James' World 2

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The ancient Greek physician Hippocrates defined health as a body in balance. The human body was a system of four coordinated humors (blood, black bile, yellow bile, phlegm), each of which had its own balance of qualities (hot or cold, wet or dry) connected to the four elements (fire, air, earth, water). The balance of these qualities and humors was inextricably linked to environmental conditions. Phlegm, for instance, was connected to the element of water, and had the qualities of cold and wet. Hippocrates recognized that when this bodily system was exposed to conditions that perturbed or exacerbated its humors, such as the cold and wet of a snowstorm, the system became unbalanced, in this case producing too much phlegm. His treatments for an abundance of phlegm focused on removing the excess humor and increasing the yellow bile (hot and dry) to bring the body back into balance. Today, we might identify such a condition as a respiratory disease. Hippocrates would not have identified the condition so locally. He would have considered it a condition of the whole body: ‘dis-ease’ was literally a system out of ease or balance.

Today, we think less about the whole body as a complex system and more about its parts and sub-systems. An X-ray of the lungs shows congestion, so we assume the problem is in the lungs and treat for pneumonia, not worrying about other parts of the body unless they show their own symptoms. If a culture in the pathology lab shows a particular microbe at work, we prescribe the relevant antibiotics to combat that microbe rather than attempt to rebalance the system as a whole (despite the current trend to add ‘probiotics’ to the antibiotics approach). This move toward localized diagnoses began in the 18th century with the rise of morbid anatomy and the localization of symptoms to parts. The French physician René Laënnec’s invention of the stethoscope in 1816 allowed him to hear various abnormal sounds in the chest of a patient suffering respiratory distress. He could then carry out an autopsy after the patient died and correlate the visibly abnormal parts with the symptoms that he had detected, which led to powerful diagnostic tools.

The result was the localization of abnormalities to particular parts of the body, which led to the concept of localized diseases and the need for specialized treatments. Modern medicine celebrates the ability to diagnose problems based on localization of symptoms. The systemic imbalance or ‘dis-ease’ of Hippocrates thus became a growing set of separate diseases associated with specific causes, dissociated from the notion of the body as a system.

Following the localization of diseases came the specialization of treatments. These treatments typically rely on identifying the problem within a particular part or subsystem and fixing it, with the goal of getting the patient back to ‘normal’. If a physical part is damaged, we want to repair it so that it works again as closely as possible to the way it was working before. Or, if it cannot be fixed, perhaps because a limb was cut off or a kidney failed, then the tradition has been to replace it with something as close as possible that will work the same way: prosthetics for lost limbs, dialysis machines for failing kidneys.

Despite vast differences in understanding of disease and treatments, models of health from Hippocrates to modern medicine have focused on reestablishing the same state as occurred before illness. Health is a concept imbued with a sense of stability; it is constituted by a body returning to a state that existed before disease or injury and the maintenance of this state. Stability is therefore understood as the maintenance or regeneration of a single, ‘healthy’ state of the body. Since this approach has saved vast numbers of lives, medicine applauds the invention of new analytical tools, procedures, and treatments that advance an understanding of health as a return to a previous state. The sense of stability implicit in thinking about health leads to a picture of health as an outcome of regeneration: a body damaged by injury or disease is brought back to, or regenerates, a previous, ‘healthy’ state.

But what if health isn’t simply a return to a previous state? If we think about health as part of a larger framework of considering organisms as complex systems, there is no ‘return’. Complex systems shift in response to environmental challenges; they adapt to their conditions in order to survive – and adaptation breeds change. Framing health in terms of regeneration, and then asking what it means to regenerate, allows us to prod our assumptions about health as a singular, predetermined outcome and rethink our values in sustaining complex systems in light of damage. That raises the question: what does regeneration mean?

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Les Baugh lost both his arms in an electrical accident when he was a teenager. Since then, he has managed life mostly without the help of prosthetic arms, finding them to be more of a nuisance than a help. Photo by Zackary Canepari/Panos

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