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| DHA in non-linear conformation with numbering from both ends (Photo credit: Wikipedia) |
It had never been there before. Its arrival was a uniquely significant biological event. Though this relatively simple carbon compound now goes by the name of docosahexaenoic acid (DHA), its impact on evolution has been stunning. In view of its remarkable importance, there are two absolute certainties about it, which must be clearly stated. The first absolute certainty is that if it had not arrived, you would not now be reading this page, nor I writing it. This is because it permits nerve tissues to transmit, and eventually human beings to think. Without it we would be nowhere. However, in order to see quite how remarkable this is, it is equally important to acknowledge the other absolute certainty – namely we shall never, ever know how it came into existence, nor how it has managed to persist unchanged for an aeon of geological time.
The plight of our globally deteriorating mental health demands a much clearer strategy than that currently deployed. With the WHO predicting more deaths from mental disease than from obesity and cardiac diseases combined, radical action is required. And in particular we desperately need a device, a modern version of Occam’s Razor to guide us through our phenomenal and ever-growing complexities. In 50 years’ medical work the type of rule of thumb I found most useful is one that is simple, understandable and more often right than not. In medical practice, it is vital to prioritise, to concentrate on those enquiries that prove more fruitful, at the expense of those less so. Not only does this save invaluable time and indeed lives, it also discourages toxic speculation. Accordingly expanding Occam’s Razor from stating that “simplicity is best”, we need to explore every item under four Points – 1) where does it come from? 2) what is it like? 3) what does it do? and 4) what it is for?
The practical value of this approach, termed here the Certainty Principle, is that it redirects attention away from what is indelibly unknowable to what we can certainly know more about. And a minute’s reflection will confirm that it is rather easier on the mind to wrestle with problems and challenges we can do something about, rather than to struggle endlessly with questions that can never be known, which are quite beyond our comprehension anyway, and will always remain so.
MANUAL CERTAINTIES
The main thrust of this paper is the application of the Certainty Principle to consciousness and its better wellbeing. However such intangibles benefit from concrete examples. So before proceeding to consider how and why our current versions of psychiatric practice need remedy, it is prudent to digress and apply this Principle to that most practical of all items, the human hand. If the reader will consider how this applies to his or her own appendage, the discussion might bear more weight. Point 1 of the Certainty Principle enquires as to the origin of this invaluable extension to human anatomy. For my own part, I have simply no idea where my hand came from. It’s been there for as long as I can remember, and probably for some time before that – but where it originated, I cannot possibly say. This reinforces the absolute uncertainty of our knowledge of our hand – we cannot begin to know how it came about, and there is generally little practical value to be gained from pursuing this line. Speculation is usually interesting, but should not be confused with concrete, evidenced knowledge – thus we may have developed our hands to help pick up small shell fish and other edible items on the sea’s edge – but we cannot be sure, and it would make little sense to invest huge amounts of time or mental energy on the question.
Point 2 relates to what the hand is actually like – and here again, I have only a grossly inaccurate picture. What you see on the outside is very far from what the hand really is. Nor does the picture become clearer on closer, more detailed examination. You might like to think that your hand has four fingers and a thumb – and there are those who would agree. However, if you were to set out to define precisely what you meant by ‘thumb’, you would soon come to grief – the tighter your definition, the sooner and deeper the grief. Suppose you defined your thumb as consisting of two bones, how do you place the skin fold, which comes halfway along the second bone? What are you going to do about the ‘third bone’, the one adjoining the palm, which links the first two to the wrist, and which alone makes provision for the invaluable ‘opposing’ of the thumb. This third bone by itself won’t get you very far – you need the several wrist bones, which in turn call upon the radius, the humerus, the clavicle and so on, all of which blend with the other 400 bones in our complex makeup.
This is only the bony substrate. The nerves, muscles, blood vessels, skin, tendons, even blood all need to be included in any comprehensive ‘definition’ – there is no limit to the number of items involved, nor therefore any end to what we may ‘know’ about the thumb. Even when the anatomy of this invaluable object is disclosed, its physiology or function leaves the mind gasping. It is powered by what medical texts cheerily label ‘voluntary musculature’ – does this entail Free Will? Are you convinced?
It is therefore a verbal illusion to suppose that we can know more about an object by describing it ever more minutely. Which takes us, with much relief, to Point 3) of the Certainty Principle – ‘what does the hand do?’ And here, provided we stick to pragmatic principles, we are indeed for the first time on solid ground. The simple answer is that it performs an infinite number of manual tasks, from feeding invaluable fish oils into our mouths to composing verbose texts on what it is all about. This may seem rather less than absolute, and open to the suggestion that different individuals will have a differing answer to the question – ‘what does your hand do?’ However, it does at least make sense – a vital commodity when considering items as intrinsically complex as consciousness. It is reasonable to concede that what one person might wish to do with their hands is rather different from another – but there is much less harm in variety than in dogma.
If there are many answers to the question ‘what do hands do?’ then of course there are innumerably more to the next question ‘what are they for?’, which forms the fourth and final Point of the Certainty Principle. However from a medical viewpoint, this question has vital significance. Indeed clinically it is the most important of them all. In the overall clinical context, every medical symptom represents a failure or partial failure of one aspect of the whole human being. So the question, ‘what is that aspect for?’, has immediate practical value. In the case of the hand, if it is diseased, what can you no longer do ? – if feeding, then alternative gismos need to be invoked, if shaking hands, an alternative form of greeting needs to be acquired. Whatever the loss, the remedy is to ascertain the fundamental purpose that has become deficient, to then evaluate this on a life-death scale, prior to implementing the best available remedies to address that loss. Clinical medicine (and global politics) in a nutshell.
So here the Certainty Principle is applied to the hand – 1) we have no idea where it came from, and this should trouble us little. 2) Our picture of what it is really like, is astoundingly inaccurate, and though this is troubling, it is less so. 3) We know what it does – indeed we perhaps know too many things it does, but this is much better than our indelible ignorance as in the first two Points. Finally 4) we know well enough what it is for – it is to help us through the many challenges which beset all living organisms on this rather curious and not always quite so hospitable planet.
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