Medical Hypotheses is one of my favorite academic journals. It is one of the few places in today’s scientific world where one can publish his/her own thoughts on a given topic without backing up every word with references to recent empirical findings and where one can express subjective opinion. This is a great rarity in pubmed-driven academia, and I have read a great number of interesting articles in this journal. Not surprisingly, while many exciting insights are published there, some articles are really unexpected, controversial and weird. My personal favorites are articles by Harinder Jaseja, who insists in a number of papers that meditation predisposes to epilepsy, and holds his ground despite rebuttals from a number of other scientists.
Another article that caught my attention is a recent paper by Sue Llewellyn entitled: “Is ‘bipolar disorder’ the brain’s autopoietic response to schizophrenia?” My pubmed notifications are set to deliver updates about anything related to ‘autopoiesis’ so this article landed in my inbox. I was intrigued, and had to reread the article a number of times in an attempt to make sense of it. I am not sure if I can…
So here goes: the author borrowes the term ‘autopoiesis’ coined by Maturana and Varela in their Autopoiesis and Cognition: the realization of the living (1980), which can be defined as a process by which a living system organizes itself and exists in a state of structural coupling with its environment. In a nutshell, an autopoietic system is self-creating (thus auto-poiesis), it is a closed system that is thermodynamically open to interact with its environment. It can also take on a number of perturbations and will attempt to restore its essential identity, so there is a homeostatic function to a process of autopoiesis.
Here’s an exerpt from the abstract of this article:
The mind/brain is a self-producing, self-organizing system. Autopoiesis applies to such systems. Neuromodulation accomplishes self-organization in the mind/brain. If schizophrenia is a state in-between waking and dreaming, characterized by aminergic/cholinergic interpenetration and dopaminergic imbalance then bipolar ‘disorder’ could be a modulatory response. This autopoietic reaction may take the form of either aminergic hyperactivity aimed at producing a purer waking state, (precipitating mania in the waking state), or cholinergic hyperactivity aimed at producing a purer dreaming state, (producing depression in the waking state), or both, resulting in rapid cycling bipolar disorder. Thus bipolar activity may be an autopoietic response aimed at restoring differentiation to the in-between state of schizophrenia.
Further the author explains in considerable detail similarities and differences in neurophysiology of schizophrenia and bipolar disorder, pointing out that the two seem to be on the opposite ends of the same continuum. I personally agree with the idea that psychiatric disorders perhaps should not be seen as fixed states but rather as dynamic interactive and complex conditions situated along some continuum and not existing in their own niche, and I think that recognizing this non-fixed, changing and complex nature of mental states will greatly help us understand psychic processes and consciousness itself.
However, it seems to me that in this case the term autopoiesis is used synonymously to homeostasis or compensation mechanism. The author argues that if brain in an autopoietic system (yeah… so?), and if schizophrenia is a disorder where mind/brain is ‘trapped’ between waking and dreaming (well… I’m not sure of that at all!), then bipolar disorder is a brain’s: “attempt to restore order – the mind/brain’s autopoietic reaction” (…. what?….). So bipolars are… overcompensating schizophrenics?
Now let’s consider that a schizophrenic person – as a whole – is also an autopoietic system. And his/her mind is also an autopoietic system. Despite, or perhaps with a little help of, delusions and hallucinations this person as an entity is perfectly able to bring forth a world (to borrow Varela’s own words), which is, really the ultimate goal, if you wish, of autopoiesis. Whether this person fits well in a society (which is also an autopoietic system) is another question. Sometimes yes, sometimes no, but he is a part of that system nonetheless. Now, it seems to me that it is the society, as a system, that attempts to regulate and normalize the schizophrenic element. For the schizophrenic person the world is not necessarily incoherent and senseless. Through his autopoiesis, he is able to function in structural coupling with the world. His autopoiesis is actualized. That’s it.
A bipolar person is also an autopoietic system… so is a ‘healthy’ person. Autopoiesis is not a mechanism to ‘normalize’ a system, autopoiesis is a way by which this system functions. Healthy or not, it has its own subjectivity, it creates and sustains itself.
To finish this rant, I’ll evoke Maturana and Varela. They write: “everything said is said by an observer” in relation to the definition of a system and its characteristics. In the case of the present article, an observer decides that a schizophrenic system by means of autopoiesis as some king of a compensatory mechanism becomes bipolar. In my world, this does not make sense. But I am just an observer myself, of course.