(Mis)matched

The 300,000 year old history of our species is one of migrations made possible by our biological and cultural adaptations. From their East African cradle, homo sapiens now occupy every longitude and latitude of the world. As a generalist species with a penchant for story-telling, socializing, teaching, learning, technology, and engineering, we have transformed our… Continue reading (Mis)matched

The Study of Others

As fundamentally social primates living in and dependent on exceptionally large and heterogeneous groups, other humans are among the most important features of the environment for humans. For humans, having the capacity to infer the intentions, goals, and feelings of others is essential for the Darwinian goals of survival and reproduction. In fact, the networked… Continue reading The Study of Others

The Study of Self

Cover: Strangers to Ourselves The philosopher Karl Jaspers introduced the concept of the Axial Age to describe convergent movements in thought that occurred across the Old World from the Greco-Roman to the Indian and Chinese. This period from approximately 8th century to the 3rd century BCE was the documented birth of the study of self.… Continue reading The Study of Self

The Foggy Road

In his book Surfing Uncertainty: Prediction, Action, and the Embodied Mind, Andy Clark used the metaphor of driving on a foggy but familiar road versus driving on a similarly foggy but unfamiliar road, to the tension between the top-down predictions and bottom-up sensory data. When navigating the familiar but foggy road, memory of that road… Continue reading The Foggy Road

Great Expectations

Visual illusions (see below) provide unique insights into the generative aspects of perceptions and the gaps between perception and reality. They not only illustrate the disproportionate impact our learned and innate knowledge of the world - our priors - have on our perceptions, but also that perception is not a direct reflection of the world… Continue reading Great Expectations

Feelings Felt

We learn early in our education about the five senses - visual, auditory, gustatory, tactile, and olfactory. This processing of information from the “external environment” is termed exteroception. Intermittently, salient sights, sounds, tastes, smells, or touches enter our awareness but for the most part exteroception happens subconsciously. However, the brain not only monitors the external… Continue reading Feelings Felt

Language and Its Discontents

Ludwig Wittgenstein wrote, “the limits of my language mean the limits of my world.” Fortunately, human communication carries multiple layers of signals - verbal and non-verbal, conscious and subconscious - with language or consciousness representing summarizations of all those signals. Similarly, the patient-physician interaction also is laden with signals.  Even without considering the vagaries of… Continue reading Language and Its Discontents

Worlds Far and Wide, Near and Close

Who we are emerges out of the dynamic interplay of what we are (the person), where we are (the situation), what we say we will do (intentions), and what we do (actions). Medicine has built a model of disease with a focus on the person in a hospital or a clinic and their intentions. In… Continue reading Worlds Far and Wide, Near and Close

The Person and the Situation

It has almost become a truism to attribute the causes of diseases to social determinants of health (SDOH).  By one estimate, SDOH account for 60% of premature death in the United States. According to the CDC, SDOH are the conditions in the environments where people are born, live, learn, work, play, worship, and age. While… Continue reading The Person and the Situation

The Wanderer

A core functionality of biological organisms is to track regularities in the environment and utilize those regularities as a substrate for predictions. In general, organisms that can identify markers of risk, danger, and safety and respond appropriately to those markers are better adapted than organisms that lack this functionality. Thus, the largely reflexive fight-flight-freeze responses… Continue reading The Wanderer

Steep Hills

As I discussed in my last essay, social relationships - the types, the numbers, and the nature - constitute a major risk factor for health. It rivals well established medical risk factors such as hypertension, hyperlipidemia, obesity, and physical fitness. In fact, by one estimate nearly 60% of the variation in health outcomes is caused… Continue reading Steep Hills

The Systems Above

The 17th century poet, John Donne, famously wrote, “No man is an island, entire of itself; every man is a piece of the continent, A part of the main.” In reality, even an island is not an island - structurally or functionally. Islands are separated (or connected) - depending on perspective or purpose - to… Continue reading The Systems Above

The systems above, the genomes below

In medicine, it is often said the exceptions are the rule and atypical presentations of diseases are typical. However, diagnoses are also often preceded by typical symptoms, accompanied by diseases, and succeeded by other symptoms and diseases. There are patterns in these journeys and they often follow consistent trajectories.  A heart attack is announced by… Continue reading The systems above, the genomes below

Histories

Winston Churchill wrote, “the farther backward you can look, the farther forward you can see.” However, looking backwards is often obscured by time, form, or perspective. Nonetheless, if viewed through a reflective and measured lens, it is clear that like all life on Earth, humans are also a historical species, we carry the markers of… Continue reading Histories

The Arrow of Time

Psychologically and experientially the passage of time is malleable. It accelerates during novelty and decelerates with redundancy. It is cyclical but also linear. Depending on perspective or motives, it can be progressive or regressive. The natural world is rooted and synchronized to the cyclical nature of days and nights and the rhythms of the seasons.… Continue reading The Arrow of Time