophecy of yet another disappointment was going to fulfill itself. In that moment, I had an intuitive flash and was compelled to ask her if she had had any dreams about him since he passed. I am never sure where such impulses arise from, but I have learned to trust and act on them. She looked at me, stunned, and then related the following: "I just had one last night... It was so vivid. It was like it was real. We were at home together. He was trying to tell me things, but I wouldn't listen. I just went from room to room, but he kept following me. I was just so mad and angry at him for leaving that I didn't want to hear what he had to say. When I woke up though, I just felt so guilty that I treated him that way, and lost my chance to talk to him." At that point the tears just started to flow.

I asked her, "What was your relationship like when you were together?"

She replied, "Oh we used to fight all the time."

I interjected, "Forgive me if I am off base here, but you strike me as the kind of a woman who might give a man the silent treatment."

"I am", she said with a hint of surprise. "I used to give him the silent treatment all of the time after we fought. Sometimes, I wouldn't answer the phone for weeks. Once, I even de-friended him on Facebook!"

"So what you're saying is that the way you treated him in the dream is pretty normal behavior for you two."

"Well, I guess it was," she said.

With that, I was advised her to unplug one of her two phones so that it was off the hook, and place it under her bed, so as to continue the silent treatment towards her partner that she had started in her first dream. I told her that she was certain to have another dream of him: perhaps in one day, one week, or one month; who was to know? Although she looked at me as if I had gone insane, she promised me she would follow through with it. We made an appointment to meet again in two weeks.

She didn't show up for that appointment, but the week after that she came by, unscheduled and unannounced. Her demeanor was completely different. She was light, smiling, and youthful, and she had a bounce in her step. She was wearing a spring dress.

"How are you," I said.

She blurted out, "I had another dream. I did what you said, and took the phone off the hook, and put it under the bed. I thought you were crazy, but that very night I had another dream. It was just like the first, however, this time he had duct tape across his mouth, and wherever he followed me, all he could do was mumble. It was easy for me to ignore him."

"How do you feel now?" I asked.

"Great," she said, "but I am ready to talk with him now."

"Alright, what do you normally do when you've punished him enough for his foolishness, and want to end the silent treatment?"

"Well, normally I cook a great meal for him. He really liked my cooking," she replied.

"Okay, I'll suggest what you should do next. First, plug the phone back in, but keep it under your bed. Next, I want you to cook his favorite meal, and be sure to invite over his father so that you and your daughters can have a meal together with him. Don't forget to set an extra setting at the table for your partner when you serve it up, the dinner is for him after all. Over the meal, enjoy each other's company, and share some stories. When the meal is done, take your partner's plate out to the woods, and place his meal down in a clean place. Then say to him what is in your heart, and forgive each other, as if you have just made up from a fight. Do you think you can do that?"

"Sure I can," she said.

"Great," I exclaimed, "but one last thing: sometime in the future in one day, or one week, or in one month, you should expect to have another dream. I imagine it will be a very interesting conversation." And, with that, she left my office happy, and I like to believe, transformed.

As a child, my Big Grandpa tried to teach me the drums. But at that time in my life, I was rhythmically impaired. I couldn't even keep time clapping a simple beat, never mind drum out a jazz rift. Later in life, however, I realized that the drums were just not my instrument. The seeds my grandfather planted came to fruition, as I found my own jazz through my medicine. He would be proud to see me let my music come forth. Interestingly, my Grandfather always wanted to be a physician, yet that was never in the cards for him. In many ways, we have succeeded in complementing and completing each other.

Metaphors and performances in hand, let us return to the starting question of what makes medicine holistic. It would seem correct to reason that any medicine that is holistic would also contain the possibilities of all other medical expression, including orthodoxy, alternative, complimentary, mind-body, functional, integrative, and the like. In a sense, a holistic medicine would need to be a meta-medicine. Along these lines, in addition to being a medicine of deep knowing, in order to hold complexity, it would also need to be a medicine of deep not-knowing. Finally, just as holistic medicine, as ordered within a hierarchy of logical typing, would need contain all the possibilities of medicine, it would need to be further grounded in the greater wholeness of the living world, thereby reflecting a Life-affirming premise. "Good medicine" can happen anywhere, with anybody, at any time. As we come to honor the intrinsic relational composition of Life, we will correspondingly begin to respect the world.

Performance, like service and sensuality, is a path into the world of wholeness. Through skillful means, an improvised medical practice allows us and our patients to utilize all of what is available to us in Life, including our illness and our suffering. In this way, the physician and the patient can become the medicine, as can the family, community, or the natural world. What we need, in my estimation, is a new generation of playwrights that embrace and exemplify novelty and innovation, and not more policy makers of the status quo. Performance blurs the boundaries of past distinctions, allowing for fresh formulations to emerge. Are the actors being people, or are they people being actors? In this way, we can talk about music, medicine, and even gardening, as one and the same, as all can be supported by the same principles naturally present in an epistemology-of-wholeness. Go forward then. Act boldly, sing boldly, dance boldly, heal boldly, and birth into the world a medicine of complexity, abundance, and wholeness, and let us all be surprised by the outcomes!

Thank you

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Act IV - Scene I: Night Round - The Wizard

Doctor's Narration: After a rare night of sound sleep, I awoke to the morning sun streaming through my window. I was unable to remember when I had slept so well, or so deeply. It was pure and much needed nourishment for my body, mind, and soul. My night had been largely dreamless, except for one, and like the others it was both hypnotic and entrancing. I had taken to leaving a journal at the side of my bed since the series of nightly visions had begun, so I could jot down my recollections while they were still fresh in my thoughts...

In the dream, I find myself in a hospital corridor. As I go past a window, I note my strange reflection. My body is stretched and flattened, as though I only have two dimensions. My arms and head are disconnected from my torso, appearing to float in space. Walking through one of the doors to my right is a most interesting fellow to behold. He has a rusty handsaw (of the kind I remember my father using to saw wood during my childhood) embedded in the middle of his cranium, splitting his head in half. Oddly, he seems in no specific distress from this.

He walks into the office as I sit down on the bench to the right of the door. Funny, I don't remember seeing the bench there when I first looked down the hall. On the door is a name plate with Milton Erickson, MD scribed on it. When I look to my right, I notice Gregory Bateson is sitting beside me. Strange, I don't remember seeing him when I first sat down either.

He says to me, "You're going to see my friend, the Purple Wizard, I see. He is a crafty old codger. Pay attention to everything when you are with him, but pay no heed to those things that others who have come before you thought were important, for they are not. Don't walk away with tricks and trinkets; that is not what the old man is all about. If the old wizard disappears in front of your eyes, it is not a foolhardy trick of power; rather it is the dropping of his own ego that allows him to work in the weave of the total complex. His work, in truth, is entirely of the aesthetic sort."

I sit beside Gregory in silence for a number of minutes, or perhaps hours. Who is to know about these sorts of things? Suddenly, the door opens and the man I had seen go in previously exits. He has undergone an amazing transformation. His head is now woven back together, and in his left hand he now holds a brightly polished wood saw. He looks at me directly in the eyes, and with a smile he says, "Like the Good Shepherd, himself, I am a carpenter now. If you will excuse me, I have some fences to mend, some walls to tear down, and some bridges to build," and with that he bids me farewell.

A secretary then appears at the door, and in a most pleasant manner says to me, "The doctor will see you now." I look back to say goodbye to Gregory, but he has gone, and where he was sitting a live crab now lies.

Through the door, I find myself inside a small bungalow. I am directed to the study. Entering the study, I see an older gentleman sitting in a wheelchair, dressed in a lab coat that is oddly colored purple rather than the traditional white. His body is diminutive; his frame carries the memories of flesh and sinew ravished by its battles with polio. The corporal story that his body tells is essential and true. His hair is silver, as is his bushy eyebrows and well-trimmed mustache. His face is etched with the lines of many a smile and many a grimace, but most remarkable of all are his eyes, sparkling with vitality and sagacity. Those mesmerizing orbs invite one to magical inner places yet to be explored. His gaze suspends me with the internal tensions it creates.

He greets me as I walk into the room, and in a slow, rhythmic, monotonous drawl, he begins to speak.

(Introduction)

Wizard: Please sit down Doctor, or lie down if you prefer. I was never much inclined towards the couch myself, and have long since done away with it. It seems you are acquainted with that old Trickster, Bateson. You would be wise to listen to everything the good professor says, but only as a whole and never in parts. Crabs are never the same after you take the dissection knife to them, if you catch my drift. Now, how can I help?

Doctor: I am feeling a bit disconnected from myself, and stretched very thin of late.

Wizard: Yes, for certain you are...

Doctor: I work hard for my patients. In my heart, I feel I am a good doctor doing good medicine. That being said, I am also tired and out of balance with the rest of my life.

Wizard: I see, of course...doctor to doctor that is.

Doctor: And an uneasy feeling grows inside of me, a type of dissonance that my practice is somewhat out of step with Life: that somehow things could be different, and I am not even sure what I mean by that.

(Induction)

Wizard: That's right... certainly, as we speak, there are certain parts of you right now that are uneasy, and out of balance...and certainly there are feelings within you that may continue to grow... and just as certainly there are things that are dissonant within you, although not to the point of dissociation... yet.

I find that, as a physician, I am fine as long as I keep moving, but when I finally sit down I realize how deeply tired I really am. Once I sit down at the end of a long, long day, I feel as though I may never get up, particularly if my chair is a comfortable one. And even if it's odd, it will soon be time for some much needed sleep, so that I can later awake refreshed. Yes, I think all doctors must have this experience...

Of course, you realize that it is not only your body that is heavy, but also the heavy feelings that you have brought home...uncertain and ambiguous...something starting to form...

As physicians, when we examine someone, we must depend on our abilities of perception, as well as our in-tuition, to develop in-sight into the nature of things, that is to say the etiology underlying the patient's present condition. That's right...

Now, when we look at the symmetry of your joints, we may find that things are, indeed, out of balance, or in balance, depending on how you change your perspective ...We could look at your hips, or your knees, or your ankles...or the way your head and neck sit on your shoulders. Certainly, close internal observation will show that there is more tension in one of your shoulders, hips, knees, or ankles...that's right... when comparing right to left and left to right. And since we are both physicians, we would have a good inter-rater reliability most of the time. But occasionally we will disagree about these things, and that is fine as long as we are agreeable about our disagreeing, and use those points of difference to further deepen our discussion. That's right...yes...

More importantly, getting back to your head, we see that its balance is a rather different thing than the symmetrical joints, and if you agree or disagree with what I am saying, you may want to nod your head to let me know... That's good...

Heads out of balance may nod forward or backwards, or side to side till they come to some resting point... indeed...that's true isn't it?

Now, for such a simple device, the stethoscope is an amazing tool. Through it, we can hear the inner workings of the body, revealing to us understandings that we otherwise wouldn't have. Everything is in the nature of the rhythms...breath in...breath out...breath in...breath out...deeply...that's right, or the sound of a heart beating...

How often does a physician pick up his stethoscope? So many times in a day, in a week, in a month, in a year, or tonight, that your hand knows how to move all by itself. Placing it on chest after chest...that's right...listening for differences that matter, variations from what has been normal...yes...

How every physician chooses to use a stethoscope is unique. Each one has a style or pattern developed individually over time. So I don't know if you will raise your left hand or right hand...or if you will listen to the heart, or the lungs...or the front or the back...or the right or the left...first...or last...

And what you hear through your stethoscope, or what an astronomer sees through his telescope, or what a biologist sees through his microscope, is entirely up to you as you begin to precisely focus on what is truly important for this particular task at hand... now...

As a physician...it is our sworn duty to relieve suffering, and to do no harm in the process...it is a position of trust in which our patients need to feel at ease with what we are doing in co-operation with them...and like any operation, sedation of one sort or another is required. Sometimes we deliver a conscious sedation; other times, the operation is such that we need a deep sedation...only you know, as the physician, what is inevitably needed in each case...that's right isn't it?

In anesthesia, the administration of sedative drugs or anesthetics is called an induction, and its purpose is to put the conscious mind to sleep...As well, the anesthesiologist may want to give an analgesic to help with any pain, an anxiolytic to reduce anxiety, an amnestic to suppress memory, or a paralytic to settle any unwanted movement or tension in the patient's body...but that is, of course, based on the wisdom of the doctor for what he feels is best in this particular case...at another time, he may choose something different, as every operation is different...

Sometimes when I do an induction, I will have the patient count backwards from 100 by 3s...that's right...10... If, however, they were counting backwards from 10...9... by ones, I have rarely seen a patient...8...remember getting to 3...7... even if they did...6...try to prove...5....that by the power of their will...4....that they could avoid... falling... asleep...3...NOW...

Doctor: zzzzz...zzzzz...zzzzz...

(Generation)

Wizard: Western nursery rhymes can be very much like Western epistemology; they can be overly concerned with parts and fixing these parts. As we all well know...Humpty Dumpty sat on a wall, Humpty Dumpty had a great fall, and all the King's horses and all the King's men couldn't put Humpty together again. No wonder though, as a horse's hooves are far from suitable tools in Humpty's case. Luckily for us, people are not eggs, and our resilience is such that we can recover from our falls...

Yes, I quite think that eggs are better left for omelets...

Speaking of the Western tradition, the Greeks have the myth of the Three Fates. Now these three sisters, Clotho, Lachesis, and Atropos were said to have held the metaphorical Thread of Life. They decided the fate of every mortal from birth to death, as dictated by the allotted portion of thread they cut. Three days and three nights after the birth of each child they were said to appear with their spindle, rod, and shears to spin, measure, and cut a length of thread, thus determining the future course of that child's life. Their power was such that it lay outside the purview of even the Olympian gods' ability to change a mortal's ultimate fate. All had to submit to the decision of these dreaded sisters.

Threads, however, are most interesting when woven together, and that brings us to another Greek myth. There once upon a time lived a beautiful woman named Arachne who was known far and wide for her great skill as a spinner and weaver. Her work was said to be so delicate that even the forest nymphs would come to gaze on it. Although very gifted, and a favorite amongst the people, she was also very vain and boastful of her gift. She claimed that her skill was entirely innate, and she never missed an opportunity to take full credit for her accomplishments and prowess. She was heard at times to boast that her ability surpassed even that of Athena, the goddess of wisdom and the arts. Displeased with what she heard from Archane's lips, Athena disguised herself as an old woman and kindly advised Arachne to compete freely with her fellow mortals, but to never challenge the gods, lest she incur their divine wrath. Arachne, so caught up in the veils of self, would hear none of this, and openly declared a challenge to Athena. Enraged, Athena transformed into her goddess form and accepted the challenge on the spot. In awe of the presence of the goddess, all others in the room knelt and averted their gaze, but not the pride-filled Arachne. The competition started, and they both began to weave. Like the constellations themselves, Athena's beautiful tapestry portrayed the glory of Olympian pantheon, containing the great stories of god, demigod, and man alike. Conversely, although technically perfect in its execution, Arachne's weave mocked the gods, portraying them as foolish, unwise and fearful. When they both finished weaving, Athena looked at Arachne scornfully and said, "You stubborn foolish woman, if you think so much of your weaving, then weave forever." With that, Arachne was transformed into a spider whose curse is to endlessly weave, with all her efforts being eternally disrespected by mankind.

Do the Greeks, then, offer us a thread of hope? In Greek tradition, Asclepius was said to be the god of medicine and healing. He was born of Apollo and a mortal woman. Some say Asclepius' mother died during childbirth. Hermes rescued the infant, cutting the umbilicus that tethered the child to his lifeless mother's womb. He took the newborn to the wounded healer Chiron, the great Centaur, who helped the child develop his skills in the healing arts. Physicians, of course, recognize the myth of Asclepius, as we still use his snake-wound staff as the symbol of our profession today.

As a sign of fruitfulness and renewal, Asclepius went on to have five daughters. Each was said to perform one aspect of Apollo's healing art. Together, the five were representative of the whole of medicine and healing. Panacea was the goddess of remedies and medicines. Hygeia was the goddess of good health, cleanliness, and sanitation. Iaso was the goddess of the power of recuperation from illness. Akeso was the goddess of the cure, and Aglaea (perhaps the most intriguing goddess in terms of our discussion) the goddess of beauty...curious really. Of course, the end of this tale brings us to the beginning of your tale as a physician, for you once pledged an oath: "I swear by Apollo the Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant..."

(Integration)

Wizard: The process, however, does not end with the completion of the operation. Bodies need time to heal, and tissue takes time to re-knit. Every doctor will tell you that you need to be easy on yourself for the first 6 weeks after a surgery, although the healing may continue for up to six months or a year. Who is to know exactly about these things since everyone is unique. In that regard, it seems suitable to leave you with the myth of the magnificent Phoenix, who once every thousand years builds a nest of sticks and wood, and then, igniting itself on fire, burns down to ashes, only to have a new golden Phoenix egg spring forth from the char....but that should be no surprise, as eggs are generative sorts of things.

Now, our time here is nearly done, but not quite yet...3...as you come back to your conscious mind...4... it is very similar to gently waking up from a restful, nourishing sleep...5... where all the tiredness and tension has left your body...6...but, like waking up from a deep sleep, sometimes we remember our dreams...7... and at other times we don't...8... Or sometimes we remember part of our dreams...9... and other times a full dream will come back to us only when it is needed...10...that's right isn't it?

Wizard: How do you feel?

Doctor: Better...rested, calm, full...integrated somehow.

Wizard: Yes, for every sympathetic ear there is also a parasympathetic.

Doctor: Balance is important.

Wizard: As is integration.

Doctor: Does that conclude the session then?

Wizard: No, things are rarely that easy Doctor. I have a prescription, and some homework for you.

Doctor: Prescription and homework?

(Dr. Erickson then proceeds to write a lengthy prescription out, and hands it over to me.)

 There is only one illness: rigidity of the mind.

 Heraclitus was right, "No man ever steps in the same river twice". Remember that when you are next with your patients!

 Trust the generative mind that forms when the unconscious of one meets the unconscious of the other.

 Accept and utilize everything in therapy. Both the lightness and darkness of experience can be in the service of transformation.

 There is no such thing as patient, only the patient-in-context.

 Symptoms are a form of communication. They are heralds of the possibility of change, not signs of pathology.

 Disturbances in Life are opportunities for development and growth

 Know that there are more than mouths that do the talking, and more than ears that do the listening.

 There is a story for every story which should always re-mind you of a story, and that re-minds me of a story, too. After all what's a Meta for?

 Love is the greatest medicine.

Dr. Milton Erickson

Doctor: And, as for the homework?

Wizard: More of a suggestion really. There might come a time in 6 weeks, 6 months or a year...I don't know what it will be for you... when you decide to write a book...I have no doubt that there is one waiting to hatch. When this time comes, and you have published the book, I want you to burn the first copy in a fire. When the fire burns down, and cools, collect all of the ashes. Then dig a hole outside and throw the ashes into it. In that hole, I want you to plant a fruit-bearing tree of your choice. Nurture it till it grows to bear fruit.

Doctor: Anything else?

Wizard: Just one more thing...when you wake up make an omelet for breakfast. It will help you be more eggcepting of all things in your life. 10, 9, 8...Eggcectly right doctor ...7...6... 5...4...3...that's right.

Doctor: zzz...

Back to the Table of Contents
Act IV - Scene II: Day Rounds on Aesthetics

For these rounds, I would like to start with a riddle posed by the great master of cybernetic thought, Gregory Bateson. Inspired by the Psalmist's question, "What is man, that Thou art mindful of him," he poses to physicians a double-pronged riddle that is at the crux of our vocation: "What is man that he may recognize disease or disruption or ugliness, and what is disease or disruption and ugliness that man may know it?"

Now, Gregory Bateson was fond of quoting Pascal when he said, "Le cœur a ses raisons que la raison ne connaît point" – "the heart has its reasons of which the reason does not at all perceive". We can go about answering Bateson's riddle by way of the head or of the heart. Pascal's reasons of the heart are in many ways like a Zen koan (question or riddle), in which the truth of its non-linear/non-rational inquiry lies in the transcendence of its intrinsic paradox. Hence, just as Bateson poses his double question to us, he could equally have asked the koan: "Who are you that you may know who you are?" before he proceeded to slap us on our collective heads!

The head, unlike the heart, has a way of coveting the limelight. It is just its nature. My hope in these rounds is to assuage and to reassure that cerebral part of ourselves so that the heart, too, can shine in our practice. Nevertheless, I digress. In the broadest of terms, we can view Bateson's riddle as one of a philosophical nature. From previous rounds you will remember the fundamental double question that philosophy has similarly posed for us. First, the problem of how things are, that is to say: What is reality? What sort of world is this? What is a person? This mode of questioning is, as we know, ontological. Secondly, we have the issue of the nature of knowledge, or how we know, how we know we know, or more specifically; what sort of creatures are we that we can know something? In other words, questions of an epistemological sort. But when we look at these questions through a cybernetic lens, we realize that they are recursively bound to each other in a way that is congruent with our lived experience. Our beliefs of the world, both conscious and unconscious, determine how we perceive it and act within it. Conversely, our ways of perceiving and acting will determine our beliefs about the nature of our nature, and the nature of Nature itself, in whole or in part.

In his work, Bateson recognized the need to reconcile the legacy of the Cartesian body/mind divide, the split between quantity and quality, and the prioritization of substance over pattern that has resulted in the polarization of the materialistic and idealistic paradigm within our culture. To do this, he used a strategy of tackling words that non-materialists felt were important, but that materialists felt were outside the accessibility of scientific scrutiny. He took concepts such as "love", "wisdom", "mind", or "sacred", and redefined them through a cybernetic framework to create a more inclusive understanding of the concepts. This facilitated dialogue, study, and ultimately reconciliation between the two camps. By recognizing the cybernetic bond between epistemology and ontology, Bateson redefined the terms, stressing the intrinsic relationship between the two studies under a new definition of a cybernetic epistemology. In Bateson's own words, epistemology is defined as:

A branch of science combined with a branch of philosophy. As science, epistemology is a study of how particular organisms know, think, and decide. As philosophy, epistemology is the study of the necessary limits and other characteristics of the process of knowing, thinking, and deciding.117b

In returning to Bateson's riddle to us, "What is a man that he may recognize disease or disruption or ugliness, and what is disease or disruption and ugliness that a man may know it?" We can see that the first question is epistemological, and the second portion is ontological. Together, the two positions compose or structure what Bateson calls the "science of epistemology".

In continuing our analysis, we can look at this riddle not only through the view of a recursive framework, but also through the cybernetic tool of logical types. Each of the two questions is of a different logical type. The first, "What is a man that he may recognize disease or disruption or ugliness?" deals with the nature of perceptions and cognitions, while the second, "What is disease or disruption and ugliness that a man may know it?" deals with what can be perceived and cognized. This is not a trivial semantic difference; rather, these questions represent very different levels of interrelated abstractions. Together, they form a cybernetic dialectic found in alternate recursions between form and function, structure and process.

For a moment, then, while the head is digesting the reason for all this reasoning, let us slip in a small tidbit for the heart. Why a riddle becomes a riddle is not a play of linear logic (or for that matter circular); rather, it comes about from collapsing of the accounting provided to us by logical typing. When we collapse different levels of abstraction to par, we succeed in creating a conundrum, and if we are very successful: a paradox. We see this exemplified in the assignment of a koan (the sound of one hand clapping anyone...anyone...no one?) from a Zen master to the Zen adept. These are tools to help transcend the cognitive habits that form a perceived separation of the world, parsed into a collection of objects, as compared to a world of intrinsic wholeness, inseparable from one's true nature. The answer to the koan is a reflection of a moment of insight (kensho or satori): a spontaneous expression born of wholeness that is not rational in any linear sense. As a Zen master might say, it is something that arises spontaneously and naturally.

Bateson in his writings often argued that this same process of collapsing logical types, or what he has termed a double bind, is not only the source of our art, poetry, humor, and the religious impulse, but also our madness.

This provides us a segue back to our riddle. Just as we can view this double riddle through a first-order cybernetic analysis (feedback, orders of abstraction, pragmatics, etc.), we can also further participate in it from an aesthetic stance (i.e. a second-order position). Traditionally, aesthetics is the branch of philosophy that tries to understand the nature of beauty. In this traditional form, this question of beauty is considered to be beyond the purview of scientific inquiry, so in typical style, Bateson has re-defined the term aesthetics through a cybernetic framework to, "the study of the process in creator and onlooker whereby beauty is created and acknowledged." In this way, by acknowledging process (in addition to form), he makes beauty a legitimate topic of inquiry for both science and medicine. For Bateson, the source of beauty (i.e. aesthetics) is to be found within the relationships or correspondences found in any given system that could be viewed as patterns, and patterns of patterns, or in his own words, "the pattern that connects." Again, just like he accomplished with epistemology, his cybernetic redefining of aesthetics succeeds in creating a scientific, as well as a philosophical inquiry. However, we must recognize that we are dealing with a qualitative science.

Looking back at Bateson's "forked riddle," we realize disease, disruption, and ugliness are in fact aesthetic pronouncements. How then is man able to make such discernments? We find a good starting point towards answering this question in an interview with Bateson. The interviewer asks, "Would it be correct to suggest that the aesthetic is this unifying glimpse that makes us aware of the unity of things that are not consciousness?" Bateson replies, "That's right; that is what I am getting at. The flash which appears in consciousness as a disturbance of consciousness is the thing that I am talking about." This is a curious statement, and quite counter-intuitive, since when we think about art or beauty, we often reflect on such things as our appreciation of it, the narrative explanation of the work, and other similar such notions; and these, of course, are all conscious acts. However, we must remember that consciousness is but a small part of the totality of mind, the vast majority of which is unconscious in nature. Unconscious habit is necessary for economy and efficiency in cognitive systems. Consistently repeatable and predictable generalities of action and relational engagements are driven down into the unconscious, while the conscious is left to deal with the remaining "pragmatics of particular instances."

Consequently, conscious thought becomes only a "partial arc" of the total connected circular circuitry of mind. To rely on consciousness as a source of primary guidance is to depend on a very small and necessarily distorted portion of self. The partial truths of consciousness will always be a distortion of the greater "Truth" of the larger unified mind. This is inevitable, for if we conceive of mind as an integrated network of communication with diverse and distributed mental processes, then a conscious view, limited to selective samplings of localities within that network, can only result in ignorance or outright denial of the integrated whole. As Bateson reminds us, "From the cutting of consciousness, what appears above the surface is arcs of circuits instead of either the complete circuits or the larger complete circuits of circuits."

Up until now, I have been speaking in generalities. Nevertheless, this issue of conscious domination of thought is of real concern to our profession. We find within the cybernetic majesty of the human body (to say nothing of that related environmental ecology that subsumes it) a true miracle of complexity and systemic integration. Many of us, however, have become blind to this beauty, both in ourselves and in our patients. This is a great travesty. In light of the hubris born of our knowledge, we have profaned the body and lost our reverence for this majestic expression of Life. By analogy, what we know of the body through our studies as practitioners of medicine can be compared to what an unaided consciousness is able to discern about the total mind. With our purposeful actions, driven by the quest for cure, we look for (and hence create) linear causation, and reduce complex processes to a set of simple variables open to our manipulation, hoping to develop and validate reified models of predictability. Now, despite our "progress" and "evidenced-based knowledge," we are not ecologically wiser for our efforts. We attempt to control infectious disease with antibiotics at the level of the individual, but the bugs in turn respond with resistance and increased virulence, leading to an inevitable systemic worsening of the original problem. Is this a problem of quantity? I would emphatically answer no! What we have is a problem of perception. We address acute conditions well, but chronic disease continues to grow. Of course orthodox medicine, as it now functions, is only one reflection of a self-destructive epistemology. Similar examples could be taken from agriculture, education, architecture, and a whole host of other modern industrial endeavors and associated technologies. This being said, despite the magnitude (or limitations) of our knowledge, we cannot escape the fact that we live in a world of relationships and interconnectedness. Bateson suggests that our very survival on the planet rests on our recognition of the essential truth of systemic circularity, or what he terms "wisdom." I would go one step further, suggesting that recognition of this inherent circularity is a start, but not solely sufficient. Wisdom also needs to be embodied and expressed within the whole via the individual in his context, thus allowing the manifestation of naturally arising, non-purposeful actions.

The difficulty with consciousness as the ultimate source of individual and collective guidance is a very real and pressing concern on multiple scales, as our repeated intentions (good or otherwise) continue to undermine the systemic wisdom present within the whole. Yet in rebelling against the hegemony of consciousness, how can we leverage our unconscious as a primary guide, or at the very least use it as a buffer against the consequence of limited conscious purposefulness? In other words, how do we access wisdom?

Drawing on what we have learned, we can see that we come up immediately against a wall, as the primary processes of the unconscious mind remains triply inaccessible to our consciousness. First, we have necessarily submerged many of our mental processes into the unconscious to acquire habits, automatic rotes, and responses for the efficiency and economy gained by such a strategy. Secondly, because the scrutiny of conscious thought (no matter how good the intention) undermines and destroys the workings of the underlying unconscious process. This is evident when we voice such common idioms as "self-consciousness" or "performance anxiety" as part of our common experience. In the extreme, we have even medicalized the experience by giving it a diagnosis of "social phobia." Finally, the inaccessibility of the primary process is compounded by the fact that the language of the unconscious is very different from that of the secondary processes of conscious thought. Consciousness largely relies on denotative language as the base for abstraction and linear logic, while the unconscious turns to metaphor, gestalt, and iconic imagery. Difficulties in the translation of iconic communication are further compounded by the inability to express tense or negation in the unconscious. Furthermore, consciousness talks about things or persons, while the unconscious focuses instead on the relationships between them.

So here we find ourselves in a true predicament. We are unable, by and large, to access our unconscious mind, and if we do succeed, our scrutiny is self-destructive. Worse, the structure and processes defining the two modes of expression are so alien to each other as to remain almost un-translatable. So we must return once again to the fundamental question of how do we allow ourselves to be guided by the unconscious in our quest for wisdom? Bateson believed the answer to this question lay within the corrective nature of art, or more broadly speaking, aesthetics. In this vein, he poses a question to us: "What sorts of correction in the direction of wisdom would be created by viewing [a] work of art?" Can art succeed in reorienting a too-purposive mode of individual or cultural action into something more systemic in nature?

To start with, we must realize that art (when done artfully) acts as a specific category of communication. All expressions of art, with the exception of poetry (which uses language to draw a picture), are trying to convey messages that are not conveyable by words. If they were, there would be no necessity for the art, as a linguistic explanation would suffice. Conversely, any verbal explanation of a work of art (assuming the validity of its artistry) is a facile forgery of the authentic wisdom contained within the work, contrary to what any critic, curator, historian, or artist (including the one who produced the piece) might tell you. Any use of words is a falsification of the message found within the creation, for it implies that what is being conveyed is fully open and voluntary to conscious understanding. To what part of the mind does art communicate, then, if not to the conscious? Bateson suggests that art acts as an interface between the unconscious (and systemic) mind and the conscious mind. Artistic creation is a partly unconscious and partly conscious act, that allows us to communicate in a largely unconscious way, thus creating an access point or interface between our two minds that cannot and must not meet directly, lest they destroy each other.

When talking about the nature of art (as it relates to systemic wisdom, and the conscious and unconscious mind), we must contend with the question of what makes "good art" that raises overall level of available wisdom available to us within our culture, or in other words: has the ability to correct our epistemological pathologies. By this, I mean that we must have a way of producing, engaging, and interacting with art that is not solely an aesthetic expression of human experience in isolation, but is representative of a reflection of our greater relationship with the numinous whole.

We can start by looking at the patterning of a piece of art, and note and comment on the veracity of such qualities as style, materials, composition, rhythm, centers, and other various design elements and principles. Nevertheless, the conscious review of pattern and design analysis can never be solely sufficient, as these processes do not necessarily distinguish purely human-centered expressions from the holo-centric offerings our society requires. Bateson suggests that from a perspective of systemic meaning, we need to look further for the presence of "pattern, redundancy, information and restraint." These are all discipline-specific synonyms that refer to essentially the same concept; the set of relations contained in any portion or piece of the whole relays knowledge about the pattern of the whole in its entirety.

Next in asking what constitutes the aesthetic, we can also reflect on the quality of artistic performance. As we develop greater aptitude in our field through repetition and practice, the more habitual our actions become. Specific actions and decisions are gradually transferred from the conscious to the unconscious mind. This is of particular importance to artists (in both the narrow and broad sense), for as they become more skilled and their creative actions have their genesis rooted deeper and deeper in the unconscious, they find themselves able to access more and more pattern in the relational matrix of the unconscious or systemic mind, thereby obtaining greater access to the wisdom of the systemic whole. The irony of this is that as the artist becomes more skilled, the less conscious understanding he has of his own work and process. At the highest levels of artistry, an artist can say very little about the work or his role in it, and this muteness becomes a potential indicator of the artist's skill and the work's greatness. In this moment, the artist has become an "open vessel" or "hollow reed" for the totality of mind. The work is "through him, and not of him" in the sense that there is a progressive extinguishing of the conscious self and its role in the work, making way for a dominant rise of unconscious expression. To see the cultivation of this type of mastery, we turn to the Zen arts such as bow and sword, or brush and tea. Through these cultural forms, we see embodied such aesthetic concepts as shoshin or beginners mind, and mushin or empty mind. Interestingly, the character shin, translated as mind in this case, is also the Chinese character for heart. In this spirit, the quality of improvisation in art and performance, as a natural product of unconscious primacy, becomes the primary evidence of the working of the greater mind.

We can start to see how such deep, unconsciously patterned artwork can be a potential source for correction of partial conscious arcs, with their associated cultural pathologies, and become a vehicle for a gradual holistic transformation within a society. Art's trans-lingual and holistic expression mediates, unifies, and rebalances conscious and unconscious processes. Furthermore, when we consider Bateson's definition of mind, the unconscious acts as an interface with other subsets of systemic mind, whether individual, cultural, or ecological. By accessing his unconscious process, the artist may find himself situated in progressively greater abstractions of recursively embedded mind in nature, with its ever increasing expansion towards holistic unity.

The artistic process shows us how systemic wisdom can be accessed and brought forth through creative acts. But for art to correct our epistemological pathologies, it must be both contextually and relationally situated. Every performance demands an audience, even if the performer and the audience are one and the same. Just as the unconscious mind is generative, it also must be receptive if we are to be both purveyors and recipients of wisdom and the grace it entails. In what form do we receive wisdom? The answer is also aesthetic, and found within the pattern of our common and shared biology.

When examining patients, families, cultures, and societies – or correspondingly, species, ecosystems, and total ecologies – we must not forget that these are self-organizing, self-corrective, recursive systems. Their organization uses multiple feedback pathways to maintain integrity of structure and function, forming the basis for complex adaptive systems. As such, each living system is imbued with an internal recognition of state disruption within in its own functioning through the avenues of circularity and feedback, as determined by its historically derived structure. Conversely, through the drawing of functional distinctions, cybernetic systems are necessarily responsive to the harmony of function within their organization. From this awareness of internal harmony or coherence (as differentiated from disharmony or disruption or incoherence), we can postulate the existence of further bridging through recursive linkage in levels of embedded order, to greater phenomenological abstractions of beauty and awe (and conversely ugliness and horror), through the process of analogous pattern recognition (i.e. the process of abduction) present in the larger, more inclusive systems of nested mind.

In review: we find the cybernetic mechanisms needed for a potential recognition of beauty through distinction, feedback, abduction, and logical typing. Using the unconscious skill of the artist, coupled with the intended audience's internal awareness of their own state of integrity (whether individual, family, community, culture or society), we create a pathway for art to help correct our epistemological pathologies returning us to a state of health. The artist serves as an interface to re-connect the conscious mind (with its partial arcs of connectivity) to the wisdom of the integrated mind, subsuming consciousness into the greater service of wholeness.

Because of the individual organism's recursive organization, it remains capable of drawing distinctions between harmony (i.e. the integrity of its invariant organization) and disruption (i.e. overwhelming perturbations or stresses threatening its invariant organization) in its structure and function. In theory, given a requisite level of complexity, this fundamental biological distinction between harmony and disruption allows for the emergence of a greater recognition of awe, reverence, and beauty (or conversely, the horror of disruption, dissonance, and ugliness) within the greater systemic levels of mind. Such a mechanism could create the necessary appreciation for any systemic wisdom available in a given aesthetic offering. The newly-generated awareness is fed back to the conscious mind as a flash, ripple, or disturbance, but nevertheless is fully available to the individual's unconscious. This allows for the possibility of conscious purpose to be attuned and aligned with the greater system's organizational rhythms and flows. Thus, the generation and reception of aesthetic acts has the potential to show us the essential unity underlying the greater mind, raising us above the limited horizons of our conscious prejudices, with their destructive tendencies, purposeful biases, and disjunctions.

Perhaps not surprisingly, just as the study or pursuit of aesthetics is traditionally centered on questioning the nature of beauty, it historically has also been closely associated with religion through its art, ritual, and ceremony. Through religious expression, we also find a natural bridging from aesthetics to the sacred. In reflecting on beauty in a second order cybernetic fashion, we begin to develop some insight into the nature of the sacred. The sacred, like beauty, is an impulse that stirs the conscious mind, but is fundamentally beyond its grasping. The sacred is a manifestation of a unity; it directs us towards wholeness and allows for the embrace of mystery, or that which remains inaccessible to us. Interestingly, the words holy, whole, and health share etymological roots. Like beauty, the sacred acts as a corrective agency, shielding against the cutting gaze of consciousness, which if left unchecked becomes the source of profanity and disenchantment in the world.

The word sacred originates from the Latin sacer, which can translate two ways. One: to be so holy and pure as to be considered sacred, and two: to be so unholy and impure as to be viewed as sacred. The former is the source of religion, the latter the source of magic. The sacred is the holder of both attraction and loathing; consecration and execration. What binds them is their transformative and corrective powers within the greater mind, warding off the partial arcs of conscious purposefulness through blessings – and curses. Between these two poles, the profane world sits in a stupor; impoverished, and disenchanted by its own desecration and sanctioned sacrilege.

This view of the sacred should hold a special place in our perception of ourselves as physicians. From the perspective of the sacred, physicians share a certain proximity or intimacy to the holy mysteries of birth and death (and occasionally resurrection), yet in their craft, they simultaneously carry the impure stink of flesh, blood, bone, pus, decay, and excrement. Viewed through a sacred frame, doctors are both blessed and cursed, and consequently bestow blessings and curses through their prognostications and pronouncements. In our work, physicians are at times both priest and shaman.

And like artists, we can offer an interface for what cybernetically would be referred to as a systemic correction, although more colloquially, we would call healing. This highlights the difference between healing and curing; healing is a reflection of the total systemic circuitry presenting as wisdom, while curing is the product of the partial arc of consciousness. The first embraces integration, the second denies it. Liminality and margins; thresholds and edges, these are the spaces that define the physician's role at the poles of sacred experience. The transitional and transformational times of human life require a midwife of sorts at every stage: birth, illness, aging, and death. This is the physician's vocation: the sacred bond between physician and patient, and we must embrace it as our guiding ethos.

Bateson himself makes a curious statement about our profession:

Notice that the ideal I offer you comes close to being a religious hope or ideal. We are not going to get far unless we acknowledge that the whole of science and technology, like medicine from Hippocrates downward, springs out of and impinges on religion. In two ways all health practitioners are religious –necessarily accepting some system of ethics and necessarily subscribing to some the theory of body-mind-relations, a mythology, for better or worse.

Religion is to the sacred as art is to beauty. Both play an equal role in systemic correction or healing, both arise from unconscious access to systemic wisdom, and both spring from the aesthetic impulse. Beyond any of their pragmatic roles or perfunctory functions, art, ritual, and ceremony, as experienced through both individual and communal participation, provide a necessary interface with the systemic mind. As physicians engaging the sacred domain it behooves us remember that our own rituals and ceremony, as aesthetic acts, are capable of transformative impact beyond the pragmatic clichés and routines. But we must also ask ourselves: does our current system of ethics and mythology of mind-body relations serve our patients, or is it the source of the problem?

Just as beauty is in some way connected to the sacred, the sacred is connected to health. As I have already mentioned, the words "holy", "whole", and "health" have the same etymological source. In Bateson's words:

It is very difficult as you probably know, to talk about those living systems that are healthy and doing well; it's much easier to talk about living systems when they are sick, when they are disturbed, when things are going wrong. Pathology is a relatively easy thing to discuss, health is very difficult. This of course is one of the reasons why there is such thing a thing as the sacred, and why it is difficult to talk about, because the sacred is peculiarly related to the healthy. One does not like to disturb the sacred, for in general, to talk about something changes it, and perhaps will turn it into a pathology.

Hold that idea for a moment while we visit another holistic thinker with direct relevance to our field: the "Old Doctor" Andrew Taylor Still, founder of Osteopathic Medicine. Writing on the philosophy and art of medicine, Dr. Still stated, "To find health should be the object of the doctor. Anyone can find disease." The resonance with Bateson's comment should be of no surprise, as Bateson found in the Old Doctor an exemplar of holistic and patterned medicine.

Bateson and Still understood that physiological organization, recursively supported by the body's anatomy in its intrinsic wholeness (that is to say not just the parts, but the relationship between parts) was a matter of communication. They also knew that the pathologies centered in the body were the result of a disruption in these avenues of communication, despite their profound interconnectivity.

Bateson sympathized with Still and considered him a genius well ahead of his time: "He went a little crazy, I think, as men do who have ideas a hundred years too soon." Still founded Osteopathy in the late 1800's, boot-strapped his theories by the science and working metaphors available to him at his time and place in history. Nevertheless, his writings are a true example of early holism in medicine, and the embodied practice of traditional osteopathy serves as stellar example of epistemological wholeness within the medical field.

Let's take a moment to digest what the Old Professor and the Old Doctor have served us up, and ask ourselves why health is harder to find than disease, and why is it important that we should seek it? Bateson riddles us: "What is a man that he may recognize disease or disruption or ugliness and what is disease or disruption and ugliness that a man may know it?" In light of what he and Still have said, I suggest it would be useful to reformulate the riddle as: "What is a mind that it may recognize health, coherency, and beauty and what is health, coherency, and beauty that a mind may know it?" I think it is fair that Bateson started with the former disease-centric form of the riddle, rather our reformulated health-centric version, for the original is congruent with our present-day "epistemology-of-separateness". Like all good physicians of change, Bateson is making a house call to the epistemological home where we presently reside. But although he uses our patho-centric language to reach us, he is using it in a subversive way, for his riddle contains the seeds for a holistic transformation of our epistemology.

Each version of the riddle speaks to one of the two portions of mind; namely the conscious and unconscious. In speaking of men and disease, we are using the language of things. The conscious mind recognizes such objectification, and in the case of disease, forms abstractions, creates orders, develops taxonomies, and imposes rigid hierarchical classifications. In this way, consciousness creates the illusion that diseases are substantive, thereby creating a self-fulfilling purposefulness: the need of a cure.

Conversely, our re-presenting of the riddle speaks openly to the unconscious portion of mind. It is of a different order from the original version, as it is springs forth from an "epistemology-of-wholeness". Health, like beauty and the sacred, is an aesthetic thing. It is that "flash which appears in consciousness as a disturbance of consciousness." Health, unlike disease, cannot be reduced, and as it lives in the world of primary unconscious process, it remains elusive from the conscious mind.

As Bateson and Still remind us, anyone can find disease. It is a parlor trick devised by the conscious mind to entertain itself. But to find health, we have to be artists in our craft. As we deeply develop our skills and expertise, we become more and more unconscious of what we do and why we do it. With our increasing access to the greater systemic mind, we will begin to glimpse health and relate to it in our therapeutic work, just as beauty manifests in the artist's creation. Our conscious mind recognizes a perturbation when this encounter with health occurs, but it defies the limits of our linear logic and denotative language. So we must turn to art, song, poetry, dance, or metaphor to share this unspeakable experience. Healing becomes aesthetic, whether it is manifested through beauty, the sacred or health. The irony is that we start our career focused on knowing, but as our skill develops it is our deep not-knowing that becomes the artistry of our craft.

Also note that the shared aesthetic encounter with health rouses a disturbance in the conscious processes of our patients, while simultaneously accessing and transforming their unconscious process. Interfacing with health in this way, the physician will paradoxically find himself also healed. Healing does not involve purposeful ideas of helping, fixing, or curing the other. Health does not discriminate the recipient of its grace, for we all are members of the whole. In working in this way, we come to further understand Dr. Remen's words first presented in our rounds on service:

When we serve in this way, we understand that this person's suffering is also my suffering that their joy is also my joy and then the impulse to serve arises naturally - our natural wisdom and compassion presents itself quite simply. A server knows that they're being used and has the willingness to be used in the service of something greater. We may help or fix many things in our lives, but when we serve, we are always in the service of wholeness.

To serve the mind of Nature is to work with beauty. It is to work with the sacred. It is to work with health. It is a reminder that to serve is to be served.

Having said this, Bateson cautions us against applying the language of consciousness to the likes of beauty, the sacred and health, for to talk about something fundamentally changes it, and risks making it a pathology. It is a good time to remind ourselves of Pascal's wise words "Le cœur a ses raisons que la raison ne connaît point." – "The heart has its reasons of which the reason does not at all perceive." In this spirit, our restated form of the Batesonian riddle, focusing on the holism of health, rather than the reification of disease, is paradoxically not to be answered, but acted on. "Act to know" is an aesthetic endeavor.

So the next time a Zen master presents the koan, "What is health?" "What is beauty?" "Show me the sacred!" or "Who are you?" perhaps you will have an answer that serves in that moment...or perhaps not...who is to know (or deeply not know) about such things?

Before concluding this morning, I would like to reflect on the process of integration as I believe it is relevant to our discussion around the nature of aesthetics in our lives. My own encounters with traditional and indigenous peoples around the globe challenged me to integrate these diverse experiences into my own cultural framework. One of the endeavors that helped me with this transition was painting. My good friend Andy McClure is an artist and art teacher, and for a great number of years we have shared a close collaboration around perspectives and practices of healing. Together, we decided to act on those ideas, inspirations, and impulses, and apply them towards painting. Taking a large blank canvas as a starting point, we would evoke a variety of natural, spontaneous, and un-choreographed movements, breaths, and shouts. Dipping our fingers into wells of acrylic paints, we would translate our combined rhythm into strokes on the slate in an exercise of co-painting. Nary would a word be spoken. Our communication was one of point and counterpoint. In the early moments of the painting, many a nice image would arise, only to be erased by the other with a stroke of the naked hand: a random mix of color the only remnant of a fleeting and ephemeral creation. Individual ego had no part in this experience, despite its need to rear its ugly head. It was always tamed by the other in the co-relationship, and easily silenced with a whip of the hand, or the slice of a finger across the canvas, despite any unspoken protest. Interestingly, there was always a moment in the process where the painting seemed irrevocably lost. After many iterations, the once-distinct colorations, with their individuated hues and saturations, would seem reduced to mud, clouding the joy of whatever creative impulse had initially possessed us. Then, as if by magic, the work would start to appear out of the chaotic confluence of pigment and stroke. With each motion adding greater and greater clarity, the painting itself would pull us both towards the climax of the process, and in a single moment the finished work would show itself, both of us knowing that it was complete.

Certainly, our work would be considered abstract in nature. Many people (including Andy and I) in viewing the finished piece, will voice a vast array of visual mythology that they feel to be present in the work. This in itself proves to be a fascinating and playful discovery. Andy and I also continually take joy in the abstraction, dynamics, and complexity within our paintings – the movement, rhythm, centers, pattern, orientation, relationships, and fractal-like structures – the things that give the work Life. Even now, years later, I can look at any one of our creations and it still speaks to me as though I had just painted it. As I change, the work changes with me, unveiling a new, deep, yet undiscovered portion of our story. I feel at peace whenever I sit with this work, but never prideful. Although I have the memory of laying paint to paper with my own hands, I can claim no ownership over it. My role in it feels more akin to that of a Master of Ceremony introducing the guest of honor to those who have gathered in the hall.

To close these rounds, I want to leave you with some final questions for reflection, but not to answer now: Where is health? Is it in you? Is it in the patient? Is it shared between both of you? Is it in the family? Is it in the community? Is it in the natural world? Where is health to be found? Do we treat just the patient, or do we treat the relational whole of patient-in-their-environment? This is an important distinction for physicians, and a radical change in how we practice. I would suggest to us all that we have an ethical responsibility to explore Bateson's riddle with both the reckless abandon of imagination, and the discipline and rigor also required of intellectual enquiry. In the tension found between these two poles, it is my hope for you that you will not only find the science of medicine, but discover medicine's deep healing art. Remember in your pursuits of excellence to satisfy not only the head, but also the heart – of patient and practitioner alike.

Thank you

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Act V - Scene I: Night Round - The Philosopher

Doctor's Narration: Finally, I had a weekend off. After so many days and nights of straight working, I had lost count of the hours. Somewhere in that time, unbeknownst to me, spring had slipped into summer: yard-work beckoned. After a morning of garden planting, lawn mowing, general tidying, and the like, I took a swig of some much needed cool water and retreated from the glare of the noon-time sun. I lay under the shade of the weeping willow in the yard, settling in for a small siesta. I last remembered the cool breeze on my face only to wake up to the smell and feel of sultry sea air...

On a nearby rock, at the head of the beach, sits a noble looking gentleman. His pate is balding, and he wears his beard long. He is dressed in a linen tunic and a cloak of an ancient Greek style, his feet bare in the sand. The sun is high overhead, and the waves lap gently at the shore. There is no wind today other than a mild sea breeze. The kindly old sage welcomes me over to where he is sitting. As a sign of respect and deference to his wisdom, I sit at his feet on an Aegean blue lab coat spread out on the sand.

Doctor: This is such a beautiful place. Where are we?

Philosopher: It is my birthplace. We are both celebrating a homecoming here.

Doctor: A homecoming?

Philosopher: Yes, for here is the place where many of the seeds of Western thought began their germination. The world was not always the way it is now. Once our thinking was congruent with all you see around you... What is it that you see Doctor?

Doctor: As I said, it is beautiful. The mountains, the ocean, the coast, the forest, the blue sky, and clouds above all combine to make a glorious scene. I can see how it must have inspired the Ancients.

Philosopher: Think closely about what you just said, as it shows both the source of your confusion, and at the same moment your way forward through to the clarity of understanding and wisdom.

Doctor: I am unsure of what you mean. You asked a simple question, and I gave a simple answer.

Philosopher: True, I asked a simple question that points towards something complex, and your answer, far from being simple, only serves to complicate things.

Doctor: Once again, I find myself in a place of not understanding. What is it that you see that I don't?

Philosopher: Doctor, it is obvious by your statement that you have a bias towards the world of substance or things. For me, what lies before us is really a question of pattern. Rather than ask what a thing "is," I look for patterns revealing the immaterial relationships between things. This is not a new tension in thought, however, as it has run throughout all the ages of humankind. Lovers of pattern have at various times throughout history been labeled and denounced as heretics, and some have even lost their lives for holding such views. Yet you, Doctor, live in an interesting time. With the emergence of a new understanding of complexity, the West is finally in a place to question its ontological and epistemological underpinnings, and perhaps chart a new course. Through an understanding of pattern, one learns to become a lover of wisdom.

Doctor: What are these new understandings that you mention?

Philosopher: Chaos theory, complexity science, complex adaptive systems, and the like. Although it is arguable that chaos is not a theory, complexity not yet a science, and determining what observations define a system is a tricky thing. But despite our muddled nomenclature, the adaptability of living systems is not in question.

Doctor: I thought the role of science is to simplify our understanding of the world, and make it less chaotic and complex.

Philosopher: It has always been in our nature to try to fit things to our own understanding. It gives us a false illusion of control and predictability. We are biased in our perception, and see only those things that serve to validate our own worldview, discarding any evidence that points to a different truth.

Doctor: As physicians, our understanding guides our search for order and disorder. It is what we do. Disease is, without a doubt, a process of disordering. Our vastly increasing knowledge allows us to diagnose, treat, and predict outcomes in ever-advancing ways!

Philosopher: And how has that been working for you?

Doctor: Well...it's not an exact science... yet.

Philosopher: It's not an exact science despite your obsession with quantification and measurement. How many hairs will you split before you realize that learning more and more about less and less will not give you the answers that you search for?

Doctor: I still don't understand how what you're saying applies to the field of medicine.

Philosopher: Doctor, what I am suggesting applies to far more than medicine; it is a reflection of Life itself. What if we began as scientists to have a small insight into the patterns and organizations that compose and orchestrate the foundation for all of Life's processes? Would this understanding not radically change our medicine? In my estimation, a life-affirming medicine should be in alignment with Life's rhythms and flows. How otherwise could it be effective or relevant to our lives?

Doctor: You are speaking about chaos and complexity, but to me health is about orderliness, harmony, and predictability. Diseases, on the other hand, are disordered, dissonant, and complicated things.

Philosopher: And this, Doctor, is the clinical paradox, and the origin of my question for you. How is disease a source of too much order, and disorder a marker of health?

Doctor: Ah... more riddles.

Philosopher: Yes, paradox and riddles: the well-trodden path of both philosophers and physicians alike. Let us start your tutelage in complexity medicine with an introductory grounding in the mathematics of chaos, shall we?

Doctor: Is the answer, "the square of the hypotenuse is equal to the sum of the squares of the other two sides?"

Philosopher: No: we will be viewing a geometry of a different order in our immersion into the rough and turbulent waters of chaos.

Doctor: How can a state of confusion, randomness, disorder, and disorganization give rise to a mathematical system?

Philosopher: Admittedly, there is a semantic challenge for the lay person in the choice of the term chaos, who in his colloquial use of the word is referring to indeterminate-indeterminism, that is to say utter randomness or noise. Mathematicians and physicists, however, with their semantics and jargon, refer to a type of indeterminate-determinism, or unpredictable organization, and this has been an easy source of confusion for us all! Stated otherwise, chaos describes behaviors of a certain type of system that on the surface appear random, but in actuality, are produced by a deep underlying order.

Doctor: I am already feeling roughed up by all of this.

Philosopher: Excellent segue, Doctor, for the roughness found in nature is at the center of the geometric expression of chaos theory; we are exploring the difference between the linear and non-linear. For years, mathematicians and scientists have concentrated on the former, rather than the latter because they lacked the computing power to deal with the complexity of non-linearity effectively. In an attempt to solve non-linear problems, they would try to simplify their models by approximating with a series of linear elements. Quickly they found that their predictive power was very confined with this methodological approach. Such reductionist and linear estimations have only limited and local ranges of applicability when applied to complex systems, beyond which point predictive reliability quickly breaks down. Luckily, we have good weather on the Island of Samos today despite what the weatherman may have tried to predict in earnest last week.

Doctor: You're being a little tangential in your talk here. Let's take a step back, and define linear and non-linear so that we may go forward.

Philosopher: Excellent proposition. To start with, when examining linear systems we must take note that we are dealing with the principles of proportionality and superposition. With linear proportionality, we find mathematically an equation, or structurally a mechanism where the systemic output has a direct relationship to the original input. In linear systems, we see that the magnitude of the response is always directly proportional to the stimuli acting on it. Superposition describes how we can understand the relationship of input to output in a linear system composed of multiple parts, by separating these components to determine their individual input-output totals, then summating them to derive the total output. In cases of superposition, the measurement of the parts equals the measurement of the whole exactly. As we can see, linear systems are very orderly, well behaved, and most importantly: predictable! They lend themselves well to a reductionist framework where parts are looked at to better understand wholes.

Doctor: And this discourse is very supportive of my earlier point about how medical science has allowed us to understand the order of health and disorder of disease. Reductionism has been a powerful tool in this regard.

Philosopher: Powerful yes, but perhaps misdirected and misapplied.

Doctor: How so?

Philosopher: Your question brings us back to our examination of the non-linear. In contrast to linear systems, non-linear systems do not comply with the principles of proportionality and superposition. When considering proportionality, we can see that small changes to the input in non-linear systems can have drastic and unanticipated effects on the output in either direction. A single non-linear equation can generate a steady state, successive and predictable interval oscillations, states that exhibit wild erratic fluctuations, or, contrarily, the formation of highly complex, but ordered systems. Small changes in such a system, then, can have enormous unanticipated effects; what in popular culture has been coined the "Butterfly Effect." Likewise, superposition also does not hold true with non-linearity, as the components in a system are capable of interacting in varying ways with each other. Rather than dependent, static, mechanical parts and determined operations, as seen in a linear system, we can think of the interactions between non-linear systemic elements as variable, relationally rich, dynamic, and at times exhibiting agency. Consequently, in these cases, "the measure of the whole is always more than the measure of the sum of its individual parts". The collapse of proportionality and superposition in a non-linear system is a result of the phenomena of coupling. Through coupling, we find that the subunits of a system are connected through reciprocal feedback structures resulting in a circular causality, rather than a linear one. Thus even a very simple non-linear equation can generate extraordinarily complex outcomes through its iterative processes. This ability of the components of a non-linear system to interact results in a breakdown of the reductionist paradigm, revealing to us its severe limitations. This, of course, should be of great concern to you as a practitioner of medicine, as the great majority of the processes in the body are non-linear, as are the vast number of processes throughout the living world!

Doctor: Are you suggesting that chaos theory is a new and powerful tool for models of outcome and predictability in the medical field?

Philosopher: Yes and no. The problem with non-linear dynamical systems is that they are, well... dynamical! Very small initial differences in input can cause and lead to radically different outputs or outcomes. It is what we refer to as, "sensitive dependency on initial conditions." The most extreme of these non-linear states is what has been termed chaotic. Now chaos, unlike its colloquial use in the common vernacular, refers to a type of unpredictable systemic behavior that can be observed within the parameters or constraints of the non-linear equation that defines a system, despite the fact that we know everything there is to know about the equation, and no additional source of randomness has been introduced. The result is a discrete system that continues to generate non-repeating sequences, trains, or patterns of activity. Consequently, we refer to this extreme non-linear state as deterministic chaos, or indeterminate-determinism (versus that of general noise or the true randomness of indeterminate-indeterminism in which any semblance of underlying order or pattern is absent). To summarize, chaotic systems are deterministic in that the current behavior or state is precisely predicated upon past states; however, extreme sensitive dependence on initial conditions means that future states remain fundamentally unpredictable. Therein is the crux of the problem, as non-linear states of all orders are ubiquitous in the environment, humbling us to the fact that science's long sought after dream of an omniscient Laplacian quantification and universal predictability achieved through the power of physical determinism has failed us.

Doctor: What you have said is, indeed, chaotic! For the physicist it would appear that the promised dream has become nightmarish. I can most definitely relate.

Philosopher: You are not the only dreamer, Doctor, for Pierre-Simon Laplace once conceived of a being of tremendous intellect, that could know the exact location of every atom in the universe, along with its precise momentum and trajectory, it would be able, through the Laws of Classical Newtonian Mechanics and Cartesian Coordinates, be able to determinately determine each particle's past and future values, thereby attaining infallible predictability; a perfect clockwork universe. However, in imagining such a being, Laplace evoked and unleashed a demon of terrible voracity that continues to suffer him in the hell of his own making. It is a nightmare that does not end  The only way out is to enter the dream within the dream, and embrace the paradox found therein.

Doctor: What is, then, the Paradox of Leplace's Demon?

Philosopher: To understand, you must first show some initial sensitivity in your views Doctor, open your closed mind, and be fascinated by what emerges, as Leplace's Demon transforms before our very eyes into a wondrous butterfly.

Doctor: You sit there speaking in riddles, and criticize approaches of reductionism and models of cause and effect in medicine, but what hope do you offer the profession? You have untied our moorings, and have left us to float in uncharted waters, lost in terms of our position.

Philosopher: Indeed, chaos is the wayfarer's nightmare, as it ensures position cannot be known. The path to specific outcomes and predictability may be a fruitless one, but the path towards patternability is not.

Doctor: Patternability?

Philosopher: Patternability, through which we may understand more about a system's non-trivial possibilities, predilections, and propensities, but never its trivial predictabilities. I am of course referring to an approach of form beyond substance; the understanding of quality, in juxtaposition to quantity. It is both the father and the mother of our created – or more accurately: constructed – world. From the Latin roots for father and mother, we have the terms pater and mater, from which we derive the English words pattern and matrix. The former refers to a specific set of relational connections, while the later speaks to the unbroken contextual ground supporting these patterns. This returns us to my initial question: what do you see around you?

Doctor: I feel I am no further along in being able to answer that. It would seem that I remain blind to the answer you seek.

Philosopher: I have found my answers Doctor. The answers you search for are yours alone. Foundation building is a slow process. Be patient, and let the question incubate within. Let us continue on with our exploration of the scientific principles of non-linearity. Another fundamental principle in non-linear dynamics is that of universality, or the invariance of the critical dynamics underlying all non-linear systems. Despite the vast variety of examples in the world of non-linear processes, all of which differ greatly in their specific detail, application and appearance, there are a number of common patterns of structure and response that repeat themselves. An example of such a universal class of phenomena is that of bifurcations, or patterns of systemic instability that manifest as spontaneous transformations of state. In a bifurcation, even minor perturbations can cause a radical transformation resulting in a set of new governing laws driving a system's internal dynamics. As a result, we see systems dynamically transform from a static state to a series of periodic oscillations and rhythmic alternations, and then into to fully chaotic states. The converse can also hold true where systems are brought back to states of dynamic equilibria through the stabilizing feedback loops of certain bifurcations. Curiously, in these cases, massive perturbations to a system may result in very little change, and the non-linear system remains stable.

Doctor: That's fascinating. Without realizing it, I had been utilizing the concept of bifurcations within my medicine. It is, in a sense, the foundation of our clinical bedside acumen.

Philosopher: Very good Doctor! Now you are beginning to see the essence of patternability. Let me share with you another example of a universal phenomenon intrinsic to dynamical systems: fractals. Fractals may be thought of as the structural remnants, in both space and time, of the non-linear processes that have shaped them in their environment. They are Nature's geometry. This is important to us, for to use non-linear approaches, we must be able to identify pattern in the apparent randomness of chaotic movement and form. Fractal geometry affords a way to model the irregular and discontinuous formations that compose the structure of the natural world. Chaos, unlike true randomness or noise, implies a hidden or concealed order despite its apparent unpredictability. Hence, a fractal becomes a manifest representation of the deep order that is inherent in a chaotic system. It shows us both the pattern of activity and alludes to its function. Furthermore, it points to the governing dynamics that shape the system.

Doctor: So just as bifurcations produce and reveal one mode of pattern recognition, fractals form another. I think I am beginning to see a relationship here. But, at this point, I wouldn't know a fractal if it was standing right in front of me.

Philosopher: I suggest that you open up the eyes on that face of yours, and look all around you, for fractal geometry abounds. We see them on the shore, in the waves, on the mountains, in the clouds, and in the forests that surround us. It is what I see always, and what you have been blind to. You have seen things called mountains and forests and the like, while I see patterns and patterns of patterns. Ultimately, they are all the patterns that connect.

Doctor: How do I begin to see these patterns?

Philosopher: Let us look to fractals in their wholeness, and perhaps you will begin to understand. Take the shoreline for example: What do you see when you look at it?

Doctor: A craggy, uneven rugged line running up the coast.

Philosopher: And if an ant were to visualize it, what would he see?

Doctor: A craggy, uneven, rugged line, I imagine, from the scale of perspective that ants are inclined to observe such things.

Philosopher: And the eagle high above?

Doctor: The same I suspect, only with a difference in scale.

Philosopher: And from space, Doctor? How would the coastline appear in its entirety?

Doctor: Once again, we would see the same craggy, rugged, uneven line.

Philosopher: Right you are, and so the same for mountains in their ranges, trees in their forests, and rivers with their tributaries. Although not entirely identical, in the natural world at every scale, we see a self-similarity where patterns intrinsic to the whole repeat throughout the organizational structure of its parts. Similarly, we observe the property of scale-invariance, whereby the inherent fractal pattern holds true across multiple spatial and temporal scales contained within the system. Self-similarity and scale-invariance are aesthetic identifiers signaling to us that the object of examination is fractal-like in its form.

Doctor: By your example of trees and rivers, I can see that analogous processes exist in the human body. For example, in both the respiratory and the circulatory system, we observe progressive branching in smaller scales. In the lungs we move from the trachea to the bronchi to the bronchioles, and finally to the alveoli. Indeed, we even call the structure in its totality the bronchial tree. Equally we see the major arteries branch becoming minor arteries, eventually scaling down to becoming arterioles and capillaries. I can think of other anatomic structures such as the brain, nerves, the kidneys, the intestines, and the heart's electrical system, to name just a few, that also exhibit fractal-like organization.

Philosopher: Yes, all of the structures you name are indeed fractal-like. Unlike the idealized mathematical abstractions of computer-generated fractals, such as the Mandelbrot set (sometimes called true fractals) with their infinite scaling and exact self-similarity, the natural world has upper and lower limits of scale, and exhibits only approximate, or quasi self-similarity. By convention, we refer to such real structures as fractal-like, but the principles hold true nonetheless. This being said, there is another defining quality of fractals that holds true for both the idealized and natural world, and it is the property that gives them their name; they all exhibit the phenomena of fractal- or fractured-dimensions.

Doctor: Fractured dimensions; now we're talking medicine! Perhaps what it requires is a simple orthopedic reduction?

Philosopher: What works for broken bones, Doctor, does not work for fractal geometry, as a reduction, orthopedic or otherwise, is a rather linear sort of thing. In geometry, one dimension defines a straight line, two dimensions give us an area, and from three dimensions we derive volume. As a thought exercise, I want you to imagine measuring out the Greek coastline. How long would it be?

Doctor: I am not sure off the top of my head, but I am certain there must be statistics for such things.

Philosopher: If there are, they are only there to keep the bureaucrats and statisticians happy, for inevitably they will be inaccurate. Now what do I mean by that? If you took a measure of the coastline in units of kilometers, it would be a certain distance. If you measured it in meters, the total distance would be greater still. And if we further dropped down to centimeters, the total measured distance would be even greater. This carries on infinitely because of the fractal property of self-similarity and scale-invariance. Consequently, there can be no simply-defined length for such an irregular curve, since the smaller the unit of measurement, the greater the defined length, ad infinitum. A coastline, despite its name, is not a one-dimensional line in any traditional sense, because as a fixed dimension, a line has a limited and measurable length by definition. Equally, a coastline cannot be categorized as fully two-dimensional, as it has no defined surface area. Similarly, by attempting to trace out a mountain's surface area, we fall into the same predicament of scaling and self-similarity, with progressively higher values being measured at smaller scales. Thus, a coastline has what is called a fractured, fractional or fractal dimension between one and two dimensions, while a mountain's surface area falls between two and three dimensions. This fractured dimensionality, as a measure of roughness, is a hallmark of fractal organization.

Doctor: So the body exhibits fractal geometry in its anatomy from which we can infer that its structures developed from non-linear processes. Beyond the obvious functional definitions that lungs are for respiration, hearts for circulation, kidneys for filtration, and intestines are for absorption, what is the physiological advantage for fractal geometry in the body?

Philosopher: This is a vital question. Indeed, the fractal forms in the body have arisen from the dynamics of embryonic development and morphogenesis; this same strategy having been preserved throughout evolution's phylogenic record1. It is a fundamental organizing principle for Life as we know it. Although these fractal anatomies undertake a number of diverse functions, we see a variety of commonalities and themes emerge. First, fractal branching and folding serve to greatly increase available surface area for varied physiological processes. The spatial volume in the body (which is to say its quantity-limiting values in three dimensions) housing the anatomical architecture is, for practical consideration, fixed. (Archimedes, in his eureka moment showed us that displacement is a simple measure of this!) However, the fractal dimension of a surface's area can, with its multi-scale folding, approach that of three-dimensions, thus maximizing the surface area available within the fixed volume of an organ. Secondly, by virtue of their inherent redundancy, fractal surfaces are robust and resilient enough to resist injury or assault, allowing for continued mechanical function within relatively normal ranges despite extensive tissue damage.

Doctor: Are there other examples of non-linear systems at work within our physiology?

Philosopher: Most certainly there are. Fractals are not only useful in helping us understand complex physiological structures, they also help us model and better understand dynamic physiological processes measured across scales of time. A number of processes in our physiology show self-similar fluctuations or variability over multiple time-scales, or orders of temporal magnitude (i.e. milliseconds to seconds to minutes to hours to days to weeks). The fact that in these dynamic temporal functions there is no singular characteristic time-scale that defines the process is equivalent to scale-invariance in geometric fractal forms.

Doctor: I understand how we can geometrically view self-similarity on multiple scales, but how do we observe the self-similarity of dynamic processes?

Philosopher: An excellent inquiry! You are right in saying that our experience of fractals is a sensual one. To observe the fractal nature of a temporal process, we must plot the measurements of the event of interest in relation to time, giving us a time-series run. This, in turn, provides a visual representation of the dynamic process through which we can identify a self-similarity of pattern of activity at various temporal scales.

Doctor: What would be examples of dynamic fractal processes in our physiology?

Philosopher: The one that is, perhaps, most amenable to observation is our heart rate. If we plot heart rate in a healthy individual on a time series of varying scales, we will see a highly variable and erratic self-similar response that is reminiscent of another fractal structure: namely that of the sharp and varied peaks of a mountain range. If we compare a healthy individual's time-series to the plotting of an elderly person's, or to that of an unwell person, what we find is a much more blunted response, with less variability and increased oscillations, periodicity, or otherwise stated: predictably repeating patterns. The most extreme examples of a loss of variability would be the appearance of a sine-wave on electrocardiogram (ECG), indicative of severe hyperkalemia (high potassium), or the flat-line of asystole of the non-beating heart in cardiac arrest. Interestingly, as a physician, you rely so much on the ECG for diagnosis and as a metric for stability, yet in the example of a healthy individual compared to one with sleep apnea, we would see a similar normal sinus rhythm on ECG with no abnormalities in both patients. Only through the analysis of a time-series recording would we note pathological changes as represented by the loss of heart-rate variability. Other systems in the body that show similar temporal fractal processes include respiration rate, hormone release, neurological activity, and immune system response.

Doctor: Self-similarity, then, allows us to visually identify fractals, although I imagine there is a large amount of imprecision in this. You mentioned previously about fractal dimensionality. Is there a way to calculate this?

Philosopher: It is true that the eyes can be fooled. Fractals, that is to say the pattern beneath the disordered appearance of Life, have always been there. Some artists have intuitively known this, but it took the mathematical creativity that Mandelbrot touched upon to bring it to our pot-modern collective consciousness. Art and mathematics are aesthetic siblings related through their recognition and pursuit of pattern. But I digress: the degree of fractal-dimensionality can be calculated as a measurement of an object's roughness. For example, a coastline could be between one and two dimensions, just as a mountain's terrain or the lung's surface area can be between two and three dimensions. The higher the value, the higher the order of complexity present in the fractal form. The fractal dimensionality is determined in part through a mathematical relationship known as a power-law. It is this power-law that is responsible for both scale-invariance and self-similarity in any fractal system, whether manifested through structure or process. If there is non-linearity about, the power-law is lurking close by!

Doctor: Tell me more about this power-law.

Philosopher: The power-law is representative of a type of logarithmic asymmetric statistical distribution ubiquitous throughout the natural world, including human systems. It reveals to us a pattern of progressive declination from many small-scale events to very limited manifestations of large-scale events over time. A common example is earthquakes, where small-magnitude earthquakes are relatively frequent and commonplace, whereas large magnitude earthquakes are thankfully a much rarer event. The scaling inherent to the power-law distribution is captured in the case of earthquakes by the Richter scale, whereby an increase of one on the scale represents a ten-fold increase in magnitude of the quake.

Doctor: So, with fractals, we are talking about seeing deeper levels of order: a dynamic order behind apparent randomness. What process structures that order?

Philosopher: To answer that, let us turn to the ideal that Nature can be expressed numerically; that we can model a deep organization that forms the basis of pattern in the manifest world; a pattern underlying pattern if you will. Without going into the complexities of fractal mathematics, whenever we use feedback or iteration in an equation where the end result of the last calculation becomes the starting input of the next, we produce dynamic, rather than static variables. We can map these equations visually in a number of ways depending on their nature: Self-similar and scale-invariant fractal representations (such as the Mandelbrot Set); cobweb plots (i.e. Verhulst Diagram) to depict the qualitative behavior of one-dimensional iterated functions, allowing us to infer the long term status of an initial condition after repeated mappings of the function as either a fixed point, periodic, or chaotic attractor.1] [phase space diagrams representing all possible states of a system, with each state corresponding to a single unique point in the phase space model (e.g. Lorenz Attractor); or bifurcation plots (i.e. Feigenbaum Diagram) that show all the possible state trajectories of a system (equilibria/fixed/static points, periodicity or chaotic/indeterminate fluctuations) over time in response to varying stimuli. Like fractal images, bifurcation plots also exhibit self-similarity at multiple scales.

Doctor: I can see that the various representations you cited such as fractals, phase-space diagrams, and bifurcation plots help elucidate the structure of dynamical systems, but what is the ordering organization that forms the basis of all these structures and representations?

Philosopher: In all of these mathematically idealized circumstances, the non-linear equation itself defines the boundary conditions of the system of interest...a type of defined externality if you will. From the function arises a class of internal order defining the system's possible ranges of behavior. The deep structures of potential relational configuration within a system are known as attractors. Although we use the noun, attractors are not things in any manifest sense. Equally, we could have named them repelors, but this would have been equally misleading. There is no act of pulling or pushing; they are merely explanatory principles. An attractor is a representation of a given end-state of a non-linear systemic behavior manifesting over its specific time course. In this manner, we speak also of basins of attraction. The basin of attraction is the set of all possible initial conditions that are drawn towards the organizing stability of the attractor within a dynamic system. Fractals, among other dynamical representations, are immanent forms that manifest the processes directed by the ordering organization specific to the boundary conditions set by the systemic function, thereby highlighting the attractors at play. Interestingly, even very simple non-linear equations can produce orders of incredible complexity. Attractors, too, are universally present in our descriptions of dynamic processes.

Doctor: Admittedly, I experience a strange attraction to what you are saying, although the nature of some of your utterances, I must say, repulses me at times. If I understand you correctly, attractors, despite their attraction, are not things in themselves, yet fractals, which are things, would have no thingness at all if it wasn't for the organizing exertions and influence of something that doesn't actually exist.

Philosopher: You are showing excellent prognostication, Doctor, as some of these attractors are very strange, indeed. Before we talk about attractors, we should, however, first better define the metaphorical terrain in which they live, or what we refer to as phase or state-space. Phase-space is a mathematical abstraction representative of all the possibilities of expression or behavior available to a defined system. Stated otherwise, the phase-space is the sum total of all the possible states that a system can occupy.

Doctor: And what of attractors?

Philosopher: Attractors come in a variety of different flavors. In attractors, we find the position (state) in phase-space towards which a system will evolve over time. This attraction (organization) is defined by the system's parameters. However, attractors are not uniform phenomena, and the three standard types of fixed-point, cyclic, and chaotic attractors can give us very different systemic behavior. With a fixed-point attractor, the system settles down to a solitary stable state within a single position in phase-space that does not change with time. With a periodic attractor, a system's states follow a cyclic path through two or more points in phase-space to have the cycle repeat itself. Chaotic attractors, however, organize their dynamic output in a pattern of apparent randomness as the system shifts from one position to another within its phase space, in such a way that its location at any given moment cannot be predicted. Nonetheless, the general shape containing a chaotic attractor's indeterminate positions becomes apparent with observations over time, revealing a coherent and consistent pattern of overall systemic behavior. The basin of a chaotic attractor is a composition of all the possible initial conditions supported by the present systemic state. The perceivable pattern derived from this plotting is always fractal in nature.

Doctor: How do attractors form?

Philosopher: If we take a moment to integrate our learning to this point, we will notice that no matter what the nomenclature we use, whether it is the language of cybernetics, or that of system's thinking, we understand that feedback is what drives iterative phenomenology. The output of an operation or function is fed back in as the new input. This is, of course, the nature of the recursive process.

Doctor: How can a process of infinite recursion create the stability of organization that you talk about with attractors? Intuitively, I would think that unchecked recursion could only result in instability.

Philosopher: Admittedly, many iterative functions are divergent and bring about no stability in organization, vanishing into the infinite void. They create no difference of any difference. We, however, see a class of recursive operations or functions that converge to one or more stable states. These special types of equations produce a self-value (i.e. eigenvalue) where stable states are seen to emerge from a set of apparently infinite recursive computations. These stable self-values, once obtained, continue to auto-produce or maintain themselves through continued recursions. More formally, we can state that the stability of a function occurs when the derivation of a function results in the function again; the function describes itself! Interestingly, the initial value inputted into the recursion has disappeared. It cannot be recovered using a reversal of the operations that brought us to our stability. We are blinded to the initial conditions with only the stable state remaining amenable to our observations. It is an understanding of this process that allows us to shed light on the processes of closure, goal directedness, computation, and autonomy in cybernetic process, and from a system's perspective forms a basis for our understanding of attractors and their role.

Doctor: From what you are saying, it sounds like there is an overall stability in dynamic systems, whether they have fixed, periodic, or chaotic attractors, yet we know from our talk about bifurcations that these systems are prone to abrupt change. How do you reconcile the ideas of attractors stabilizing the dynamics of a system with the diametrical concept of ever-present potential destabilizations or state changes (as evidenced in a bifurcation plot)?

Philosopher: Now you are getting at the heart of why these non-linear systems are called dynamic! It is time that we put all of our various concepts related to chaos theory together. Non-linear systems demonstrate neither proportionality nor superposition. This is a result of the process of coupling, leading to feedback or cross-talk between the components or agents of the systems. The result of this iterative feedback (also known as recursion or circular causation) is twofold. First, small changes in initial conditions can lead to vastly different outcomes. Second, infinite recursion need not result in divergent instability, but given the proper variables can converge into a finite set of values that result in self-organization and systemic stability. Consequently, perturbations in the form of stresses or stimuli can transform an established system in a non-linear and unpredictable fashion. This sensitivity to initial conditions and the effects of perturbations create the potential for bifurcations or state changes. When a bifurcation causes the abrupt transition to a new dynamic state in phase space, the system shifts from one attractor to another, an attractor that remained only a potential state prior to the bifurcation. The very nature of attractors explains why phase transitions can be so abrupt. The result of all of these dynamical organizations is the manifestation of complex spatial and temporal forms and processes, the remnants of which can be observed as a fractal presentations on our sensory landscape.

Doctor: This helps explain why patients will often make sudden changes in their presentation or symptomology. As physicians, we base our clinical diagnosis and decision making on the symptoms generated by a given physiological attractor. Chaos theory helps us explain why people can sometimes seem so resilient to catastrophic injury and trauma as a result of redundancy and a dampening of injurious process from feedback, yet also unexpectedly so fragile at times in the face of only minor insults leading unexpectedly to a bifurcation into system instability or a catastrophic feed-forward process.

Philosopher: Indeed, the human condition is a mysterious one.

Doctor: So, the conventional belief is that the body is mechanistic with stress-related breakdown or disorder indicative of the disease and aging process. But our discussion implies that increased disorder (physiological variability, change, and fluctuation) is actually a marker of health, and that too much order (periodicity and recurrence) is an indicator of disease. I must say, I am feeling a little disordered myself in this moment as my sense of the order of things has been shaken!

Philosopher: Right you are Doctor. We see many examples of this in pathology where a loss of variability or complexity and the onset of increased periodicity or rhythmicity is the hallmark of disease. Congestive heart failure, Cheyne-Stokes respiration in the very ill or near-dead, the shuffling gait of a Parkinson's patient, obstructive sleep apnea, depression, sudden cardiac death, and fetal distress during labor: all exhibit this physiologic impoverishment.

Doctor: So if a loss of variability leads to disease, how does the same variability safe-guard health?

Philosopher: In living forms in general, and in the human being specifically, adaptability is a mark of healthy function. In human anatomy and physiology we find incredible examples of complexity at work. An integrated physiological response must be able to work within the narrow parameters of a biological system's dictates, and at the same time show plasticity in its response to wide ranges of environmental stimuli over multiple scales. Living organisms operate under a wide range of conditions, and, therefore, requisitely demonstrate both adaptability and flexibility. This plasticity allows biological systems to cope with exigencies of an unpredictable nature in a changing, complex world. Fractal long-range correlations in the body's make-up serve as a type of non-central, diversified organizational template for the coordination of highly intricate, multi-scaled processes. Furthermore, varied, irregular fluctuations in physiological response allow for broad system responsiveness in an expeditious manner on multiple temporal and spatial scales to changing external and internal environments, whereas in very limited periodic responses, such as we see in aging or disease processes, we see much more limited ranges of responsiveness. Finally, as these non-linear systems are dynamic, open, dissipative systems, they require an input of steady energy and matter, allowing for their continued operation in a far-from-equilibrium state. Consequently, they are able to hold dense amounts of order and pattern within their phase space. Conversely, systems that have lost variability and complexity become relatively aesthetically impoverished due to the accompanying degradation of order when a system moves towards static equilibrium as a result of increasing entropy.

Doctor: ...Wait a minute! If I understand you correctly, you are challenging all of my profession's cherished beliefs. You have put forth the heresy that disease is a product of too much order, with the converse being true for health, and now you are saying that the dynamic states that support such a reality are far-from-equilibrium?

Philosopher: That is correct.

Doctor: But you are challenging the sacrosanct truth of homeostasis, one of the central tenants of medicine!

Philosopher: Guilty as charged, but throughout the annals of history, we lovers of pattern are no strangers to heresy, nor to the swift scorn and punishment of the orthodoxy. Homeostasis, as classically conceived, reduces variability to maintain a constant and steady physiological state. The homeostatic system, as so traditionally defined, acts as though it has a fixed attractor. Yet in non-linear systems, through the shaping or influence of complex periodic and chaotic attractors, we observe the opposite behavior. Variability is self-generated even in the absence of external stimuli, while a theory of orthodox homeostasis predicts that variability should settle down in the absence of perturbation. From a classical viewpoint, we would expect homeostatic systems to destabilize as their internal milieu becomes progressively more variable, however non-linear complex adaptive systems show us just the opposite is true. Variability becomes the source of overall stability within the parameters of a living system

Doctor: What is the source of these discrepancies in view-point?

Philosopher: It is another example of reductionist mechanistic slight-of-hand leading us to erroneously believe that all bodily processes can be linearly approximated. That being said, all is not lost. Homeostasis conceptually uses feedback in its organization, and like homeostasis, even the variability present in non-linear systems has ranges of physiological tolerability protecting the organizational limits of corporal integrity. Perhaps homeodynamic would be a better phrase, in light of a non-linear dynamic understanding. The term may better capture a non-linear orientation in our evolving understanding of physiology.

Doctor: I have heard many things so far, and I am intrigued by all of them. Nevertheless, it still seems that there are many strings left to tie up. I have heard mention of systems, complexity, adaptability, dynamics, and far-from-equilibrium-states, but I am still unsure of how these concepts weave together, not to mention their application to medicine.

Philosopher: Although the mathematics of chaos theory gives us a strong foundation to help us understand some of the body's structures and processes, it alone is not enough. Mathematics provides a type of uncharted logic through which we can better understand our constructions of the world. Chaos theory shows us clearly the limits of our ability to predict in a linear, deterministic fashion, highlighting our deficiencies in causal attribution. However, it also allows us to understand the global workings of pattern and behavior within the formulaic limits of the mathematical function that delineates a non-linear system. What we lose in our ability to quantify, we gain in our ability to qualify. Nevertheless, chaos theory is not enough to begin understanding the essential question of how Life may have come to be formed. For this, we will have to inquire beyond chaos into the nature of complexity itself, and the workings of complex adaptive systems.

Doctor: So things are about to get even more complicated.

Philosopher: Quite to the contrary Doctor, chaos theory has shown us that even very simple rules can generate incredibly complex systems. From these simple origins, there is an incredible flourishing of relationships, connections, and interactions that together create a web of vast complexity. Conversely, the study of complexity begins by embracing that which is manifold, variegated, and beyond the grasp of our intellectual comprehension, but paradoxically creates an understanding of the whole that is profoundly eloquent in its simplicity.

Doctor: Despite my fear of our already complex conversation becoming more complicated, tell me more about the fledgling field of complexity science, so that I may better understand the nature of a medicine of complexity.

Philosopher: Complexity at this stage of development is a nascent science with many diverse and sometimes conflicting views. Yet it remains ripe with a multitude of novel concepts. Complexity science, as a rigorously-defined discipline, still lies somewhere in our future. This is both a source of excitement and frustration, as we struggle to see things in a new way. It is also a period of mourning the loss of old perceptions and paradigms, and as we know, the grief generated by such a transition can be difficult. But even now we can say that the study of complexity attempts to understand the holism and synergy in a system that results from the interactions of its component parts or subsystems. The unique nature of these complex relational patterns or matrices that becomes the focus of our philosophic and scientific work as complex system theorists.

Doctor: But all systems have relationships between their component parts. Are all systems, then, complex?

Philosopher: This is a good question. Although some systems may be complicated, not all systems are complex. If you remember in our conversation around chaos theory, we discussed the principles of proportionality and superposition. In a linear system, the relations between parts are fixed, and their outcomes set. This is why they are governed by proportionality and superposition, and consequently, their input is proportional to their output; the sum of the productivity of the parts is equal to the productivity of the whole. From this, we can say that an automobile or a plane is complicated, but not complex. We can label these types of operations as trivial, as the internal functions or operators are known, and the output predictable and exact.

Doctor: How, then, do the component relations differ in a complex system?

Philosopher: In a complex system, we have a number of unique organizational relations that construct and support it. First, the number of elements needed to support a complex system is sufficiently large that it is impractical to investigate individual elements, and the relevance of each component is never self-evident. Also, many of the component parts of a complex system have multiple relationships comprising many local interactions, as well as more distant connections throughout the system. In addition, the diverse avenues of connectivity may exhibit varying strengths of connection with other parts in the system. This goes well beyond the general notions of serial or parallel connectivity that we associate with linear systems. Metaphors of nets or webs serve us better when conceptualizing complex systems. Finally, we should be clear in our understanding that the nature of such connectivity is supported through feedback, where the final outputs in an interaction form the next cycle of inputs into a system. This feedback could be negative (dampening) in its effect or positive (amplifying). Interactions become even more nuanced and complex as feedback may occur after a single operation between components, after a series of operations, or between subsystems. The synergistic relations created using feedback, connectivity, and a sufficient number of components, structure the observable dynamics or behaviors of the non-linear systemic architecture. The outcome of this interactional process is the emergence of a systemic whole, whose measure is greater than the measure of the sum of its parts. They are deterministic, yet unpredictable. We can observe the systemic inputs, and we can observe the outputs, but we can never, because of the vast computational complexity of such systems, discover the transforms generated within the system's internal operations; the generative interactions challenging any notions we may have of linear causality. The system's own continuous experience transforms itself continuously! We can therefore think of these systems as non-trivial. Trivial systems remain responsive to the voices of their creators giving us predictable outputs for each of our inputs: a good thing for automobiles and 747s. They play by our rules. Not so for the non-trivial systems. They too respond to a voice, but rather from a voice from within. We can dictate to the trivial, and they will obey. But in a non-trivial system, all we can hope is to engage it as equals in an improvised dialogue of call and response, unsure what each new moment will bring.

Doctor: If I may ask, one non-trivial system to another that is, how do the properties of non-linear systems, with their relational complexity, contrast with the properties of linear ones?

Philosopher: You will remember, Doctor, that linear systems are defined by their proportionality and superposition. In comparison, complex systems, with the aforementioned relational architecture in place, exhibit a number of unique characteristics that determine their internal workings and stability. At once, we see that they are what we refer to as dissipative systems. They owe their existence to the continuous flow of energies that feed them, creating the needed thermodynamic gradient requisite to their self-organization and continued maintenance of form and function. Such systems are said to operate far from equilibrium, thus exhibiting very different properties from static state systems resting at equilibrium. We can view far-from-equilibrium systems as open systems. Next, we encounter the phenomena of emergence and emergent behaviors, what in many ways is the hallmark of complex/dynamical systems. Emergence is the spontaneous manifestation of novel patterns, behaviors, processes, or organizations that cannot be predicted, a priori, based on an understanding of component interactions. Nor is the outcome, a posteriori, analytically attributable to its various components, and cannot be explained in a reductionist fashion. Emergent behaviors are the result of a systemic self-organization in which we observe new levels of integration and systemic states of increasing complexity, as a product of manifold relational interactions between the components. Self-organization arises spontaneously from the ground of relational activity, and is representative of a fundamental ontological change. Consequently, emergence may be conceptualized as a local (heterarchical) process, while complexity (both organizationally and behaviorally) is produced out of a lower order: local interactions containing no centralized dictums or set responses to controlling hierarchies. Specific elements within a complex system are ignorant of the total system's integrated behavior, and are only responsive in ways that correspond to their specific and largely local connectivity. This differs very much from linear systems, where component parts are organized in a centralized (hierarchical) model, and the end product is known in advance as a consequence of external dictates. Furthermore, complex systems exhibit histories. By this, I mean that as dynamic systems change over time, past states influence future ones, and thus the present state can be only understood in relation to its historical context. This concept is known as hysteresis, or the notion that the dependence of a system is not only predicated on its current environment, but also on all of its past states. This necessary historical dependence is a product of a dynamic system's access to more than one internal state (attractors), and their integral operation and use of complex feedback loops. The same, however, cannot be said for any linear system, as the outcome of the last systemic output has no bearing on the next round of process. Finally, we encounter the notion that complex systems are nested entities, with the components of a complex system, often being complex sub-systems themselves. Here we find the notion of a whole system being a composite of integrated subsystems. This is, of course, entirely relevant to medicine, as we see that cells, tissues organs, and organ systems are all complex systems when viewed in isolation, but simultaneously form the component parts of the body in its emergent totality.

Doctor: If I understand what you are saying, the complexity born of these relationships is what provides us with the foundation for an understanding of living systems.

Philosopher: It is true, but although complex systems are sufficient for helping us to understand material reality and its corresponding interactions, they are in themselves insufficient for understanding the biological world. Nevertheless, out of this physical reality's interactions, we can see the emergence of an organization which we can continue to view as complex, but also observe as adaptable: a complex adaptive system.

Doctor: Intuitively, I can understand that living systems are different from non-living ones, but how do complex adaptive systems differ from ones that are simply complex?

Philosopher: The major categorical difference is one of agency. Complex systems are to be understood through the purview of physics. From an ontogenic perspective, the physical world is causally dictated and driven by physical laws, forces, interactions and happenstance, none of which can be framed as agency. By agency, I mean the capacity, condition, or state to act and interact in responsive ways to changing conditions or perturbations. Living systems, however, exhibit autonomy, and based on the determinacy of their structure, degrees of behavioral freedom that transcend the externality of linear cause and effect. It is this quality of agency in the living system that indicates its ontogenic emergence. Because of the degrees of freedom within their structural determinants, these agents are able to interact, connect, and couple with each other and their environment in unpredictable and unplanned ways. (Billiard balls do not avoid the cue, although the balled-up hedgehogs in Alice's game of croquet against the Queen frustratingly conspire with the pink flamingo mallets, thereby fixing the game!) One only need to think of the balletic choreography of a starling murmuration or a vast ball of schooling oceanic fish in nature to intuitively grasp what I am talking about. Any agent may belong to any number of other sub-systems based on the number of connections, and the strength of the connections that it forms with other systemic agents. Consequently, complex physical systems may be thought of as causally reactive, exhibiting a circular cause and effect, while living systems must be seen as causally interactive, exhibiting stimulus and response. This is not a trivial difference, as a complexity perspective demarcates for us a clear ontological delineation between our study of physics and biology. To misunderstand this is to make a gross error in logical type, the consequence of which cannot be understated.

Doctor: If agency is a defining condition of complex adaptive systems, and complex adaptive systems emerge out of physically complex systems, what are some of the novel states we observe as emergent in such a system?

Philosopher: Well, first and foremost we have adaptability! Living systems also demonstrate memory, as well as the capacity to learn and exhibit plasticity. These capabilities, facilitate appropriate contextual stimulus response and the ability to change with experience. Complexity and adaptability are inextricably related. When a complex adaptive system is confronted with novelty in its external or internal environment, some subset of its components and sub-systems, linked through their recursive circuitry, may have the capacity, not just to dissipate or assimilate, but to accommodate and integrate into a new and transformative relationship. As a result, we see the exercising of the principles of dynamic self-organization in the maintenance of organizational self-stability. Living systems are always under threat from turbulent, chaotic challenges from their environment. When systemic integrity is threatened, we see that complex adaptive systems have the ability to respond and self-organize into higher levels of order with increased structural complexity, function, and requisite adaptability. Complex adaptive systems have the capacity to undergo a transformative emergence that establishes a new self-stability or coherence in the face of overwhelming environmental or evolutionary pressures. Emergence in living systems is nothing less than an act of biological creativity, born of the combination of complex internal relationships between a system's agents, coupled in a further recursion with its ever-changing environment.

Doctor: So, what you are suggesting is that the more complexity and diversity in a living system, the more it is likely to be able to respond to the challenge of environmental pressures that pose a threat to its organizational integrity. Conversely, we can infer that the destruction of such relational integration will lead to a lack of resilience and adaptability within a system. The support of diversity within the system, then, would seem an imperative to any living organization.

Philosopher: Yes, what you are saying is absolutely correct until it is not!

Doctor: (Sigh)...You have succeeded once more in setting me a drift, rudderless, and without direction...

Philosopher: Let me help you find your moorings again, Doctor. Whether it is the human body or an ecosystem, diversity is an imperative for health within the system. Diversity allows for a rich potential resource pool that serves as the source of resilience, and remains a reservoir for potential novelty. A breakdown of relationship represented either in the forms of disease or extinction, respectively, may result in a catastrophic cascade that ultimately threatens the sustainability of a system and its continued existence. There is, however, an important paradox here.

Doctor: I am starting to think that paradox is the new status quo, when it comes to living with complexity.

Philosophy: Yes: change is the new stability amongst the scientific intelligentsia.

Doctor: So what is the nature of our present conundrum?

Philosopher: Sand piles.

Doctor: Piles? Now you are just becoming a pain in my backside!

Philosopher: Once again, Doctor, you fail to see the patterns that connect. If I keep picking up handfuls of sundried sand, allowing the grains to fall into a pile on the beach, when will be the exact moment that the pile becomes unstable, forming landslides and avalanches? And what will be the destructive magnitude of those avalanches in respect to the structural stability of my pile? Will the inevitable landslides be only minor inconveniences with a resultant restructuring and maintenance of general stability, or will they culminate in a catastrophic or even cataclysmic event?

Doctor: I am afraid I don't know the answer to that.

Philosopher: Exactly, and neither do I, and that, of course, is a feature of complex systems. Now, in many state changes such as phase-transitions between solids, liquids, and gases, there is a precise threshold, with its accompanying metric (i.e. temperature, pressure, etc.) that determines the outcome of the transition. For example, we can say that pure water at sea level, with such and such partial pressure of water vapor present in the air, will boil at 100 degrees Celsius. The phase transitions of water have clearly defined and predictable critical points of transition. Complex systems, however, don't behave in that manner. With each additional grain of sand that I add to my pile, I have no idea when an avalanche will form, or what magnitude it will be. Once my sand pile reaches its critical state, there is no correlation between the system's responses to the perturbation of each falling grain and the present structure of the system (number of grains, shape of pile, height dropped from, etc.) The dynamics are unpredictable. This means that dropping another grain of sand onto the pile may cause nothing at all to happen, or it may cause my pile to collapse in a massive sand-slide. In categorizing this phenomenon, we say that a sand pile, like other dynamic systems, exhibits self-organized criticality. A system's control parameters do not take the form of a precisely-defined and predictable transition point, but vary depending on the system's dynamics at a specific point in time and space. Once again we see the workings of sensitivity to initial conditions and the consequences of an indeterminate determinism.

Doctor: Certainly we must have some predictive power in your given example; the higher the pile, the more likely the avalanche, right?

Philosopher: In systems with self-organized criticality, we know certain things: one, that dynamic systems are open, dissipative systems; two, that the components of a non-linear systems system are often governed by relatively simple rules; three, that indeterminate thresholds exist within a system; four, that pressures will build until the threshold is crossed; five, that there is scale invariance in the system; and six, with the presence of the phenomenon of scale invariance, simple power laws must be at play. What this means for us is that a similar perturbation may cause a small avalanche, a massive avalanche or no avalanche at all. Based on our understanding of power laws, we can generate probability distributions of event timings and sizes, but not predictions of specific occurrences. When examining systems with a self-organizing criticality, despite having an understanding of a system's components, we can never know for certain where a system's threshold lies at a given time within its phase space. These models show us that change in complex systems is a mixture of gradual processes combined with sudden punctuated events, all of which defy our predictive ability.

Doctor: Diversity, variability, and complexity are the source of a system's resilience, and the wellspring of novelty from which new phenomena and order may emerge. At the same time, by increasing complexity in a system, we can find ourselves confronted with ever-increasing probabilities of organizational criticality where a worst case scenario leads to a catastrophic event where the global integrity of a system is overwhelmed and disintegrates if a novel relational systemic is not achieved.

Philosopher: Stressful isn't it? But don't worry, we will come back to this point again when we try to further understand the strategies that living systems have adopted to utilize this paradoxical tension.

Doctor: This mix of ideas is becoming chaotic.

Philosopher: So it is, but not yet critical. It is the tension of paradox that allows us to stretch and fold ideas until a deeper order of understanding emerges. Allow me to introduce, then, a new thought in to the dynamics of our morphing co-creation. Emergent phenomena represent the development of new orders of abstraction, and thereby serve to transform a system as a whole. With emergence, the organization of a system fundamentally changes. When this occurs, we tend to exercise our reductionist reflex of forming linear assumptions and abstractions, and as a result we often choose to formulate our observations in a hierarchical and hegemonic manner. For example, in the body, by anatomical convention, we list an ontogenic hierarchy starting with cells, traversing tissues, organs, and organ systems to then arrive at the corporal apex of whole bodies. This type of imposed hierarchy, we must never forget, is a construction of the observer of the system. A better conception of these emergent relationships is the nested model where relations cut across levels of emergent ordering, thereby communicating difference in a recursive fashion, creating a seamless whole. So, as you see, we are necessarily confronted in our habitual perspectives, challenged by the organizing need for exclusive hierarchies that nevertheless, in their democratic mutuality, define an inclusive whole. This is the paradoxical reality of emergence.

Doctor: How, then, do we go about treating our collective professional dis-ease around this conundrum of the presence of paradox in both science and medicine?

Philosopher: There is a saying in medicine that we treat an excitable patient's anxiety, so that we may relieve our own! For us, our healing lies not in dampening our anxiety; rather it is in its embrace, for paradox by its very nature begets more paradox. Accepting this situation drops us into the chaotic maelstrom of understanding. Dynamic complex systems are by definition open systems. But living organisms, as complex adaptive systems, appear bounded and autonomous, behaving as though they are organizationally closed. Yet if there is to be a relaying of difference, and the addition of matter and energy to power these dissipative systems, then a living organism must be an open system. But this would be a contradiction of the closed, unified, and bounded state that defines the biological as living!

Doctor: Closed yet open; how does one wrap one's mind around that?

Philosopher: The wrapping and warping of minds! Listen to your unconscious wisdom, for a cybernetic philosophy of mind is needed to deal with both the closed and open nature of cognitive/mental systems. Our situation highlights the general truth that without the participation of closed, autonomous subsystems, we are unable to obtain the needed integrated complexity of parts to construct the emergent whole. However, it is also the emergent global properties that simultaneously define the workings and parameters of subsystems nested within the global construct. Nevertheless, this mutual specification and manifestation of the global and the local within an emergent system cannot obtain a state of self-organization without the non-linear recursive pathways that cut across levels of order in an open fashion, thereby relaying transformations of state, and the energy and material needed to maintain integrity.

Doctor: Fascinating, so when we make the statement that, "the whole is greater than the sum of its parts," we are reveling in ignorance; a vestigial remnant of our reductionist mindset if you will.

Philosopher: An acute observation, Doctor. As you have helped bring to our awareness the term greater in this Aristotelian adage necessarily implies a quantification, and should be more explicitly phrased as, "the measure of the whole is greater than the sum of the measures of its parts." However, when we understand that wholes and parts define themselves in their mutuality and simultaneity, this statement of quantity ceases to hold meaning for us. It, perhaps, should be qualitatively stated from an emergent perspective as, "the emergent pattern forming the whole is composed by the relations of its parts which in turn exist only in relation to the whole that defines them as such."

Doctor: I think I am beginning to understand. A system (or subsystem) may be viewed as an organizationally closed and bounded unity, while simultaneously being perceptually, energetically, and materially open. Thus it is able to, through the maintenance of its own organization confront the entropic tide, and participate in the creation of the wholeness that birthed it. Circles within circles.

Philosopher: Excellent summation, Doctor. You are surely showing progress towards the goal...though our point of original departure is now veiled to us...

Doctor: And what is our goal?

Philosopher: Who's to know, that is the problem with observing non-trivial systems, even when they are our own, I am afraid.

Back to the Table of Contents
2nd Intermission: Refreshments – Re: Fresh Mint

My prescription for you is the following:

Collect up a number of used larger-sized plastic pop bottles. Wash your collection of bottles with hot water and soap. After the soaking, remove the labels. Cut the bottles in half, so there is a top half and a bottom half. Poke four small holes in the bottom of the bottom half. Place a small amount of gravel over the holes, and fill the rest of the bottom of the bottle with potting soil. In the soil, plant a few mint seeds (peppermint, spearmint, lemon mint, chocolate mint...your choice). You can search on the internet for heirloom or heritage seed providers in your area for suppliers of unique and diverse varieties of mint. After you have planted the seeds, water them and place the top portion of the bottle over the bottom, overlapping them slightly; in effect creating your own mini-greenhouse.

Nurse your collection of bottles at home, giving them appropriate water and light. When the mint sprouts and grows into a small bush inside the container, you are ready for the next step.

With, your collection of plants in hand, set up a refreshment stand in front of your house. Recruit your children or other kids you know from the neighborhood to work the stand. Make a sign that says:

RE-FRESH-MINT STAND

$1

With each bottle of mint that you sell give this recipe for summer mint tea:

 Wash 1 cup of freshly picked mint leaves.

 Bring 1cup of mint in 1 liter of fresh water to a boil.

 Simmer for 10 minutes.

 Sweeten with honey if desired.

 Place in refrigerator to cool.

 Serve on ice.

Have samples of prepared mint tea available to try (both sweetened and unsweetened).

Donate the money raised to an organization dedicated to saving the wetlands. Send each of your helpers home with their own package of mint seeds and some bottles so that they can start their own Re-Fresh-Mint stands. To finish the project, try to be the first to upload a video on You Tube with the keyword Re-Fresh-Mint somewhere in the title. Know that through this work you are planting the seeds of a growing movement.

Back to the Table of Contents
Act V - Scene II: Night Round - The Philosopher

Doctor: I must admit that I am still having difficulty resolving another paradox that hits close to home, professionally that is. Chaos theory has shown us that non-linear, chaotic processes fractally shape the form and function of our physiology. As a result, within that dynamical milieu, we find that a state of health depends on the presence of variability, fluctuation, and responsive change; what you termed "homeodynamic". This concept is well and fine until I start viewing a living system as a closed autonomous unity. From that perspective, I no longer see health as a product of variability and flux, but instead as one of coherence; that is to say a system which exhibits consistency, integrity, and orderliness in its form and function. It appears we are required to acquiesce and return back to a more traditional conception of homeostasis requiring coherence: a steady state of overall equilibrium. How is this apparent paradox of variability and coherence within a living organism to be resolved?

Philosopher: The answer depends on how we, as observers, try to parse the situation. If we look at the logical typing, we would see that coherence and variability (i.e. whole/parts, uniformity/difference, closed/open) are of different orders of related abstraction where fluctuations, variability, and instabilities at local levels of interaction lead to global coherence: a meta-state exhibiting stability. We could also choose to collapse the separate orders of abstraction distinguishing the typing of coherence and variability, heightening the paradoxical tension, and increasing our anxiety. Both perspectives are useful and needed, I think.

Doctor: Madness! By seeing them as different orders of abstraction, we can resolve the paradox. But if we collapse our logical accounting as you suggest, we are still confronted with an untenable paradoxical relationship: no closer to resolving the dichotomy.

Philosopher: What if paradox was essential to driving the system? What if the tension between these mutually exclusive positions creates the order required for Life?

Doctor: How do I hold this tension?

Philosopher: Breathe.

Doctor: I am again inspired.

Philosopher: Never forget that your immanent expiration is always as close as your next breath. Let that serve as your continued creative motivation. But let us continue.

Viewing a complex system as open facilitates a transfer of material and energy resources, both in and out. By material, I mean the physical substances needed to form component structure and the waste generated by systemic processes. Although this may seem self-evident, it is important to emphasize, for our propositions about complex adaptive systems are built upon a material paradigm. I want to assure you that the ghost of vitalism is not to be found here, although the role of immateriality is equally important. When I talk about energy, I am referring to the capacity of a physical system to perform work. When referring to complex adaptive systems and their relation to energy, we are talking about a metabolism in either a direct or analogous way. Such systems, as we mentioned previously, are dissipative. In this way, the system's organization maintains internal integrity despite changing environmental circumstance.

Doctor: I have heard it said that complex systems are also informationally open. What is meant by that?

Philosopher: The concept of information is such a muddled mess in the world of the layman, scientist, and philosopher alike; everyone uses the term differently, yet assumes its meaning should be self-evident to all. Its only use, as far as I can see is to give the listener a glimpse into the underlying epistemology of the speaker.

Doctor: How would your use of the word tell me something about your epistemological orientation?

Philosopher: An excellent question, Doctor. You will understand something about my epistemology by observing that I choose not to use the word. It does not exist for me. What is information? Where is information? The fact that we make a thing of information points to our epistemological bias. It shows our strongly held and reinforced belief of the truth of an objective reality independent of the observer. Energetic signals carrying the raw unprocessed information of this ontologically privileged world of things becomes data for our perceptual machinery. We process, store, and retrieve this raw material to create a representation of this mythological universe of inherent form and permanence. Input and output: does this sound familiar to you?

Doctor: I am processing the information as you speak.

Philosopher: An aberration has occurred in the world with the computer of our making now creating us in its own image. We have taken our constructed metaphors, and have turned them back on ourselves, calling these reflections reality. We must acknowledge that the living organism is by definition a cognitive one, and that information generated through the process of our distinction-making is an effect of that organization, and not some product of the outside world. In our case, we see that nervous systems are closed networks. They circle back in on themselves. A nervous system operates on itself. The environment does not operate or direct it. There are far more inter-neurons (by a number of orders of magnitude) than effectors (sensory neurons) or affectors (motor neurons). If we make our observations contextually, we must concede that there can be no perception without motor activity, and no motor activity without preceptors. The loop between perception and motor response is closed through our actions on the environment. Perceptual-motor recursion leads to stable self-values (i.e. eigen-values or attractors), thereby becoming necessarily reified cognitions, perceptions, and behaviors. Learning is not the process of corresponding mapping outside objects onto the brain; it is the computative generation, and radical construction of stable cognitive realities. This results, as you can imagine, in a very different type of mapping.

Doctor: I wholly agree that procuring a map at this juncture in our journey would be useful. It really does feel like we are going in circles.

Philosopher: But we must remember that map is only useful if used in the same context that the topographer created it initially. The information paradigm with its ontic predilections, and its assembly-line conceptions of inputs, processing, and outputs, leads to an allotropic modeling where the mapping of the "objective" environment onto "subjective" mind in a 1:1 fashion is seen as a matter of course. Context is not considered. Conversely, what I am talking about can be thought of as autotopic or self-mapping. An organism maps its experience of the environment through itself, and then back to the environment in a reiterative fashion until it achieves pattern stability. This stability of form is a product of mind as determined by the structure of the individual organism and is inherently contextual. It is not an intrinsic product of the environment. Bateson quoting Korzybski said, "The map is not the territory" and no doubt Kant with his "dingh an sich" (the thing, in itself) would agree. Although, by exposing a radical constructivist stance of mind, we find we must proclaim, "The Map is the Territory" for it is only in our map that we find the requisite stability required to create a world. Thus, I prefer the word pattern over information, and difference over data. Pattern is delineated by the viewer; it is unequivocally mental in nature. Information, however, implies a direction from outside the viewer with its closed organization. Unlike our muddled notions of information, the concept of pattern is much far likely to provide a better understanding of the nature of Life.

Doctor: Patterns are broad-reaching, deep, and intricate forms. A pattern language is not easily translated into a syntactical one. I don't know if the semantics of the two even have equivalencies. Is there a Rosetta stone available to help us translate?

Professor: That is what we are doing here. We are creating a pattern language to help us understand the language of patterns. That is what complexity is: a dialogical dance where we put a silhouetted footstep down on the floor after we have danced the step, inviting others to follow, if it serves them. Without realizing, we are already drawing upon the new lexicon of complexity.

Doctor: I know we are dancing our dialogical duet, but this puts me off balance.

Philosopher: And so it must be, as it is the off-balancing that creates the patterns necessary for the conditions for Life to organize. Symmetrical organization in the living is rooted in a fundamental asymmetry. Living systems are dissipative, requiring energy to stay as far as possible from equilibrium. Conventional thought on entropy is that, in any thermodynamically closed system, disorder will increase in isolation, but never decrease. The system continues evolving towards thermodynamic equilibrium: a resting state of maximal entropy where no further net flow of energy or matter occurs. Living organisms, however, are not in a state of thermodynamic equilibrium. As open/dissipative structures, they undergo a continual flow and flux of bio-chemical and bio-physical reactions, all of which require constant energy and matter. When energy flow stops and these processes come to a halt (i.e. mechanical/ chemical/ thermos-equilibrium), the resulting loss of organizational integrity results in the death of the organism. To continue living requires continued maintenance of these far-from-equilibrium states.

Doctor: How far from near, or near to far does one need to be?

Philosopher: Near enough not to be far, and far enough not to be near! Point attractors, as close-to-equilibrium states, are not organizationally rich enough to support Life. These systems experience a type of amnesia where their initial conditions are forgotten. It may be useful to imagine marbles rolling down a bowl. No matter where on the edge you start, each marble will end in the bottom of the bowl. These systems exhibit maximal stability, demonstrating a homeostatic equilibrium in the orthodox sense of the term where fluctuation from baseline is minor, and feedback mechanisms ensure a return to the baseline state. However, as we venture further from equilibrium increase our dissipative distance (i.e. negative entropy), we begin a journey into stranger terrains with increasingly bizarre vistas. Long range co-relations begin to organize, and the system begins to operate and behave in unpredictable ways. As a non-linear system travels further from equilibrium, degrees of behavioral freedom radically increase. Initial conditions are no longer forgotten, and the sensitivity to these conditions now drives the system. Consequently, each time a bifurcation occurs, the system qualitatively changes, and we observe the occurrence of a new state reflecting its shift into a differing basin of attraction. The further away from equilibrium a system is driven, the richer, more diverse, and more complex it becomes. In near-equilibrium states, we see the stereotypical physical phenomenology generated by physical forces and effective causality. However, as we are driven further and further away from equilibrium, we see the formation of the characteristics we associate with the ontogenesis of Life, including the bounded unities we identify as living organisms. Far-from-equilibrium conditions, represented by dissipative states, become the source of order and emergent patterns within the world. This understanding is an inversion of the classical physics world-view that looks to find order within a lifeless world at rest. But what use is predictability grounded in such an aesthetic impoverishment? Non-linear, far-from-equilibrium systems are resplendent with pattern, connection, contrast, and difference, and present to us the promise of novelty, adaptive action, response, and transformation.

Doctor: Paradox it seems leads only to paradox. At once we see the body is dissipative, and hence far from equilibrium in its internal function, yet in another sense it is homeostatic, and thus by definition close to equilibrium. What is a poor country doctor to make of all of this?

Philosopher: We must never forget our logical accounting practices. We are constantly parsing out systems of interest from the whole by our acts of attention as observers. What is far from equilibrium and dynamic at one level of abstraction may be viewed as stable and homeostatic at another. It is worthwhile noting that these same, stable, individual homeostatic bodies become part of a highly dissipative system when you observe them embedded in an ecology, which proves to be a deeply-basined homeostatic entity when viewed as a singular collective.

Doctor: So a dissipative – that is to say open – system provides a mechanism for an understanding of pattern formation and energy transfer. But "open" nevertheless suggests a loss of distinct borders. This implies that boundaries within a complex system are difficult to demarcate. Nevertheless, my experience of self runs contrary to that view, as I observe myself to be an integrated and bounded whole entity. How can we reconcile these differences between what you are saying and what I am experiencing?

Philosopher: What you are expressing is not trivial for more reasons than you may presently realize, for through your present inquiry, we take yet another step closer to advancing our understanding of the nature of Life. As a physician this is of critical importance to your vocation.

Doctor: Yes, I believe that you are starting to articulate that which up until now has been just an intuition within me.

Philosopher: Never demean or disregard intuition, for from intuition, logic is birthed into the world. Let us, then, follow your impulse. This brings us to the topic of autopoiesis; the essential nature of closed and bounded systems as ontogenically foundational to Life's organization.

Doctor: Autopoiesis?

Philosopher: In reference to that which is self-creating or self-producing, or, namely the class of organization that serves as the foundation for a definition of the living.

Doctor: You mentioned a definition of life. How does autopoiesis relate to this?

Philosopher: Let me first ask you: how does one go about defining what Life is?

Doctor: I would assume by its function. Any living organism must be able to undergo metabolism, have the capacity to grow, reproduce, respond to stimuli, exhibit movement or locomotion, and have the ability to in some way adapt to its changing environment.

Philosopher: These are all clearly behavioral aspects of the living, as we have come to know it, but are they the fundamental and constitutive underpinnings that lead to the organization of the living?

Doctor: By fundamental do you mean the underlying basis of DNA, as the blueprint that constitutes life, or are you referring to our Darwinian understanding of evolution, as the mechanism required for the development of life on earth?

Philosopher: Neither, for in the former case our reductionist thinking has inverted our order of focus from wholes to parts, and in the latter, from parts to wholes. Nevertheless, the root phenomenology of Life must be found within the essential unity of a living system. We must ask ourselves: what is universally constitutive of all living systems?

Doctor: There was a time when people thought as you did; they called it vitalism, but where is this vital life force to be found?

Philosopher: I assure you doctor, that I am no vitalist. What I am proposing is, indeed, a mechanistic perspective. There will be no addition of forces, principles, or explanatory constructs other than those found in the physical universe. Yet our focus will neither be materialistic or reductionist. Our interest lies in understanding the organization of the living. Therefore, my aim in our discussion is not to focus on the material properties of specific components within a living system; rather, it will encompass the non-material processes derived through the injunctions and relations realized through the medium of its materiality.

Doctor: Yet when we talk about such things as reproduction, growth, response to stimuli, and the like, are we not referring to these very processes?

Philosopher: In talking about Life, you must be very clear about the phenomenological domains present within the ontogenic orders that you are referencing. As observers, through a process of second-order feedback, we are always engaged with the system that we are observing. There is no such thing as impartiality, as the very act of observation changes the system being observed. Consequently, it is important to distinguish that which pertains exclusively to a system of interest free of our observership from that more abstracted phenomenology which is generated through the domain of our observation, including our observations of our own self. This particular domain arises as a consequence of our beholding a given organism's response within the context of its environment. We misattribute the organism's observable response as being causally directed by its (open) relation to its environment, rather than as a self-generated response produced of its own intrinsic (closed) organization, independent of the milieu that it is situated in. The only phenomena available to our observation is the interaction between the organism and its environment, which we name behavior. Naming those interactions heralds the creation of a new phenomenological domain: the domain of our description. We see, then, three different levels of iteration or feedback at work in the phenomenological domains of our experience. Two of which are accessible to our observation and participation (i.e. the in vitro domains of observation and description), while the other (i.e. the in vivo domain of the constitutive organization of the living unity) remains closed and inviolate. Explanations are always reformulations; they are not the experience. We must be very careful to distinguish that a system's intrinsic nature from the descriptions that are a product of the domains of our experience as observers. Such is the humility and the yoke of a second-order cybernetician.

Doctor: What constitutes this root phenomenology of the living; the veritable ontological underpinnings of life?

Philosopher: To answer this we must focus on organization: the composite of relations (and the relations among relations) supported by the physical components of the living organism so as to continually maintain an autopoietic organization. But if our definition for Life is to have epistemologically validity, it must be generalizable, and not particular to any one specific mode of Life (known or otherwise). It must focus on the identification and analysis of structurally specific components which are invariant. Anatomies differ from species to species (i.e. homology). Anatomical parts may be traded out or replaced with different forms. A living organism must constantly replace its component parts over its lifespan (i.e. ontogeny). These material-specific transformations are largely irrelevant to our understanding of the living. As long as they continue to serve their relationally contextual function, as dictated by the organizational template that defines the living machine, they maintain identity as a unity over time. Unlike the stance held by our reductionist colleagues, the specificity, material construction or mechanism of specific parts in a biological system is not our specific concern. We are developing a definition for Life grounded in a fundamental biological phenomenology (i.e. ontogenesis) therefore our gaze must steadfastly remain on the organization and the quality of its relational patterns.

Doctor: Let's return to that term, "autopoiesis". Does that mean that at some level, reproduction is at the core of what constitutes a living organization?

Philosopher: Autopoiesis refers to self-production, not self-re-production. Autopoietic or living machines are very different from other types of machines. That which is living must embody the following organizational dictates: First, a living entity must constitute an autonomous unity, where the process of self-distinguishment has differentiated the internal from the external and therefore entity from environment. Secondly, an autopoietic machine must be organized as a self-sustaining recursive network of the molecular processes of production (i.e. anabolic or catabolic metabolism) realized entirely through its own component structure. Thirdly, the underlying organization, or pattern of an autopoietic system remains invariant, while its material form may be malleable, to the extent that the organization that specifies it is maintained. Hence, an autopoietic organization remains independent of the material properties of its components, which can ultimately be of any sort (including inorganic). The breakdown of an entity's organization, not its component materiality, is what results in the disintegration of the organism as a unity (i.e. death). Fourthly, autopoietic unities are self-producing; their function, purpose, or goal in a cybernetic sense is the ongoing production of the material components that are required to maintain the relationships that fulfill its own organizational requirements. The processes of self-production also include the material components forming the membrane that defines the organism's boundaries within topological space. Enclosing the system within a membrane distinguishes an organism's internal structure and process from its outside environment, providing the means for sustaining the organizational closure required of all autopoietic systems. Note that the membrane is not an inert barrier; it plays an active role in the self-production process in conjunction with the other internal component sub-systems. Recursion is fundamental to autopoietic process. Through its circular relations we see that autopoietic self-production is necessarily synonymous with both autonomy and closure.

Doctor: Fascinating; though I suspect you are trying to enclose me within your web of circles. Nevertheless, we come to understand that life as a product of its own ontogenesis is both organizationally closed and physically bounded, and that its closure is what specifies it as an autonomous unity. Furthermore, the nature of its organization is such that the living organism is self-referential, self-organizing, and self-producing, and by extension must necessarily be a closed system. How do we reconcile this with what we know of open systems?

Philosopher: You tell me the answer.

Doctor: I saw the clue when you encouraged me to be clear about my accounting of the phenomenological domains born of the capacity to observe. I must own the truth of my observership lest in my discourse, I mistake the domains of my observation for that which is intrinsic and constitutive. When we view open and closed systems with this clarity of domain, we observe that the movement and exchange of energy and material in an open system is the essential condition of the physical world. However the root phenomenological domain of biology remains necessarily closed, as defined by its autopoietic organization. Of course, there is an intimate, recursive relation between these two ontogenic domains (i.e. the physical world and the living world). The biological is predicated on the physical, and is structured by it forces. But the quality of differentiation in the physical world – how material reality may come to know itself – is a function of the autopoietic organization of the living. Living is a cognitive process, for only that which is living can differ difference that make a differences from those that don't.

Philosopher: Yes! Cognition is fundamental to the biological domain: "Living systems are cognitive systems and living as a process is a process of cognition." And difference-making is the essential core of cognition. You will find no difference in the physical domain which is separate from the biological. We must acknowledge that there is no such thing as physics separate from biology. Please do not misconstrue what I am saying. Physical forces and the perturbations they generate exist, but the naming and differentiation of such things is a product of cognition – Life's emergent privilege. Of course, this view is completely counter to the reductionist position that views all of biology as ultimately reducible to the terms of physics. The nature of emergence challenges this simplified and purely materialist dogma.

Doctor: Pattern, and the recognition of such, however, is not limited to the self-recognition found in the autopoietic domain. From our observational and descriptive domains, we can categorize a number of systems that form a functional, aesthetic collage of living and inorganic patterning that cannot be singularly categorized as specific to the physical or biological domain. They form a different order of difference. I am wondering, ontogenically, how we can discuss the co\- in co-evolution? I sense that as a consequence of this merging that a new domain may be opening up to us.

Philosopher: Yes, emergent from the biological (autopoietic) domain, there is a further systemic ontogenesis that we can think of as the mental domain. It is derived from our observations and naming of the congruent structural changes brought about by autopoietic unities in conjunction with their environment. This is sometimes called structural coupling: the process whereby reciprocal interactions or between an organism and another organism, or between an organism and its environment, trigger mutual structural changes. Over time the sum of these changes create a systemic ecology.

Doctor: So structural coupling is the cause of structural change?

Philosopher: Be very clear about what you mean by "cause" in this instance. The concept of triggering change is foundational to our understanding of environmental coupling. External or internal stimuli or perturbation cannot specify changes or direct the autopoietic organism, as by definition an autonomous unity has organizationally closure. In living organisms, stimuli can only trigger structural change as per the set determinants of the organization, and not dictate it. Poke a stone and it will react as Newton predicted. Poke a sleeping bear and it will respond with an unpredictable structural change predicated on its history, reflective of its underlying autopoietic organization. Thus all living organisms will respond to their environment with a continuum of self-generated structural changes as determined by their previous structure.

Doctor: And what is the relationship of this to a systemic ontogenesis?

Philosopher: Structural coupling forms the keystone of a systemic ontogenesis (i.e. Mind). Its inherent plasticity provides for systemic learning, adaption, and development. The ontogeny of the organism – its lifetime of structural transformations – becomes a progressive living record of its interaction with its environment. An organism's structure at any point in its development represents the record of all its previous structural changes brought about through coupling with its environment. The nature of feedback loops being what they are, each structural change will necessarily influence future behavior. While the pattern of invariant relationships within an autopoietic organization delineates an organism's as an autonomous unity, as a product of its coupling, it is the organism's evolving structure or ontogeny that structurally determines an appropriate systemic response to a perturbation. To an observer, this looks a lot like learning and adaption. And the coordination of these behaviors between an organism and its environment is what we call communication, the Conversational Domain, or perhaps the Dance of Life. Thus the idea of structural coupling leads us to the understanding that every system in the systemic or mental domain is a living system.

Doctor: Fascinating, in the Dance of Life, there can be no dance separate from the dancer, and no dancer separate from the dance. The dancer, as an individual organism maintains its autopoietic autonomy in its engagement with its environment. Its unique, dynamically changing structure determines the form and degrees of freedom the dance may take in each given moment. Steps are not dictated; rather they are negotiated within this changing context, never to be danced the same way twice. The living system is forever changed by the ephemeral and intimate encounter brought about by Creation dancing itself.

Philosopher: Such is Life's poetry.

Doctor: Poetry is, after all, the art of distinguishing continual distinctions. You have emphasized that autopoietic systems (and its representative biological domain) are cognitive systems, based on their ability to self-organization through self-distinction. Yet you also refer to systemic ontogenesis as the mental domain. Is there not some mistyping in our ontogenic ordering of cognitive processes?

Philosopher: Answering that would only serve to go over territory already covered. Do not forget that the mental order emerges from the biological. In this sense all systems, if named as such, must be living systems, as they are an extension of the naming, and thus are in relationship with that which names. Think back your previous mentors on the eco-systemic nature of mind with its ecology-of-ideas. Through recursive iterations and complex feedback trains, living organisms undergo a history of congruent structural changes with their shared environment. Within this systemic ontogenesis we find the open flow of mind through the organization of patterns that connect, as well as an immersion into the circuitry and greater organization of the natural world.

Doctor: I am perplexed, for if we extend the path of mind to its logical extension, that is to say its ultimate divergence, don't things paradoxically wrap in on themselves, converging into a net that we can only think of as wholeness? Mind as a phenomenon of the mental domain is open, as evidenced by the flow of differences that make a difference, and the rise and fall of the deeper patterns that connect. But if taken to its extremes, all of these patterns must circle back on themselves, and the system must again be seen as closed.

Philosopher: Yes, and we cross a further threshold into yet another ontological – or more specifically ontogenic - realm, introducing us to the Great Mother Gaia: the Mind of Nature in its totality.

Doctor: Gaia, the goddess? Have we resorted to a regression into a revival of neo-pantheism or neo-paganism?

Philosopher: Carefully consider your slights, for all mythologies, including our own dogmatically held beliefs, are metaphor, and fraught with both promise and pitfall. Religions of the hearth are never far from health. In this case, Gaia refers to the scientific theory that living organisms, coupled with their inorganic environments, interact through multiple levels of feedback to form a highly complex and self-regulating system that creates and maintains the conditions for continued Life on the planet. The history of Gaia is a tale of the formation and continued maintenance of our biosphere. The biological co-evolution of organism and geology on Earth has resulted in the formation and continued maintenance of our biosphere; a global "homeostasis," through the dynamic regulation of temperature, ocean salinity, atmospheric gas composition, and overall climatic conditions. Life regulates itself; shaping the planet, as the planet in turn shapes it, determining the habitability of the planet over the course of geological time.

Doctor: Is the planetary biosphere autopoietic, then? It seems to have met all the necessary prerequisite criteria, including the elements of autonomy, unity, and self-organization.

Philosopher: Although it may seem so at first pass, I would propose that Gaia is not autopoietic from an ontogenic perspective.

Doctor: And why is that?

Philosopher: The rule of logical types tells us that no class of abstraction can contain itself within its own membership. The lower classes form the higher through their memberships, but the inverse is prohibited. In this way, we see that the physical is subsumed by the biological, the biological by the systemic, and the systemic by the whole. Autopoiesis, by its definition, constitutes the biological and not the Gain domain. It is a theory that deals only with molecular self-organization leading to molecular self-production.

Doctor: Ahhh, I see...I understand now.

Philosopher: Sadly, your statement of understanding only serves to prove the opposite, for I have in hoping to aid your understanding lied to you, and thus ultimately provided a disservice.

Doctor: I am unsure of what you mean.

Philosopher: As are many things, logical typing is a useful tool for understanding, but, ultimately proves to be a falsity. It was originally meant as a guard against self-reference, and consequently, class confusion and paradox from within the descriptive domain. Yet the cybernetic reality is entirely one of self-reference. I would have had you believe that all the emergent ontogenic domains of existence were strictly hierarchical and unidirectional in nature. The truth is that feedback circuits cut across all domains (physical, biological, mental, and whole) in a reciprocal fashion, forming the necessary and required milieu for self-reference. Open-closed-open-closed; there is no escape from paradox, as each domain in truth simultaneously defines, and is defined by all the others. Only through their differences may unity be achieved.

Doctor: All right, we have a basis of understanding of the paradoxical position of closed and open systems, and now have an operational definition for what constitutes a living organism (in relationship to the other emergent orders). We are still left to examine the paradoxical position of variability and coherence in complex adaptive systems, as two mutually exclusive markers of health in a system.

Philosopher: I think it would be useful to look at the twin processes of embryology contrasted with evolutionary process to highlight the paradoxical presence of variability and coherence within Living systems.

Doctor: Twin processes? How can the development of a given individual or organism over its lifetime (i.e. its ontogeny) be twinned with the adaption of a species over evolutionary time (i.e. its phylogeny)? This seems like a mistake of logical types.

Philosopher: Beyond how, we should be exploring why, as this hits more to the essentiality of the relationship, and may help us find peace with our paradox of variability and coherence, as mutually exclusive, yet essential markers of health.

Doctor: Moving forward, then, it would appear with an evolution in our thought.

Philosopher: Hold that statement, for we will return to your point that evolution and thought are indeed connected processes. But let's start at the very beginning with the emergence of primordial Life, and its subsequent creative explosion into the great diversity which we see today. We should begin with a statement of our assumptions, and make them explicit. First, there are random evolutionary events; what we refer to as mutations. Secondly, that without an infusion of the random, there can be no introduction of novelty into a system. Thirdly, there is a non-random selective process permitting certain random changes to survive in an organism longer than others, and that this process is inherently weighted towards conservation of both form and function. Fourthly, randomly-generated mutations are stored in the greater genetic pool of the population, and that the mechanisms of natural selection will work to eliminate all unfavorable alternatives. Only benign or beneficial mutations that increase survivability persist. Finally, we acknowledge the importance of the value of logical typing to help us conceptualize that what might be good for an individual could turn out lethal for a population, with the inverse also being true. An example in medicine could be that a particular drug may provide a symptomatic short-term relief, but in the long term is addictive or injuring. Similarly, we see with antibiotic use that a patient may be cured of specific disease, but due to issues with resistance, the population may become exposed to resistant and more virulent strains of bacteria. Thus, we must realize that pathologies may lie in various levels of naming, and are not necessarily specific to any one level, nor are they necessarily global in their presentation. Therefore, we must always be cognizant of the fact that the process of evolution, like any cybernetic circuit, may exhibit a process of pathological feed-forward runaway. Inherent systemic mechanisms are not necessarily benign or favorable.

Doctor: Why has life continued on the planet if such runaway possibilities are present? It seems that self-destruction and catastrophes are built into the system.

Philosopher: Luckily, such runaway scenarios are rare thanks to the patterns governing self-criticality in complex systems. Yet we have documented mass extinctions within the evolutionary record indicating occasional catastrophic changes. But it may be helpful to reflect on the fact that there is no such thing as an absolute feed-forward event. Any unstable feed-forward event, when viewed from the order of the greater logical type that contains it, is in reality a higher-order negative feedback process. By definition there is a resolution of the process at its moment of critical instability, and this output becomes the new input for a negative feedback cycle. The paradoxical process of feedback provides for adaptive variability within a living system by generating novelty, while simultaneously guarding against excessive oscillation or runaway positive feedback. The combined feedback processes sustain the whole.

Doctor: What are the systemic relationships that accomplish this?

Philosopher: When viewed from the systemic order, evolution, like learning, is a mental process: immaterial, dynamic, and process-oriented. It is the ongoing process of exploration and change that perpetuates itself by exploiting randomness in nature, introducing novelty to the ecological system. The evolutionary process, if left unchecked, presents us with inherent difficulties. There is no mechanism in place to prevent self-destructive feed-forward mechanisms that, if left unchecked long enough, would reach an ecological climax, limiting the developmental freedom of future generations.

Doctor: Thus, from the scene you have set for us in this great Play of Life; enter embryology, stage left, as the balancing mechanism to evolutionary progress.

Philosopher: Yes! As variability is to evolution, coherence is to embryology. Embryology, through the process of epigenesis, must serve as a filter or anchor to prevent pathological change throughout the reciprocal orders of living systems. It must also prevent the saturation of evolutionary change from being shouldered by subsequent generations. Embryology must have a way to wipe the slate clean for each generation so that fresh exploration between organism and environment, may take place. From the systemic ontogenic domain, evolution is the vehicle to explore freedom and entertain difference. But if evolution feeds on the random, then an ideal embryology needs be the gatekeeper of predictability, repetition, and replication. The embryological process, with its balancing tension, attempts to prevent the incursion of novel patterning into the system. It is a convergent process that encourages predictability, and hence is a disposing state. Conversely, evolution works through the creativity of structural change and response, derived by the coupling of organism and environment, and by necessity is divergent and inherently unpredictable: a proposing state.

Doctor: Certainly, since Darwin's unveiling, we have developed a bias in thought towards the process of evolutionary change either through mutation or the random shuffling and mixing of genes. You have rectified our bias by introducing embryology as a counterpoint. Now I understand the "why" of embryology, but what of the "how"?

Philosopher: Ultimately, the "how" of embryology is accomplished through its "conservatism". Will the new embryo tolerate any new change, or will such change be lethal to the integrity of its autopoietic organization? It will help us to understand the inherent protective mechanisms if we follow the process from conception. To start, in sexual reproduction, we note the matching up of chromosomes from the two haploid gametes to form a diploid embryo. This process provides compatibility screening for the newly forming organism through acts of comparison. What presents as novel and random in the genetic profile of either egg or sperm must always meet the bar of what is old and venerable in its counterpart. The new genetic material is tested against the chromosomal template, and will be conserved only if it has maintained a large degree of conformity. If not, it is rejected on the grounds of incompatibility, and the embryo will be inviable. But if genetic fusion is successful, the embryo will then enter into the next phase of conservation, involving the unfolding complexities of development and morphogenesis.

Doctor: From the transformation of the genotype, through morphological development, to the final phenotype, there are many increases in the complexity of the developmental process. This changing internal complexity affords the introduction of randomness. How does the process of embryology/morphology guard against this?

Philosopher: One of our cultural biases that we have to address in our observation of this process is that we see the new is an improvement over the old. This is rarely true from the perspective of ontogeny, as phylogeny provides for us only a historical record of the success stories: evolutionary hindsight. Given enough time for it to play out in individuals, populations, ecosystems, societies, etcetera, all that we can eventually ascertain is that the evolutionary transformation is not worse than the old. We do know that time tests the fitness of old adaptations against specific evolutionary pressures, at least to some degree. However, the same cannot be said about the viability of new adaptations which have not been tested in the various internal and external contexts contained within the requisite orders of logical typing. Internal, ontogenic selection thus becomes the first intensive source of morphogenic scrutiny. The embryological process scrutinizes for formal homology: the resemblance and coherence of its internal morphogenetic relationships. Of course, the most ancient, most tested of phylogenetic pathways remain intact and resistant to change, which no doubt weights this scrutiny. The oldest of such structures are found within the individual cells, with all of their cytological relationships. As we examine the multitude of plants and animals throughout the natural world, we see that many of the same internal patterns of cellular constituents, in both structure and function, remain profoundly similar, thereby pointing to an ancient evolutionary conservatism. It follows, then, that the earlier in the developmental process that a mutation's effect is exhibited, the more likely the consequences of such a change will be felt throughout the many processes of the largely undifferentiated embryo, as a long chain of morphological transformations still remains ahead.

Doctor: The result of which is?

Philosopher: The result being that the probability of lethality to the embryo at this early stage is greatly increased. The chance that a novel phenotypical transformation will be benign is highly improbable at such a foundational juncture. Conversely, mutation-driven changes later in the morphological process of the fetus will effect more developmentally-specific and evolutionarily recent homological expressions and pathways, and consequently will have limited influence. Even at this point, the chances of mutational change providing any advantage are low. Nonetheless, its survivability is better than any change to longstanding ancient evolutionary relationships found in the nascent embryonic period. Thus deviation at the beginning of the pathway is much more scrutinized than deviation at later stages. Of course, this is just the internal, ontogenic scrutiny; the organism must still survive the scrutiny of the external world where any change must yet prove adaptive, or at least not less fit. The small changes that are ultimately found acceptable are only then amended on to the existing organization that guides the embryological process. In these ways, embryology acts as the counter-tension to the novelty generation intrinsic to the evolutionary process. Through the mass-produced gametes of sexual organisms, the species clears house of the memorabilia of its evolutionary forays; each generation retaining only the very best of its acquisitions, thereby making the individual, and, ultimately, the population ready once more for evolutionary exploration.

Doctor: Beyond expanding my knowledge of teratology, how is this all relevant to my practice of medicine?

Philosopher: Relevance is found in the fact that evolution and embryology are reflective of domains of mental process, only differing in their logical types. For example, we see that learning parallels in many ways the process of evolution. Both require a random component; through trial and error, we acquire novelty. Learning, like evolution, is subject to scrutiny. Are new ideas coherent in that they already conform in some manner to a preset internal relational logic? The vast majority of new notions come from reshuffling old ideas, similar to the recombination and reshuffling of genes through sexual reproduction. Truly novel ideas or imaginations, like mutations, are a rarity. In learning, rigor, as an expression of some sort of internal tautology of the mind, would be the equivalent of the internal coherence present in the embryologic process. As well, ideas, like evolutionary change, are further subject to external pressures, and must survive the selection, adaption, and fitness processes through their cultural development and acceptance. In this context, one could imagine a social scientist searching for formal, entrenched similarities in cultural expression present throughout history, just as a zoologist will look at comparative anatomy to find persistent patterns of evolutionary dynamics. If learning was just left to itself without the vigilance of rigorous examination, the products of unchallenged thought would quickly become a burden on the individual and cultural mind.

Doctor: And what will become of the ideas we are posing here?

Philosopher: Who is to know? They may wither on the page, or take root in our collective, societal mind and thrive. Like the Fates of Ancient Greece; even the gods were not beyond the scrutiny and consequence of their singular gaze.

Doctor: But you have yet to answer my question about the relevance of all this to medicine?

Philosopher: Answer your own question by looking for the patterns which connect. What connects the twin stochastic processes of evolution and learning?

Doctor: Umm... well, they can both be viewed as mental processes within the cybernetic conception of systemic mind, as they are dynamically shaped – and are shaped - by their respective underlying relational organization, and predicated on the construction of difference and the response to differences.

Philosopher: Yes...

Doctor: ...Then if evolution and learning are mental processes containing the paradoxical yet requisite states of variability and coherence (i.e. novelty generation and conservancy or a process of selection), then by extension health can be viewed as a mental process that also engenders both variability and coherence. Variability allows quick, resilient, and novel response to the ever-changing open relationship between the organism and its environment. Yet this variability is subject to the filter of the system's overall homeostatic parameters that keep the organism coherent within the organizational blueprint of its closed, self-referential system.

Philosopher: Very good Doctor...very good. Mutation/epigenesis, creativity/rigor, open/closed, variable/coherent, divergent/convergent, and ordered/chaotic: all are examples of similar relational processes differing only in logical type. Now, we can intuitively see the relationships, but what is the higher-order logical typing that unifies these mental processes? All of these relationships are embedded in their paradoxical position to the second law of thermo-dynamics. Entropy is the tendency for disorder to increase, causing organization and pattern to break down. Yet paradoxically, the creation of new order requires randomness. Noise creates the necessary condition for novel emergence among the plethora of infinite potential differences inherent in an entropic state. In this way, living organizations gather the raw material required to maintain systemic integrity despite changing circumstances. Although it is true that order arises from order, it is an imperative for Life's development that order must arise from disorder.

Doctor: Yet even with our identification and discussion of paradox within living systems, the paradoxes all still remain...well...paradoxical!

Philosopher: Hmmm...despite the diversity and circumferential nature of our discussion, it is obvious your training in medicine has honed your observational acumen. What we require is a dialectical method; a way to deal with opposing pairs, poles, extremes, modes, or sides. Paradox arises when an organism is given two injunctions, each one drawn from a dualistic paring that remain mutually exclusive by definition when observed from within the same contextual set. For example, if we accept the injunction that living beings must be closed systems, and a second injunction that all living beings are also dissipative systems (which by operational definition are open systems), then we create a paradox. Or as we noted above, living individuals of a species are given the injunction that survival is dependent on the flawless maintenance and transmission of its morphogenetic process to future generations; in other words, maintenance of the status quo. Paradoxically, however, species' populations require adaption and change for co-evolutionary fitness, and ultimately survival. Yet it must be noted that the membership of populations is a collective of individuals.

Doctor: Exactly, this is the conundrum I find myself in.

Philosopher: A conundrum shared by you and all living organisms. Before we address the essential paradox though, let us examine our dialectics first, for we need a new way to deal with opposites other than that which has been traditionally taught in the West.

Doctor: You are referring to dialectics as described by the philosopher Hegel, or Hegelian dialectics?

Philosopher: Yes, that is what I am getting at. Tell me what you know of that process.

Doctor: Simply put, the dialectic process is the practice of arriving at a more encompassing, or enlightened perspective through the process of logical argument. It serves as an epistemological tool. In the Hegelian view, we state an initial position: The thesis. We then, take the opposing position, and name this the antithesis. Then, through a process of combination, compromise, and resolution, we attempt to integrate them into a coherent synthesis.

Philosopher: Is this process a linear or non-linear one?

Doctor: A linear one, I would think. It is a movement of point and counterpoint, forward in its trajectory in time. It creates history, rather than cyclicity.

Philosopher: What, then, would a circular dialectic look like?

Doctor: That is an excellent question.

Philosopher: An essential one as well. To start, let's begin with the premise that the Hegelian view is predicated on the reality or existence of dualities, or oppositions. Although its impulse may be a unifying one, it is nonetheless a reaction to the dualist and reductionist tradition. In contrast to this position, a recursive dialectic would be founded on the premise of a monistic unity represented by a holistic paradigm.

Doctor: I agree with what you are saying intuitively, but my understanding is that wholeness or unity, because of its privileged ontogenic status as the whole, defies description by its composing members, yet these constituent parts form the descriptors of language.

Philosopher: Yes, you would be correct in that critique. Another way of rephrasing what you have said, from a perspective of logical types, is what we have stated previously. A higher-order class within a whole system cannot be a member of its own lower-order membership. Certainly this must first and foremost apply to the ultimate ontological ordering of holism, as this is by its own self-referential definition, the most encompassing of domains. This leaves us with no domain of reference for a formal description. The highest level of abstraction in our accounting of ontogenic ordering must remain trans-linguistic. Now for the sake of our discussion, there is a way around this predicament. Rather than appealing directly to a unity, we can turn to a trinity.

Doctor: A trinity? Are we, then, appealing to a 'trialectic' to aid us in our knowing?

Philosopher: Yes, it is a cybernetic method of inquiry that allows us to contemplate how opposing pairs are related, yet remain distinct.

Doctor: How do we accomplish this leap in thought?

Philosopher: Our metaphorical trinity is formed by a pairing of dialectical tensions that carries an implicit unifying injunction within it. This pairing and injunction mutually specifies difference while also defining the non-dual, complimentary, or unitary relationship that holds them both. It is non-Hegelian, however, in that the merger creates no synthesis. Rather, a cybernetic trinity is circular and self-referential. The relationship is a cycle, not a progression. A trinity thus requires the following: First, a referential pairing of the object (or whole, or "it") (i.e. that which has been named or that which has been distinguished/noun), and the "process leading to it" (dynamic relational organization/verb). And secondly, a bridging of these two dialectic positions across levels of logical-typing through an intrinsic relational statement such as, "consider both sides of..." Taking into account levels of logical typing in a cybernetic system, we could represent the concept of the trinity by the phrasing "(object  (process leading to it))", where the notational symbol of the circular, bi-directional, reciprocating arrows "" in addition to meaning "consider both sides of..." can be alternatively understood as "is in recursive relationship with..." (Note: Notational symbols do not appear in some E-book formats. Please refer to Appendix B for examples of the circular arrow notation used in the above Cybernetic Dialectic versus the bidirectional arrow symbol used to represent the linear direction and opposing relationship in a Hegelian Dialectic.) The use of successive brackets, i.e. ((( ))), places each side of the relationship in its respective class, thereby demarcating the position of their logical type in a "nested" relation to each other. When looking at these embedded groupings of brackets, remember that the hierarchy of logical types in a cybernetic system is more like a set of Russian dolls or Chinese Boxes, than that of a ladder. In this way, the equation (object  (process leading to it)) can be expanded out to, "object – in recursive relationship with – the embedded or imbricated – process leading to it." Equally, the symbol  could be voiced as, "in a win-win relationship with..." as a trinity is a positive sum game.

Doctor: What would be a concrete example of a trinity?

Philosopher: Perhaps the one exemplar most central to the conversation here would be the trinity of (whole  (parts)). The whole, as a set of simultaneously interacting parts, components, nodes or subsystems exhibits stability as a totality, while simultaneously creating the context, boundary conditions, or dynamics that defines the parts and their roles within the whole. We can, through our difference-making as observers, parse or understand parts in relation to local connective patterns, or by their specified interactions. As a product of our differentiation, we can chop out various sequential processes (i.e. the sub-systems) from the whole so that we may examine aspects of their individual participation. This reductive exercise has shown to be a useful process for understanding, but we must always remember that such an act is an artifice of our own creation. We forget the whole and the reintegration process at our peril.

Doctor: I feel an understanding starting to emerge, but I am still grasping at the edges. Please help me to further my knowledge regarding how this dialectic is non-linear and recursive in form and process.

Philosopher: Let us go back and compare our cybernetic trinities to Hegelian dualities for a better understanding. The Hegelian paradigm with its notion of dualities shows a clash of opposites; that is to say (A) and not (A), (+) and (–), and the like. We see that each negates the other in a reverse symmetry to create a zero sum game. The dualistic pairing applies on the same order of abstraction, so we can notate the Hegelian dialectic as: (A)  (Not A). The opposing brackets show that both sides of the pairing are of the same logical type, and the bidirectional arrow "" shows that their relationship is negating, that is to say a zero sum game.

Doctor: But aren't we confronted with this very same situation when we look to such concepts as open/closed, coherence/variability, order/chaos, and all the other dialectic forms?

Philosopher: The answer to your question is both yes and no.

Doctor: (Sigh)...more elusion.

Philosopher: Well then, I will be clear: the answer is yes, we are confronted with the same pairs, and no, because we are not confronted in the way you continue to view them. You must make the leap from dualities to trinities.

Doctor: How do I make this leap?

Philosopher: Let us look again at the form of a trinity. Using a cybernetic or post-Hegelian dialectic, we need to recognize that the form of the pairing is intrinsically asymmetric. The pairs have an implied difference in logical types. Nevertheless, they remain related and interdependent across class levels, and we can see that one side of the dyad emerges from the other. Consequently, the pair is best represented by an imbrication or embedded folding in which one facet is seen as coming forth from the other. Thus A births B, and, subsequently, B provides the necessary conditions for the reemergence of A (A  (B)) and we maintain our proper accounting of class. As you can see, the logic in the case is not lineal; its circularity across levels allows it to be self-referential. In this form, the "it" and "the process leading to it" are complimentary, not dualistic, and together the trinity forms a unity. From this perspective, we can look at the structure and process or form and function inherent to these relationships. The structure, the "it" in the trinity creates its own "process" which in turn provides the context for a continuation of the original form. Trinities are always self-referential and self-organized by their intrinsic cybernetic relations.

Doctor: So to this way of thinking, a closed autopoietic system coupling within its environment creates the prerequisite for a dynamic open complex adaptive system that maintains the continued integrity of the autopoietic organism. Or similarly, at the level of the individual, embryology and developmental ontogeny engages the evolutionary process, inciting adaptive change in the species, which feeds back to perpetuate the ongoing ontogeny within individual members.

Philosopher: It seems you have it.

Doctor: There is still one thing I am unsure of. Certainly, there are times when there are true Hegelian pairs that are not part of trinity. For example, we must concede that something like predator and prey are true opposites, and thus cancel each other out.

Philosopher: In these circumstances that appear opposite and clashing, we must simply evoke the trinity that encompasses the apparent opposites at the next level on our ladder or hierarchy of recursive type, order, class or domain. Using your example, we can see that in nature, predator and prey do not operate antagonistically, although our choice of language would lead you to believe so. When viewed from the higher order of the eco-systemic domain, the co-evolutionary relationship between predator and prey species is complimentary, mutually stabilizing and beneficial to the survival of both. Rather than the dualism (predator)  (prey), we could imagine the cybernetic trinity (ecosystem  (species interaction)) or (ecosystem  (co-evolutionary process)). Or if we wish to include the original pairing, the trinity could be further imbricated to read as (ecosystem  (co-evolutionary process)  (predator/prey))), thereby capturing the fuller expression of cybernetic logical typing.

Doctor: I see. From this perspective, we can begin to envision, and bring forth a very different world; a world in which the rifts of separation begin to heal.

Philosopher: Yes, and many of those rifts are not inconsequential. Certainly, since the start of the Age of Reason, we have seen a divide between that of science, and that of the religious spirit.

Doctor: As physician-scientists, it is taboo for us to discuss matters and emotions that are of that other domain.

Philosopher: Yet there is an irony in this, as there is certainly an art of medicine, as much as there is a science of medicine But evoking art brings us into the world of the religious, for certainly such words as transformation, beauty, and the sacred are both part of the aesthetic and spiritual conversational domain. Has not your personal experience of the practice of medicine touched on some of those themes?

Doctor: Indeed, I would say it has. They have appeared in some of my most treasured patient encounters. This is the beauty of medicine, as both a practice and a vocation. How, then, does one make one's vocation an invocation of the sacred?

Philosopher: The cybernetic paradigm is the answer to this quandary. Rather than seeing the Hegelian divide of (science)  (religion), and trying to force a synthesis of these stated opposites, what if we were to turn our attention to a search for a trinity that connects them?

Doctor: For example?

Philosopher: For example, let us look at the (evolutionist)  (creationist) debate, or what I prefer to categorize as the dual processes of evolution and devolution.

Doctor: Devolution? Are we talking steps backwards towards the primordial soup?

Philosopher: Sometimes, I am forced to wonder. But as scientists, when we look at evolution from a complexity standpoint across geological time, we have chosen to view the phenomena of Life as a divergent expansion of increasing complexity punctuated by novel emergent forms. In other words, we have traversed from the simple to the complex in our ascent (despite the contradictory vernacular usage of referring to our phylogenic descent from a common ancestor, we simultaneously speak of the evolutionary "ascent" of man). Conversely, traditional religion or indigenous belief has by and large adopted a convergent view, or a perspective of "descent", by which Life travels from Creator through to the created. It is an arrow of change that travels from the complex to the simple (from on-High to below). From the Hegelian perspective, both views are seen as polar (and many would argue anathema) to each other, and have been ordered traditionally in the opposing pairing of (religion) (science), (idealism)  (materialism), (immaterial) (material), and most broadly relevant to our discussion, (mind)  (body).

Doctor: How do we come to an adequate reconciling of our ideological differences?

Philosopher: We do this by giving equal weight to their common relations, as well as their distinctions. The major divide separating the perspectives of evolution and devolution are notions and distinctions around time. Devolution is brought forth in a singular generative moment. Evolution, on the other hand, unfolds over eons of geological time, with cycles of extinction and long episodes of evolutionary quiescence between new ecological forms. But these two perspectives of time are largely a temporal reflection of the perceptive domains of the right and left hemispheres of our brain, as informed by our understandings from neuroscience and neuropsychology. The right is intuitive, metaphoric, concrete, simultaneous, connotative, and whole-seeking, while the left has a predilection towards the analytical, abstract, specific, denotative, part-oriented, and sequential. Our triad for this cognitive pairing could be (intuition  (rational)), where intuitive comprehension gives rise to rational thinking, and this in turn circles back to create further intuitive understanding. In understanding how the intuitive mind and rational mind view time and space, we can also understand why the positions of devolution and evolution are both correct when viewed through the lens of the specific logical systems that birthed them. The right-sided hemisphere perceives wholes, and so looks at time and space as a simultaneous creative singularity, free of the constraints of beginnings and ends. Metaphorically we can view wholeness, with the sum of its nodes and relationships, as a web: a necessarily closed system. As a recursive web has no initiating or final endpoints, it has no basis for temporality, thereby forming the seamless context required for devolution. But to understand a simultaneous, timeless whole with no beginnings or ends requires a left-hemispheric, evolutionary perspective. The left brain is the master of the specific. Its specialty is parsing, and the creating of parts. If we start to cut and slice at our web of the unified, relational intact, and closed whole, we enter into the metaphorical opening process of constructing trees with their accompanying branches. The base of the tree, that is to say the initial cut between any two nodes of our choosing on the web, gives us an arbitrary starting position in space (point A), and an initiating point in time (time zero). From this mental construction, we can continue down the various nodal pathways, visiting each of what now seems to us as sequential events arrived at in sequential time. We may return to previous nodes in the circuit, but always in what now appears to be a sequential linear progression. In this way, the tree branches in a divergent manner from its arbitrary starting point out into the future. Our metaphor is exemplified by Darwin's now infamous, evolutionary tree, and, although the creationist wouldn't necessarily phrase it as such (Indra's Net not withstanding); it stands in paradoxical relation to our closed devolutionary web of Life.

Doctor: So, if we are to create a triad from this analysis, we have the closed web of devolution in its timeless whole, the "it" of our cybernetic dialectic, and the holder (via the right-side of our brain) of the left side of our trinity equation. Evolution, then, would necessarily be placed (via the left hemisphere) on the right, "process" side of the equation as a member of the former domain. Then, through bidirectional, cross-level relations, (i.e. recursion), the two stated positions of devolution and evolution create a self-referential unity. In our notation, we can view the metaphor of the relationships as (webs  (trees)), or dialogically as (devolution  (evolution)). That being said, what should we call this unity?

Philosopher: Life no doubt! In this way, from an even higher order of typing, it could be notated as (Life  (processes of creation or creativity)), or incorporating our former triad, we could equally note the relationship as (Life  (devolution  (evolution))), thus showing our nested/embedded/imbricated and recursive relationships across multiple levels.

Doctor: Through our post-Hegelian cybernetic dialectic, we have found a way to understand and embrace paradox as acceptable within the form of circular, recursive logic found within a cybernetic dialectic. That is intellectually exciting and conceptually very useful. Nonetheless, the idea has been raised that intentional paradox is created by a collapsing of logical types, and that this mistyping is essential to the creative process. How is this existential madness accomplished?

Philosopher: It is time to increase the cognitive tension, I see, for that is what paradoxes accomplish; their pull forms creative and generative tensions, as we try to reconcile their irreconcilable differences. For example, if you emphatically state that a system is closed, you would be wrong. If you then say that a system must, therefore, be unequivocally open, you would also be wrong. If you say there must be a combination or a synthesis of the two positions, you will be yet again misdirected. If you go on to attempt to use your newfound knowledge, and say that which is closed is of a higher logical abstraction that encompasses the embedded orders of process, as reflected in the open, then you are only intellectualizing, and haven't truly resolved or understood the paradox. This is the problem with discussions about paradox. Discussions are not solutions, only the naming of solutions. Nor are discussions of discussions about solutions, and so on. In the Zen tradition, we see the reality of paradox applied into action through the double-binding riddles known as Zen koans: paradoxical questions presented from Master to student. For example:

A Zen master holds up the keisaku (a flattened hardwood stick for checking posture and also for hitting dozing off students) in front of his student. In a demanding voice, full of urgency, he states, "If you say this stick is real I will beat you. If you say it is unreal, likewise you will receive a thorough beating. If you say nothing, you will receive an even worse beating. Tell me now, what is your answer!"

In this case, any opening of his mouth on the part of the student, in an act of intellectualization, will result in his beating. Where does the right answer lie? What is this monk's way out of the conceptual box that he has trapped himself in? In what action (or non-action) will his enlightenment emerge? By analogy, complex adaptive systems of all scales face a similar koan in trying to reconcile the intrinsic paradoxes at the root of their order. No side of the paradox is sufficient, in itself, nor is a compromise. When a system's integral organization is threatened, a radical transformation of interactions generates a new contextual diversity, and a new organizational pattern that transcends and embodies the paradoxical challenge emerges. The phenomenon of emergence is the equivalent of a systemic enlightenment, if you will. We find the creation of a new order of abstraction that embraces both poles of the paradox. Herein once more, we find our trinity. In complexity theory, this crossroads of transformation is what is referred to as the edge-of-chaos, and it is the narrow razor's edge on which Life balances.

Doctor: Yet edges are scary things. To play it safe is to enter into complacency; to stray too close is to risk oblivion.

Philosopher: Your words ring true, Doctor. And, as it is true for you, so is it is also for all complex adaptive systems. How could it be otherwise? Now, you will remember when we talked about attractors, we mentioned three classes: a point attractor leading to a fixed outcome, a cycling or oscillating periodic attractor, and the ever-strange chaotic attractor with its sensitivity to initial conditions and patterns of non-repeating unpredictability. However, early computer modeling revealed an unknown class of attractor that produced coherent structures of incredible complexity, precariously situated in the transitional borderland between the ordered and chaotic, and representative of an entirely separate class of richly-ordered, yet responsive and adaptive existence. The computer modeling unveiled a transitional point, both precarious and at times ephemeral, between order and chaos where complex forms, computations and dynamics manifesting both order and chaos were suddenly present: the Promised Land, "the edge-of-chaos". This discovery has profound implications to science and the nature of Life itself.

Doctor: Are you suggesting that life lies on the border between chaos and order, and that a movement in either direction is to fall off the edge that supports it?

Philosopher: That's correct. Life is a product of tensions between the two. It is always in danger of being pulled off its fine precipice, either to one side where too much order restricts requisite pattern diversity, fluidity, plasticity, and adaptability, or to the other where there are too many fluctuations, transformations, perturbations, and turbulences to maintain stability. However, in this improbable (or perhaps inevitable) position, Life finds the complexity it needs to express itself in its emergent fullness.

Doctor: Balancing acts are difficult things. On a tightrope, the walker is always at risk of falling off.

Philosopher: It would certainly seem that Life's position appears to be on the brink when we look at the order of things, although it may be more stable than your analogy implies. But let's expand your metaphor further. If I ask you to walk a fine line, you will inevitably fall to one side or the other of the line in your attempts; your balance will be wobbly. Obviously, Life cannot afford this instability. Yet, as we have stated, for Life to exist it must navigate the edge of too much order and too much chaos, and a fine edge, indeed, it is. Our modeling of the phenomena has shown us as much.

Doctor: How is a fall into the precipice below not inevitable?

Philosopher: The answer, Doctor, lies in the tensions. The position of Life on the edge is not a free one. It is stabilized by the tensions of its surrounds. To continue our thought experiment, if you are left to your own devices on the fine line you are walking, you will eventually lose your balance and fall off. If someone pulls your one arm, you will fall to the side of that pull. If someone pulls your other arm, you will fall to the other side. Yet if both your arms are pulled with relatively equal tensions, you will find that you are anchored with a new found stability, your balance much improved. As you continue your walk on the line, you will find you do so with much greater ease and grace.

Doctor: And so life is a balance of paradoxical tensions between the simply ordered, predictable, and determinate, and the complexly ordered and indeterminately determinate.

Philosopher: Yes, but we must never forget that it is always an edge, and stability is never a guarantee. A strong wind can always come battering the tightrope walker. If he compensates with his skill and experience, then all will be well, but as we well know, a fall can have unintended and often dire consequences. Life does not come with a safety net.

Doctor: You have mentioned that our understanding of complexity, and such notions as the "edge of chaos" have come from computer modeling. Could you speak more to this?

Philosopher: Every generation has its tools and technologies that allow it to explore mathematical axioms and theoretical approximations. So it was for my age, and so it is for yours. The tools of my time limited my investigations to that of the linear. Consequently, we explored the phenomena that were available to our scrutiny and created tautologies that were consistent with such linear logic. The massive computational power of your age has opened up the world of the non-linear, provided some startling realizations. Before, the world was conceived as predictable and quantifiable. Now we are realizing it is unpredictable and qualitative.

Doctor: What use is mathematics if it only serves to highlight our futility in being able to order and predict the world?

Philosopher: Not futile: fruitful! You just have to change your search from predictability to patternability. What you lose in the specific, you gain in the global. We forego a belief in the accuracy of our predictions, but embrace a new understanding of systemic behaviors. Although individual outcomes may not be known, overall systemic configurations may be, and this understanding can serve as a very powerful tool in our modern world. The mathematics of chaos and calculus are like mother and child; each has a role forming a self-referential unity of thought, encompassing both the rough and smooth things of the world. (Chaos (Calculus).

Doctor: What are some of these computational tools that are available to us?

Philosopher: Although new models are generated all of the time, a number of early computational forms provided much of the framework for our understanding of complexity. What these programs had in common was their use of autonomous agents, a set of systemic parameters establishing the relations, and a particular phenomenon to be addressed. Within the parameters of the program, the agents were permitted to interact on their own accord in novel ways, thus generating a multitude of relational configurations. Within this new paradigm, we have been able to model self-organization and properties of emergence in complex adaptive systems. What is important to note is that the solutions generated were emergent, as the programmed agents did not have a comprehension, direction, or purpose in regards to an endpoint, or even an implicit mandate to self-organize. Their role was merely to interact with their environment within the dictates of their simple programming.

Doctor: It sounds as if there is a strong biological bias to these models.

Philosopher: Indeed, there is, as Life is rich with non-linearity and complexity, and the early vanguards in the field were looking to form models that captured these very same dynamics. Already the implication of the modeling is astounding. For example, the process of cellular differentiation could prove to be a process of attractor-generated self-organization, rather than a genetically directive epigenesis, or that evolution may be more richly understood through the self-organizing dynamics of co-evolutionary processes and shared fitness landscapes.

Doctor: Such fantastic fields of discovery that dare to delve into our biological origins!

Philosopher: Yes, and there is an even more remarkable implication.

Doctor: And what would that be?

Philosopher: Order-for-free

Doctor: Order-for-free?

Philosopher: A radical thought that encompasses within itself the possibility that natural selection is necessary, but not sufficient to account for the evolution of complex organisms. That order may arise spontaneously through acts of self-organization without the need for established order outside of its own existing systemic organization. Furthermore, this declaration of order could not have been predicted a-priori, nor reduced a-posteriori once achieving state stability.

Doctor: Are you speaking heresy?

Philosopher: Think about it for a moment. Natural selection as the sole driver of evolution faces awesome mathematical odds. If we take the human genome as an example, we have tens of thousands of interdependent genes subject to the forces of random mutation. If we look at the potential number of shared states between those genes alone, the number is beyond astronomical. Yet despite this, within the span of only a few billion years on the planet we have seen the rise of a diversity of incredibly complex organisms and ecologies that by defy any probable odds, and still Life exists in the world.

Doctor: So are you saying that a number of monkeys with type-writers could not write the works of Shakespeare, given enough time?

Philosopher: Given the time of a number of universes in serial, perhaps, but the chance of success, particularly without the help of a good editor, is very, very unlikely.

Doctor: Yet you and I are here talking about the very subject of our own coming in to being. How can this be?

Philosopher: Once again, modeling has given us a possible answer. Given certain situations or rules among nodal relations in a network, the number and strength of connections, or the relative permissiveness of the rules dictating the patterns of connection, we see that even networks with a vast number of potential states will cycle through relatively small, self-organized state-cycles in patterns appropriate to the time-scales of planetary Life. The true heresy may be that, rather than improbable, the origin and resultant diversity of Life on the planet may have been inevitable.

Doctor: I see clearly now. On this dissipative edge that we call Life, we stand far from equilibrium, searching the source of our own self-organization; the self-organization that becomes the root source and template of ever transforming order in our living world. Such an enchanted world becomes a source of awe and wonder for us all.

Philosopher: Exactly, Doctor...order-for-free...the very heart of complexity...the very heart of Life...

Then the dream changed...

Back to the Table of Contents
Act V - Scene III: Day Rounds on Ceremony

At this point you are probably thinking: what is the point of these lectures? Where are they leading too? What is their purpose? This type of questioning is representative of the "as the crow flies" point of view: a type of inquiry that looks for the shortest cognitive course available to us. It is a mode of thinking that cuts across the totality of the mental landscape. It is purposeful and directive in its intent, and it is grounded more broadly in what we normally refer to as to conscious thought.

Before continuing down this thread, I want to share with you a story told by philosopher and physician Iain McGilchrist in his landmark book The Master and his Emissary. The parable, originally credited to Nietzsche, is metaphoric for the hemispheric differences of the brain in both their form and function, and the existential and phenomenological worlds they construct. As McGilchrist, in his comprehensive reviewing of the neurological and psychological literature notes:

[T]he left hemisphere, dependent on denotative language and abstractions, isolated, decontextualized, explicit, disembodied, general in nature, but ultimately lifeless. The right hemisphere, by contrast, yields a world of individual, changing, evolving, interconnected, implicit, incarnate, living beings within the context of the lived world, but in the nature of things never fully graspable, always imperfectly known – and to this world it exists in a relationship of care.

The story of the Master and the Emissary goes as follows:

There was once a wise spiritual master, who was the ruler of a small but prosperous domain, and who was known for his selfless devotion to his people. As his people flourished and grew in number, the bounds of this small domain spread; and with it the need to trust implicitly the emissaries he sent to ensure the safety of its ever more distant parts. It was not just that it was impossible for him personally to order all that needed to be dealt with: as he wisely saw, he needed to keep his distance from, and remain ignorant of, such concerns. And so he nurtured and trained carefully his emissaries, in order that they could be trusted. Eventually, however, his cleverest and most ambitious vizier, the one he most trusted to do his work, began to see himself as the master, and used his position to advance his own wealth and influence. He saw his master's temperance and forbearance as weakness, not wisdom, and on his missions on the master's behalf, adopted his mantle as his own – the emissary became contemptuous of his master. And so it came about that the master was usurped, the people were duped, the domain became a tyranny; and eventually it collapsed in ruins.

The right and left hemisphere, as McGilchrist is elucidating in his thesis are not synonymous with the primary process (unconscious) and secondary process (conscious) that Bateson elaborates upon. Nevertheless, there are important parallels in terms of relational dialectics, and the epistemological consequences of reversing such relationships, with the above parable being suitable for whichever cerebral dualism we choose.

The Master and the Emissary is a cautionary tale. What then are we to make of purposefulness and consciousness amongst the muddle of our cultural discourse around mind? Western philosophic tradition has preeminently concerned itself with the nature and workings of consciousness in mankind. Indeed, in the study of mind, consciousness is often cited a special position at the pinnacle of a perceived evolutionary hierarchy, and this is largely taken at face value. This should be of no surprise as the study of consciousness is undertaken by consciousness, and self-consciousness is inclined to see itself in a favorable light. It is an inherent bias that we must accept, and it is one we are destined to overlook if we forget to attend to things with an understanding of recursion. To not do so means that we will stay perpetually blind to our own blind spots.

With our conscious mind in mind, we first must remind ourselves that although we may speak of an evolutionary hierarchy or evolutionary tree, this metaphor is just a constructed abstraction reflective of our left-hemispheric perceptual/motor and organizational bias. This is in direct contrast to the right's construction of an evolutionary net or web that encompasses the full interconnectivity of Life on this planet. We must therefore recognize that any notion of evolutionary hierarchy with human consciousness holding the esteemed position is a creation of consciousness itself. The human being, with its self-consciousness, is no more or no less evolved than a humble bacterium, as each has adapted with maximum fitness to their shared ecological niches in a co-evolutionary relationship.

So what are we to make of consciousness? What is consciousness? What is its role? Before we go forward with these questions, let's quickly revisit the notions of emergence and complexity as they relate to evolutionary process. In complex adaptive systems, emergence is the self-organizing of novel and complex patterns arising out of a plethora of relatively simple, and often local interactions, among the multitude of agents participating in a system, all in the absence of any central or purposeful organization. This in turn forms the foundation for an integrated, embedded, imbricated, and recursively connected dynamical order central to a cybernetic understanding of wholeness. Holding to this principal of emergence, we must remind ourselves of the concept of order for free in which Life, independent of natural selection, has a tendency to become more complex as a product of emergent self-organization. It is not that natural selection doesn't play a role in evolution; it is just that evolution by natural selection is insufficient. Given the astronomical possibilities of random combinations within the finite time of our universe, it is insufficient to account for the complexity of organization we observe, including the complex phenomena of conscious thought. Using a recursive cybernetic dialectic, we can envision that self-organization, leading to the creation of emergent forms and behaviors, is one of the foundations of natural selection. The products of change recursively re-inform and cyclically recreate further self-organization (evolution  (self-organization  (emergence  (natural selection)))).

From an orthodox philosophical and scientific perspective, the notion of mind is a closed representation of individual mental processes existing in direct relation to the physical mass that we call the brain. Characteristic of this perspective is a division of conscious and unconscious processes, with consciousness hierarchically preeminent (a left-hemispheric bias). In contrast to this, we find a cybernetic conception of mind (in the Batesonian sense) as an open and distributed notion of relational interactions embedded throughout the ecological matrix. Mind, from this cybernetic perspective, is construed as a deeply unconscious process, with consciousness viewed as an integrated/emergent behavior that holds no privileged ontological status (a right-hemispheric view).

What, then, is consciousness? In some sense we all know the answer, as we are all conscious beings and therefore embodied experts on the matter. We can reflexively exercise our consciousness to attend to the nature of our consciousness, and in doing so we exhibit our self-consciousness, thereby tautologically proving our conscious state. This self-consciousness allows us to notice and examine our conscious nature, providing some type of answer as to what consciousness is, at least from a first-person phenomenological perspective. So in this way consciousness is what we consciously observe it to be; which of course is how we experience it. Yet we must also admit that such a self-referential phenomenological representation acting as a convenient tautological retort is not really addressing the question in the true spirit of conscious inquiry.

Through our examination of the nature of consciousness from a neuroscience perspective, we have also tried to understand the phenomena in a reductionist manner. Interestingly, neuroscience and neuro-psychology have shown us that there are many more unconscious processes underlying the formation of the conscious experience than our self-reflection on the subject would lead us to believe. There is a self-constructive element – a fill in the blanks if you will – that covertly applies itself to maintain spatial and temporal coherence around our conscious experiences. We attend to what we know to attend. What we perceive informs our conscious thought, and our conscious thoughts influence what we attend to with our perceptive machinery. Once again, we find that same self-referential specter. A problematic aspect of the reductionist/materialist approach is that it necessarily must grapple with the ghost of mental phenomena.

Should we be surprised with the steadfast, self-referential nature of (self) consciousness? I think not. It is likely that consciousness, either through reductionist or phenomenological means, is not epistemologically reducible to something we can know. We are, after all structurally determined entities, and we must accept that our structure creates epistemological limits. An understanding of consciousness may very well exceed our cognitive limits, and thereby need remain an explanatory principal, recognized and constructed entirely as a product of its perceived effects. From this perspective, the conscious mind would be incapable of understanding itself in its entirety. As a cybernetic dialectic, this makes perfect sense, as mind births consciousness, and consciousness subsequently informs mind, but to reverse this relationship is to create an aberration. A brain studying itself is an amazing evolutionary feat, but such an inquiry remains a slippery and shady sort of business. Remind yourself to remain vigilant, as consciousness will deceive you in a way that the unconscious never can.

Regardless of the many epistemological and ontological debates around the nature of consciousness, let us leave it in its black box for now, choosing not to answer the question of what consciousness is. The more fruitful question, I would think, is: what role does consciousness serve in regards to mind as an unbroken totality?

Throughout these rounds we have discussed numerous tensions of process; open/closed, coherence/variability, and order/chaos to name a few. The specific example I would like to return us to is that of evolution/embryology. Evolution is the creative, generative process that in each ontogenic wave introduced the random and the novel as agents of change, thereby providing the prerequisites for self-organization, along with the adaptive potentialities required in the ever-changing ecological landscape. In counter-point to this, we examined how the embryological process maintains deep conservatism, and the known, rather than the novel, becomes the bar of the genetic status quo, thereby screening out difference, and minimizing the possibility of destructive and pathological transformation. As a consequence, the embryological process renews the ontogenic template, giving each new generation the freedom to explore evolutionary creativity, unfettered by their ancestors. With the evolutionary/ embryological metaphor in mind, I would like to suggest a novel idea of my own that consciousness is an analogous mental process to that of the evolutionary ideal, and serves as the creative impetus for our cultural evolution.

Self-consciousness appears as a largely human trait, at least with the profundity that we experience it as part of our collective life and workings. I think a reasonable approach would be to try to answer the question of the role of consciousness from an evolutionary perspective: is consciousness adaptive?

In the Batesonain conception of mind, consciousness is viewed as a partial arc within the greater recursive circuitry of mind in its totality. As a partial arc, consciousness is only a snippet of the greater, largely unconscious mind of wholeness. Any arc, if small enough, will appear straight or flat if the greater context is not appreciated. Consciousness, with its misguided sense of linearity, by its very nature cuts and tears at the fabric of the whole. It has start points and end points. It situates itself in self-referential positions of time and space, thereby creating its own context. Because of its limited perspective, however, consciousness lacks wisdom within the context of the greater mind. Although quite knowledgeable, consciousness would necessarily lack insight into the holistic context (i.e. wisdom) because of its very self-limited nature. Consequently, the product of conscious (i.e. purposeful) actions and intents can have many unpredictable and undesirable consequences, as they are dissonant to the rhythms and flow of mind as a whole (i.e. Life).

This view of consciousness seems very much at odds with the imperial-like status that it is offered in the Western Philosophical tradition. From the perspective of cybernetics, consciousness must be viewed at best as suspect, and at worst, a pathological epistemological force. How can these differences be reconciled?

Consciousness, with its self-referential context and purposeful intent, cuts through the integrated fabric of the greater mind. This "knife-like" metaphor could easily paint it as a destructive force. Yet is knowledge, in the conscious sense, to be viewed as anathema to the wisdom present in the whole?

I would suggest that consciousness is not a pariah of the wholeness camp - perhaps, more like a piranha. Its role just needs to be better understood. In the natural world, evolution, like consciousness is a "cutting force." Mutations and genetic mutations are disruptive to the matrix underlying the ecological web, and if left unchecked, would quickly run with lethal havoc through the evolutionary terrain. Even in the rare chance that such mutations provide a contextual benefit to an individual, and perhaps, over evolutionary timescales, a reproductive advantage to members of a species, the very same mutation may be pathological to the ecosystem's stability as a whole. Luckily, mutations are heavily buffered, and censored by the systemic whole at multiple levels, thereby minimizing the possible effects of such varied contingencies. This is, of course, a biological necessity, deeply rooted in the conservative embryological process; its lineage stretching back to the very origins of Life on this planet. It is an ancient systemic repository, renewed in each generation through individuated ontogenies, its evolutionary relations evident in our shared historical phylogeny. But at the same time, it is the store-house of Life's wisdom, a testament to Life's profound creativity, and a record of Life's heroic journey.

Nevertheless, despite the staunch reproductive stability and scrutiny of the ontogenic/ embryologic process, Life must remain flexible, vigilant, adaptive and resilient as the environmental context is always changing. Evolutionary forces provide the raw novelty for emergent change once such change is deemed "wise" from the perspective of the complex whole.

In evolution, we have the actions of liberal mutations and genetic recombination strictly balanced by the conservative embryological processes. Change is only seldom acted on, even though the raw material generated in its potentiality is great. With this thought in mind, let us return again to our abductive analogy. If evolution "cuts" the material ecology through mutation, I propose that consciousness does the same with ideas. Within an ecology-of-mind, ideas are the sources of cultural novelty. Many rise, and many more are just as quickly lost. Most ideas never leave the confines of our skulls. Nonetheless, some ideas find their time in the spotlight, and still others become the source of revolutionary change.

We know that embryology remains the balancing force to evolutionary change. To continue our analogy, we must ask ourselves what balances the wildly generative processes of ideation? What controls the amalgamation and assimilations of ideas into a body of knowledge, the derivatives of which become a tempest of change in the modern world? As they presently stand in our culture and society, born of modernity, I would put forth that our collectively growing set of ideas, that is to say our knowledge, has been left largely unchecked. This is, after all, the information age. What we have seen is not an explosion of information, but a cataclysm. The consequences of this unchecked growth have been disastrous at times. We march closer each day to the brink of ecological disaster. In the wake of this global change, we have entered into a period of mass extinction, yet we still continue to hold tight to the idea that the same intentional, knowledge driven process that got us into this mess will get us out. This is foolhardy. We need not ask what knowledge will save us; rather what source of wisdom will be our salvation? We are not in need of a furthering of our body of knowledge, but require a way to access the wisdom body through the wisdom inherent in our bodies in relation to the natural world. Evolutionary forces are checked by embryological dictums and directives. What similar mechanisms of holistic wisdom are keeping conscious thought, with its disruptive generation of novelty, in check?

Just as embryological process is both the sentinel and perpetuator of the shared inheritance and lineage of Life's unfolding and emergent processes; ceremony and custom, I would suggest, are the equivalent for the conservative maintenance of coherence and stability within a culture. Ceremony, from an indigenous perspective, is an honoring process of remembrance, reconnection, and consequently renewal. It honors cycles, rather than endpoints. It serves to reestablish us into the whole. It aids us in circumnavigating episodes of transition in our lives, and in so doing becomes a source of healing. Through ceremony, all new ideas are weighed by the wisdom inherent within the existing ecology-of-mind. Custom becomes the means through which wisdom is purveyed through generations. For example, in a traditional culture, one needs to have no knowledge of nutrition or nutritional sciences to access the health inherent in a traditional diet grounded in place, born of the land, and tested by time. This becomes the culinary wisdom of grandmothers, and not the knowledge or facts of scientists. Man is a natural being, but through a singular cut of consciousness, the modern world has severed this understanding, and forgotten this truth. Ceremony serves to re-bind us to all facets of the natural world as an act of re-enchantment. It allows us to appreciate the primordial, not in a conscious sense, but in a deeply embodied way through our sensual and aesthetic faculties. In this manner, we gradually become elders, stewards, and wisdom holders over the course of our lifetime. This is in a direct contrast to the way we are now living, where the novel is praised, youth is revered and consumption is the order of the day. Using the Bushmen's vernacular, the ceremonial process is what allows us to see, feel, and be moved by the "ropes" that connect us to all of Life and to that which lives on through us. Through the dance, the connections that have been torn and ruptured can be rewoven and made whole. It is interesting to note that in the Latin, the root from which we derive religion, religare means "to bind fast." This should be no surprise, for ceremony is an aesthetic thing born of the religious impulse that draws us towards that which is sacred.

Where does this leave consciousness? In its rightful place I hope. Consciousness is not a malevolent force, but neither is it benign. It is limited and woefully blind to its own self-referential nature. Let us celebrate it, then, for what it is. It is the source of innovation within our collective human culture. It is the well-spring we go to when a change in context (i.e. the cultural/social/physical environment), and an adaption to the becoming world is necessary. I am not suggesting consciousness should be suppressed, capped or shunned, but its products should always be weighed against the greater context and that which is inherently wise.

As doctors, we should strive to be healers, and it therefore behooves us to align with the natural world. Ceremony, born from the indigenous mind, has largely been lost, but given time and patience over generations it may be nurtured and grown again. We need to center ourselves in the aesthetic source, and mindfully surround ourselves with the living world, allowing ourselves to be moved by the innumerous relational interactions that engage us.

Ultimately, ceremony is about re-enchantment. It embraces our deep not-knowing. Mystery is the domain in which change and transformation occur. On our journey to discover our collective healing gifts, we must learn to enter into ceremony, for only within the natural mind do we find the requisite wisdom needed for our cultural metamorphosis. Service, sensuality, performance, and all the aesthetic facets of beauty, health, and the sacred become manifest and possible within the ceremonial arena.

But there remains a deep quandary which brings forth a question we must face; namely the question of transcendence. Despite a more encompassing and holistic perspective that these systemic views engender around the mind-body problem, there nonetheless remains a residue that prevents us from fully putting Descartes' ghost to rest. That is the remnant of a pervasive sense of an individuated self that evades integration into our cybernetic description and rational understanding of a greater systemic mind. That is to say our conscious self creates a sense of other, as it convinces itself of an ontic or object-independent reality, and continues to see other minds as separate from its own.

There is an asymmetry between our rational explanations of mind and our individual phenomenological experience of mind. We can account for the workings of other minds, but our own experience as mindful-beings is not exhausted by our descriptive discourse on the matter. No matter how exhaustive our inquiry, there remains this vestigial attachment to our personal experience of our own minds as individual, unique, separate, important, and thoroughly grounded in our heads. In other words, that aspect of mind that creates our rooted sense of self stubbornly remains despite our desire to integrate into a greater totality. The greater ecological mind seems like a very different and alien affair from our own experience of the world, and consequently remains experientially barred to us. This conundrum is the very crux of our investigation. We may be able to conceive of a unitary mind, but this is a very different thing from experiencing wholeness; our purely intellectual conceptions of integrated mind remain thin in comparison.

In drawing this dialectical framework, you may note that you have evoked a disturbance on the surface of consciousness. In our earlier rounds, we suggested that the aesthetic, as a transformative force, showed itself to us in just such a way. We can call these aesthetic, transcendent glimpses of wholeness intuition: that which is beautiful, that which is sacred, and that which is healing, particularly in the ceremonial context.

Intuition, largely unconscious in nature, transcends the limited perception granted by rational discourse and the linear logic of the left brain. This raises the question of how to cultivate intuition in our lives and in our culture? How do we free ourselves from the prison of ego and self? The answer lies in ceremony.

As in the story of the Master and the Emissary, we have usurped the ruling Sage and replaced him with a Machiavellian despot. Through our actions, we have created pathological reversals in the natural cybernetic dialectic, switching sides of the equations' circuitry: (Left brain  (right brain)), (logic  (intuition)), (conscious  (unconscious)), (knowledge  (wisdom)), (parts  (wholes)). These epistemological aberrations lie at the root of our cultural pathology. These actions and beliefs short-circuit the cybernetic pathways of the whole, once again leaving us with only the partial strands we have cut out, fraying wisdom's tapestry. Our limited knowledge has become central, reinforced, and reified, binding our experience to that limited scope of our own creation, and allowing the epistemology-of separateness to solidify its hold. Locked in this paradigm, it is no wonder that we turn to such a view of the world. With the path to essential wholeness cut off, we express our frustration in the only way that is available to us: that is to say dualistically. We are torn by what we can't obtain as a whole, and like dogs left to fight over scraps, we continue to pull and tear at this old carcass. Only returning the Wise Sage to his throne and reinstating his rule will correct our course. The re-enchantment of the kingdom lies within the magic of an alchemical incantation that will reinstate the proper systemic order inherent in the greater cybernetic dialectic. Intuition births logic, with logic, in turn, providing direction for future intuition. The unconscious births the conscious, with consciousness re-informing and recalibrating the unconscious. Finally, from wisdom comes knowledge, which feeds back to further enrich our sense of embodiment. This is the Ouroborous: the alchemical symbol of the snake eating its own tail – and the alpha and omega of our own tale here.

Myths of heroes and alchemical relics are wonderful to hear. Our minds willing embrace their truth from childhood, but our adult skepticism rejects such things: silly fantasy, waste of time...we are too busy with objective reality. Yet the cybernetic dialectic of (wisdom  (knowledge)) promises that a deep truth in these fictions. How can we access this greater experience of mind beyond the confines of our own sense of self and escape our epistemological prison?

Enlightenment in a Zen temple or dissolution into wholeness in the Bushmen's dance holds the air of the exotic, and only serves to solidify its difference from our own Western experience. But the latent promise of integration with systemic mind, along with the insights that such an experience offers up, may be closer than we realize. Its potentiality exists in our own day-to-day experiences of embodied and relational living, where the veneer of the mundane covers the remarkable, and the common hearth holds mysteries of health and healing. In looking deeply to our relational and emotional lives, we may be surprised to discover that ceremony is waiting there, beckoning to us. If only we had the eyes to see and the ears to listen.

There have been many times in my life where I came to realize that my conceptual boundaries, separating self from other, began to blur and fall away. Profound moments of human contact with both friends and strangers; emotions evoked by a great story; feelings and movement inspired from a piece of music or art; aesthetic engagements with nature; the ecstatic bliss that I have experienced in indigenous and religious traditions around the globe: all have helped to serve to this end. In these moments, I am bigger, as well as paradoxically smaller. I am expanded, yet humbled. Through the wisdom of this space, a deeper knowledge or creativity is present and forthcoming. This is the home of the mystic, the shaman, and the artist.

I want to share with you a quote from Carl Rogers, the founder of the psychotherapeutic approach of Person Centered Therapy, and one of the vanguards of a Humanistic Psychology. He is best known to us in the medical field because of his body of work around the topic of empathy. I have included it because, like us, Rogers is not an overt mystic or radical artist, but a practitioner of an orthodox Western health tradition. He shares this experience:

When I am at my best, as a group facilitator or as a therapist, I discover another characteristic. I find that when I am closest to my inner, intuitive self, when I am somehow in touch with the unknown in me, when perhaps I am in a slightly altered state of consciousness, then whatever I do seems to be full of healing. Then, simply my presence is releasing and helpful to the other. There is nothing I can do to force this experience, but when I can relax and be close to the transcendental core of me, then I may behave in a strange and impulsive way in the relationship, ways which I cannot justify rationally, which have nothing to do with my thought processes. But these strange behaviors turn out to be right, in some odd way; it seems that my inner spirit has reached out and touched the inner spirit of the other. Our relationship transcends itself and becomes a part of something larger. Profound growth and healing and energy are present.

In a similar light, I would further like to share a quote from one of the great healers of our time, the psychiatrist Dr. Milton Erikson, a rejuvenator of clinical hypnosis in North America, and one of the early founders of brief and systems-based psychotherapy.

I don't know. I don't know what I'm going to do. I don't know what I'm going to say. All I know is that I trust my unconscious to shelve into my conscious what is appropriate. And I don't know how the clients are going to respond. All I know is that they will respond. I don't know why. I don't know when. All I know is that they'll respond in a way that best suits them as individuals. And I become so intrigued with wondering exactly how their unconscious will choose to respond that I can comfortably wait for their response, knowing that when it occurs I can accept and utilize it. I know that sounds ridiculous, but it works.

Finally there is one more quote I would like to share. It comes from an interview between Bradford Keeney and Gregory Bateson, and it concerns the work of psychiatrist Milton Erickson. Gregory Bateson was a friend of Erickson, and was known to refer to Erickson as "the Mozart of communication."

Keeney: You're saying that people [therapists] who go to Erickson [to study from him] come away with a craving for power?

Bateson: Yes they all want power.

Keeney: Is there something about seeing Erickson that induces this power hungriness?

Bateson: Well, it's the skill which he has of manipulating the other person which really in the long run does not separate him as ego dominant to the other person. He works in the weave of the total complex and they [the therapists] come away [after viewing his work] with a trick [strategy/method] which is separate from the total complex, therefore goes counter to it, and becomes a sort of power. I think it's something like that.

Erickson enters into the organizational whole through his work, the "aesthetic field" or the "weave of the total complex" (that equally expresses both doctor and patient), thereby engaging its self-corrective and self-organizational properties and processes. In this mode, the ethos expressed is one of Love. In direct contrast, the observing therapists, looking to capture a "technique" inadvertently bring about a type of corruption and sense of power where change is imposed bereft of the wider embodied context.

To change our epistemology, and to step collectively into greater wholeness, we must turn away from our old ways of doing things. Our stubborn self-consciousness and our unwillingness to detach is the problem. Like the visiting therapists targeted by Bateson's scorn, we will only succeed in creating imitations of change, and in doing so, convince ourselves that we have power over others and the planet. Power is a myth of the modern mind. Within the complex web of wholeness, without beginnings or ends, you will find no such concept as power. Power is an aberrancy of the reductionist mode of parsing the world.

So this brings us back to the question: how do we deal with the vestige of the differentiated self in juxtaposition to the transpersonal experience of the undifferentiated whole? Religious and spiritual traditions from around the world have utilized a plethora of sacred praxis since the dawn of the human experience. We see such acts as prayer, meditation, contemplation, song, dance, movement, fasting, dreaming, visioning, and purifications, to name but a few. As physicians, I believe that we are engaged in a sacred profession, and that we have been given a sacred charge. Our work is our service to the whole. In this book, I have suggested that the gates or paths of service, sensuality, performance, aesthetics, and now ceremony will lead to the experience of wisdom, and ultimately, a greater love. To evoke wisdom is to touch and be touched by the transpersonal mind. In becoming less, we paradoxically become more.

Complexity is not a servant of science. It is not a tool to be manipulated for purposeful outcome. Complexity does not abide to our will. It cannot be reduced to pragmatics. Complexity is a reflection of the deeper, unfathomable truth of the greater mind. It is the aesthetic reflection of wholeness.

I have always pondered over the idea of "being in love." Being in love suggests to me an immersion. Just like the jelly fish is in the ocean: the ocean's water no different than that contained within the boundaries of its own body. I would offer up that the embodied experience of mind or wholeness is a similar thing. It is through our immersion into mind that we experience the fundamental ground-of-being. This necessarily requires a subordination of the ego back to its rightful place. Although this transformation may occur as a flash of enlightenment, or some great epiphany in a single moment, I don't believe it must be so. In small ways each day, in each moment of our lives, the possibility for a transcendent shift is available. It is the potentiality that every relationship holds, for relationship by its definition implies something that transcends any one of us in isolation. We cannot force this experience. It is something that arises naturally from the whole. Perhaps it is what we mean by the concept of grace. It is in these small moments that the seeds and initial actions of change begin to grow in amazing, unpredictable organic ways.

Complexity, cybernetics, chaos theory, and all of their associated studies hold many promises. That being said, I want to leave physicians, physical scientists, social scientists, and other academics with a warning. Treat complexity complexly! Treat it with respect. Intellectualizing, theorizing, pontificating, hypothesizing, modeling, and abstracting are not enough. If you do this you will inevitably be disappointed. You will not find the change or understanding of the systemic world that you are searching for, and you risk pathologizing the whole endeavor. Complexity needs to be engaged with humility. Remember the cybernetic paradigm, "Act to know". Allow for the process of feedback, and then act to know again. There is no goal or endpoint to be found anywhere in this process. Systems have no endpoints. Endpoints are illusory. When trying to cure the patient, or exploring remedies for climate change, as noble as these goals may seem, we must be prepared to set them aside to allow for the self-corrective, self-referential wisdom of the eco-systemic mind to use us in service to the whole. Inspiration, creativity, genius: these are our birthrights, and the source of systemic abundance, should we be prepared to accept them.

Though these rounds, it has been my hope that you have seen glimpses of wisdom, for Grand Rounds are a type of ceremony in our lineage as Western physicians. I have tried to plant seeds of possibility in the garden of your hearts and minds. In concluding today, I want to leave you some final words, revising some of what we have discussed in our journey and quest towards epistemological transformation.

One of the critiques of systems/dynamics thinking, whether it be chaos theory, complexity science, complex adaptive systems, or the myriad other of related inquiries and fields, is that the knowledge that it has generated has yet to create much applied change in the world. Is knowledge of complexity sufficient, in and of itself, to bring about deep and meaningful change? Will knowledge alone create a transformation in our underlying epistemology? Knowledge, as we have come to realize, is not wisdom. Despite all of what we know, we can still continue to make unwise, and perhaps lethal choices as a civilization. Whether reductionist or holistic, knowledge alone is insufficient. Reductionism creates dangerous, decontextualized actions, while intellectual holism fails to create meaningful change, despite its broader, far-reaching view. Regardless of our preferred intellectual stance on these matters of science and medicine, knowledge without wisdom is the legacy of our present epistemology, which has proved to be either damaging or impotent in the face of pending ecological catastrophe.

What, then, are we to do? Is there any hope of traversing this epistemological chasm? This is not a trivial question for our survival, along with the survival of every other species on this planet may depend on the answer. To begin, we must always remember Heinz von Forster's ethical imperative, "Act always so as to increase the number of choices." Act simply to act, not for any purposeful outcome, and then with the knowledge gained from your action, act again. It is not simply enough to talk about wholeness; we must become whole. It is not enough to talk about innovation and change; we need to be both innovative and transformed. It is not enough to know; we must become wise, and let our knowledge flow from the deep well of unbroken mind. How can we embody knowledge, as both a culture and as individuals? We can through the pursuit of the sensual accompanied with the expressiveness of performance integrated with an immersion into the aesthetic, within the context of the ceremonial, undertaken in the spirit of service. In this way, I truly believe we can have a re-enchanting of our disenchanted world. The time for just talking and theorizing has come to an end. We must get our epistemological house in order. The Information Age, for its own sake, must cease, and the Age of Wisdom needs to begin.

What will this holistic future look like? How would the practice of medicine evolve? Citing sensitivity to initial conditions, we are forced to answer with a deep and resounding, "We don't know." It is through this humility of not-knowing that we begin our collective healing journey into wisdom. Although I don't know what the future will hold, I will suggest a couple of epistemological markers that may suggest we have arrived. First, our language will evolve to reflect the nature of relationships, rather than things. The despotic rule of the noun will come to an end. Secondly, there will be a return of reverence and awe in our appreciation for the beauty of the natural world, for it is what feeds us both literally and metaphorically. Thirdly, there will be a return of the religious spirit in a way that is not at odds with our science. We will share an equal embrace of the Mystery of Life alongside our understanding of the same. Finally, I propose that, over the long course of time, the need to even have this conversation will disappear, as will the need to operationally define such things as "sensuality", "beauty", "mind/body", "holism", "sacred", "health", and the like. At some point, through the deep embodiment of these things, just as a snake outgrows and sheds his own skin, we will release our conscious hold on these concepts, and let them submerge into the depths of our collective unconscious. From this deep place, we can allow the wisdom inherent in the greater systemic mind to inform our behavior, and inspire us with a purposeless and unintentional rightness. Perhaps this is what the Taoist sages of the east meant by wu-wei or non-action. In this way, "Act to know" and "Non-action" are paradoxically a unified cybernetic whole. This should be of no surprise, as our journey into an epistemology-of-wholeness has been all about the embrace of paradox.

If you practice your medicine the same way each day, your medicine is dying. In its predictability, it is has strayed far from the generative, life-supporting, life-sustaining edge-of-chaos. It ironically threatens to become a lifeless medicine that, in its original intent, was meant to be in the service of Life.

When you are with your first patient tomorrow, you will have a chance to act in a new way not predicated on knowledge. Are you brave enough to step into that mystery? To be a doctor is to be knowledgeable, and this is noble. To be a healer, however, is to be wise, and this requires humility and subservience to the greater mind. This is what is meant by invoking the term holism in medicine. To serve is to heal and be healed simultaneously. True healing is always a transcendental act. We must always remember that medicine is both art and science, but that the former births the later in a continued relational circle. This is the proper order of things. Always be aware and remain vigilant to this truth, for the opposite is teratogenesis. We have enough monsters in the world, what we need is more heroes. For in this age, there is no shortage of healing quests to be undertaken.

Thank you

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Act VI – Scene I: Night Round - The Physician

Doctor's Narration: ...With the Philosopher's final statement, the dream switches. I have left the Island of Samos, and suddenly I find myself flying south, low over the waves of the Aegean Sea with its tell-tale Mediterranean blues. The sun glitters off the wave crests. I soon sight land again, as I approach another island off the Turkish coast. It is the Island of Kos...

Travelling past the rocky shoals, inlets and white sand beaches, I slow as I come to a partially ruined ancient stone compound on a hilltop overlooking the water. I land in the courtyard. The temple walls are constructed from ochre colored stone. In the center of the courtyard is an omphalos, or navel stone marking this spot as sacred: a crossroads where the veils separating the worlds are thin. There are olive trees in the courtyard, and a spring-fed pool. The temple complex is small, and made of the same kind of stone that composes the outer walls. In front of the temple doors stands a statue. It is of a bearded man, strong and vital in his stature. In his hand he holds a course wooden staff with a single serpent wrapped around it. I cannot decide if his face looks young or old, but for certain, his brow is a mantel of wisdom and compassion.

By the temple well sits an older, bearded, balding sage. Like the Philosopher, he wears a wrap of ancient Greek design. Over his clothes is a plain white lab coat, a stethoscope around his neck. His feet are bare. As I approach, he continues to stroke the water with his finger; gentle ripples emanate with each motion.

Doctor: What is this place?

Philosopher: The Temple of Asclepius on the Island of Kos, the birthplace of our profession.

Doctor: Asclepius?

Physician: Sit, sit...Now that you have been tutored, and your formal study completed, it is time for you to take the Oath.

Doctor: Oath?

Physician: Yes, the Oath, now that you have finished your tutelage in Complexity Medicine.

Doctor: I still don't understand.

Physician: You swore to the Oath once, but then you so facilely pledged with an unexamined mind. But we must never forget that oaths are binding things, and the foundation of obligation. To answer your question, Asclepius was the son of the union between the mortal woman Coronis and the god Apollo. Coronis, late in her pregnancy, was slain by a jealous Apollo after committing an act of adultery. As her newly dead body lay engulfed with flames on her funeral pyre, the infant Asclepius was snatched from his Mother's womb by Hermes, the messenger of the gods. The child was given by Hermes to the wise centaur Chiron, the wounded healer. In this way, he was raised, nurtured, and educated in all of the healing ways.

Doctor: And this, then, is his sacred temple?

Physician: Indeed it is, Doctor. Although you are of the Hippocratic tradition, it is through this ancient lineage, the lineage of the Asclepiads (followers of Asclepius) that we trace our line back to its origins. It is in our respect for Life, our reverence for wisdom in nature, and our shared love of pattern that the Asclepiads and the followers of Hippocrates find an essential unity. We each carry one side of the greater tradition: the Hippocratic follows the logical: the Asclepiads, the intuitive. It would be an error, however, to see these two traditions as polar and antagonistic. In truth they are, in their distinctiveness, one.

Doctor: Yes, I can see how my dreams have been preparing me for this visit with you now. My mind has been open to understanding the truth of this unity of thought in medicine and in life.

Physician: You are correct in both your thought and your speech, for how could medicine and Life be different, as the former is a reflection of the later. I can see in you that you are now ready to take your oath anew. The fruit always falls from the tree when it is ripe. With all that you have learned from your teachers and mentors, you have become equipped with a new corpus of medicine: a medicine of complexity. It is in this undertaking that you must swear the oath.

Doctor: My thoughts and understanding are still in embryonic form, but I will act and do as you ask, so that I may know more.

Physician: I ask nothing more and nothing less. A well-examined life is worth more than any multitude of examinations. The finish is already present at the outset. Such is the way of Complexity Medicine.

Doctor: Does the oath have a prescribed ceremony?

Physician: No, it should change as the world changes. And even if it is done exactly the same, each time it will be different until eventually it too disappears from conscious memory. Never cling tightly to the words, for it's the spirit that underlies them that enlivens and transforms.

Doctor: As for our ceremony?

Physician: Is your heart dancing?

Doctor: I believe it is.

Physician: Then it is time to administer this elixir of health. Together let us recite the Oath, and the Precepts of our lineage with both heart, head, and body for this sacred trinity is the basis underlying mind in all of its mystery.

(And with that, I close my eyes, take a deep breath, and effortlessly pour the following words from my lips in rhythmic certitude.)

Doctor: I pledge to immerse myself in the epistemological realms of Gaia and Sophia, allowing myself to be moved by their metaphoric truths. I recognize that to witness is to be witnessed, and knowing this, I enter fully and boldly into this oath and sacred covenant.

With Wisdom as my guide, I commit to use no longer the knife of purposefulness to cut through the woven threads of the tapestry forming that which is intrinsically whole. I submit to the sublimity of Life, recognizing that I am Life's servant, and that Life does not exist to serve me.

The expanding corpus of medical knowledge, foundational for our clinical acumen, is a gift, and serves as the tool of our trade and profession. I recognize, however, that in its application, such knowledge, however erudite, must always be measured and weighed against the standards of systemic sagacity. In this spirit, I also recognize the inherent limits of our craft's knowledge, as such is the nature of Life's complexity. With this understanding, I accept and surrender to the Mystery of deep not-knowing.

As much as I am a practitioner of the sciences, and the pragmatics born thereof, I also express the artistry of these healing endeavors, embracing the performance of the ancient healing dance, and all the aesthetic expression that emerge.

The physician's role is a sacred one, embracing all the exigencies of Life. Ours is not to judge; it is to meet the patient where they are. I must never forget to acknowledge the greater context, and the context of contexts that our encounters are embedded in, for our patient's lives, and our relationship to them cannot be understood without this.

Physician: Our sacred precepts, then, are as follows: have awe for and show respect to the natural world. It is our Mother. See the beauty in all things. Embrace circularity. Like Asclepius' staff, the Ouroborous is also a symbol of our lineage. Recognize that that which is liminal is also a source for transformation and change. Utilize all things present in the relations of the moment, even those which initially appear antithetical, as the goddess shows herself in many guises. Recognize that although, at times, we may be dispensers of cure, we are first and foremost healing practitioners. Never forget that this is the proper order of things. The nurturing of relationship is paramount in our work. Tend to such things diligently. Always consult first the legacy of co-evolutionary process, along with our shared and ancient embryonic wisdom. Placebo is not an untruth, but a reflection of a deep verity. Cure with food and herbs. Encourage movements in your patients that align with the flow of Life. Cultivate vitality and mindfulness. Listen deeply. Stillness is different from stagnation. Let the words that that spill from your lips be poetic, serving as a healing balm, and learn to limit your prose. Laughter still remains the best medicine, and although Wisdom is as serious as Life and Death, it is sometimes crazy and absurd. Your pharmaceutical armamentarium and surgical prowess is a great gift. Use it sparingly and wisely, as the arrows of linearity are fraught with danger. Strengthen your treatments and prescriptions with your belief in them, and your belief in the patient to receive them, and use them as a bridge to help engage Health within. Recognize that none of us can predict the nature and direction of systemic response and change, including catastrophic change. Observe and engage the patterns of being as they present themselves, yet always remain humble, lest you be humbled. There is no room for arrogance in this work, and remember that ours is a profession of uncertainty and ambiguity. In our ministrations to patients, we ourselves must recognize that we are ultimately myth-makers, and this is how we purvey our healing truths. Do you accept these precepts?

Doctor: I do.

Physician: Then swear to your oath, and to the sacred covenant centered therein.

Doctor: In swearing this oath, I honor my teachers and the ancestors, and I pledge to be a mentor to those who follow, with the promise to guide and initiate them into these healing ways as has been done for me. Ours is a noble lineage, and I will act in such manner as to uphold that nobility. Through all my actions, I will choose that which fosters and diversifies Life in all regards. To serve is to be served. To heal is to be healed. Life is bounded in mutual reciprocity. Wholeness arises naturally. This alone is sufficient. To this I swear...

With that, the Old Doctor gives me a welcoming embrace. Having now been admitted to our ranks, I am also admitted to the temple. In the days that follow, I am purified in the sacred waters of the healing well; in quietude I rest and am made whole. It is a time of incubation, and a time to dream. In one of these temple visions, I dream I am a doctor, and in this moment, I return to myself again...

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Act VI - Scene II: Day Rounds on Love

In this final lecture, standing before you, I wish I could tell you what a medicine of complexity will look like. But the truth is, I cannot. Just as after a single week, the accuracy of our predictions of the weather fall apart, so too our predictions about most things. Such is the nature of complexity. As a physician, there is one common diagnosis that will unite us all, and that is the final common pathway of death. This is an unavoidable and ultimate clinical endpoint! The question, then, arises for all of us: how do we choose to live, knowing that our choice of death is beyond our purview? What is the medicine we want to practice going forth? Is there such thing as a medicine of the heart, and the soul?

In these Grand Rounds today, I want to discuss a word that we don't hear often in our hallowed medical halls. It is a small word. It is a simple word. It is, at times, an uncomfortable word, perhaps even a threatening one. That word is Love.

In these series of talks (with some trepidation), we have tackled a plethora of non-traditional subjects from the perspective of the medical orthodoxy, including service, sensuality, performance, beauty, the sacred, and wholeness. It seems only fitting that we should end with perhaps the most challenging of topics, namely that of love. Like the other subjects of investigation covered in these rounds, language, with its semantics, poorly captures the essence of embodied experience, and love is no exception to this. Nevertheless, we will persevere, if not with the minds of scientists, at least with the hearts of poets, who with outstretched hands struggle to catch and grasp the ephemeral recollections of Love's touch.

In my life, I have had the honor and privilege of knowing many healers. Men and women from an array of different cultures and traditions have served as my mentors: some over the course of just a short encounter, and some over the span of years. When your heart is open and soft, and you are ready to receive, your shared chronography is not the limiting factor. Love, as a transformative elixir, is transcendent of both time and place.

As I get older, I often find myself reflecting back on my time spent with those beautiful teachers that have impacted my life in so many profound ways, and by doing so helped me discover and explore my inner gifts. They have been there during my joys and my sorrows, accompanied me during my falls from grace, and travelled along with me in the times that I have soared. They have been with me at the moments that I have felt utterly fractured, and were there to aid me in my journey back to wholeness. Although my time together with many of these elders has passed, they continue to live in my heart.

Okuyama Sensei, the karate master, the Bushmen healers, Carolyn Gould, the Mi'kmaq elder, Alice Bennet, the Jamaican granny, Osumi Sensei, master of Seiki-jitsu, Rudy, country herbalist and Christian healer, Master Duan, kung-fu lineage holder and chi-gung master, and my teacher Bradford Keeney, whose ideas and crazy wisdom have been peppered throughout these rounds. These are just a few of those who have touched my life deeply, and I mention them now to honor their efforts and the wisdom they hold. I was very blessed to have had such guides, and even with their diverse cultural backgrounds, each one encouraged me not to strive to become a facsimile of them. Instead they urged me to delve deeply into the complex person that I am, in all of the contexts of my life.

Before continuing, there is one specific acknowledgement that I want to make. There have been two men in my life that have been foundational in my growth since the age of 19. Without their encouragement, it is unlikely that I would have gone into medicine. Their names are Fabian Morrisseau and Clem Courchene, and they are Ojibway elders and ceremonial men from Manitoba, Canada. My time with them, and the adventures we have shared along with their wives, brothers, sisters, children, grandchildren, and friends, could fill an entire book in its own right. I mention them to you now because of the unbounded gratitude I feel for them. They are in the deepest sense my family. Moreover, I bring them forth in this discussion because of the example they provide to us as healers. These two men have experienced much of the world. They have been both sinners and saints in their lifetime. They have survived hard times, abuse, and trauma. They have both lost children before their time. Yet in contrast with their hardships, they have shared great joys and successes, laughed with abundance, and continue to carry many fond memories of a simpler time. They also remember what the old folks use to tell them. Because of all this, they are great healers (although they would never say this about themselves). Their joys and sorrows have cracked their hearts wide open, and despite what they would have you believe with their antics and gruff exterior, they know where love comes from, acknowledge its source, and share in its bounty. In this day and age, where many a person wants to be called a "healer" after attending a weekend workshop, I wonder if any of those aspiring healers would want to shoulder even a portion of the suffering that my two friends have experienced in their lives. To heal is to hold wisdom, and wisdom only comes after having hardship, and a generous share of missteps and mistakes! Don't aspire to this; it will happen on its own accord if you are so inclined. Nevertheless, if you are prone to the generosity bestowed by adversity, don't just keep making the same mistakes! That's plain unwise (not to mention a poor use of feedback).

I would like to offer up to you one last recollection from an event that happened during medical school. At the time, I was in a trauma service elective working on 24-hour call with the teaching hospital's trauma team. I have always loved trauma and emergency medicine. It may surprise you to know that I like the skills and procedures, the mechanics, the precision, the performance under pressure, and quick decisions that emergency, trauma and critical care medicine require. This too is a holistic medicine when the situation demands it.

One night late in the evening, the trauma-team pager went off. We all assembled in the trauma bay awaiting the arrival of the incoming patient. When the patient arrived, we were informed that she had been a passenger in a high-speed collision. The condition of the young woman was dire. She had suffered a profound head injury, and was completely unresponsive at presentation.

After her situation was stabilized in the trauma-bay, the brain-injured girl was transferred up to the intensive care unit. She was placed on a respirator, and the critical care team took over her care. Central IV lines were inserted, along with arterial monitoring. As this was all being urgently attended to, the family, who had been notified, began to arrive at the hospital. As I had been involved in the case from the start, I took a moment to explain to them what had occurred, and what had been done for their daughter throughout her tragic ordeal. The mother had shut down emotionally in the face of this situation. Her face stern, her jaw rigid; her singular focus was her injured daughter lying in front of her. The patient's father, however, quickly took on a mediation role for the family. In those initial hours, he was visibly and openly emotional, but centered nonetheless. The young woman was from a First Nations reservation, and as this was all happening, the word of the accident had spread throughout the reserve. Friends and family from the local community and abroad to begin to pour in to the ICU in large numbers, to the point that it almost overwhelmed the facility. For all the negative stereotypes portrayed about native life, and despite all the real issues that challenge those living on reserve, nothing compares to their collective strength in the face of adversity. The rallied communal effort was a healing and supportive force.

Over the course of the evening, I tried to approach the patient's mother a couple of times to see if she had any needs or questions. She pushed away each time, her face unreadable. The attending physician was a very experienced and knowledgeable ICU doctor. Before continuing, I need to mention my gratitude for the trust that physician showed in me at the time, for it was the foundation for this whole encounter. I contacted her, after a number of years had passed, to get her recollection and perspective of the events of that time. Here is part of what she said:

I recall the girl's mother when she first arrived in the intensive care unit. She appeared upset and isolated, standing alone outside of the room where nurses were tending to her daughter's care. I tried to connect, offer support, offer a chair... but felt an intense reaction that I perceived was hostile and for which I was ill-prepared. She didn't want a chair, she didn't have any questions for me, she didn't want to talk and I felt that she wanted me to go away. It was palpably awkward, and I do recall that moment quite well. I felt impotent to help her and (selfishly, I'll admit) unappreciated. As I recall, I spoke with our End of Life specialist about this and that's when I learned about you and the rapport that you had developed with the family in the emergency room. I asked her to keep you involved, if possible.

I think it is important to reflect on this physician's recollection, for it is a more common scenario in our work than we generally realize. When we think back to our exploration of the sacred, we can recall that the Latin root, sacre had two poles. One: to be so holy and pure as to be sacred, and two: to be so vile or repulsive as to be sacred. As physicians in our roles, we must remember that we wear both of these masks in balance. Upon occasion, we are required to dawn the metaphorical physician's plague mask of medieval times. With it, we become the harbingers of bad tidings. At such times of imminent death or terrible tragedy, we must remember that, the patient's loved ones associate everything about the hospital with the unthinkable tragedy that has occurred. It is a type of profound and raw conditioning brought about by a sudden, violent tear in the relational weave. During these moments, as physicians, we become the symbolic face of that ugly association despite all of our efforts to champion the cause of hope. This is natural thing, as the living need to voice to the living their angst, because of the unfathomable magnitude of their grief and feelings of injustice. The fabric of Life has been rent, and both witness and sacrifice is demanded to receive the incipient rage born of this violent act. This is a process of reckoning. Healing will come later, slowly in time.

Prepare yourself well now for that future, for you will inevitably be called on to play both roles in your doctoring. In your work you will be revered, and at other times, reviled. It is not something that you choose, instead it is what is called for and called forth in a given moment. Nevertheless, if accepted graciously and humbly, both of these vocational positions can render a profound act of service to the suffering. No parent can, even in their worst imaginings, consider the notion that they will pass before their child. Such suffering can never be held by an individual alone, and hope to be survived. Like a tsunami, it overwhelms and crashes through all our defenses. A larger context is required if a family is to weather this storm, and as doctors, we are called to hold a protective container. But in so doing, we necessarily become recipients of a tempest that is not of our own making. When this happens, reframe it as an honor that the family trusted you to hold this sacred gift of their unbearable suffering until such time that they, in their healing, are ready to take it back into their life.

Throughout the evening, I continued to attend to the girl. As a medical student, I had the luxury of committed time, as I had no other duties calling me. Throughout the shift, I sutured the patient and dressed her many wounds. In truth, this was more out of respect for the girl and her family than for medical concerns. The unspoken reality was that we all realized there was little hope of recovery at that point. There was something profound and evocative in attending to the patient's body in an almost ceremonial way, although my ministrations, in a pragmatic sense, were certainly futile given the severity of her injuries.

During the night, I would touch base with the girl's father, taking time to answer his questions, give updates on her condition, and share what was happening medically around his daughter. It was important for him because he had become the spokesperson to the large number of friends and family that had arrived. At one point in the night, I felt compelled to express what I was feeling with him:

I just wanted to share something with you, not doctor to father, but father to father. What you are going through now, I can't even bring myself to imagine with my own children. I am so sorry for what has happened, and I just wanted you to know my family and I will be praying for your daughter and your family. Again I am so sorry.

With that, this big burly man gave me a hug. There were tears in his eyes. Everything that needed to be communicated and shared had passed between us in the feeling and truth of that moment. No more was needed to be said.

By the next morning things were not going well. The girl's life was preserved only by intensive care support, and we were fast approaching the point where it was necessary to talk about futility of future treatment and the withdrawal of care. The subject of organ donation needed to be discussed. The ICU staff tested and confirmed brain-death. At this point, because of the rapport I had developed, along with my experience with native culture, I was asked to facilitate a meeting between the family and the ICU team. Emotions were running very high all around. We scheduled the meeting for the next morning.

In that meeting, all of the immediate family and any extended family or support they wanted was in attendance. The small conference room was packed with the girl's loved ones and supporters, as well as the members of the health care team. The tension was palpable. After we sat down, my opening remarks centered on the truth that none of our team could possibly understand the grief and loss that they, the family, were undergoing in that moment. I followed up by acknowledging that no words that I or anyone of us could say would do justice to the gravity and the immensity of the situation before us. I admitted that I would likely... inevitably... say the wrong thing, as there weren't the right words to encompass this tragedy, and that it was my sincere hope that we would be each able to share the language of our hearts as a truer reflection of what we wanted to communicate.

I asked them to confide in us their spiritual perspective, and they shared with the team aspects of their traditional native belief. I explained to them that I only knew their daughter as a patient, and although her great strength, determination, and spirit were evident, I had no context to understand who she was, and how she lived her life. With that invitation, the family opened up completely, the mother most of all, talking about her daughter's strength, her love, her humor, and her passion for living. This young girl, in her short time in this world, touched many lives in a deep and profound way. The outpouring of joy, grief, and remembrance was a testament to that. There was not a single dry eye in the room.

After the family had finished, we turned to the unavoidable conversation that all of us had been dreading; the removal of life-support in light of the futility of the situation. We reviewed the fierce reality of the situation, and I explained the process for withdrawal of life-support. Then the topic of organ donation was breached. This caused some consternation with the family, as it conflicted with their traditional beliefs, yet it was also what they knew their daughter would have wanted. Knowing that their daughter's life was ending, in a moment of deep despair and anguish, the following words slipped from her Father's lips. "We will agree to the donation if you grant us just one more day to be with her...please..." This was a remarkable and heart-breaking gesture of love, but I explained to them that we were not there to coerce them into an action they were uncomfortable with, even though our team's bias was explicitly pro-organ donation. They could have another day with their daughter no matter what their decision was in regards to organ donation. With that, specifics were agreed to so that the family, friends, and community members could come and visit. Arrangements were made for traditional ceremony and prayers to be done on the floor. As for the other considerations, the father said he would have to consult with his elders. Ultimately, the family did agree to donation with the exception of their daughter's eyes and heart. The metaphoric significance of their choice and compromise honored their daughter in ways that no words ever could.

Far more important than the details of our exchange was the feeling that filled the room during the family meeting. It had a profound sense of holiness. We left that meeting unified and fortified by the experience of a new, deep relationship forged despite the immense sadness and tragedy that surrounded us all. We experienced a blessing in that room in a way that can never be quantified. There was not one person who was not moved deeply by love. We were literally and figuratively in love: a true immersion into that mystery. Through this encounter, we were all made whole and healed in some way. As I recall this story, I get goose-bumps to this day.

A flavor of love and healing is what I want you to take away from this story. What you must realize, however, is that these gifts of the Spirit were able to present themselves only from within the greater context of this young woman's full life, as it was held by her family, friends, and community. In this rich web of relationship, we were transformed by the healing that we were all unknowingly searching for. The ICU physician captured this point well in her correspondence and recollection:

There were a very large number of individuals at that final family meeting that I attended and you facilitated. You briefed me beforehand about the approach that you would take based upon your understanding of the native culture and spirituality. You had friends and family who were present talk about the girl, who she was to them and to others. You talked about her energy and spirit. You talked about the tragedy in a very general, broad perspective in the context of life and death. You might have provided the family an opportunity to voice their concerns with the quality of caring provided at various stages of their daughter's hospital stay. Eventually you came around to the discussion of organ donation.

I am continually refining my approach to end-of-life discussions. I found your ability to put this tragic loss of life in the ICU into the perspective of a broader landscape very compelling. Showing an interest in the girl, who she is/was, and her roles in the others' lives was relatively new to me at that time, very nicely done and something that I try to assimilate into all of my meetings of this nature. My most vivid memory is of your deep caring and advocacy for the girl and for her parents.

In service, we serve the sacred. It is our physician's role: at times revered, at other reviled. In this encounter, the staff physician and I acted as a compliment to each other in our service to the family. I, by chance and circumstance alone, became the face associated with the transformation and transition from life to death, while the ICU physician became the required face of grief, loss, and tragedy. Next time the roles could be reversed. The lab-coat and the stethoscope are the least important of the costumes we dawn. There is a wisdom in wholeness that we can never control or manipulate, yet through our service to this wisdom, we may become facilitators of healing in our work.

The job of the physician is never an easy one. The work will paradoxically harden some of its practitioners' hearts, while softening others. Take care to cultivate the heart of your choosing, for love, whether given or received, is a tender seed that, if nurtured, will bring forth fruits that are immeasurably sweet.

Thank you

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Act VII: Night Round - Jazzman

Doctor's Narration: Strangely one night, I find myself in the streets of old New Orleans on a hot summer day. They ER will page me if they need me, I think to myself. The air is wet and humid, and the vegetation is lush. The aroma of Southern cooking wafts on the air from numerous restaurants, bistros, and delis. I am standing outside of an old church with a mule-drawn hearse parked outside, two blasé mules preparing to pull. The driver is in front, sporting a top hat and tails, reins in hand. From inside the church, the voices of a Black Gospel ensemble pour out through the open door and windows in radiant celebration. Amazing Grace is on the wind. Around me are a multitude of jazz and big-band musicians. Instruments in hand, they are dressed to the nines despite the hot Louisiana sun. In the crowd, black and white faces find their unity through the music. A large brass and drum marching band has assembled near the door of the church. I see a collection of trumpets, trombones, saxophones, tubas, and clarinets. The glare of the sun reflects golden off the brass. Accompanying them is the percussion section consisting of a set of snares, and a big bass drum. They are all wearing jackets of purple velour. To my jaw-dropping disbelief, I find myself in a real "Nawlins" Jazz Funeral.

The gospel music in the church winds down and the band outside starts up. The funeral procession starts to make its way out of the church with all its members taking slow, rhythmic steps. There is obviously no rush to be anywhere else today. As they approach the door of the church, the Grand Marshal of this parade is in the lead. He is a large man, not only grand in size, but also in stature and charisma. He is decked out in formal naval attire. Around his neck is slung a snare drum, his sticks are in hand. As I make eye contact, there is a deep stirring of recognition. The joyous smile of reunion follows quickly. The Grand Marshal is my maternal grandfather: the man I affectionately call "Big Grandpa!"

The procession files forth from the church, led by the Grand Marshal and the pallbearers who carry the coffin. The pallbearers all appear to be physicians, garbed in their white lab coats, stethoscopes draped around their necks. With each step closer to the door, the band becomes more raucous and spirited. Other musicians in the crowd join the celebration by offering up their music, all expressing both joy and grief through their shared song. As they clear the doors of the church, the pallbearers began to sway the coffin, side to side and up and down in bigger arcs, all in time to the band's exuberant playing. Each time they come close to losing control, and then continue in an improvised frenzy until finally coming to rest. Taking the coffin, now back under control, the pallbearers place it on the back of the open-air hearse. The Grand Marshal lightly steps on to the rear bumper, talking up his position in front of the coffin. The hearse has now become his makeshift float from which he directs this magnificent mob of revelers and mourners alike.

With the coffin on board, and the Grand Marshal in place, the mules put their weight into their harnesses, the iron and wooden wheels of the cart creak and groan as though protesting one last final grievance. Finally, the hearse begins to move. The pallbearers take up their place followed by the marching band, thus forming the first or the main line. All the while, the music never stops.

This would be sight enough, but as the main line proceeds to wind their way through the New Orleans streets, a festive masked multitude begins to pour onto the roads from the nearby buildings and side streets, forming the infamous second line. There are Mardi Gras masks of all sorts: jesters, plague physicians and Venetian courtiers with their parasols. As well, there is a motley crew of masked shamans, clowns, and contrarians: a veritable diaspora of displaced anthropological delight. Their dance is riotous and jubilant. They twirl, they jump, they shake, and they fall, only to rise again once more. Their rattles, drums, bells, and shakers produce a rhythmic cacophony of syncopated madness. Yet the band plays on, un-phased by all of this unbridled commotion.

As we snake through the streets of old New Orleans, the procession follows no fixed route that I can discern. Nevertheless, we eventually find ourselves at the gate of the cemetery. The graveyard's gate and fencing is constructed of wrought iron. Through the fence is an elaborate array of lavish stone crypts and ornate mausoleums, all embellished with sculpture, statues, and stonework. The multiple rows of tombs create a vast and cadaverous streetscape.

As the gates open before the procession, the Grand Marshal steps to the side and, snare drum in hand, he drums them all – hearse, main line and second line – through the gates and into the heart of the cemetery. As I start to follow the end of the line, my Big Grandpa stops his drumming.

Grand Marshal: You can go no further than this, my Grandson. This is the threshold to the City of the Dead, and I testify to the truth that you are still very much alive. The strength of your vitality is given away by the beating of a strong heart, the rise and fall of your breath, and the weight of your footfalls.

Doctor: Grandpa, whose funeral is this?

Grand Marshal: It's a funeral for the way things were, so as to make room for what may be! Beginnings and endings, endings and beginnings; this is nothing more than a celebration of an idea who has had its time, but whose time has come to pass. We now lay it to rest so that tomorrow we may celebrate a birth.

Doctor: Will I see you again Grandpa? I have missed your company, our conversations and the ideas that we shared together.

Grand Marshal: Dreams Grandson, dreams...feed us so we may nourish you, and continue to dream together. Can you dig that?

Doctor: Before you go Grandpa, I want you to know that I have finally found my rhythm.

Grand Marshal: Stop believing that it was ever lost. The reverberations of your beat continue to live on after you play it, even in death, and you have always been playing it. It's a crazy thing...a crazy thing.

With that he picks up his snare drum. He hands me his sticks. "Carry on our Jazz." He says. "I got to go finish this gig now, and besides, these are some seriously cool cats to hang with. I like their groove." As he walks away, marching to his own beat, as he had always done in life, the gates close behind him.

"See you later Daddy O," I mumble to myself. It always strikes me as funny that you can have tears and a smile at the same time. I guess that is what a Jazz funeral is all about.

The dream then shifts, as dreams will, and I find myself in a cartoon episode of The Simpsons. Lisa Simpson is there singing with Bleeding Gums Murphy on the sax. Together they are jamming to Carole King and David Palmer's Jazzman:

When the Jazzman's testifyin'

A faithless man believes

He can sing you into paradise

Or bring you to your knees

It's a gospel kind of feelin'

A touch of Georgia slide

A song of pure revival

And a style that's sanctified

Jazzman, take my blues away

Make my pain the same as yours

With every change you play

Jazzman, oh, Jazzman

...I am startled awake with the sound of my pager calling. I make a note to myself to remember to change the ringtone to something a little more velvety...

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Encore: Gardens

As I was writing this book, I was also engaged in a parallel task, both of which proved very healing for me at that time of my life. In addition to my writing, I had taken up gardening. My family and I had moved to a new house in the country with a large backyard and much too much grass to cut. In the back was a very large weeping willow tree that was to become the de facto focal point for our new garden. So, my family and I started into the task: breaking sod, hoeing the top soil, shoveling the efforts of our labor into raised beds, and finally covering the beds with a straw and manure mulch from our neighbor's horse pen. In the end, we had the initial workings of a large family garden. There was not a straight line to be found, and every curve and contour paid homage to that Grandmother willow.

With the digging done, we began planting seeds. Each day we faithfully watered and watched, tending to our newly-sown charges. These initial days are a difficult time in a new gardener's life. Every day, I would scan for an inkling of new growth, and every day I would be disappointed. My worry increased, but hope sprang eternal. Then, as if by magic, the garden began to bloom into the splendor that is Life, with the full renewal and vigor that summer days promise. We were blessed with great abundance that summer, each day bringing a new surprise. We ate directly from the garden: our bodies merging with the living soil. We froze, we canned, we fermented, and we shared what we reaped. Many lessons were learned that season. For sure there were a multitude of successes, but also our fair share of failures. Nevertheless, through both the rewards and the disappointments, the garden never ceased to be a wonderful teacher. It was to become my family's summer of healing.

In designing the garden, I tried to honor the teaching of complexity by utilizing permaculture principles: south facing positioning, raised beds, locally acquired mulch, companion planting, rain water collection, no-till design, and the like. What was amazing to me in that year was to see that diversity, indeed, promoted diversity. By creating edges of new habitat, a multitude of new neighbors moved in: insects of all types, a population explosion of earth worms, bees, and other pollinators, song birds, garter snakes, butterflies, moths, caterpillars, toads, and even a baby rabbit. In saying that, not all were welcome guests; nevertheless, we found various ways to come to a truce. We took from our share of the garden, and they took from theirs.

When asked by others what we grow, we could cite a very long list of vegetables and fruit, but as I have come to realize the real answer is soil, for without a healthy ground nothing can flourish. In that soil, there is an ecosystem of micro and macro-organisms as diverse in its structure as any great forest. It is the soil that a true gardener stewards, and it is the soil that he tries to grow from year to year. If you are still struggling with the concept of Pleroma and Creatura, one only has to look to the relationship between the inorganic matter, the micro-biota ecology, the plants and animals, and the farmer; all of which are subsystems within the mind that we call a garden. It is true that a garden is a humble thing, yet it is a miraculous, awesome, mysterious, life-affirming humble thing.

The analogies between the garden and this book are many for me. Like the garden, this book, too, was grown. The soil of thought was tilled, and prepared many years ago. The seeds of experience, investigation, and search have been planted over the decades. There have been many worrisome times where I felt that what I had planted would not grow, and all that labored ground would be left bereft and barren. But then one day it happens. Thoughts begin to sprout and grow, ideas fruit, concepts intermingle, and before you realize it, mental abundance abounds, and a book becomes a completed entity.

My question to all of you is: what if we were to think of medicine as a majestic old garden? How would we tend to this inheritance? What kind of caretakers should we be? That is what this book has been about. There is not a single way to have a garden. There are many ways. That being said, gardens are natural, living things. They are complex, and so too is our medicine. Complexity science begins to give us inklings of possibility around conceptions that were previously shrouded from us. As much as we should be proud of what we know with our medicine, we should also be humbled by what we don't. Knowledge is a great thing, but knowledge without wisdom is blind. Ultimately, a garden grows itself. The same can be said for Health. What, then, is the role of the gardener? What is his relationship to his garden? Similarly, what is the role of the physician? What is our relationship to Health?

In this book, I have presented to you a number of metaphors for mind. They are certainly not exhaustive. Yet all, I would argue, are reflections of a different epistemology than the one we presently have. They are reflections of an epistemology-of-wholeness, an epistemology grounded in the wisdom of the natural world. By looking at what can be known, as well as how we know, we better understand our position in the order of things. Our actions have consequences, many unintended. We cut relationships in the vast Web of Being at our own peril. To nurture relationship and diversity should be the central tenant for all of us. "Love your neighbor as yourself" is wisdom of the highest degree, but what we must begin to realize is that our definition of "neighbor" must become a more inclusive one. Gaia is a crowded and diverse community, and it is imperative that we all must learn to play well with one another.

In the various acts of this play (as well through our various acts of play), we have explored a number of ideas related to the mind-body relationship. With the Glass Bead Game, we see a metaphorical pedagogy of mind through which we can order and hold our thoughts and experiences around complexity, giving them time to ferment and eventually coalesce into a coherent whole. Other acts of this play have looked at the mind-body from a rational, articulated, and logical perspective, and in this way we have encountered second-order cybernetics, chaos theory, complex adaptive systems, and autopoiesis. We have also explored embodied paradigms such as the Bushmen healing tradition, the martial arts, Ericksonian hypnosis, jazz, Zen, and, of course, gardening. The juxtaposition of these rational and intuitive approaches was an intentional one.

I want to leave you with one last story. Osumi Sensei, the traditional healer, and practitioner of Seiki-jitsu that I lived with in Japan, had a small Japanese style garden in the front of her Tokyo home. She would always initiate her new apprentices with the caretaking of this garden as a requirement in their daily tasks. It was only when they mastered this caretaking, or when they had learned to attend and respond "to the call of the garden," were they allowed to start working with patients. Mrs. Osumi knew that whether we answered the call of the garden, the patient, or ourselves, that it was the same identical call: a call from and back to wholeness. She lived healing in its myriad forms and guises. In the midst of Life's wonder, she allowed herself to be continually surprised. She chose to live an enchanted life.

My garden and my patients alike have been great teachers to me. Like Osumi Sensei, I am learning not to be surprised by the fact that Life brings continuous surprises. In gardens, growth is a promise. In my patient's faces, I continually see my own reflected back. The human condition, after all, is a deeply shared one. What, then, will be your garden? What will you choose to nourish with your time and attention, so that it might nourish you? I think it is good to end here with more questions, rather than answers.

When I was leaving the Kalahari, the Bushmen elders told me, "Whenever and wherever you dance, know that we will be with you... that we will be with each other." Such is the way of the dance. In this spirit, I hope that whenever you pick up this book and read these words, you will know that we will be with each other. It is in this promise that I find hope and solace as we walk, hand in hand, into the unknown future...together...in harmony, in relationship...in wholeness.

Sincerely,

William Sutherland, MD

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Appendix A

Mathematical Pictorial Representations of Non-Linear Dynamics

Fractal Image (Mandelbrot Set)

Bifurcation Plot (Feigenbaum Diagram)

Phase Space Diagram (Lorenz Attractor)

Cobweb Plot (Verhulst Diagram) – Fixed Point Attractor

Cobweb Plot – Periodic Attractor

Cobweb Plot – Chaotic Attractor

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Appendix B

  1. Comparing Cybernetic versus a Hegelian Dialectic

Symbol of Interactional/Circular, Cutting across Type/Domain Relationship in a Cybernetic Dialectic (i.e. object/process relationship)

Symbol of Same Type Domain, Zero-Sum Relationship in a Hegelian Dialectic (i.e thesis/antithesis relationship)

2. Examples of a "Nested", "Circular" Cybernetic Dialectic

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Endnotes

1. (Bateson and Bateson 2005, p.177).

2. The Night Rounds take the form of a dialogue situated in the Lewis Carroll tradition. Gregory Bateson, the elder statesman of cybernetics, utilized a similar form of communication throughout his writings which he termed a "metalogue," referring to a form of conversation that deals specifically with a mental or relational process where the form of the interaction between the participants embodies the specific subject matter at hand. Bateson's daughter, Mary Catherine, has carried on her father's tradition of the metalogue, as has Bradford Keeney, following in the footsteps of his mentor.

3. What is meant by these two words, "Complexity" and "Medicine" in the light of the greater dialog that is presently going on within medicine? With the advent in recent decades of a Systems Theory approach (including its offspring of Chaos Theory, Complexity Theory, Complex Adaptive Systems, and the like), we have seen this new paradigm of thought edge its way into the broader scientific literature, and, more slowly, into medical literature. But although systems thinking is meant as a macro, pattern-based approach to understanding, researchers in their fields, despite an obvious impulse towards holism in their thinking, instead oft opt to wield these innovative concepts as a blunt instrument within the reductionist framework of the scientific method. For example, the literature is full of such research titles as "Using nonlinear methods to quantify changes in infant limb movements and vocalization," or "Nonlinear complexity analysis of brain FMRI signals in schizophrenia," each revealing a bias towards parsing, rather than systemic unification or pattern connection.

That being stated, there are a few voices directing us towards a change in epistemology and understanding within the conversation of the greater medical community. Specifically, the Rambihars have raised the call in a number of prominent journals, including The Lancet, The British Medical Journal, and the Canadian Family Physician. They note that "Science keeps changing, as does medicine – the science of humanity. Hippocratic medicine replaced divine intervention and the supernatural with the science of natural observations, guiding medicine to the 18th century. A post-Hippocratic medicine emerged with influences from classical science of structure and predictability, probabilistic and reductionist modern science and then a post-modern science of deconstruction. These coalesced into a normal science, before 2000, of a puzzle-solving approach with uncertainty managed and values unspoken" (Rambihar and Rambihar 2010, p.1162).

Rambihar, Rambihar & Rambihar have voiced that the time has come for the continued evolution of the medical ideal, an evolution that they feel lies within the promise of a 21st century science of complexity. They have adopted the term "neo-Hippocratic science" from a 1966 essay by Rene Dubois, entitled "Hippocrates in a modern dress." In that paper, Dubois writes:

The art of medicine demands of the physician a holistic attitude very different from the typical scientific approach. It involves the ability to select, intuitively as it were, those aspects of the total medical situation in all its complexity, which can be manipulated not only by scientific medical technologies but also by any other kind of influence which promises to be useful. Seen in this light, the art of medicine appears so complex and personal as to be outside the scope of the scientific method, just as is artistic creation

(Rambihar, Rambihar and Rambihar 2014, p.232). With the light of this ethos, Rambihar and Rambihar define "complexity-based medicine" as a "post normal, more holistic science, with features of uncertainty, irregularity, and subjectivity, which serves medicine better" (Rambihar and Rambihar 2010, p.1162). Moreover, they see the neo-Hippocratic approach as a way of making "medicine a human story, with an ever-changing complex dynamic, intertwined art and science – and chaos and complexity its science for the 21st century" (Rambihar and Rambihar 2010, p.1162). With these frames in place, we will find that our reductionist efforts find a rightful place in our practice as, "Complexity based medicine reflects evidenced based medicine in context, allowing us to understand and translate evidence to reality" (V. Rambihar 2014).

4. Bateson often cited the dialectic formed by "rigor" and "imagination" in regards to approaching any investigation or scrutiny of thought. In his own words, "rigor and imagination, the two great contraries of mental processes, either of which by itself are lethal. Rigor alone is a paralytic death, but imagination alone is insanity." (Bateson 2002, p.205). Bateson also felt hopeful that an aesthetic science could be brought about by, "the creative man that could combine scientific rigor with imagination." (Charlton, p.129).

5. Bradford Keeney, Personal communication

6. The imagination of the Glass Bead Game comes from Hermann Hesse's novel of the same name. The setting of the novel is a future post-apocalyptic world. The story centers on a type of academic monastery where an austere order of resident-scholars pursue mastery over the established intellectual and artistic classics within their specific disciplines of learning. The exception to this is the Glass Bead Game, which is simultaneously seen as the pinnacle of all learning, but also remains suspect because of the novelty it generates through its trans-disciplinary modus operandi that cuts across all established and sanctioned disciplines. The rules, structure, and play of the Game remain vague throughout the book, and are only alluded to with minimal detail. What I present as the Glass Bead Game in this Act is my best attempt at a compilation of the descriptions of the game found at various junctures throughout the novel.

7. The term zero-sum game comes from Game Theory. Game theory is the study of strategic and optimal decision making among those with the capacity and agency to make decisions that affect not only their own outcome but the outcome of other members involved. In zero-sum games, one person's gains exactly equals the losses of all the other participants. Win-win would represent a situation where all the participants benefit in some manor, the opposite being true for a lose-lose or no-win scenario.

8. Cybernetics is a trans-disciplinary inquiry that arose in the 1940's out of a series of inter-disciplinary dialogues among a number of innovative and diverse scholars from the pure and applied sciences, the humanities, and the social sciences, as they explored the unifying concept of 'feedback' or 'circularity' and its application in the regulation and organization of physical, mechanical, biological, cognitive, and social systems. More information on the study and history of cybernetics in general can be obtained at the websites of the American Society of Cybernetics in the United States and the Cybernetics Society in the UK.

9. (Von Foerster 2003, p.289).

10. (Von Foerster 2003, p.304).

11. (Von Foerster 2003, p.304).

12. (Water 1999, p.83).

13. (Water 1999, p.83).

14. See, The N/om of Storytelling (Keeney and Keeney 2013a, pp. 76-78).

15. (Ostaseski and Remen 1996).

16. (Bradford Keeney, Personal Communication). For further elucidation of this epistemological perspective, and the nature of improvisational conduct, refer also to (Keeney and Keeney 2012, p.35).

17. (B. P. Keeney 1983, p.13).

18. A paradigm is a distinct conception, pattern of thought, or grouping of ideas found within a greater epistemological context. Thomas Kuhn put forth in his 1962 book, The Structure of Scientific Revolutions the concept of a paradigm shift which was said to represent a revolutionary change in the basic assumptions, or "paradigms" within the ruling theory of science. Von Forester, although supportive of Kuhn's general insights, was quick to note that, "Paradigms don't shift. People shift: humans change, but paradigms don't change. They've got no idea how to change. Paradigm shift is a mis-formulation, once more attention shifts to the paradigm rather than the person who's talking about it." (Von Foerster 2014, p.69)

19. (Maturana and Poerksen 2011, p.16).

20. The 18th century philosopher, Immanuel Kant, distinguished between objects derived of our senses (and sense-making), or phenomena, and the sensory independent nature of an object, or what he termed the noumena. In Kant' view, the human condition meant that one could never understand or experience the noumena directly, as the related "ding an sich," or "thing in itself." Instead, he proposed that through our experience of sensed phenomena, we attempt to correlate our experiences with the structure and order of various aspects of the universe that are open to our senses, and then make inferences about the object-centered world based on our correspondences and co-relations. Nevertheless, direct knowledge of the noumena remains forever barred.

21. (Franchi, Guzeldere and Minch 1995).

22. Keeney terms these competing epistemologies "non-lineal" and "lineal." Refer to the section on Alternative Epistemologies in (B. P. Keeney 1983, pp.12-18) for a discussion on this theme, and its greater relation to psychotherapy theory and practice.

23. Radical constructivism purports that an individual actively constructs their knowledge and understanding based on their subjective and internal interpretation of their active perceptual/motor experiences, not on a literal representation of what has really occurred in the world 'out there'. In this way, understanding and acting are not seen as distinct and separate from each other; rather they are circularly conjoined, self-referential processes leading to a systemic cognitive stability within the closed system of the organism.

24. Thompson and Varela (2001, p.420) offer up provisional definition of emergence within a complex dynamical system as follows:

A network, N, of interrelated components exhibits an emergent process, E, with emergent properties, P, if and only if: (1) E is a global process that instantiates P and arises from the nonlinear dynamics, D, of the local interactions of N's components. (2) E and P have a global-to-local ('downward') determinative influence on the dynamics D of the components of N. And (possibly): (3) E and P are not exhaustively determined by the intrinsic properties of the components of N, that is, they exhibit 'relational holism.'

25. Kauffman, is one of the pioneers in the field of biological complexity, and, in his work, he explores what he has termed, "order for free," or the principal that complexity, itself, is the root of self-organization in the universe (S. Kauffman 1995).

26. (Pangaro 2011, p.2).

27. For a comprehensive review on the literature examining downward causation in complex systems, see Appendix B in (Thompson 2010, pp.417-441).

28. Solipsism is the epistemological stance that only one's individual mind is known to exist and that anything outside of one's mind, including the external world and the minds of others cannot be known and therefore may not exist outside of one's own cognitive reality.

29. Complex systems are systems derived from a sufficiently large number of interacting components in which the aggregate activity and generated processes are driven by non-linear relationships between the parts.

30. i.e. Autopoiesis. The nature and relevance of autopoiesis will be discussed in detail later in the book.

31. Dr. Eric Smith of the Santa Fe Institute argues against the improbability of the primordial emergence of life on earth in favor of the inevitable. He argues that in cellular metabolism we find the maintenance of ancient and archaic bio-geochemical pathways that were the foundation for the formation of early incipient life on the planet.

32. (Maturana and Varela 1987, p.89).

33. (Bateson 2002, p.19).

34. (Personal communication, Bradford Keeney). It is interesting to note that Heinz von Foerster also felt that in many ways 'everything that was old is new again'. In relation to the new 'complexity sciences' he states, "For me, of course, it's ridiculously funny that these people who are dealing with recursive functions, with eigenvalues, which have been called "eigenvalues" for a hundred years, have renamed them...My suspicion are in the direction – that they knew nothing about it...from a mathematical perspective, we were dealing with very similar or analogous problems, without using vocabulary like "chaos theory" and "attractors." (Von Foerster 2014, p.68)As the author of Grand Rounds, it is my hope that this work will, in some way, help bridge these generational divides.

35. A teleology is the philosophical notion that holds that final causes, or a movement towards a defined goal exists in nature - analogous in process to the concept of purpose found in human actions.

36. (Von Foerster 2003, p.248).

37. (Von Foerster 2003, p.290).

38. (Maturana and Poerksen 2011, pp.13-14). In looking at the everyday and common experiences of asking questions, committing mistakes, and trusting in the regularity of natural processes, Maturana explores the epistemological implications of the "ordinary" that, as a biologist, changed his investigative an reflective process from considerations of "how things are" to one of "asking for the processes that gave origin to them, and for the criteria that [one uses] to accept the answers that [one considers] valid."

39. (Von Foerster 2003, p.291).

40. See Ethics and Second Order Cybernetics (Von Foerster 2003).

41. (Von Foerster 2003, p.293).

42. (Bateson and Bateson 2005, p.34).

43. (Von Foerster 2003, p.227).

44. (Von Foerster 2003, p.227).

45. If it were possible to condense the expansive life-work of Gregory Bateson into two phrases, I believe they would have to be "The pattern that connects" and "A difference which make a difference." In describing his work, Bateson states, "In my life I have put the descriptions of sticks and stones and billiard balls and galaxies in one box... and have left them alone. In the other box, I put living things: crabs, people, problems of beauty, and problems of difference. The contents of the second box are the subject [of my work]." (Bateson 2002, p.7). While the orthodoxy of his time (and for that matter our time) concentrated on the nature of things, Bateson turn his attention to the relationship between things; what he termed "pattern," and in the broadest sense "mind." The question of how we understand quality as distinct from quantity is fundamental in this exploration. Bateson has asked, "What pattern connects the crab to the lobster and the orchid to the primrose and all four of them to me? And me to you. And all six of us to the amoeba in one direction and to the back-ward schizophrenic in another? ...What is the pattern which connects all the living creatures" (Bateson 2002, p.7). How, then, shall we answer?

46. This reference to "First" and "Second Creation" in my stylized version of the Bushmen Creation Myth comes from the extensive anthropological field work of Dr. Bradford Keeney. A translation of this myth can be found in (B. Keeney 2007a, pp.242-243). A further expansion on the embodied role of this myth in Bushmen culture, as well as a cybernetic analysis of its form and function can be found in (Keeney and Keeney 2012), (Keeney and Kenney 2013b), and in the upcoming book and definitive scholarly examination of Bushmen spiritual traditions, The Bushmen Way (Keeney & Keeney 2015).

47. Keeney (2010b, p.77) relates, in all seriousness, a powerful vision or "kabi" of a great Bushmen Healer. The elder states:

I was in the bush and came across the most beautiful giraffe I had ever seen. It was not a giraffe to be eaten as meat; God set this one aside. As I admired its beauty, God picked me up and threw me up the ass of that giraffe. Once inside its intestines, I started dancing. The giraffe gave me its nom [spirit]."

When considering the organs of the body, it is good to remember that the intestine is a wonderful metaphor for transformation and change.

48. "Insulting the meat" in Bushmen culture is a type of regular communal teasing directed towards the skill of individuals to prevent pride and arrogance in the face of their accomplishments. See (B. Keeney 2010b, pp.85-87).

49. For an in-depth discussion on Bushmen perspectives on language, see (B. Keeney 2010a).

50. (Von Foerster 2003, pp.133-135). From the essay, Molecular Ethology, An Immodest Proposal for Semantic Clarification.

51. Keeney (2007a, p.55) notes that the Bushmen experience a type of interactional synesthesia in ceremony, or the combining of senses, that they refer to as "getting your second eyes." Also see, (B. Keeney 2007a) for a comprehensive review of Bushmen perceptual experience in a spiritual/experiential context.

52. Keeney, in his ground breaking works (Kalahari Bushmen Healers 1999b), and (Ropes to God: Experiencing the Bushman Spiritual Universe 2003) presents a comprehensive expose on the nature of Bushmen spiritual beliefs, including "the ropes," from first-person Bushmen healer accounts.

53. Anabolism is in reference to the aspect of metabolic processes that require energy, and are constructive in nature. Conversely, catabolism entails the metabolic processes of deconstruction, wherein energy is released for use in the anabolic process and cellular cleaning and maintenance is performed.

54. For a description of the relation between the Bushmen ceremonial dance, First Creation, Second Creation and acts of healing, see (Keeney and Kenney 2013b).

55. Bateson defined the "elementary unit of information" as a "difference that makes a difference." In his seminal lecture, Form, Substance and Difference (Bateson 1972), Bateson lays forth the tenants of his cybernetic epistemology, as he explores the nature of difference, information, ideas, and their ecology, and the relation of all of these to mind, in both the individual and in nature as a whole.

56. In describing an "ecology-of -ideas," or synonymously, an "ecology- of-mind," Bateson proposes to us the possibility of a new, "Science of Mind and Order," the study of which looks at a "new way of thinking about ideas, and about those aggregates of ideas which [he] call[s] 'minds.'" (Bateson 1972, p.xxiii) Bateson, in his introduction to Steps to an Ecology of Mind, asks in regard to this new science, "How do ideas interact? Is there some sort of natural selection which determines the survival of some ideas and the extinction or death of others? What sort of economics limits the multiplicity of ideas in a given region of mind? What are the necessary conditions for stability (or survival) of such a system or subsystem?" As Bateson notes in his lecture Forms, Substance and Difference, "Socrates as a bioenergetic individual is dead. But much of him still lives in the contemporary ecology of ideas." (Bateson 1972, p.467).

57. A Collies fracture is a fracture of the wrist involving a dorsal angulation of the distal radius and the ulnar styloid bone.

58. (B. Keeney 2007a).

59. For a retelling of a detailed, yet intimate long-term relation with the Bushmen people and their healing dance, I recommend a reading of my friend and mentor, Bradford Keeney's autobiographical works, (B. Keeney 1994), (B. Keeney 2005), and (B. Keeney 2010b). Keeney has spent close to 30 years in the Kalahari in relationship with the Bushmen, and is recognized as an elder healer within their tradition. He has written extensively on his experiences and insights.

60. I would highly recommend the works of Dr. Abraham Verghese and his reflections on the lost art of touch, observation, and the physical exam in medicine. His TED talk: A doctor's touch, is an excellent starting resource.

61. There are certain fundamental principles that form the framework of a Batesonian Epistemology found throughout the works of Gregory Bateson. The Keeney's have named these key concepts, "A Batesonian Tool Kit" (Keeney and Keeney 2012, pp. 77-91). These central ideas are: 1. the notion of difference, recursion, and logical typing. Said otherwise, we are referring to the acts of creative generation, circular causation, or how difference can operate upon itself, and the drawing of related contextual abstractions. As Keeney and Keeney note, these three tools are, in essence, separate metaphors for a singular unified cybernetic process in nature.

62. (Spencer-Brown 2011, p.xxii). In summary of Spencer-Brown's primary notion, Keeney and Keeney write, "G. Spencer Brown distinguishes between the original act of creating an experiential world - the first act of distinction - and its subsequent regress of indications, punctuations, framings, and interpretations. The territory is found in the moving hand that draws the distinction, while the map emerges in the recalling of that distinction through all the indications and names we ascribe to it." (Keeney and Keeney 2012, p.56)

63. Gregory Bateson was known to regularly pull out a freshly cooked Crustacean in front of his university classes, and have them conceive of an argument that would convince a Martian that the object present was indeed the remnants of something living. Refer to the introduction of (Bateson 2002, pp. 6-12).

64. Bateson writes:

Official education was telling people almost nothing of the nature of all those things on the seashores, and in the redwood forests, in the deserts, and in the plains. Even grown-up persons with children of their own cannot give a reasonable account of concepts such as entropy, sacrament, syntax, number, quantity, pattern, linear relation, name, class, relevance, energy, redundancy, force, probability, parts, whole, information, tautology, homology, mass (either Newtonian or Christian), explanation, description, rule of dimensions, logical type, metaphor, topology, and so on. What are butterflies? What are starfish? What are beauty and ugliness?...It seemed to me that the writing out of some of these very elementary ideas could be entitled, with a little irony, 'Every Schoolboy Knows.' (Bateson 2002, p.3)

65. In the documentary, An Ecology of Mind, by Nora Bateson, her father Gregory reflected that, "The nature of the world in which I live, and which I wish you lived, all of you, and all the time. But even I don't live in it all of the time. There are times, when I catch myself believing that there is such a thing as a something that is separate from something else."

66. Bateson in his earlier anthropological work proposed a societal categorization where the relationships in the society where either seen to be chiefly "symmetrical" or predominately "complimentary." If cultural restraints in this pattern breakdown, the result is a progressive differentiation or "schismogenesis," a type of feed-forward effect that leads to the breakdown of the system or to a new equilibrium. See Culture Contact and Schismogenesis in (Bateson 1972).

67. (B. P. Keeney 1983, p.69).

68. The types of type theory was proposed by Bertrand Russell in his work, Principia Mathematica. Its purpose was to avoid paradox in mathematics (as well as more broadly) by developing a hierarchy of types (orders, classes, domains, etc.), then assigning a type to each mathematical construction. Mathematical objects of a given type or class are built exclusively from objects of types that proceed them lower in the hierarchy thus preventing loops and the creation of paradox. Gregory Bateson co-opted Russell's concept of typing by proposing a hierarchy of types that embraced loops and recursions across levels of abstraction, accepting paradox as a holistic as well as an intellectual reality.

69. (Bateson and Bateson 2005, p.161). In regards to this idea of the abstractive and generative nature of naming and what it indicates about us and our guiding epistemology, Bateson enjoyed citing a passage from Lewis Carroll's, Through the Looking Glass, where Alice is engaged in a frustrating and obtuse conversation with the White Knight to exemplify the point:

"You are sad," the Knight said in an anxious tone: "let me sing you a song to comfort you."

"Is it very long?" Alice asked, for she had heard a good deal of poetry that day.

"It's long," said the Knight, "but very, very beautiful. Everybody that hears me sing it— either it brings the tears into their eyes, or else— "

"Or else what?" said Alice, for the Knight had made a sudden pause. "Or else it doesn't, you know. The name of the song is called 'Haddock's Eyes.'"

"Oh, that's the name of the song, is it?" Alice said, trying to feel interested.

"No, you don't understand," the Knight said, looking a little vexed. "That's what the name is called. The name really is 'The Aged Aged Man.'"

"Then I ought to have said 'That's what the song is called?'" Alice corrected herself.

"No, you oughtn't: that's quite another thing! The song is called 'Ways and Means' but that's only what it's called, you know!"

"Well, what is the song then?" said Alice, who was by this time completely bewildered.

"I was coming to that," the Knight said. "The song really is 'A-sitting On a Gate' and the tune's my own invention."

70. Bateson shared that his students use to suspect that, "Bateson knows something which he does not tell you" or "There's something behind what Bateson says, but he never says what it is." In this vein, Bateson himself confessed, "I have often been impatient with colleagues who seemed unable to discern the difference between the trivial and the profound. But when students have asked me to define the difference, I have been struck dumb. I have said vaguely that any study which throws light upon the nature of 'order' or 'pattern' in the universe is surely non-trivial." (Bateson 1972, pp.xxiv-xxv)

71. For Bateson's reflection on Schizophrenia and the broader human experience see, Towards a Theory of Schizophrenia in (Bateson 1972) and The Double Bind Theory – Misunderstood in (Bateson 1991).

72. For a mature elucidation on Bateson's conception of Mind, read (Bateson 2002).

73. In addition to the processes of induction and deduction, Bateson also includes the necessary process of "abduction." "Abduction" is a logical specification that builds on the theme of, "the pattern which connects." In abduction one looks for, "resemblances between differences" or "resemblances between the differences between the resemblances between the differences" thus creating a lateral extension, or network of inter-related propositions. In this way, abduction serves as a type of qualitative modeling where formal comparisons are derived through contrasts and ratios, and convergences and divergences of form. Due to its tautological nature, it is not, however, recognized in the orthodox scientific form, yet Bateson argues that it, nevertheless, forms the basis for "metaphor, dream, parable, allegory, the whole of art, the whole of science, the whole of poetry, totemism...the organization of comparative anatomy – all of these are instances or aggregates of instances of abduction, within the human mental sphere." (Harris-Jones 2002, pp.177-180).

74. Bateson, on reflecting on the nature of an ecology of mind, saw a pattern between the mental nature of learning and evolution, or what he termed "The Great Stochastic Processes." In his own words, "...both genetic change and the process called learning...are stochastic processes. In each case there is, I believe, a stream of events that is random in certain aspects and in each case there is a non-random selective process which causes certain of the random components to "survive" longer than others. Without the random, there can be no new thing." (Bateson 2002, p.139).

75. A stochastic process is a random proceeding that serves to create a probabilistic counterpart to what would otherwise be a deterministic process. While deterministic processes are limited to develop in only one way, the introduction of stochastic elements means that there will be a corresponding indeterminacy, even if the initial conditions are well defined. The result of this event is that a stochastic system may develop and move forward in a multitude, or even infinite number of possible ways. In other words, in a stochastic process we see a sequence of determined events combining with some random process wherein certain outcomes of the random are selected and allowed to continue to endure thus generating new sources of novelty in a system.

76. See, The Logical Categories of Learning and Communication in (Bateson 1972).

77. Classical or Pavlovian conditioning is a type of learning whereby an innate response to a biological stimulus is paired with a neutral stimulus in repeated circumstances such that the previous neutral stimulus becomes an active trigger of response in its own right. While classical conditioning works by eliciting intrinsic antecedent conditions or instincts to bring about a reflexive response, operant conditioning works on both antecedents and consequences within the environment. In this way, responses to stimuli are followed by another stimuli thus creating a situation of reinforcement, thus behaviors are weakened or strengthened as a result of consequence.

78. Ontogeny: Pertaining to the origination and development of a singular organism through to its maturation, and throughout the course of its lifespan.

79. Bateson, through his thinking on ecology, and the nature of pattern and relationship in the living world, proposed in his work, a radical new definition of Mind in Nature. Bateson's six criteria in his own words are:

1. A mind is an aggregate of interacting parts or components. 2. The interaction between parts of mind is triggered by difference. 3. Mental process requires collateral energy. 4. Mental process requires circular (or more complex) chains of determination. 5. In mental process, the effects of difference are to be regarded as transforms (i.e. coded versions) of events which proceeded them. 6. The description and classification of these processes of transformations disclose a hierarchy of logical types immanent in the phenomena." (Bateson and Bateson 2005, pp.18-19) He believed these criteria of mind to be the foundation for the complex phenomena of "systems." Finally, as a result of mind, Bateson put forth that all such systems would also have the characteristics of "autonomy" and "death," based on the maintenance or destruction of its feedback circuitry between the systemic components. (Bateson 2002, pp.117-118).

80. In Bateson's words:

Mind is empty; it is a no-thing. It exists only in its ideas, and these again are no things. Only the ideas are imminent, embodied in their examples. And the examples are, again, no things...an example, is not the Ding an Sich; it is precisely not the 'thing in itself.' Rather, it is what the mind makes of it, namely, an example of something or other. (Bateson 2002, p.10).

81. (Bateson and Bateson 2005, p.19).

82. See, Form Substance, and Difference in (Bateson 1972).

83. (Jung 1916).

84. For a comprehensive comparative analysis of hemispheric differences, and their epistemological and phenomenological relevance to our generated, individuated, and consensual cultural world views, please refer to McGilchrist's in-depth work on the subject, The Master and the Emissary (McGilchrist 2010).

85. (McGilchrist 2010)

86. (McGilchrist 2010)

87. For a fascinating, first person, phenomenological account of right hemispheric experience read neuroanatomist, Dr. Jill Bolte Taylor's, My Stoke of Insight: A Brain Scientists Personal Journey. Dr. Taylor experienced a massive left-hemispheric stroke that incapacitated the left-side of her brain allowing for her "stepping into the right", and the remarkable embodied insights that came through that experience and subsequent recovery.

88. See, Ecology of Mind: The Sacred in (Bateson 1991).

89. (Bateson 1991, pp266-267).

90. See Bateson's Metalogue: What Is an Instinct (Bateson 1972).

91. Bateson in replying to an interviewer's comments about the relationship of consciousness, aesthetics, and the sacred stated:

"Consciousness is always going to be selective. When you get the other two, the sacred and the aesthetic, which are very closely related you are partly standing off to see a whole. Consciousness is tending to focus in, whereas notions like the sacred and the beautiful tend to be always looking for the larger, the whole. This is why I distrust consciousness as a prime guide." (Bateson 1991, p.299).

92. Ockham's razor states that when choosing among competing hypotheses with equal predictive values that the simplest one should be selected. In this way, one can minimize assumptions in decision making.

93. For Bateson on the nature of consciousness, see Effects of Conscious Purpose on Human Adaption in (Bateson 1972).

94. (Bateson 1972, pp.144-147).

95. The "Royal Road" references Freud's famous quote, "The interpretation of dreams is the royal road to a knowledge of the unconscious activities of the mind."

96. Homo sapiens translates from the Latin to English as "wise man".

97. To further explore the idea of vicious and virtuous circles from a cybernetic perspective and their important role in therapy, see From Circulus Vitiosus to Circulus Creativus in (Keeney and Keeney 2012, pp.57-60).

98. See Defenses of Faith in (Bateson and Bateson 2005).

99. As Bateson notes, "You decide that you want to get rid of the by-products of human life and that Lake Erie will be a good place to put them. You forget that the eco-mental system called Lake Erie is a part of your wider eco-mental system - and that if Lake Erie is driven insane, its insanity is incorporated in the larger system of your thought and experience." (Bateson 1972, p.492). During the era of Bateson's writing, the pollution levels of Lake Erie were legendary, and it was to become a symbol of vast environmental destruction and degradation. They Cuyahoga River which flowed into Erie was known, on multiple occasions, to have caught fire. It was quoted in Time Magazine in 1969 as a river that "oozes rather than flows," and where a person "does not drown but decays."

100. To further explore this theme refer to the case of, The Psychiatrist Wanted to be a Priest, the Psychologist Wanted to be a Shaman in (Kottler, Carlson and Keeney 2004).

101. The gut contains its own intrinsic nervous system numbering over 500 million neurons, and engages in part in autonomous nervous function and self-regulation.

102. Interestingly, Louis Pasteur (1882-1895) one of the great innovators and promoters of germ theory, was purported to have said on his deathbed that "The microbe is nothing. The terrain is everything." In this, he was quoting a contemporary, Claude Bernard (1813-1878), an early systems-biology thinker who proposed that disease was a product of an imbalance found within the internal body terrain. If a system was at balance, germs (pathogens), he felt, could not flourish and thus would be unable to cause disease. This of course was in direct contrast to Pasture's reductionist view that assigned the cause of disease to the microbes directly. For Bernard, germs were a sign of diseased conditions of terrain while for Pasteur they were the cause themselves. Ironically, in choosing Pasteur over Bernard, we have inadvertently succeeded in worsening the very cause of our vigilance and paranoia as our antibiotic interventions have only succeeded in bringing about further damage and destruction to our internal terrain as a type of collateral damage on our war against the bugs thereby further advantaging our perceived enemy!

103. The microbiota are the colonies of commensal, symbiotic and pathogenic bacteria, fungi, and protozoa that ecologically inhabit our body spaces the most predominant of which is in our gut.

104. A super-organism is a grouping of many organisms that together, synergistically function and exhibit the characteristics of a solitary or unified organism in terms of communication pathways and specialization of labor contributing to the function of the whole.

105. Prokaryote are an ancient domain of single-celled organisms that lack a membrane-bound nucleus, mitochondria, and other membrane-bound organelles and form the ancient groupings of Bacteria and Archaea. The more modern eukaryotes, however are any organism whose cells contain a nucleus and cellular organelles bounded by membranes.

106. Ungulates refers to the order of hoofed mammals, Ruminants are a suborder of ungulates that use gut bacteria and a specialized digestive system to breakdown ingested cellulose.

107. CAFO – Concentrated Animal Feeding Operations: Large scale production operations that substitute labor and land for specialized structure and equipment that allows for animals to be fed in areas that do not produce vegetation thereby allowing for non-localized, modern production, industrial economies of scale.

108. Joel Salatin puts forth these innovative solutions in his 2011 book, Folks, This Ain't Normal. He is representative of a growing movement of farmers and growers who are endeavoring to implement (and plant) an applied holistic epistemology as a foundation for a regenerative (beyond sustainable) agriculture.

109. (B. Keeney 2007a, p.903).

110. See the N/om of Storytelling in (Keeney and Keeney 2013a, pp.75-78).

111. See, (B. Keeney 2011) and (Keeney and Keeney 2013c) to explore jazz as a therapeutic metaphor, as well as the nature of performance and improvisation in therapy.

112. (Keeney and Keeney 2012, pp.125-134).

113. The Ouroborous: an ancient symbol of a serpent consuming its tail, is found in gnostic, alchemical and hermetical references. It serves as a metaphor of cyclicality, and, hence, has likewise been adopted into cybernetic lore and metaphor.

114. This type of improvised and contextual therapeutic intervention is part of tradition of interactive/ resource-focused case encounters exemplified in the case work of the likes of Milton Erikson MD, Carl Whitaker MD, and Bradford Keeney PhD. As such, a review of their extensive published case work is highly recommended.

115. For a review of the therapeutic approach of Milton Erikson in clinical hypnosis and brief psychotherapy see (S. G. Gilligan 1987) and (S. Gilligan 2002).

116 In reference to the Hippocratic Oath pledged by all medical students in the Western medical tradition upon graduation. The original oath as contained within the Hippocratic Corpus read

I swear by Apollo the physician, and Aesculapius the surgeon, likewise Hygeia and Panacea, and call all the gods and goddesses to witness, that I will observe and keep this underwritten oath, to the utmost of my power and judgment.

I will reverence my master who taught me the art. Equally with my parents, will I allow him things necessary for his support, and will consider his sons as brothers. I will teach them my art without reward or agreement; and I will impart all my acquirement, instructions, and whatever I know, to my master's children, as to my own; and likewise to all my pupils, who shall bind and tie themselves by a professional oath, but to none else.

With regard to healing the sick, I will devise and order for them the best diet, according to my judgment and means; and I will take care that they suffer no hurt or damage.

Nor shall any man's entreaty prevail upon me to administer poison to anyone; neither will I counsel any man to do so. Moreover, I will give no sort of medicine to any pregnant woman, with a view to destroy the child.

Further, I will comport myself and use my knowledge in a godly manner.

I will not cut for the stone, but will commit that affair entirely to the surgeons.

Whatsoever house I may enter, my visit shall be for the convenience and advantage of the patient; and I will willingly refrain from doing any injury or wrong from falsehood, and (in an especial manner) from acts of an amorous nature, whatever may be the rank of those who it may be my duty to cure, whether mistress or servant, bond or free.

Whatever, in the course of my practice, I may see or hear (even when not invited), whatever I may happen to obtain knowledge of, if it be not proper to repeat it, I will keep sacred and secret within my own breast.

If I faithfully observe this oath, may I thrive and prosper in my fortune and profession, and live in the estimation of posterity; or on breach thereof, may the reverse be my fate!

117. (Bateson and Bateson 2005, p.181).

117b. (Bateson 2002, p.212).

118. A double bind is a paradoxical communication, whereby an individual or group (and I would also argue, more broadly, a system) receives two or more conflicting messages, wherein one message is in negation of the other, thereby creating an untenable conflict. In this situation, a successful response to one message engenders a failed response to the other, with the inverse also being true. Consequently the person will be in error regardless of their response. The double bind occurs when the person, by result of the position or context they have been placed in, are unable to resolve or remove themselves from the given situation through logical means (Bateson 1972, pp.291-227). Bateson's more colorful example of a double bind was Lewis Carroll's literary conundrum of the "Bread-and-Butterfly."

"'Crawling at your feet,' said the Gnat (Alice drew her feet back in some alarm), `you may observe a Bread-and-Butterfly. Its wings are thin slices of Bread-and-butter, its body is a crust, and its head is a lump of sugar.'

'And what does IT live on?' '

Weak tea with cream in it.'

A new difficulty came into Alice's head. `Supposing it couldn't find any?' she suggested.

'Then it would die, of course.'

'But that must happen very often,' Alice remarked thoughtfully.

'It always happens,' said the Gnat."

119. (Bateson and Bateson 2005, p.207).

120. For a broader appreciation of Bateson's reflections on aesthetics and their relationship to health, see Style, Grace, and Information in Primitive Art in (Bateson 1972) and the collected essays in Part IV of Health, Ethics, Aesthetics and the Sacred in (Bateson 1991).

121. (Bateson 1991, p.300).

122. (Bateson 1972, p.142).

123. (Bateson 1972, p.145).

124. (Bateson 1972, pp.138-142).

125. (Bateson 1972, p.147).

126. Bateson was fond of a quote from the famed dancer, Isadora Duncan, who, when asked about the nature of a particular performance replied, "If I could tell you what it meant, there would be no point in dancing it." (Bateson 1972, p.137).

127. (Bateson 1972, p.130).

128. (Bateson and Bateson 2005, p.181).

129. (Bateson 1991, pp.267-268).

130. (Bateson and Bateson 2005, p.177).

131. (Bateson 1991, pp.265-266).

132. From Andrew Still's, Philosophy of Osteopathy.

133. (Bateson and Bateson 2005, p.180).

134. (Ostaseski and Remen 1996).

135. (Bateson 1972, p.134).

136. As mentioned in the introduction, this work is in part meant to serve as a unique academic primer on the topics of chaos theory, complexity science, and complex adaptive systems. The reader may also want to pursue other general interest and summative popular books on these subjects. Works that I have referred to include: (Mitchell 2009), (Gribbin 2004), (Capra 1996), (Waldrop 1993), (Briggs 1992) and (Gleick 1988).

137.The Marquis Pierre-Simon de Laplace was a late 18th century, early 19th century French physicist, and intellectual heir to Newton's thinking, advancing ideas on causal determinism and what he perceived as the mechanistic nature of the universe. He was known for a concept that was later to be named 'Laplace's Demon'. In his own words, describing this infamous thought experiment, Laplace states, "We may regard the present state of the universe as the effect of its past and the cause of its future. An intellect [i.e. the Demon] which at any given moment knew all of the forces that animate nature and the mutual positions of the beings that compose it, if this intellect were vast enough to submit the data to analysis, could condense into a single formula the movement of the greatest bodies of the universe and that of the lightest atom; for such an intellect nothing could be uncertain and the future just like the past would be present before its eyes."

138. The Laplacian position, however, sets up a paradox. If such a powerful creature where to exist, it would mean that the all-knowing demon, possessing a mind as complex as the universe itself, could predict all outcomes including the results of his own actions. In theory, then, this means that the creature could change his actions in advance, thus altering the future outcomes. The result is that causal determinism would no longer apply because of the inherent self-reference brought about by the fact that the demon is an inhabitant of same world it is trying to know. Chaos theory, with it sensitivity to initial conditions, the nature of emergent phenomena in complex, and cybernetic understandings of self-reference help us challenge the deterministic paradigm, and reframe the Laplacian paradox.

139. Von Foerster, in an extension of Bateson's notion of "The pattern which connects" notes that "'Pattern' comes from... 'pater;' it is the father whose stamp is printed across everything, always looking exactly the same – that is the pattern. This I would like to compare with a mother, a matrix – 'the matrix that embeds'... The papa is responsible for the pattern, and the mama makes sure the pattern falls on fruitful ground in which it can blossom, thrive, and spread itself...I feel these two poles belong together, the Batesonian pattern and the Foersterian matrix." (Von Foerster 2014, p.135).

140. Ary L. Goldberger, MD, is a Harvard professor of medicine, who has written numerous review articles (see references) on the emerging understandings of chaos theory and complexity in relation to human physiology, and towards its potential role in medical theory and practice.

141. Phylogeny: In contrast to ontogeny or the structural history of an individual organism, phylogeny is in reference to the evolutionary history and form of a specific taxonomic grouping.

142. Mathematical functions are a way to express a certain equation in term of allowable inputs and possible output. A function can be thought of as a type mathematical "machine" that allows for the conversion of one value to another in a known way. We feed the machine an input, it does some calculations on it, and then gives you back another value, the output. A reiterative function occurs when the outputs of our "machine" are continually fed back in as the new inputs.

143. When a continuous sequence of recursive or iterative operations, that is to say, operations on operations, produces a stable value or equilibria, it is said to have a self-value, or, in the German, an eigenvalue (or eigen-function, eigen-state, eigen-behavior, etcetera, depending on the domain of observation and the variable of interest). Because of the recursive nature of such a function, eigenvalues are said to produce themselves, via acts of self-reference, implying a type of topological closure. Living organisms (i.e. autopoietic machines) are such a self-referential system, as operations on the molecular components produce themselves. Although appearing as discreet objects, states, or stabilities, the process which leads to them is in actuality a dynamic and self-constructive one. Von Foerster reminds us that, "Eigenvalues have been found ontologically to be discreet, stable separable, and composable, while ontogenetically to arise as equilibria that determine themselves through circular processes." See the essay, Objects: Tokens for (Eigen-) Behaviors, (Von Foerster 2003, p.266).

144. To understand the nature of functions that produce an eigenvalue, Von Foerster suggests a simple calculation with a pocket calculator. Take the square root of any number, and continue to take the square root of each successive answer (i.e. a recursion). Ultimately, after a number of iterations, we will arrive at the number 1, and continue to do so with all subsequent answers (i.e. input/outputs). We have, through this iterative process, come to the eigenvalue of the function; a stability. Equally important, to note, however, is that the process is no longer a reversible one once the eigen-stability has been obtained via our calculations. The number 1, repeatedly squared, will continue to only give us one. Our initial value, and the values leading to the eigen-value have disappeared, with the only thing remaining from the recursive operation being the equilibrium state itself (Segal 2001, pp.126-127). This cybernetic understanding (and complexity perspective with its various "attractors") has a profound philosophical implication in the ontological domain, for we see a similar self-organizing process in human development. In infancy, we obtain recursive closure of the nervous system via our sensory-motor/motor-sensory feedback. Object Constancy is the process of cognitive development where an infant develops the ability to perceive an object as unchanging, even under different conditions of observation. The "Object" in object constancy, then, is not to be seen as a starting point for the process. Instead, recursive sensory-motor interaction leads to the dynamical interplay that culminates in the formation of an eigen-stability (i.e. the object). Once such object permanence, however, has been achieved, the process of recursion that led to it is lost to us creating the cognitive belief or impression (illusion) that objects, in and of themselves, have an ontological veritas or independent reality.

145. See Von Foerster's essays, Perception of the Future and the Future of Perception, and For Niklas Luhmann: How Recursive is Communication (Von Foerster 2003).

146. The term dissipative structure was coined by Nobel Prize winning Russian-Belgian physical chemist, Ilya Prigogine, who was a pioneer in the understanding of these state dynamics. Earlier, Karl Ludwig von Bertalanffy, one of the founders of general systems theory, had similarly proposed that the classical laws of thermodynamics that applied to closed systems could not strictly be applied to open systems that interacted with their surroundings in a manner that energy, information, and material transfer occurred into and out of the systemic boundaries.

147. The concept of self-organized criticality was put forward by Per Bak, Chao Tang and Kurt Wiesenfeld in their 1987 paper, Self-organized criticality: an explanation of 1/ f noise, published in 1987 in Physical Review Letters, and is considered to be one of the fundamental physical process through which complexity spontaneously arises in nature.

148. The description of chaotic systems is known as chaotic topology. Chaotic topology suggests that chaotic attractors are built up through the two fundamental processes of repeated stretching and folding and squeezing. Stretching as a process is responsible for "sensitivity to initial conditions" in chaotic systems, while folding and squeezing builds up a layered structuring that forms a "fractal."

149. (Pangaro 2011, p.2).

150. Psychiatrist R.D. Laing noted that, "The 'data' (given) of research are not so much given as taken out of a constantly elusive matrix of happenings. We should speak of capta rather than data. The quantitatively interchangeable grist that goes into the mills of reliability studies and rating scales is the expression of a processing that we do on reality, which is not the expression of the processes of reality." (Laing 1990).

151. (Pangaro 2003, p.13).

152. See the essay Form, Substance, and Difference in (Bateson 1972), for Bateson's commentary on Korzybski's famous phrase, "The map is not the territory."

153. (Von Forester and Poerksen 2002, p.81) Von Foerster further elaborated that, "the map of the map is not the map of the territory" (Von Forester and Poerksen 2002, p.82) in support of a radical constructivist view that we can discuss a difference between conceived worlds without referring to a presumed, independent, and external reality to serves as the basis or marker for distinction.

154. The idea of phenomenological domains is a second-order cybernetic concept put forth by Humberto Maturana and Francisco Varela in their work on cognition. The concept of domains is analogous to that of logical types, in that it serves as a form of logical accounting of our modes of observation. Its purpose is to highlight the unity of a living system of interest, within the distinctions (i.e. domains) we make as participants/observers. For example, a system can be viewed from the fundamental level of its dynamic, internal, self-organized state, where no external environment exists. Instead we find only self-referential functioning, as dictated by the historically-derived structure founded upon the system's closed organization. However we can also view a unity that interacts with its environment, and establish certain features, co-relations or patterns of interactions, that we then term behaviors. All of these views contribute to our faceted understanding of the organism as a whole autonomy. Nevertheless, by forgetting our initial distinctions and indications and collapsing of our domains, we generate a muddle of false appellations, attributions, and correspondences that don't intrinsically exist. See Behavioral Domains in (Maturana and Varela 1987).

155. Autopoiesis is a theory put forth by Maturana and Varela to provide a systemic and cybernetic description of the fundamental nature of living systems. It is a broad and expansive theory with implications for how we define and view life, evolution, cognition, social organization, and language. My interpretation of the theory in this discussion is necessarily impoverished and brief. For primary source elaboration on the topic refer to (Maturana and Varela 1972), (Maturana and Varela 1987), and (Varela 1979).

156. In the biological context, homology is in reference to specific structures in differing species that share a common evolutionary ancestry.

157. (Maturana and Varela 1972, p.13).

158. (Maturana and Varela 1987, pp.75-80).

159. (Maturana and Varela 1987, pp.95-99).

160. The Gaia theory was proposed by James Lovelock, and co-developed by Lynn Margulis. It proposes that living organisms interact with their inorganic environments to produce a self-regulating, complex system that forms and maintains the changing and dynamic conditions required for the sustaining of life on the planet.

161. Bateson, in defining what he terms a mental process in his ecological definition of mind states:

I am going to include within the category mental process a number of phenomena which most people do not think of as processes of thought. For example, I shall include the processes by which you and I achieve our anatomy – the injunctions, false starts and self-corrections, obedience to circumstance, and so on, by which the differentiation and development of the embryo is achieved. "Embryology" is for me a mental process. And I shall also include the still more mysterious processes by which it comes about that the formal relations of our anatomy are recognizable in the anthropoid ape, the horse, and the whale – what zoologists call homology – i.e. along with embryology I shall include evolution within the term "mental process."...Along with those two big ones – biological evolution and embryology – I include all those lesser exchanges of information and injunction that occur inside organisms and between organisms and that, in the aggregate, we call life...In fact, wherever information – or comparison – is of the essence of our explanation, there, for me, is mental process. (Bateson and Bateson 2005, pp.16-17).

For further elucidation on this key Batesonian premise see, (Bateson 2002, pp.42-45, 139-174).

162. (B. P. Keeney 1983, p.72).

163. Genotype is the specific genetic makeup of an individual cell structured in the form of DNA which translates into a specific characteristic (phenotype) for that cell/organism/individual.

164. Phenotype is the palette of an organism's observable characteristics including such things as an organism's specific anatomical, physiological and developmental traits.

165. Teratology is the study of abnormalities of anatomical and physiological development.

166. A tautology is a composite of linked propositions in which the validity of the linkages between them cannot be contested, while the truth of the propositions, itself, is not claimed. As such, it forms a logical statement where the conclusion is equivalent to the premises. As a result, all tautologies, as described are true in all instances. For example, "It will rain tomorrow or it will not." Such logic forms the proofs of Euclidian geometry.

167. (Bateson 2002, p.173).

168. (Bateson 2002, p.166).

169. The recursive, circular or cybernetic dialectic that is being proposed here was articulated and presented by Varela, and detailed in his paper, (Not One, Not Two 1976), and revisited in (Principles of Biological Autonomy 1979). Similarly, Bateson also put forth a type of Cybernetic dialectic which is structured as a type of progressively abstractive, alternating, "zigzagging" ladder between form (typology) and process, through levels of logical type (Bateson 2002, pp.181-182), (B. P. Keeney 1983, pp.41-43).

170. (Varela 1976).

171. Idealism is the philosophical assertion that reality as it can be known is fundamentally mental, and therefore immaterial in nature. Epistemologically, the idealist position is one of skepticism when it comes to knowing the possibility of knowing any mind-independent "thing".

172. "Indra's net", serving as a metaphor for the construction of the universe, belonged to the Hindu deity Indra and was said to hang over his mountain palace. The mythological net contained a faceted jewel at each crossroads in the webbing and were situated such that each reflected all others. The Zen scholar, Alan Watts described Indra's net as a, "multidimensional spider's web in the early morning covered with dew drops. And every dew drop contains the reflection of all the other dew drops. And, in each reflected dew drop, the reflections of all the other dew drops in that reflection. And so ad infinitum."

173. (Varela 1976).

174. (Bateson 1972, p.208)

175. The term, "the edge of chaos" comes from the work of Christopher Langton who noted in his computer modelling a region between order and chaos where the complexity is maximal. In relation to our discussion here, this concept was later elaborated on by Stuart Kauffman who expanded on the relevance of this finding in the self-organization of biological systems.

176. (M. Baranger n.d.)

177. In his published works, Kauffman has strived to reintroduce the concept of the sacred, and the importance of respecting such, into our understanding of the biological, that is to say living world. In so doing, he supports the creation of an epistemological metaphor that supports and acknowledges a needed biological mythology. In his own words, "If biologists have ignored self-organization, it is not because self-ordering is not pervasive and profound. It is because we biologists have yet to understand how to think about systems governed simultaneously by two sources of order. Yet who seeing the snowflake, who seeing simple lipid molecules cast adrift in water forming themselves into cell-like hollow lipid vesicles, who seeing the potential for the crystallization of life in swarms of reacting molecules, who seeing the stunning order for free in networks linking tens upon tens of thousands of variables, can fail to entertain a central thought: if ever we are to attain a final theory in biology, we will surely, surely have to understand the commingling of self-organization and selection. We will have to see that we are the natural expressions of a deeper order. Ultimately, we will discover in our creation myth that we are expected after all." (S. Kauffman 1995, p.112).

178. Stuart Kauffman has proposed in his writings that the process of self-organization, as a product of the phenomena of spontaneous emergence, is ubiquitous throughout nature, and plays a fundamental role in the evolutionary process beyond that of the Darwinian mechanisms of natural selection.

179. My editor, Roger Sumner, concurs.

180. (McGilchrist 2010, p.174).

181. (McGilchrist 2010, p.14). Printed with verbal permission from Yale Press under fair-use copyright practice.

182. Bateson's writing remained ambiguous about the purpose of consciousness, however he was unequivocal in his voicing about conscious-purpose. He states, "...that conscious-purpose very rapidly becomes destructive. 'Purpose' is a very dangerous concept. Consciousness, I don't know. I have been very careful to say as little as possible about consciousness." (Bateson 1991, p.299).

183. (Rogers 1980, p.129).

184. (S. G. Gilligan 1987, p.83).

185. (S. Gilligan 2002, p.104).

186. Literally "monster creating." Traditionally used in biological reference to malformations or defects in the process of morphogenesis.

187. An ancient Greek religious artifact marking the center of the mythological world.

188. In reference to the Hippocratic Oath. See note 116.

189. In Greek mythology Gaia was the primal mother earth goddess and emblematic of the generative powers of Life's creative force.

190. The Hellenistic goddess Sophia, is the personification of Wisdom, and was to play an important role in Gnostic iconography and thought.

191. Permaculture is a principle's based, system's approach to agricultural and social design. Permaculture design is rooted in creating systems based on patterns observed in the ecology and honors the complexity and wisdom found within natural ecosystems as the template of our learning.

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Back Matter- Book Description

Dear Physician, Dear Patient,

Welcome to _Grand Rounds: Healing Wisdom for a Complex World_

What makes for a truly _Holistic Medicine_? How will we comprise and construct a map on our Hero's venture towards _Holism_? What markers will we find along the way letting us know that our path is true and our course correct? What will be the rewards of discovery? What trials and tribulations may come our way on route? Beyond getting there alive, how can we learn to deeply live along the way?

True _Holism_ in _Health_ transcends any words that would try to capture it. How can it possibly be any different for the truly _Holistic_? Hence I find myself in a quandary of sorts. How does one denote and describe a book that is written to defy description? How does one become prosaic about prose that are meant to be read as poetry? How does one deliver a straight line from a circle? This is the dilemma of my authorship. As such, I leave to you, the reader, a choice of description for this wayfarer's guide-book that suits your own fancy:

 Can it be that our modern obsession with disease is misplaced, taking our collective attention away from the real problem: _disenchantment_? Have you ever wondered how such diverse experiences and worlds as _cybernetics, Bushmen healing, the modern ICU, gardening, complexity science, martial arts, Molluscan mating behaviour, epistemology and ontology, orthopedics, improvised performance, radical constructivism, laying of hands, Chaos theory, jazz music, Greek mythology, paradox, hypnosis and psychosis, evolution and embryology, ethics, snakes eating their own tails, a fictional post-apocalyptic strategy game, a New Orleans funeral, and finger painting_ are intimately related to Health: including the health of you, the health of me, and the health of the world we live on? If you are the least bit intrigued, then know there is hope for us all. Join Dr. William Sutherland on this _tour de force_ of tall-tale telling and let the " _patterns that connect_ " embrace you as you begin your reintegration back into _Wholeness_. Welcome to the enchanted woods of _Complexity Medicine_ , where one can truly see the forest through the trees.

 A deeply embodied and thoughtful foray into the _philosophy_ , _science_ , and _phenomenology_ of _Chaos_ , _Complexity_ , _Holism_ , and _Health_. Take a transformative journey with the Doctor and be glad that you will never be able to see the world the same again!

 Dr. Sutherland is about to prescribe you _six words_ that you are unlikely to hear in any other doctor's office but which are absolutely vital to your vitality: _Service_ , _Sensuality_ , _Performance_ , _Beauty_ , _Ceremony_ , and _Love_. Intrigued? Just wait till you experience the Good Doctor's healing ministrations in a _metaphoric_ and _mythological_ appointment that you will never forget.

 Join the Doctor on a holistic journey starting with our species' earliest healing and spirited expressions, then on through the ages to the emerging Science of Complexity; connecting the dots in between as we go. Grand Rounds is a healing balm to our collective individual, cultural, ecological, and evolutionary ails. Come and enjoy the magical & mirth-filled medicine that Dr. Sutherland has prescribed.

 This is the book you have always deeply known that you needed to read without knowing it! (I know it was the one that I always needed to write).

 One word: _Relationship._

The door is now open and all that is left is for us to step through...

Welcome Home,

Dr. William Sutherland

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How to Further Help with the Vision of a Complexity Medicine

 Email me at info@complexitymedicine.org and tell me what you thought of the book. As you know by now, it is all about feedback!

 Recognize that this book is first and foremost a social experiment in _Complexity_ and self-publishing. In other words, we can't do it without your help!

 Know that in the world of _Complexity Medicine_ , "going viral" isn't necessarily a bad thing.

 If you received a free copy of _Grand Rounds: Healing Wisdom for a Complex World_ and enjoyed it, consider purchasing a print-on-demand copy through Amazon or purchasing another electronic version to give to a friend or donate to an institution.

 Be social on our behalf; tweet your twitters or post our "face" on your Facebook,– and thanks for the shout out!

 Visit us at the _Institute of Complexity & Connection Medicine_ website at _www.complexitymedicine.org_. Feel free to link to our sites from yours.

 Send me an e-mail to plant the seeds for a possible academic or embodied conversation. Creating a rich set of relationships is the ground that a medicine of complexity grows from.

 If you are a health professional, consider treating yourself to one of our retreats and support the healing of our healers.

 An invitation to speak, present a keynote, or do a workshop is always warmly received and welcomed. Teaching is what it is all about.

 Send a copy of the book to an agent or publisher that you work with, if you think they would be interested in its promotion.

 Lastly, if you are an independent, wealthy philanthropist who would be interested in helping support the visionary reality of community-integrated, nature-based campus of Complexity and Connection Medicine, and help co-create an original model of something remarkable for our collective health and healing then always feel free to give me a call...seriously.

Thanks for your participation,

Dr. William Sutherland

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Contact

Dr. William Sutherland

Website: www.complexitymedicine.org

Email: info@complexitymedicine.org

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Thank you

Thank you for reading my book. I hope you have enjoyed it. If the words within have lit a spark of interest (or perhaps ignited a raging inferno of passion and transformative change), won't you please take a moment to leave me a review at your favorite retailer?

Yours in Healing,

Dr. William Sutherland

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About the Author

Dr. William Sutherland

Dr. William Sutherland is the innovator of the Complexity Medicine concept and the founder of the Institute for Complexity & Connection Medicine. Moved by the spirit of Lewis Carroll, Dr. Sutherland found himself going down the rabbit hole from an early age, each path taking him to another door; each door to another world. Bonded to his Jazz drumming grandfather in his childhood, fascinated and pulled by the natural world, later to be immersed and schooled into the martial ways of Japan, and from there spring boarding into a deep mentorship into indigenous and traditional healing ways around the globe; all of this was to serve as the foundation for a future career in medicine, the seed of which was always present from the start.

Holism, of course is funny that way, it inevitably finds you and, once so enticed, it does not let go, and having caught hold of you, you can never see the world again in a disenchanted, dispassionate way. As well, it becomes the shaper of everything you do, and of everything you perceive. It is these living verities and experiential truths that have served to shape Dr. Sutherland throughout his healing journey and path of discovery, and are what have formed the foundation for the bringing forth of a medicine that is the embodiment of complexity and wholeness, that is to say a Complexity Medicine.

Presently, Dr. Sutherland is an Adjunct Assistant Clinical Professor at McMaster University and a Research Fellow at the Waterloo Institute of Complexity and Innovation. As well, his clinical practice time includes general practice psychotherapy, functional medicine, and emergency department care. In all of these diverse clinical settings, he works to embody and impart the feeling central to a practice of Complexity Medicine. Moreover, he is the father of four children, an avid gardener, and a blessed husband who lovely wife Lisa gently and artfully helps him to remember to apply his principles of holism in medicine to the broader aspects of his life.

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