In my previous article I tried to make the case that the appearance of independence (of the things in the world) is illusory. Independence is an artifact that results from the misuse of language. Inter-dependence (of the things in the world) on the other hand, is simply a truism based on the commonplace observation that everything depends on something else – hence inter-dependent.

Almost effortlessly, words carve out and define useable pieces and patterns from the totality of our manifest experience. By naming, they call our attention to an object or idea, but simultaneously and unavoidably ignore everything else. They are inescapably content oriented. The context or the background gets discarded (unless, of course, it is called forth as content). As one might expect, this unwitting oversight of the larger perspective has rather profound and wide ranging implications. I will return to some medical applications, but first I want to unpack some of the ideas surrounding the central idea: everything depends on something else.

Perhaps you can see that from the wide perspective of inter-dependence there are no entities entire of themselves. Ordinary items like books, boats, and ballpoint pens do not exist as the word “entity” implies: complete, separate, independent, autonomous, discrete. They don’t exist as entities (or “entire- ties”) because they depend on other things. Like a leaky bucket, an entity cannot contain its “self-hood” because its fundamental essence is tapped out by its multiple dependencies. A book is dependent on paper, ink, an author, intelligible ideas, etc. The book itself cannot be identified beyond its components parts. Entities only exist because we bestow, through our language and naming ability, a kind of provisional existence to them. But ultimately things exist only within a unified interlocking whole and by virtue of the innumerable conditions that conspired to bring about and maintain their apparent reality. To my knowledge this inter-connectedness has never been proven in any formal manner and probably can never be proven. The problem is that all of us are always already immersed within the matrix of totality and therefore cannot achieve any sort of untainted perspective about the whole. Even if someone claimed to have found an example of something totally independent, the finding itself would invalidate the claim.

A useful way to look at this interconnectedness is through the lens of contents and contexts. Like apples in a bowl, everything that has a form can be said to have a context. Even contexts have contexts. For example, a letter like “q” is contextualized by the word, “quick”. The word “quick” in turn can be contextualized by this very sentence which in turn is contained within this essay, and then again found within the computer and so on infinitum. If our ability to contextualize is always available, and I think it is, then no single thing can legitimately claim ontological independence. Why? Because it takes two — both content and context — to perceive or know anything. Why? Because our sense organs and brain only respond to differences. And it takes two somethings to make one difference. We need an edge (like between context and content) or a change to perceive something. Curiously, everything depends on its own absence for us to perceive it. If the apple didn’t have space or the bowl immediately adjacent to it, we couldn’t identify it – we would see apple extended forever. To claim that something is independent is to ignore its context. Yet language conspires with this deception with every word we utter. It beguiles us into thinking that things are separate and this misapprehension constitutes our consensual reality. It also obscures another more intimate way of experiencing the world.

The basic idea of universal interconnectedness was articulated over two thousand years ago. It is a kind of commonsense idea, yet we don’t generally seem to speak or behave in ways that reflect our fundamental understanding of it. Supported by habit and cultural norms, we have become enchanted or hypnotized by our own words. And in the clamoring and competitive cacophony of narrative we have covered up a truth (or two) of tremendous import and relevance to health and life. It may be instructive to remember, that the words health, wholeness, and holy are derived from a common Teutonic root, hale, which meant unwounded, whole (connected).

Here is an idea that helped me understand this issue: the notion of “two truths”. As a heuristic device, or a learning tool, it supports construction of new understanding – much like scaffolding at a construction site. So what are the two truths? The first is the truth of language. It says that indeed, things do exist just as they are named. Books, bicycles, barometers and bacteria truly exist. This covers our conventional work-a-day world. We rely on it and it works brilliantly. It isn’t indispensible, of course, since trees and most animals do fine without a language truth. They seem to confine their language to actions (like bees) or colors and songs (like birds) and don’t seem to bother with sophisticated abstractions like verbal language.

This first truth, the word truth, while true, can be improved by knowing about the second truth. The second, considered the ultimate truth historically, is that there are no entities because every named thing is ultimately interconnected or inter-dependent. Every atom we encounter and every syllable we speak participates in relationship. The second truth is the unspoken wisdom that sees this linkage. It is unsayable because any designation, even a well-intentioned designation, would render this totalizing vision as just another word-object with its unavoidably divisive baggage. The second truth resembles absence, but that characterization won’t do either for similar reasons. It is a mysterious, tacit (wordless) intuition of totality based on interconnectedness and no more.

I will skip ahead a little and reveal what happens when the “two-truth” scaffolding comes down, a peak behind the curtain. It has been called, at times, the third truth. It is simply that the first truth (conventional, word truth) and the second truth (the unspeakable, non-objective, apprehension of totality) are the same. In other words, the locus and limits of the two truths is the same. They both apply to our familiar universe – just viewed either more or less completely. Paradoxical? Yes. But also an invitation to transcend our ordinary habits of thinking that tend to reject paradox as unworkable. (Many paradoxes have utility — like the square root of minus one, or the conundrums that surround the idea of infinity). Paradox may lead to the discovery of a new way of experiencing. How one understands the aporia (Greek: no door, impasse) makes all the difference.

So what does all of this philosophy have to do with medicine, specifically pain and suffering?

Pain first. Pain, for better and worse, is part of our biological systems. Like the red warning light on the car’s dash, it indicates structural or functional disruption. It is an invaluable system and without it we would be continually injuring ourselves. Sadly, in chronic pain, the warning system doesn’t shut down properly and it cannot be easily disconnected or overruled. For example, sometimes the nerves themselves are sick (neuropathies) or sometimes the red light is stuck or hyper active or over sensitive as in migraine headaches. I have a patient who gets a headache every time the barometric pressure goes down. But if we combine the management of pain syndromes with our new found insight of interdependency, we discover something. We see that there are no single causes in the same way that there are so single “things”. Instead we find multiple, interlocking causes. We see that causes have causes and so on in an infinite regress. The migraine is not only caused by the barometric pressure going down, but by the confluence of that with genetics, mood, diet, xenotoxins, etc., etc. All of the above combine to push the pain triggering mechanism over threshold. And the reverse is true also, viz. if we can remove the contributing factors, especially the key factors, then the symptom abates. If the pain problem cannot be solved one way, there are always a myriad other approaches because there is no such thing as a single cause. Single causes, like independent things, don’t exist. They are part of the artifacts of language. Sometimes having this knowledge of multi-causality can be liberating for patients who feel trapped or dead-ended. When conditions are right, dis-ease appears; if conditions recede sufficiently, the dis-ease dissolves. It is a little like weeds in the garden. They don’t appear unless all of the conditions are right like enough water, the proper seed, satisfactory soil, etc. But remove those things and the weed dies.

Unfortunately, a cure is not always possible because some conditions are outside our ordinary ability to change – like our genetics or the weather. Likewise it is not always possible to identify the salient co-factors that gave rise to the symptom. But, the key is adopting a different sensibility. Much of modern medicine assumes that there is “the cause” and “the consequence” or “the effect”. For example, “smoking causes cancer”. The narrative I am suggesting is wider and more provisional. Smoking is a serious contributing factor, no doubt. But if it were the cause of lung cancer then everyone who smoked would have it and only about 1 in 5 get lung cancer. Our science isn’t sophisticated enough yet to know all of the various conditions that contribute to illness. But we might begin to more closely embrace the idea of multi-causality to begin the task of sorting it out. And I have no doubt that as we do this; patterns (clusters of conditions) will emerge that hone the edge of our diagnostic acumen.

Fortunately, most of us, most of the time, do not have pain. Suffering on the other hand is ubiquitous. By suffering I don’t mean intense pain (although that is one of its meanings), but rather the cognitive overlay (thinking), that surrounds pain or misfortune. If pain is the signal, suffering is the noise. It is the judgments, the catastrophizing, the black and white analysis, the woe, the hand wringing, the worrying, and so on, that are piled on top of the pain. The toxic overlay invariably leads to debilitating feelings of sadness, fright, grief, and so on which complicates and exacerbates the original painful condition. My analysis is undoubtedly more linear and formulaic than the reality, but it might help identify some key points in the loop to improve the “signal to noise ratio”.

I want to take aim at the thinking aspect of the pain/suffering cycle since it seems most amiable to change and relates to this whole issue of language and words. My sense is that if we can change our thinking we can ameliorate some (but not all) of our misery.

For example, we can see that context and content are inextricably connected. The content is named and in the foreground while the context is unnamed and background. If we can enlarge our focus to include context we see that the content can shift or deepen. The rose is sweeter if it comes from a lover. The slap in the face hurts less if it was accidental than if it was intentional. The temperature of boiling water depends on the altitude. 1 + 1 doesn’t = 2 in binary based math. We can therefore never be 100% certain about content (including this sentence, paradoxically) because the context can change. And if the context changes then so too does the content if one has learned to be sensitive to their requisite co-dependency.

One advantage of understanding some of the limitations of language is that we might be less easily caught in a rut of absolutist thinking (need I mention religious dogma?). Physicists tell us that the universe is still expanding at an astounding rate. In short, it isn’t finished. Thus, to take an absolutist position about the “way things are” in any arena is probably misguided since conditions may change at some time in the future.

In my view, the world may turn out to be more like a vast conversation than a complex mechanism. A flower “talks” with the insect. The tall grass whispers to the gardener. The stars sing to the poets. The tree has a exchange with the birds, people communicate with each other and with themselves. The world may all be a complex interconnecting web of signals with feedback and learning. How I engage the world, even who I am, may resemble styles of communication more than the separate entity called out by my name. And since we cannot opt out, we cannot not communicate, it would make a enormous difference to us and our world if we optimized the use of our words. By developing contextual awareness we might avoid some of the toxic consequences of absolutes, we might enhance our tolerance of other views, we might enlarge the scope of our ecological concerns, and we might assuage some of the fear and anxiety about death or those that spring from an incomplete assessment of the situation. We might say that we have overlooked the other half of the world if we cannot find our way into the wordless forest of possibilities that coexists with our conventional wordy world. My hope would be that we might reduce some of our self-imposed suffering if we could perfect our language skills and calibrate them to the texture of the interconnected and majestic manifestation before us.

  language and medicine