distinction between temporary, virtual forms and their consolidation in more durable media by being “saved” to them, is commonplace to all users of this ubiquitous technology. Is it now so problematic to consider thoughts as virtual structures that are created by neural operations? They are real only for so long as they are fed by a source of power or are incorporated by inclusion within a matrix. These structures may be based upon linguistic grammars and collections of images from recollected templates in the visual centres, the whole fed with a set of modes constructed—some converging, some conflicting—from structures within the limbic system. These operations (or modes or moods) are mostly derived from and modified by experience but may be created separately from intrinsic elements (which is surely the basis of imagination). They remain virtual unless they are laid down in memory although even here they are constantly refashioned whenever retrieved. If they are written down or spoken to others or recorded in some other way, they may persist as human artefacts, though seen always through the filter of interpretation.
The patient's way of telling personal experiences and the practitioner's particular arrangements for the recording of them is of course contingent upon so many accidental features of the lives of the people involved, including those not present but who are chosen to feature in the narrative or who are called upon, whether figuratively or physically, to present themselves.
Clinical practice may seem distant from academic philosophy but in our reflective practice—given that the data obtained leads us to those choices we make in our prescriptive acts—do we not then have need of an explanatory framework? If we want such a framework to be consistent at any one time, then time itself suggests that the framework must evolve to accommodate the acts of critical reflection and the effects of our prescriptions reported by our patients. Incorporation in the literal sense is the process of mind and body over time, time being the driver and determinant of development.
The sound of one hand clapping
To separate out the five (or if you prefer four plus one) axes is as senseless and provocative as the zen phrase above.16 It is not that integration seems like the right thing to do but rather the separate components are meaningless on their own.
At the molecular level, the metabolic process arises from the interweaving of endocrine steroids with hormones made from protein derivatives connected obligatorily by the mobile glue of enzymes (all of them also proteins).
At the axis level, the steroids are responsible for the maintenance of life and also for the differentiation of its structures. You could say that the adrenal axis is for the immediate term and the gonadic for the longer term, though these two hands have to clap together. The proteins are responsible for the enactment of the processes, with the thyroid providing metabolic energy and the somatic amassing storage, so that thyroxine contrasts in a sense with insulin. At the pituitary level, the stimuli seem to be unevenly distributed given the relative number17 of secretory cells in the gland:
The greatest variability seems to be with lactotropes which presumably respond to the varying intensity of TRH. This pulse generator, by virtue of being composed of a mere three peptides, can be made very quickly. It is not clear from the text in Ganong (and perhaps nobody knows) but I assume that higher levels of prolactin are derived from somatotropes but also from thyrotropes, given that the TRH will mobilise TSH. Such an interpretation would favour the endobiogenic view.
The adrenal gland helps maintain the circulatory volume by secretion of mineralocorticoids and of blood glucose by glucocorticoids, without which human life would simply be impossible. After this primary role of maintenance and survival, the second phase proceeds by seizing nutrient (if supply is adequate and there is not too high a charge imposed by constant stress). The energy for development and differentiation (gonadic axis) is made available by TSH permitting entry into cells of appropriate hormones. Any surplus is partitioned for growth between the two anabolic axes. All of this depends upon the rate of pulsation of the hypothalamic generators: CRH :: GnRH. These are both tuned to circadian rhythms.
Is TRH truly a reactive hormone?
Academic really, when you think of the connections between hypothalamus with the limbic system and also the extensive aminergic and cholinergic circuits of the brain and spinal cord. Serotonin, noradrenaline, adrenaline, histamine, dopamine: they make the other hand clap and the limbs move. I probably haven't answered your question.
There is no life without motion
Perhaps I am stalling because in the next section, I am going to broach the theory of mindedness and the scale of this project embarrasses me, but in an attempt to settle stage fright, a down–to–earth breakdown (of the subject, I mean) might break the ice.
The most symmetric solid body is a sphere and most of us start as a nearly spherical zygote. It becomes geometrically difficult to maintain the size of the sphere as cells divide. Eventually, gastrulation breaks the spherical symmetry and establishes bilateral symmetry in its place. Motion through a fluid requires flagellae, limbs or other projections so even unicellular organisms broke with spherical symmetry. Otherwise living forms would have remained passive spheres wandering through a nutrient field, which is difficult to envisage in a physical environment which is heterogenous and a world which is asymmetric to time. Locomotion by limbs involves the coupling of oscillators that requires huge amounts of circuitry and computational power as we shall see in Moravec's paradox in Section 6.
The spherical sun radiates, the moon reflects. We do not posses their spin but we and all living things are patterned by them. Biological systems are pushed or push themselves as far as they can from chemical equilibrium in order to retain for themselves the energy to operate which cells can only do in the presence of excess or redundant energy: an obligatory operating reserve. These arrangements of symmetry breaking acquire less randomness than exists in the outer world and constitutes a small but crucial bias. This is not a teleological theory but one that suggests that the energy of the biological impulse is carried over to the other spheres of human life, the psyche and the social.
There is no life without energy
Our experiences of colour, sound and time are not intrinsic properties of matter but an expression of our particular relationship with the physical world. These adaptive perceptual modes differ between different forms of life as each evolves along with its ecological niche: our range of hearing differs from that of bats, of vision from that of bees, to take the commonly known examples. Our sense of time is much slower than that of flies and much faster than deep-water fish. It also varies according to time of day, stage of life and according to levels and types of stress, so that everything “slows down” as a calamitous traffic accident unfolds, for instance. An individual's relationship with the tenses of time itself, with past and future is an index of personality that I will discuss more fully in Sections 5 and 14. Time in many ways defines our capacitance.
The interconversions between matter and energy is for physicists. The word “fuel” has no real meaning unless there is a biological (or technological) engine that has an absolute need for one. This is the nub of the meaning of human health, according to the axiom of poise that I want to elaborate in this book. The idea is absurdly simple and obvious.
The very few minutes left to us when we are starved of oxygen provides a vivid reminder of the urgency of fuel which the “life–giver” enables. To enable the fuel to be presented to the fires of combustion, there must always be a supply. If our lives are not to be arbitrary, that supply cannot be broken because the moment we run out of fuel we die. Utterly unlike a vehicle with an internal combustion engine, we cannot be revived if we run out of fuel. There must therefore be some kind of ratio between that in use and that in reserve and if that ratio is altered by circumstances, we must be made aware of it. A drain on the ratio would be a drain on health and generate signs as symptoms