NB still a draft!
Below I will describe my psychophysiological behavioral medicine paradigm, which is my way to meet my own critics on common clinical paradigms (as I understand them). That is, clinical work is about an individual (ideographic perspective). Methodological weakness and shortcomings in nomothetical levels is not discussed below (but elsewhere at my web sites).
Basics for my way is using a dynamic Integrated Psychophysiological Behavioral Medicine approach connected with IBED, Individual Biological (or Biopsychosocial) Evidenced based Documentation, based on Single Case design (below link from 1973) https://jamanetwork.com/journals/jamapsychiatry/article-abstract/490969), but where the Independent Variables are a biopsychosocial medicine toolbox where patients during education tailor themselves and/or coached their “way“ according to estimated prerequisites.
Closer to individual real-world needs is clinically a priority for such methodology. Patients first including “patient as a reasonable competent educated resource and coworker in own rehab”, which is our biopsychosocial manual HELLA, not just to be considered in Medicine? | Cultural Medicine). Why not just one treatment (Independent variable)? The answer is: This is not what lifestyle medicine is about – or? Rea world is not just one “thing”!
The procedures are: After intake assessments (importantly the psychophysiological stress tests, which measured different conditions including also a patient´s capacity to influence identified dysfunctions (important also to show the patients not only dysfunction and explain what they indicate as well as how they usually can be treated, preparing for coming treatment planning – individualized independent variables) based also on a priori predictions and post test is done at associated cut-off (and if not reached, modification of the independent variables or suggest other clinical focuses …).
But, if you use many treatments, we do not know which one was effective, if data is meeting a priori predictions? That is the point, real world is not “one thing” and if we make priority for the patient (and not reductionistic, artificial science), we miss our clinical priority! But there is more here, many variables works often in synergies, so actually, we need to chose the patient´s in front of us or reductionistic data of no (at least) clinical use!
Independent of clinical (ideographic) or basic scientific (nomothetical usually) perspective, we also, when it concerns complex (biopsychosocial medicine) processes, we deal with extremely complex processes, systems which we have limited knowledge how they interact both “Horizontal” and “vertical”. To make it complex: When we think about e,g, an individual real world perceptions of sound, vision, smell, …, we do not understand well, e.g. how all this is integrated into a cognitive expression/idea/memory construction …
“But how to glue this very complex neural information together in our consciousness so that an idea is created? That question is one aspect of the mystery of consciousness. Something that is often called the bonding problem. Information has been encoded in different parts of our brain but how does it come (put) together in our consciousness into one (meaningful) unity” (p 293, sorry but machine translation from Swedish in “Life on the edge”, (https://books.google.se/books/about/Life_on_the_Edge.html?id=1voKBAAAQBAJ&printsec=frontcover&source=kp_read_button&hl=en&redir_esc=y#v=snippet&q=Chauvet&f=false)
Perhaps also a problem where, especially in human Western reductionist fragmentary science, it is difficult to integrate into a system’s integrated processes that can also recreate a single individual’s image of its reality. Starting from Karl Popper’s three worlds hypothesis and world 2, where each human being has his own ”world map”, which should then be set against an extremely complex standardized biological approach identifying based on limited knowledge of the human biological system – normatively and ideographically!
I will briefly, here first, simplify somewhat in line with one of the authors of “Life on the edge”, JohnJo McFadden (“Life is simple”), when concerning homo sapiens. Systems theory suggest simplify as high up in systems as possible (Complex Systems of Knowledge Integration: A Pragmatic Proposal for Coordinating and Enhancing Inter/Transdisciplinarity https://www.researchgate.net/publication/332470851_Complex_Systems_of_Knowledge_Integration_A_Pragmatic_Proposal_for_Coordinating_and_Enhancing_InterTransdisciplinarity * see abstract below
We need to concern about at least three limitations in simplifying; (a) that most knowledge is not absolute complete knowledge requiring elaboration with limited knowledge and (b) the problem with complex knowledge integration and (c) how to, especially in biopsychosocial-cultural medicine, express knowledge from “a” and “b” into ideographic knowledge, of crucial importance in clinical work where we work with living individuals and not mean data. If we use systems thinking in terms of “integration would may be at highest levels enabling integration of knowledge at lower levels”, we, in human information systems try to integrated Limbic, spatial- and human brain verbal information processing. While trying to understand (based on trine brain – Karl Popper´s three worlds, evolution of nature and culture … | Cultural Medicine + Toward development of a guide facilitating knowledge and practice-based use of human Limbic systems information processing in general and health care services in particular | Cultural Medicine + Cultural evolution of human brain based on our (very much modified interacting with) mammalian and reptilian brains … | Cultural Medicine + Paradigm | Biopsychosocial Medicine)
Just “one” positive” factor associated with the above is that evolution of the human brain IS based on trying to survive on limited knowledge. Not much “solace”? The alternative was never possible for survival. So, as I see it, it is really to try also (!) to understand old traditional (what some of us call) wisdom! Think about that many outstanding scientific discoveries is based on “luck” or “fribble” (as how Fleming is argued to did his extremely important discovery)! Quantum biology is a new scientific field, but have existed since “ever” (not figures!), which raise the question “may some of the wisdom be based on quantum biology (not examples yet, in spite not only I have some serious (!) ideas). Simplifying, I have tried to discuss this at some web sites as e.g. HELLA, not just to be considered in Medicine? | Cultural Medicine while I have tried during the years to integrated eastern and western science using psychophysiological behavioral medicine as interface ..
I have discussed this at Eastern and western medicine – can they both meet in win-win using an integrating psychophysiological platform? | Cultural Medicine + How to deal with not absolut knowledge – which no one of us have access to | Biopsychosocial Medicine + Challenges for future care: Here focusing only on “who decides – normative evidence vs clinical ideographic evidence” | Biopsychosocial Medicine + Summarized of the paradigm used by Bo von Schéele | Biopsychosocial Medicine + Humanism before capitalism in health care, nursing and school! | Biopsychosocial Medicine
I will elsewhere discuss if we during reductionistic education get blind for complex systems integration, believing too much on what we are examined on? Also, how we can avoid it. I think this is particular important in all kinds of clinical or non-clinical work by anybody working in such fields – exanimated or not! Furthermore, discuss also how to deal with complex knowledge (but some at To SEE (vision) but not to SEE (understand) may not be a impossible problem sometimes: We may find out options in spite of not understanding? | Biopsychosocial Medicine + Is health care inefficient, reductionistic, rigid regulatory system where the patient is lost – at best? | Biopsychosocial Medicine + Evidenced based falsification of data or validation of the individual patient in front of us? | Biopsychosocial Medicine + Is health care inefficient, reductionistic, rigid regulatory system where the patient is lost – at best? | Biopsychosocial Medicine
More is to come …
* ”Complex Systems of Knowledge Integration: A Pragmatic Proposal for Coordinating and Enhancing Inter/Trans disciplinarity. Abstract: “Humanity’s biggest challenges call for organized collective action, informed by the most complex forms of thinking. Different forms of knowledge and practices of knowing operate at different levels of organization within society. Scientific knowledge is one form of knowing, but the development of science under a culture of disciplinisation and increasing specialization has led to its fragmentation and blinded it to the possibilities offered by the integration of knowledge. Interdisciplinarity and trans disciplinarity are privileged routes for rich knowledge construction and integration. There is a pressing need for efforts directed toward the intentional construction of a culture where interdisciplinary and transdisciplinary practices may flourish. However, we believe significant change will only occur through the orchestration of a set of activities that attend to the complexity of knowledge construction and integration as emergent outcomes of a complex network of processes and relations that constitute an evolving inter and transdisciplinary ecosystem. In this paper we present a proposal for the organization of an Alliance for Knowledge Integration and of Inter/Transdisciplinary Hubs aimed at coordinating collaborative actions and contributions from a diversity of agents and systems from different levels of organization of society towards richer and more integrated practices of knowing.”