Chapter 16

Return to and continuation of the application of the theory to explain the zoic course.

2135. We return now to the original discussion from our digression, which I was happy to introduce as an aid to further progress. I wanted to demonstrate the incredible variation and multiplicity of the paths taken by the zoic course, and its extreme mobility relative to even the least causes making it deviate from its proper direction. For this reason, I explained the primal variations in the fundamental feeling of continuity and in the life instinct which produces this feeling. I also explained the variations of primal, natural stimuli and of the sense-experiences arising from them. In addition, I explained the life instinct itself which posits in being the fundamental feeling of excitation. Finally, I explained the variation in sensitivity, that is, in the faculty possessed by the fundamental feeling of excitation for being modified by new, accidental stimuli and for giving rise to partial sense-experiences which are also accidental. I called primal sense-experiences those arising as a consequence of primal stimuli furnished by nature, not produced by animal instinct itself; I called second sense-experiences those produced as a consequence of stimuli generated by the action of the instinct. I now wish to speak of these second sense-experiences and their variety.

2136. If we wish to form a clear concept of these second sense-experiences and see how much they influence the zoic course, we have to recall what was said about animal, synthetical force in Anthropology. It is this force which makes the second sense-experiences (succeeding the first) arouse new activities and as it were new potencies in the human body. These activities and potencies change the zoic course so that every association of shaped or non-shaped sense-experiences, of images, of roused or re-aroused active or passive feelings [App., no. 4], whether intellective or corporeal, produces in animality a new state, new activities, new movements. The associated sense-experiences then fuse into the sense-experience I called affection, that is, a universal feeling, halfway between sense-experiences and passions.

2137. In fact, just as an affection is an effect produced in the sensuous condition of the whole animal by contemporaneous, particular sense-experiences, so the passions are an effect of the affection from which the sensuous instinct receives its impulse to move the passions.

2138. The sensuous instinct moved by affection determines animal passions. In doing this, it invariably acts according to the law: 'Feeling takes whatever attitude is more comfortable and natural to it.' Sometimes, for example, we see the sensuous instinct affected by sadness and given over to inactivity. It takes this attitude because the contrary costs it too much. Again, total activity in the midst of joy is explained because this suits the animal better. Sometimes it is less burdensome to suffer silently. If so, the animal remains quiet because it finds this mode of being more comfortable and suitable. Sometimes it settles itself into a state of quiet to receive a pleasant sensation more fully. Sometimes it is restless and active in order to seek a pleasant sensation or an occasion of some pleasant sensation. Anger is active; when angry, the sensuous instinct rejoices in the vehement, bellicose activity that arises when a preceding activity has encountered obstacles preventing its full development and satisfaction. But excessive anger, like any other passion, is too strong a stimulus and goes on to produce torpor, the effect of excessive stimuli. This fact proves that sense-experiences are stimuli of their nature, and that the sensitive principle determines the law of stimuli. No stimulus, taken materially, achieves this because material and spiritual stimuli, as passions, obey the same law of torpor when they exceed a certain degree of force.

2139. The force of habit to which sensuous instinct (and life instinct in so far as it produces the fundamental feeling of excitation and the primal sense-experiences) is subject has an immense influence on bodily health. For example, why are mountain people, or those who dwell in places where the air is dry and oxygenated, adversely subject to varying degrees of stimulation in the air of swampy, rice-growing regions and other areas causing miasmas, or even to damp, heavier air? And why, after being subject to fevers and inflammation, do these people gradually grow accustomed to the new atmosphere? This is obviously a result of habit, and seems to take place in the following way. Habit already possessed by animal instinct can lessen or increase the effect of exterior stimuli in so far as it increases or decreases its own co-operation with these stimuli, and in so far as it collaborates with them in the production of movements and aroused sense-experiences.

Animal instinct is, therefore, the arbitrator, the regulator, balancing or harmonising in the most advantageous way the tension and activity of the nervous fibre with the varying degrees of stimuli from the atmosphere. But when this balance and harmony has been well-established in a given atmosphere and the nervous fibre has been held for a long time at the level, degree and rhythm of activity suitable for the quantity and quality of the stimuli acting upon the skin in a given climate, its given degree and the tension of the fibre are preserved and habitually continued for some time even in a new climate. Hence illness. If the atmosphere in which the animal first found itself was only lightly stimulating, the animal's vitality itself supplied with its own action for the reduced exterior excitation. But in a much more stimulating atmosphere this action becomes excessive, and this excessive effect is manifested through inflammation. Moreover, when the human body habitually lives subject to few stimuli, the whole zoic course in its sense-experiences and movements conforms itself suitably with harmonious motions and functions. But if exterior stimuli are suddenly increased or lessened, necessary changes cannot take place immediately in all the motions and functions constituting the zoic course. Change first occurs in the part to which the stimuli are applied. In our case, relative to the atmosphere, we are dealing with the skin, lungs and blood in which, from the very beginning, there must be some imbalance between the activity felt in certain parts of the body and that in other parts which do not immediately feel the action of the new stimuli. Such imbalance of activity between parts, between vessels or between portions of vessels are, as we have seen, causes of illness and of almost all illnesses. A similar argument can be used to explain melancholia in so far as it is physical, and illnesses to which the body is subject through changes even in atmospheric conditions of the same climate, and so on.

2140. It is necessary, therefore, to classify stimuli carefully to see whether, when one cause of external stimuli is increased, another is diminished as a result of atmospheric conditions or other accidents. This in turn could cause imbalance and upset, and explain the diversity in the diseases which manifest themselves.

2141. Stimuli, although they increase activity in the animal, sometimes disturb it as well. This leads us to speak of the different ways in which weakness and robustness become apparent in animals and to see if pathological weakness and robustness can be held as well-founded. First, there is weakness in the life instinct, then in the sensuous instinct.

2142. Let us consider weakness in the life instinct, prescinding for a moment from the influence exercised on it by the sensuous instinct.

There are two primal effects of life instinct:

1. The first produces the fundamental feeling of continuity relative to which the life instinct is weakened through opposition from matter or some foreign force.

2. The second produces the sense-experiences which constitute the fundamental feeling of excitation and, in addition, the accidental sense-experiences provoked by accidental, external stimuli. Relative to this effect, life instinct is weakened by the scarcity and inappropriateness of stimuli.

2143. The life instinct, by positing in act the fundamental feeling, especially that of excitation, also gives rise to consequent extrasubjective phenomena such as the tone of the living fibre, tautness of the nerves and incessant intestine movements. Its weakness is also evident in the scarcity of such phenomena. Let us indicate some proofs of this.

Tying the vessels to prevent red blood from flowing to a part of the body makes the part weak, insensitive and paralysed. Tying the nerves produces similar effects. Because such effects are then diffused according to the sphere of action of vital activity, which is different from extrasubjective and material organisation, sympathetic effects are produced in parts lacking a proximate, organic connection with the tied nerve. Molinelli and Brunn, after tying the pneumo-gastric nerves of several dogs, produced dilation of the pupillary membrane. The eye became dry and dull, and diminished in volume, while the iris turned brown and the shape of the pupil altered. It is, therefore, evident that the activity of the life instinct in enlivening the body obliges its extrasubjective particles to come together in a given way, to take and hold a given reciprocal proportion, and to be subject to certain actions and intestine motions, all of which are extrasubjective effects.

2144. Nor should we forget that the weakness of the vital principle in producing the two effects I have indicated, and the struggle which it sometimes has to sustain, presupposes the existence of an animal. Consequently, imperfect disposition of matter and inappropriateness of stimuli can never be universal; it must always pertain to a determined locality which may embrace one place or several places, or be extended in varying degree.

The reason is that the animal principle would not exist as an individual agent unless it had at least some part of matter under its full dominion, and unless certain appropriate stimuli aroused the fundamental feeling of excitation necessary to the existence of the animal.

2145. We should also consider the influence exercised on the life instinct by the sensuous instinct and the intellective principle. The life instinct can easily be weakened by this influence, the effect of which is also shown in a certain order relative to different parts of the body. It is found consequently in some locality, according to the organ of the aroused animal passion.

For example, anger, revenge and all the other passions characterised by sadness principally effect the liver: iterizia is often caused by moral causes. If a passion has an intellective origin, the first interested organ must be the brain, the organ of the imagination. But the images which attract thought, and the intellectual feeling attached to these images, act on the animal principle which, as sensuous instinct, then provokes, increases, lessens and alters the action of the liver.(130)

2146. The weakness of the life instinct proceeding from the instinct's relationship with matter also sometimes arises when the body insensibly loses molecules through transpiration, and so on, which are not renewed through other natural ways such as nutrition, and so on. In this case, the feeling of continuity decreases but without causing any disturbance. All that occurs is some lessening of the feeling of continuity and excitation. The consequent state of weakness cannot be called illness until it develops beyond a certain degree and changes its condition. At least, it cannot be called diathetic weakness because it does not produce independent disease processes.

If the natural loss of living molecules continues without any corresponding replacement, the activity of the life instinct decreases and all the functions gradually slow down. When this deceleration has reached a certain degree, the scarce matter composing the living being is reduced to such a state that it is no longer sufficiently dominated by the life instinct. As a result, material forces struggle against the life instinct by giving rise immediately to the diseased or diathetic state in which this struggle consists.

But if some part is detached in an unnatural, violent way from the living body, two effects of this separation have to be distinguished, one arising in the feeling of continuity and the other in the feeling of excitation. The first feeling, although discontinued and weakened by the detached parts, is still not in a diseased condition; the effect in the feeling of excitation - pain and its successive processes or internal movements - is a diseased condition. If the wound does not detach any part from the body, there is no diminution of the parts (prescinding from the loss of blood and so on) but only excitation and its consequent process which finishes either with healing or in some other way.

2147. The pain caused by the wound is the result of two causes: 1. the unevenness of the cut which removes a part but not so neatly that certain remaining particles are either fully separated or fully united. In this case, the life instinct struggles to retain them although they have lost the necessary position and conformation needed for full dominion of life; 2. from loss on the organisation's part of the perfect configuration which corresponded to the previous attitude taken by the feeling. Consequently, the feeling finds itself under pressure to re-adapt itself. Endeavouring to do this, it demonstrates a tendency to heal the wound provided it has the opportunity of configuring the organism to its need; if not, it cuts off and abandons the organism. Pain produced by these causes, and even the effort which feeling makes relative to one or other of these two aims, is the cause of the disease process which finishes either in health or death.

2148. A struggle is also manifest every time some foreign agent succeeds in subtracting a portion of living matter from the full dominion of life without, however, totally depriving this portion of life.

2149. Having established the concept of diseased state, we can now distinguish three kinds of robustness and weakness: physiological and pathological weakness, the second of which is subdivided into simple pathological and diathetic weakness. I do not claim that these are the most appropriate and suitable words to describe what I am dealing with; they can certainly be changed to something better by the learned. But I use them for the moment simply to indicate my concepts.

2150. For me, therefore, physiological robustness or weakness is that proper to the principle of life in the exercise of its domination over matter. The dominion of which I am speaking is perfect, tranquil, without irritation, without struggle. The feeling in which this domination exists is essentially pleasant.

2151. Pathological robustness or weakness is that which the vital principle manifests when it does not fully dominate in a way that produces the necessary, satisfying pleasure proper to the life of excitation. If something is lacking to the integrity of the organisation, as in hunger and exhaustion, we certainly have a state which is not fully healthy. But although we can say that this state, when considered on its own, is in some way pathological or diseased, we cannot call it diathetic. For the moment at least, it shows only inaction on the part of the life instinct, not clear signs of struggle. I grant that this inaction will be followed by a struggle, at least if it reaches a certain degree, as I said before, but the concept of struggle proper to the diathetic state always remains separate from the concept of simple inaction. Consequently, when these two things are found together they should still be mentally distinguished.

2152. I define and describe the pathological robustness and weakness I call diathetic as the bellicose robustness or weakness which the principle of life demonstrates in its acts. In the struggle I have described, the principle of life sometimes contends forcefully and impetuously, sometimes with less strength than it should. This requires some explanation.

2153. First I think we should distinguish the proximate, efficient cause of illness from the essence of illness. I recognise that the efficient cause of illness can sometimes consist in too vehement an action, sometimes in too retarded an action on the part of the vital principle.

2154. I speak of a vehement or retarded action rather than of robustness or weakness because the last two words are better applied to a state than an act. The proximate, efficient cause of illness, in so far as it pertains to the life instinct, can only be an act which, along with others, produces a diseased state. For example, sudden joy at some happy occurrence can momentarily increase the action of the vital principle to such a point that the blood is propelled with greater force than the walls of the vessels can sustain. The result is some form of fit. Sadness can cause death in the opposite way by reducing the action of the vital principle so that circulation is decelerated and, as a result of an accumulation of blood in the large vessels, weakens all the vital functions, even to the point of almost spontaneous death. But the exaltation and depression of force with which the vital principle acts is not illness, although it may be the proximate, efficient cause of illness. This distinction must be clear if we want to arrive at a lucid theory of illness.

2155. Simple diminution or increase of force in the action of the vital principle does not, therefore, constitute illness, although it can be its cause. In fact, it becomes the cause every time the diminished or increased action effects such an alteration in the organism or in the organated living matter that the vital principle is opposed in its full dominion over the living matter, which then tends to separate from the vital principle, and initiate the struggle which I described.

2156. According to this concept of illness, we have to conclude that all illnesses without exception contain some weakness serving as the basis of the illness itself. This fundamental weakness consists in diminished dominion over matter on the part of the vital principle. If, therefore, this principle sometimes makes use of extraordinary forces during a state of illness we must not conclude that it is stronger but only that it is, if I may use the word, more irritated. The situation is rather like that of a ruler who holds his subjects in such perfect subjection that they cannot rebel in any way. This ruler is stronger than another whose rebellious subjects attack him with some chance of victory. The second ruler may employ greater military force and be braver than the first, but he is not stronger. The violence, therefore, with which the vital principle acts during a state of illness is not a genuine sign of robustness, but of weakness, of imperilled dominion. Consequently, when the struggle has ceased, the effort made by the bellicose forces also ceases, and weakness becomes apparent in the conquering principle. This explains why all convalescents are weak. It also serves as a clear proof, I think, that the vital principle in a state of illness is always weaker than in a healthy state, although this is not apparent while the struggle is being waged. The situation is rather like that of a weak man swept away by great anger. He shows more force than a truly strong, tranquil and quiet individual.

2157. Weakness and force are, therefore, present in any illness whatsoever:

1. Fundamental weakness is present relative to material forces in rebellion against the dominion proper to life.

2. A bellicose force is present which the principle of life draws into battle in order to preserve and fully restore its own threatened dominion.

2158. This bellicose force has been the principal attraction for modern schools of medicine and has produced the generally held teaching about stimulus and counter-stimulus. I would like to make some comments on the theory. The action of animal instinct does not exceed the sphere of feeling (cf. 1935-1937), but its different adaptations do bring extrasubjective movements in its wake. These movements influence matter by provoking new actions and adaptations in the feeling itself because the same matter, which from one point of view is outside feeling, is from another point of view animated and felt.

From this I deduced that the action of feeling - and I am speaking only of the bellicose action of feeling - can produce healthy or harmful modifications in organated matter. Feeling is indeed blind in its activity relative to the usefulness or harm of extrasubjective effects, which in turn influence the subjective condition. Providence, however, has pre-established an admirable harmony through which the movements produced would often, if not always, be useful to the animal. For example, an inflamed, painful or extremely sensitive part of the animal abhors stimulus. In this case sensuous instinct produces those movements of which it is capable and to which the organism consents, in order to reject all matter touching the diseased part or any other part connected with it. Again, vomiting is frequent in encephalitis, in hydro-encephalitis, in fits, and so on. The stomach nerves reject stimuli, and so on. The sensuous instinct simply tries to withdraw from the displeasing, painful sensation, or from the tiring disturbance in the nerves which, having become painful, now want to rest. But it is providential that the movements which the instinct performs to attain this aim are so drawn together by nature that they produce the expulsion of the stimulating, extrasubjective matter.(131)

The bellicose forces, therefore, of the vital principle are not always useful to health, although as their immediate subjective end they always tend to perfect the state of feeling. Health depends in great part on the condition of extrasubjective matter. Bellicose efforts, although they always have an immediate, healthy aim within the subject, draw in their wake extrasubjective movements (which constitute in great part disease processes) through the mysterious bond of the subjective with the extrasubjective order. These movements do not always draw organated matter to a better state and disposition, but sometimes cause greater disturbance and indisposition. As a result, organated matter, more disturbed and indisposed than ever, determines the abnormality of the zoic course which finally expires.

2159. Granted, therefore, that illness has come about through some irritation (I take this word in a general sense to indicate 'an attempt by matter to withdraw itself from the dominion proper to life'), whatever the cause producing this upset, and granted that the vital principle arises to re-establish its dominion, three events can take place:

1. The vital principle does not succeed in re-establishing its tranquil dominion for the sole reason that it acts too weakly. It could indeed take place simply by an increase in its forces (excessive, universal, disproportionate weakness of the bellicose action).

2. The vital principle does not succeed in re-establishing its tranquil dominion because its excessive impetus produces violent movements in the matter, that is, extrasubjective disturbances which, relative to life, reduce the state of the matter still further. Indeed, these disturbances render the matter even less susceptible to dominion (excessive, universal, disproportionate strength of the bellicose action).

3. The vital principle does not succeed in re-establishing its tranquil dominion because its action is unequal and disproportionate. In other words, it is excessive in certain places or parts of the body or too weak relatively speaking in other parts (contemporaneous, excessive strength and weakness of the local, partial, bellicose principle).

2160. These are the three accidents which we immediately think of, but are the first two truly possible? I don't think so. At least, I do not believe, as I said earlier, that they constitute a diseased diathesis, although they can be its cause. In fact, granted that the vital principle is universally weakened as a result of any cause whatever (and abstracting from the effects which this weakness can produce), we see a barely active life, and nothing more. This does not of itself constitute a diseased condition. Moreover, if this weakness and inactivity is caused by a diseased condition or preceding irritation, the condition is not the weakness itself but something which precedes and causes the weakness. The diseased condition follows its course without finding anything capable of offering it strong opposition. If we are dealing not with weakness from a bellicose action, but with a general weakness of the vital action, the cause of illness, but not the illness itself, could be the general weakness.

This would be the case when deceleration of the life-functions causes some disturbance, plenitude or congestion of fluid, and so on.(132) Only when these effects took place would the diseased state (and the struggle) begin. These effects, however, are all local and consequently pertain to the third of the accidents listed above.
The same may be said about the universal robustness of the bellicose action. Of itself, it is not illness. But if the vehemence of the bellicose action, or even the strong action of universal, excited vitality produces some disturbance in the matter, such as the rupture of the vessels or something similar, the illness begins in this case with these local, partial effects.

2161. If we think about it, we realise that every irritation determining bellicose action is always local. But, relative to locality, a succession of actions and movements is present which extend from one part to others according to the organisation of matter and the adaptation proper to feeling. Thus, it is clear, say, that if some wound to the brain brings on hepatitis, the effect succeeding the wound is a local misfortune succeeding another local misfortune. All this is a consequence of the bellicose action of the principle of life aroused by the first irritation located in the brain. Hence, in a diseased condition, the struggle does not extend equally and contemporaneously to all parts of the body, but is confined to certain parts, one of which succeeds another. As a result, we have in every diseased condition the third accident through which 'the vital principle operates with an unequal, disproportionate action in such a way that the action is greater in certain places of the body than in others.'

2162. Having restricted the concept of illness in this way, and having distinguished the art of recovery from hygiene, which is properly concerned with the preservation and strengthening of health, we need to look at the locality marking the beginning of the bellicose action, and at all the other localities to which its effects are extended. We need to consider the following:

1. Of its nature the bellicose action tires and enervates the vital principle. As a result, it often happens that as the action diminishes, the forces proper to the sick person are conserved rather than diminished. We see something similar in the forces of a person who stops working and rests.

2. The bellicose action, by exhausting the forces of the vital principle, produces as its counterpart both apparent robustness in those parts where the bellicose action developed, accompanied by weakness and exhaustion in all the other parts. This occurs in local inflammations which decrease and extenuate the body, although great action is observed in the inflamed part. This is not robustness, but bellicose action and excessive effort.

3. Bellicose action, arising as it does from a primal irritation, either does not generate other irritating modifications proper to matter, and in this case it ceases whenever the primal irritation can be brought to an end (illnesses due to irritation), or it generates new, irritating modifications so that health can be restored only by modifying the bellicose action itself (diathetic illnesses).

4. Sometimes local bellicose action produces irritating modifications of matter because the movements aroused in the parts or particles are such that they cannot be dominated or regulated by the force of the vital principle. In this case, excess is present relative to the local bellicose action together with weakness relative to universal vitality. It was probably this which induced doctors to establish the classes of illnesses they named sthenic diathesis.

5. Local bellicose action, when weaker than the irritation which causes it, allows the irritation to prevail, and distances the badly disposed matter still further from the dominion proper to life. It was probably this which induced doctors to establish the class of asthenic diathesis illnesses.

6. It is certain that when vitality is more robust, bellicose action is equally increased. It happens, therefore, that expedients, which seem to diminish the force of vitality, are occasionally thought useful to diminish local bellicose action; on the other hand, an increase in the force of the vital principle may usefully increase bellicose action. But it has not been shown that this is the only way to increase and diminish bellicose action; it has not been shown that it is the only way of diminishing or increasing the robustness of the vital principle.

2163. We still have to investigate, therefore:

1. Whether perhaps bellicose action which produces sthenic diathesis can be adequately reduced by offering resistance to its harmful effects through an increase in the force of universal vitality. Or whether, granted advantage and disadvantage in increasing the force of this universal vitality (disadvantage through an increase of the bellicose force threatening disaster; advantage through an increase of the universal power of the machine that resists disaster), it still has to be seen if it can EVER be verified that the advantage prevails over the disadvantage and, if so, when and how this is possible.

2. Whether perhaps bellicose action which produces asthenic diathesis can be remedied solely by increasing universal vitality, or by local excitation of another irritation and arousal of a new bellicose force.(133) In this case, the causes explaining lack of lively response to stimulus on the part of bellicose action, and the reasons why this action remains as it were depressed, still have to be investigated. This will be done by determining the relationships between these different causes and suggesting possible remedies.

All these investigations pertain to analytical medicine.

Notes

(130) Images and intellectual feeling are not the same thing. However, in the case under discussion, images become 1. matter for sad thoughts; 2. sad thoughts induce a feeling or intellective passion; 3. this acts on the body, producing the movements to which the feeling or analogous animal passion corresponds. But where is the first action of intellectual feeling carried out? I believe this takes place in the brain, because thought uses images as necessary signs. Nevertheless, as long as the action remains in the brain, animal feeling is not aroused. If this is to happen, some other organ must intercede, such as the liver in our case. But does the liver affection, which follows the affection of the brain, come from the action of the brain? Is the liver affection only concomitant with the action of the brain as a result of the complex action of the vital principle? I think it probable that the liver affection (to which analogous animal feeling adheres) is tied to that of the brain even through organic, nerve passages. It is certain that when the head is severely injured, the liver becomes diseased and forms abscesses. Nevertheless, Barthez says that such a fact cannot be included in any of the known classes of sympathy between the organs. However, the communication of the cerebral nerve system with the ganglionic seems to indicate the way in which the communication of successive effects takes place, provided this way is considered to fall within the activity of the vital principle manifested in various organs.

(131) Matter lying on the stomach becomes more uncomfortable as the digestive function is further suspended or impeded. Suspension of the function obviously indicates weakness in the tired, aching or otherwise pre-occupied vital principle. - That the feeling does not intend to expel the matter, but only to withdraw from the disturbance, is shown by the contractions and churning of an empty stomach.

(132) Congestion was divided into active and passive. The latter are those blockages and obstructions which arise through poor circulation and in general through inactivity on the part of vital functions. The former are those which come about through excessive, partial activity of certain organs as they violently impel fluids into the vessels which they bloat. Normally both factors exist together, as I noted when speaking of inflammation.

(133) The action of a strong tonic on the mucous membrane of the stomach produces phenomena similar to those of gastritis. This explains why certain doctors thought that therapeutic substances assist health in the human body by opposing an artificial to a natural illness or, as I would say, one irritation to another.