stamina over time and an up-regulation of endurance; by contrast, the performance of those whose work is inflexibly timetabled will be reduced. The watched clock on the wall perhaps defines regularised boredom. Boredom is not of course confined to periods of 20 minutes but rather the period in which time is watched. Absorption in a task rather suspends anticipatory drive for other tasks. A requirement for or an aversion to stimulation are markers of personality that we will consider in Part Two, but in most cases Poise will depend upon capacities to manage phases of time which are not symmetrical through the course of the day and night.
In the tropics day and night are only roughly equal but there are other asymmetries: rest and activity, parasympathetic and orthosympathetic are not of equal duration. Like the alternation between systole and diastole of the cardiac cycle, there must be room for adaptation to events but this variance must play upon a stable ground. The set points are calibrated by the individual terrain in utero and at developmental and later life stages. In my beginning is my end.91 These initiating settings are shifted at times of stress and do not easily shift again when the stress is continuous and chronic.
2. Cholinergic and aminergic referees/regulators
The branches of the autonomic nervous system are the peripheral agents of cerebral circuits based upon these neurotransmitters that are widely distributed in networks within the brain:
1. Acetylcholine
2. Histamine
3. Noradrenaline and adrenaline
4. Dopamine
5. Serotonin.
The alternation between parasympathetic and orthosympathetic mimics that between the high energy state of day with the conserved and maintenance mode of night. Acetylcholine interpenetrates these two states.
Histamine is associated with central arousal though in some ways it may limit drive, because in the autonomic cycle its action as an autocoid attenuates the alpha–sympathetic period, priming the person for action. Caught in the priming mode may delay and even frustrate action. The central circuits have consonant centres throughout the body, especially in skin and the mucosae of the digestive and respiratory tracts and so are sites of the expression of many symptoms and obvious candidates for therapy. Histamine converges less towards gratification than dopamine so the associated drive may be one that is less resolved, though perhaps we should hesitate before dubbing it the hormone of irresolution. Serotonin provides us with a notion of our capacity and may act as some kind of internal index, while noradrenaline braces us for the discharge of adrenaline.
3. Hypothalamic–posterior pituitary Intensifiers
These have been discussed in the segment entitled Organisational Structure in Section 4c. While oxytocin may be reactive to circumstances and occasion, ADH is strongly yoked to ACTH and thus is linked with its anterior pituitary circadian drive. Much of the ADH secretion is pulsatile and independent of the posterior pituitary, though even here its setting for volume regulation of the circulation alters between day and night, conserving both water and sleep.
Anterior and Posterior Pituitary hormones are systems that have more in contrast than in common which reflects the fact that they have different embryological origins.
4. Organ responders and pacemakers
Most organs respond to demand yet there are pacemakers in the liver that prime the principal pacemaker in the SCN in the hypothalamus. The kidney's involvement with the calcitropic hormones92 is linked to the pacemakers by aldosterone and angiotensin as well as by ADH. Although the natriuretic economy monitored by the heart93 is more reactive, there exists a background circadian drag on the cardiac response. The small intestine responds of course to the food it receives yet the perception of hunger and the drive to assuage it comes as much from the digestive tract as from the hypothalamus and central regulators. The tube is replete with paracrine and endocrine cells especially with effects in the somatotrophic axis. Many of these are more resonant with seasonal and even annual rhythms than they are with the diurnal pace.
Potential applications of theory
| Dark | Light |
| If ACTH is generated early, middle insomnia, especially at 3am is almost certain | ACTH dominant at the end of night and has many receptors in the caecum and rectum at the beginning and end of the colon, hence early waking may be accompanied by digestive disturbance. Focus of treatment on the Corticotrophic axis should be considered |
| Parasympathetic and central cholinergic circuits dominate. | To launch the Beta–sympathetic, the Parasympathetic should paradoxically be maintained if good digestion of breakfast and utilisation of Serotonin is to be enhanced; however, diminution of the alpha–sympathetic will speed the day |
| If hypertonic, congestion and respiratory distress likely | |
| Prolactin and Growth Hormone will permit growth and repair. Pulse of TRH will disturb sleep | Use the morning to optimise Thyroid axis which will require good pancreatic function |
| Reduction in both Alpha– and Beta–sympathetic with reciprocal Parasympathetic response necessary to initiate sleep | Adequate generation of serotonin in the retinae and in the digestive tract and its movement to the pineal needed for melatonin formation |
| Melatonin needed to maintain sleep | |
| Late eating will tax duodenum and gallbladder and rouse typically at 2am | Optimal thyroid management by diet and activity in the morning and less of both in the afternoon will set a person up for a good night |
| Overburdened liver will disturb sleep pattern and rouse typically at 3am | |
| If histamine and noradrenaline do not sleep then neither will the patient | Diurnal expression of histamine is best managed through liver and gallbladder; noradrenaline can be best managed by the Corticotrophic axis |
| Serotonin and Dopamine need to be well expressed by day to provide adequate rest and effective dreaming by night | Prolactin needs (but according to circumstances) to liberate Dopamine by day to provide adequate drive and motivation |
| Excessive dopamine and inadequate Prolactin may tend to disorganisation | |
| Excessive Prolactin and inadequate dopamine may tend towards an obsession with organisation and a failure of imagination, or one that is confined to detail and impending catastrophe |
Configuration of the terrain within the human body
We tend naturally to see the wholeness of the physical body in front of us, but in medical practice it is helpful to switch perspectives and focus rather like the flip of a multidimensional Necker cube.
We need also to see that we are the built environment for the biome in our guts and on our skin. We may be one pinnacle of evolution but we sit upon an enormous pyramidal base of evolutionary experiment. Our survival as individuals or as a species is ineluctably dependent upon this relationship with species of microorganisms which have learnt the lessons before we have to. Our physical environments have their own state and as we move through them we have to adapt to them and to what they have adapted to. In these senses, the interactions outside the body are almost as multifarious as those within. In human interaction, whether in the clinic or the street, more than one sphere is operating and emphasis shifts from here to there from moment to moment. The following table extracts a summary of the bulleted text in Human Drives as a function of time in 3/5 Life as Trajectory in Section 3.
| The Proprioceptive or “Thalamic Mind” | contained largely in the Musculoskeletal System and its spinal and central connections |
| The “Hypothalamic Mind” | responding and ordering |
| Analogue Consciousness | |
| The Terrain | the archivist of the above relationships |
| The engines of response | Heart, Blood vessels, Spleen and Brain |
| The organs of first resort | Adrenal Cortex and Medulla Thyroid gland |
| The organs of last resort | Liver and Kidney |
The order of these elements is a deliberate reversal of the Cartesian tendency in the opposite direction. The miracle