Osteopathy de- Still -ed

di Maximilien Girardin

Proposal of a tool, permitting a new consensus platform, touching the actual drifts of Osteopathy in Europe and the World

General introduction

Following the incontestable drifts, noticed since several years in the Osteopathic profession, the authors started subsequently a research, as to the possible causes of these drifts since the 90’s. After targeting these, the authors started a search for one or several rationally acceptable and reconciliatory outcomes to shortcut these drifts that inevitably sooner or later would polarize the Osteopathic community, at the great risk of provoking a schism that may be irrevocable. Our whole world is, as its constituent societies are, in the grip of increasing polarization, between belief and rationality, possible mystifications and plausible truths. Why should the osteopathic profession escape this tendency? Science, as a method of validation and as explorer of our reality, offers its access as solution of excellence. Let us grasp it and use it intelligently.

«Intervene or not, in a complex adaptive system in the full turmoil of reflective polarization», that is the question.

The open letter from members of the Belgian Osteopathic Academy, and school principal of the Sutherland college of Osteopathic medicine Namur Belgium, stating that Osteopathy is not a medical philosophy and that cranial Osteopathy and visceral Osteopathy do not exist and should thus not be instructed and so on, motivated the authors to advance the publication of this methodological essay on Osteopathic Thought and Terminology, and thus to propose a platform for discussion.

This Platform, could offer a reconciliation of the oppositions, or at least a more plenary centering on the levels of Osteopathic philosophy, concept and science, in our profession. We mean the same Osteopathic profession that traditionally suffers intermittently from symptoms of acute apathy.

In depth analysis of the professional polarization

This polarization is in fact as old as the profession self. The reasons are multiple, but are all related in some way to the advancement of the methodology of science since the 1870’s, and the figure of Andrew Taylor Still, discoverer and explorer of Osteopathy.

One cannot call him otherwise as this is how he saw himself:

“I do not claim to be the author of this science of Osteopathy. No human hand framed its laws; I ask no greater honour than to have discovered it.”

A.T. Still’s essential principles, what incontestably distinguishes him from the other medical streams of his time, are his calls to focus on health and its potency of health maintenance instead of pathology or disease. «To find health should be the object of the doctor.”[1]

Apparently he takes intellectually the opposite road, against the mainstream of his epoch; convinced of the perfection of Nature and its products, man included.

«The Osteopath seeks first physiological perfection of form…»[2]

«Still used later on the formulation: ‘complex perfection»[3], which should have drawn the attention of the profession when the publications on complexity started to appear in the 1970-1980’s. But clearly did not.

First question:

Did Still’s conviction of the “complex perfection of Nature and man” come from his childhood’s religion Wesleyan Methodism or from another corner?

This is intriguing while at the moment when he «discovers» Osteopathy, he had already turned away from organized religion[4] [5], even from «Free Masonry» although he mentions several times the «Master Architect», distinctive terminology from the Scottish Ritus.

«The use of the word ‘Divine’ by Andrew T. Still was to describe a concept, that many preachers in 1874 considered as an atheistic thought.»[6].

This question was amplified when the authors found the following phrase[7]:

«Still’s theories had emerged from the medical ideas of his time, not apart from them.»[8]

Could Still’s certainty of ‘the Divine perfection of the human machine’ come from another origin than the religious faith or any other obedience?

Carol Trowbridge reveals, in her historic research on A.T. Still, in his American context and epoch, an interesting fact: “Still was strongly influenced by the evolution theory of Charles Darwin and Alfred Russel Walace[9] essentially promulgated in America by Herbert Spencer”[10].

That Spencer inspired and was efficient in promoting the evolution theory, is still manifesting today. Effectively, the slogans: “Struggle for Life” and “Survival of the fittest” known and sometimes misinterpreted by many, were not expressed as such by Darwin or Russel, but are Spencerian formulations. Andrew T. Still considered Herbert Spencer as his “preferred philosopher”[11]

Historically, osteopathy in its philosophy and concept is very probably directly derived from the evolutionary theory, moreover some of the expressions of A.T. Still are even direct quotes or at least strangely similar to Spencer’s formulations in his ‘First principles’. This is obvious to a point that one of Still’s direct students defined osteopathy in the’ Journal of the American Osteopathic Association’ as «Applied Evolution».[12]

C. Trowbridge writes: «Thus Still must be recognized, as others have been in their fields, for first applying the concepts of evolution to a new approach to healing. »[13]

Second question:

Whyand how did this historical affiliation and important links where subtracted from the educational curriculum and the practical cognition of osteopathy, as well in Europe as in America?

The answer to this question is probably a problem of memetic transmission and memetic derive[14], of which written traces are left.

There are however strong suspicions that another ideologist & fundamentalist phenomenon, «Creationism», might have played a dominant role as we suggest under the paragraph “theEVOST approach”.

Fact is that A.T. Still, since the very first class, had severe disappointments in his school with the students and teachers.[15]

His students:

«At the close of the term, Still was horrified to find that his school had produced nothing but ‘bunglers and imitators’, not one in his opinion, was proficient enough to practice Osteopathy. »[16]

His teachers:

Two major examples that are the most enlightening of this are furnished by Carol Trowbridge and Jane Stark D.O.:

• Carol Trowbridge[17]: “…his (William Smith) and the Littlejohns’ influence began to change the character of the ASO (American school of Osteopathy, Kirksville), leading to an inevitable clash with Still.”
• Jane Stark[18]: “John Martin Littlejohn, the founder of the British School of Osteopathy in 1917, simplified the osteopathic principle/s to one word-adjustment. Littlejohn wrote, “The underlying principle, as applied to osteopathy, is expressed in the word ‘ADJUSTMENT’.[19]

The derive of Stills’ osteopathic principles being, a derive from the principles of the theory of evolution applied in medicine, towards a musculo-osteo-articular technicalization was thus not only geographic between England and the USA but emerged also very early in the history of the profession.

The EVOST approach

The Evost approach was not the start, but the result of a fundamental methodical research in the concept and philosophy of Osteopathy. We give a short review of this research and the enfilading questions that arose from it.

The authors started questioning the principles of Osteopathy as they are generally accepted by the majority of the profession: namely the latest actualized version of 1997[20] of the original Kirksville consensus Declaration from 1953.

(For the purist readers it is very interesting to follow the intellectual and historical path from Spencers’ « First principles » and his formulations over A.T.Still’s formulations in « Philosophy of Osteopathy » to arrive at the Consensus declaration from 1953. This is the way followed by C. Trowbridge[21] while Jane Stark D.O.( in course of edition) chose a pure Stillian path. We chose to start from the 1997 version, because it is the one in use and generally accepted today and the other way would carry us too far for this methodological essay).

1. The body is a unit; the person is a unit of body, mind and spirit.
2. The body is capable of self-regulation, self-healing, and health maintenance
3. Structure and function are reciprocally interrelated
4. Rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship of structure and function.

As enounced earlier on: ‘The essence of the principles of A.T. Still, in which he distinguishes himself of the other medical streams of his epoch, is that he calls to focus on health and its potency of self maintenance instead of pathology or dis-ease..’ This is reformulated in the ‘Kirksville consensus Declaration’ that conceals the direct filiations with the theory of evolution of species from Charles Darwin, A.R. Wallace, and popularized in America by Herbert Spencer.

Even after long mailings and discussions with Carol Trowbridge, Jane Stark and Walter McKone, it was impossible for us to find out the how’s and why’s of this specific reformulation happened, but we suspect that the very popular and increasingly virulent wave of Creationism[22], in the USA since the eighties might have had its influence. Not like in a “conspiracy theory” but as an unconscious steering reason for political and public acceptance for the American audience, that is generally very religious. (Each political speech tends to be closed by the famous: “God bless America” for the same reason.) The question resides: ‘was the 1953, 1997 consensus declaration formulation the result of a populist form of diplomacy, that resulted in larger and deeper consequences than expected or thought?’

 We suspect it on the basis of coincidental information and correlating facts which are of contextual order as follows:

Two years after the Consensus Declaration reformulation 1997, in 1999[23] the ‘School Board’ of Kansas (Geographical origin of Osteopathy), decides officially to abstain the high schools of the obligation to examine the theory of evolution of species although it is in the biology curriculum.

One year later, in 2000 a survey was initiated by ‘People for the American Way’ [24] this resulted in:

• 20% of the interviewed Americans think that public schools should exclusively teach the theory of evolution of species.
• 17% of the interviewed Americans think that public schools should exclusively be taught in science class, while the religious (Creationist) explanation should be taught in another class.
• 29% of the interviewed Americans think that public schools should discuss Creationism in science class as a «belief» and not as scientific theory.
• 13% of the interviewed Americans think that public schools should teach Creationism and the theory of evolution, both as science theories in the science class.
• 16% of the interviewed Americans think that public schools should exclusively teach Creationism.

According to a study between 1985 and 2005 that was published in Science, the number of American adults that accept the theory of evolution of species diminished from 45% to 40%, while the number of the American adults that reject the theory of evolution of species also diminished from 48% to 39%, whereas the number of American adults that was undecided increased from 7% to 21%. Parallel this study compared the same data of 32 European countries, Japan and Turkey. The only country where the acceptation of the evolution theory was inferior to the USA was Turkey with 25%.[25]

Creationist influence thus stays a credible option to retain as answer to the second question. (See also the «Scopes Monkey Trial» in 1925 in Tennessee)

Most Americans that believe in creationism tend to vote Republican (the opposite is certainly not necessarily true!), so if one looks at the results of the elections in 2004 between Bush and Kerry, one can put it into a pictorial representation. (Kansas is ± in the centre of the USA, while Tennessee is more eastwards.)

This image is not more than a coincidental indicator, but calls to reflection. Every specific subject or theme always stands in a specific environment (space and time), thus the diligent observer should observe both subject and background (environment).

The authors, trying to dismantle from any dogma, did the exercise to test out if “the theory of the evolution of species” and “the principles of Osteopathy” are contradictory or if they demonstrate a conceptual and practical affiliation; and are we as a profession in that case actually consequently drifting away from our very essence our basic and maybe traditional principles?

The whole of this work forms a text that beholds ± 500 pages of which we’ll just summate the essence here:

The basic principles of «The theory of evolution of species » can be synthesized as follows:

–     1st principle being Micro-evolution. Microevolution is generated by the constant accumulation of small differences (mutations) in individuals of one species, what results in variation or diversification within that species. With as implicit underlying principle that organisms are self-regulating and self-propagating (replicate as individuals and as species, thus replicate their characteristics.) Concept that lead Richard Dawkins to the view of the selfish gene and memetics. [26]

–     2nd principle being Natural Selection. Selective pressure (competition) generating natural selection of the environment on a species; thus selection by eliminating certain characteristics by means of the procreating rate of the individuals carrying these characteristics. (Spencer’s well known « survival of the fittest » and « struggle for Life ») Spencers’ formulation is often misinterpreted therefore: Selection applies essentially through two vectors being the reproduction rate and sometimes the mortality rate. The efficiency of the reproduction rate being: the efficiency of the species and individuals to reproduce and their capacity to bring their offspring to procreating age. The mortality rate being: the rate of mortality of individuals in comparison to the reproduction rate and thus the species in their specific environment. (A.T. Still very probably thought that at this level osteopathic work could intervene: by helping to maximize the expression of the inherent natural health potential sometimes troubled by functional (potential reducing) disorders which are remediable by osteopathic intervention.)

–     3d principle being Speciation or Macro-evolution. The earlier two principles generate new species in time; this phenomenon is accelerated if the new characteristics (individuals) get isolated from the original species by environmental circumstances. As they have new characteristics they tend to conquer new ecologic niches or sometimes take over the niche of the traditional species. With globalization and the continuous introduction of new species this phenomenon is obvious to every diligent observer certainly to nature lovers and farmers. (A new species is defined by the systemic incapacity to reproduce fertile offspring with the species of origin or sister species: for example the horse, the donkey, or the zebra and the mule.)

–     Principle of the Red Queen[27]: Species (fauna and/or flora) which are in competition with each other, for instance have a predator-prey relation, augment the selective pressure; in consequence the speed of evolutionary adaptation to the environment. This previously known principle was recently dismantled and experimentally demonstrated in Africa as example between the Great Kudu and the acacia.[28]

Example in short:

The Kudu browses the acacia’s leaves > the acacia grows big thorns between the leaves out of some of the buds > the Kudu developed in time a longer more agile tongue and adapted its browsing technique >the acacia augmented its tannin production as soon as it is browsed upon, with a latency of ±20 minutes > the Kudu learned to browse no longer than ± 15 minutes on the same tree or bush > the acacia liberates volatile pheromones that warn the other downwind neighboring > acacia’s to start producing tannins despite their not browsed at yet > the Kudu’s adapted by learning to browse upwind

(Fences made smaller browsing territories to a problem in South Africa, and this is the reason why it was discovered: after fencing smaller area’s there was suddenly a high mortality in young healthy kudu bulls; because they were chased out of the adult bulls territory and thus forced to poison themselves by eating tannin rich leaves)

These major principles and their combined interactions since 3.8 billion of years in Life and since ± 200.000 years in man could only have lead to a perfectly oiled mechanism that creates the synergy in Nature’s truth or as Still and Spencer say: a progress towards complex perfection in every dimension. [29]

Reformulating Osteopathic philosophy and principles according the evolutionary principles is thus an easy exercise; actually it is a return to its source of origin. [30] [31]

Now finally we arrive to the essence of what the title of this Methodological Essay promises: the Di-Still-ation of the osteopathic formula, in all respect to the discoverer of osteopathy.

So let us start with the Di-Still-ation process by the accepted set of principles, which he did not formulate (so they are already di-Still-ed), the actualized version from 1997[32] of the earlier Kirksville consensus Declaration of 1953.

1. The body is a unit; the person is a unit of body, mind and spirit.
2. The body is capable of self-regulation, self-healing, and health maintenance
3. Structure and function are reciprocally interrelated
4. Rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship of structure and function.

If we can make one very important pre-suggestion: Form = structure & function as one, although we prefer the term behavior instead of function what Osteopaths usually use.[33]

Than this could be the EVOST reformulation of the consensus declaration:

1. Human organisms’ complexity evolved in “Form”, with consciousness, mind and spirit as emergences, as an indivisible whole.
2. Human organisms demonstrate resilience and health maintenance by means of self-regulation, and self-repair.
3. Micro-, macro-evolution as well as self organization compose interrelated structure and function as “Form”, whereas natural selection favours the best adapted “Forms” to its environment.
4. Rational treatment is based upon an understanding of the complexity and the basic principles of “Form” unity, “Form” self-maintenance, and “Form” adaptation to the environment.

Even if the majority of the profession would accept to do the intellectual effort of a return to the sources of its origin and science, nevertheless it would still be confronted with the Gordian knot of our very first question, and its paradoxes of vitalist and reductionist drifts that osteopathy knows today.

Remember the First question: Did Still’s conviction of the “complex perfection of Nature and man” come from his childhood’s religion Wesleyan Methodism or from another corner?

The ungraspable essence of the obsolete vitalism: “The whole is more than the sum of its parts”, is and stays a thorn in the eye of every rationally thinking individual.

Despite that paradox the ‘convinced vitalists’ have a point, while effectively “The whole is more than the sum of its parts”.

On the other hand the essence of the reductionists hold the other point: « the knowledge that can be verified and quantified, is the only valid knowledge ».

– – – GORDIAN KNOT? – – –

A.T. Still apparently had solved this poignant question or dilemma, in an inelegant way, by turning towards the only lines of thought that in his time were busy with this complex question: the Methodist opinion, the Masonic or others…by using their vocabulary and incorporating it in his writings: ‘God’ that became later ‘The Master Architect’ to end in ‘The God of Nature’.

This very inelegant solution is clearly not a workable, rational option for everyone in our 21st century.

But she is certainly revealing of the clash point between the drifts of ‘vitalism’ and ‘reductionism’ within the profession.

The authors think nevertheless that this does not have to be a knot of any kind, when we illuminate the intricate problem by the appropriated sciences.

In this specific case, ‘complex systems theory’ can do the job and solve the so-called Gordian knot in an elegant way. (According to the legend, Alexander the Great, failing to unravel the Gordian knot, cut it through with one blow of his sword. A priori a solution that would be as inelegant as Still’s solution in his consecutive books.)

– – – An Epistemological rupture that is inevitable or

a manifest lack of intellectual courage? – – –

The osteopathic profession balances since years on the edge of an epistemological rupture, if we as responsible professionals want to evict a destructive schism that might annihilate the profession, it is largely time to find a way of communication between the fundamentalists on both sides of the profession. This communication begins with the Spirit, the reasoning and uses a language or terminology. Or as put by Bernard Weber: (translated from French)

«Between what I think,

what I want to say,

what I think that I say,

what I say,

what you want to hear,

what you think to hear,

what you hear,

what you want to understand,

what you think to understand

and what you understand…

THERE ARE AT LEAST 9 POSSIBILITIES FOR NOT HEARING EACH OTHER.

But let us try anyway.

We are involved in the active research to find a solution, since the 1990’s, and we think that it can offer to the profession at the same time reconciliation on the level of the Spirit, the reasoning and the terminology. What we cannot offer, to our regret, is the will to communicate.

We leave this to the benevolence of each.

For the authors it is clear that a possible solution lies in the enlightening use of two sciences which are closely affiliated: “the theory of the evolution of species” and “the complex systems theory”. (These are in our opinion osteopathy’s source and future.)

In order to appreciate this conception, an introductory review of the complex systems theory is necessary while obviously this science is practically unknown to the Osteopathic profession.

A.T Still with his ‘Complex Perfection’, was not able to refer to or reflect about it, to formulate the complexity he observed, as complex systems theory saw the daylight 100 years after osteopathy was discovered.

Reflective questions to the diligent reader:

Can we take a grudge against a scientific explorer like Newton, for instance, for not having gone further in his reasoning, like the relativity theory for example and thus have demonstrated a slight piece off the truth? Must he and his work be considered as obsolete and relegate him to Oblivion? (Because his laws are wrong, they are usable on earth but there is an inherent error present as Relativity demonstrated) Or do we try to see dear old Isaac in his epoch and actualize his discoveries: keep the valuables and make use of them in the restricted frame where they are± correct and reformulate the rest of his thoughts to the knowledge of this century? Does Still earns the same treatment as Isaac Newton or are we so shortsighted as a profession?

This introduction will review shortly the study of complexity as a subject and what emerged from the study…

‘Complex System Theory’ [34]

Complex Systems theory (CST) is the unifying or coordinating theory, which was generated in the eighties, out of distinct scientific branches but having a common interest. This interest goes out on the study and research on the phenomenon complexity in itself, the mechanisms at work in complexity, and the genesis of self-organizing systems and their characteristics.

These diverse scientific and specific branches were: Cybernetics, Homeokinetics, General Systems theory, Systems dynamics, Gestalt, Chaos theory, Morphogenesis or Developmental Biology and Cellular automata. The big branches from which these developed are: Economy, Mathematics, Biology, Physics, Sociology, Anthropology, Psychology and combinations like ‘Fibonaccic Phylogenesis’ (Evolutionary Biology – Fractal mathematics).

The interrelations and common interests of these different disciplines intensified the interdisciplinary collaboration since 1980. This to a point that a new Institute was created in Santa Fe [35] in 1984 to facilitate and increase the interdisciplinary exchange on complex systems.

In order to favorise the comprehension, here follows an organigram that leads to the COMPLEX SYSTEM THEORY

The evolution of the Complex System Theory up to this point of integration permits its use in different domains and dimensions where complex systems are at play. (As example: the behavior of a unicellular organism, the development of an embryo, the behavior of a society, culture, population, financial model, ecosystem or biosphere, ecologic niche etc…) [36]

Another hint of the validity and practical applicability of the Complex Systems Theory is the fact that it was introduced and is in use in the US Army since 1990, for instance in its military doctrine for the Marine Corps.[37] It is difficult to accuse military doctrine not to be materialistic and systematic in their approach.

It seems logic to the authors, to turn towards the Complex Systems Theory to solution the Gordian knot within the Osteopathic approach.

To realize this, the authors had to initiate into complexity, before entering the territory of the complex adaptive systems that was the primary goal[38].

Therefore some very accessible references to introduce the interested reader into this theory:

¨    Lewin, Roger. Complexity, Life at the Edge of Chaos. New York: MacMillan Publishing Co., 1992.

Sites:

¨     Santa Fe Institute (www.santafe.edu)

¨     Scientific American (www.sciam.com)

¨     Stephen Wolfram (www.stephenwolfram.com)

Review:

The laureate of the Nobel price of Physics in 1972, Phil Anderson defines complexity as: “Complexity is more …and more is different.” [39]

In other words, complexity appears as soon as there is more than one parameter or agent that interacts; and a complex system demonstrates a behavior that is different from the simple agents or there sum…

–      – -Sounds familiar, rings a bell? – – –

More than one agent can self-organize in a collective object or system if they interact (n x 1(interaction) = a system).

This collectivity or system demonstrates emergent behavior, behavior that is distinctively different of the behavior of any or every single agent, or their sum of behaviors, and this even if they have the same basic algorithms (same genetics for example)

This emergent behavior or emergent characteristic can, according to the authors, be the ungraspable: more than the sum of the parts. The paradox that maddens both extreme convictions within the profession: vitalism and reductionism.

This emergent behavior is also considered as the missing link of the evolutionary theory. Although there are lots of converging experimental proofs, certain critics still doubt of the universality of the complex systems theory, using arguments that recall creationist reasoning. [40]

Overview of the definitions in use of the Fellowship:

Definition of a Complex System – A system is a complex collective unit in space-time, constituted by local agents, which by local interactions bring this unit to a configuration –FORM- that the unit tries to maintain, despite a continuous changing environment.  

(Unit, self regulation, self maintenance, self healing, form as structure and function in one…: the bell is ringing louder yet?)

Characteristics of a Complex System – A resulting complex system, demonstrates not exclusively the behaviour of each of its composing agents, but also a new emergent behaviour. This emergent behavior or emergent characteristics emerge from the complexity of the system. The behavior or characteristic is thus inherent to the complexity of the Form of the system.

Self-organization of a system – each system that forms without external constraint can be called self-organizing. The genesis and evolution of a self-organizing system towards a more complex Form is done in the absence of external constraint or restrictions. (The Form of the system can be its own constraint or restriction depending on the systems stability, resilience and internal congruency)

Characteristics of self-organization:

1. Absence of a central guidance control (the competition between the agents is the motor)
2. Multiples balance points (multiple attractors & basic algorithms)
3. Global order (emergence from local interaction)
4. Resilience (relatively insensitive to damage, tensegrity[41] of Form)
5. Self-maintenance (self-repair and Form maintenance mechanisms)
6. Complexity (multiple parameters or agents, sometimes called : fracture of symmetry)
7. Hierarchy (multiple levels self-organizing with a consistent chronology and hierarchy)

Properties of Complex Adaptive Systems:

•      CAS have a history (chronology and hierarchy) and a memory that conserves its record: The history of a CAS is important and cannot be ignored. The system has a memory that records its history and conserves track of it. Small changes of circumstances (interactions) in the system can lead to big changes in time; this property is often referred to as the “Butterfly effect.” (For example: the genes and their history record keeping in every living organism. Specific example of the butterfly effect: Drepanocytosis or Sickle Cell disease, one amino acid that is wrongly positioned in the β protein provokes the well known syndrome. Natural selection did not eliminate this error thus it is not an error that leads to a disease but a track change that carries an advantage. The genes kept the historical track of this change and it is clearly an evolutionary advantage: the change happened in the Negroid-populations[42] of central (Equatorial) Africa where malaria is endemic since ages. People that are infected by the malaria parasite and which also carry the “Drepanocytosis or Sickle Cell” track change are so resistant that their mortality rate is hugely lower than «normal» gene track people in relation to malaria. Would not slavery have carried these African Negroid-populations to other environments where there is no endemic malaria, it would never have been called a disease but a resistance. The problem was thus the forced change of environment by slavery of the complex adaptive systems well adapted to their environment by evolution and natural selection)

•      CAS are nested: (Nested should be understood as in – a bird is nested: comfortably sitting in a nest, which is in a nesting box, well attached under the cover of your roof. In other words like the Russian Matrushka puppets that are nested within each other) Nested means thus that the agents composing a CAS are themselves Complex Adaptive Systems. (For example: In a descending dimensional rate – a population is constituted by organizations (tribes or clans, or trades) which are themselves formed by people (families or others)which are themselves constituted by human individuals, themselves constituted by organ systems, themselves constituted by tissues, themselves constituted by cells themselves constituted of organelles which are ancient prokaryotes …) – The whole of these units or systems (Complexity levels) are each and all organized according to a chronology and ensuing hierarchy and can thus all of them separately and as a whole be considered as CAS. (Whereby each CAS (complexity level) forms the nest or environment of the next when on looks at it in descending hierarchical and dimensional rate)

•      CAS are determinated by the agents composing them: The Form (structure & behavior as one) of the composing agents and their properties are determining the characteristics of the studied environment. (For example: the Form of the agent neuron is going to determinate the characteristics and behavior of a neural network or a nervous system.)

•      CAS are heterogeneous: The agents are different the one from the other in characteristics and Form. (For example: a motor neuron is different from a sensitive neuron or from an interneuron.)

•      CAS are dynamic (tend naturally towards the edge of chaos): The dynamics that describe the changes or the evolution of CAS are non linear, mostly even chaotic. CAS are thus never long in a stable balance; CAS develop a dynamic balance and try to maintain themselves there despite the constant and non linear changes due to their environment. ( Edge of Chaos) (For example: A glucides rich meal will destabilize in a non linear fashion the dielectric and osmotic balance of the blood; and by this way the interstitial fluid that is the environment of almost all cells of that organism. Each and all of these cells in their hierarchy are CAS that react to maintain their dynamic balance. The type of reaction of each of these CAS will depend on their specific characteristics and Form and of the impact of the balance disrupting stimulus. (In humans glucose levels above 180 will disrupt the endothelial tight junctions.) Factually, CAS have only five possible reactions : association (absorption of the balance disrupting stimulus), metabolization (transformation of the balance disrupting stimulus), internal reorganization (which can go two ways : replication of the CAS and or differentiation of the CAS with a loss of potential), and finally decomplexification or dispersion of the system (destruction or death) The CAS stops its local interactions and falls apart into smaller components until these agents reach a dynamic balance with the environment again. Most of these reactive possibilities influence more or less the environment of the CAS and thus the CAS itself (autocrine communication, paracrine communication, endocrine communication, neurocrine communication, in the evolutionary chronology) Which is actually so remarkable that we can classify it as the next property)

•      CAS demonstrate feedback mechanisms or self-regulation mechanisms: (The mentioned communication systems above are a perfect example of this property too). The changes that happen as reaction in a CAS are often the result of feedback (self-information), to which the agents are submitted as consequence due to their own activity and eventually emergent behavior. (This explains for example why all physiological measurable data of an organism demonstrate dynamics that are ± of sinusoidal nature. Whereby each top or valley of the curve re-launches a systemic reaction, and that the zero or balance axe can be seen as the middle or theoretic average of the dynamic balance.).

•      CAS demonstrate organized Form: (Form is structure and behavior as one) The agents self-organize in groups or hierarchies imposed by their chronology of genesis. This type of organization is usually very structured; moreover will this structurisation in time impose the Form evolution of the CAS in time. (For example: a blood vessel is generated embryologically by a flux or liquid trajectory already present in the mesenchymal interstitium. Once the blood vessel is formed, it will direct the Form of the cells and tissues in its direct surroundings, because it is the prime source for more balance-disrupting stimuli) Specific example: the embryologic aorta will provoke the flexion curvature of the forming spinal column in its development by restraining its longitudinal growth on the front side. The aorta does grow too but so much slower that in fact it behaves as a restraining apparatus. It will do this so severely, while the column continues its longitudinal growth that fissures or rips will appear in the backside of the growing connective tissue and future spine. These rips will evolve to become the well known articular facets of the later spinal column.)

•      CAS demonstrate emergent behavior: The macroscopic or systemic behavior is generated by the complexity of the local interactions of the systems constituent agents; but which is different of the sum of the individual behaviors. From behavioral point of view one can thus state that: the whole is more than the sum of the parts. (For example: an ecological niche, a tissue, an organ etc. Specific example: one pine tree on a pasture forms a whole with specific properties. Fifty pine trees, close to each other on a pasture make a small park, (a system) we give it another name because it behaves differently than let us say fifty pine trees spread out on a very big pasture. Remember Phil Anderson’s expression: Complexity is more and…More is different (emergent behavior or the vitalism’s call to arms: “the whole is more than the sum of the parts”.))

•      CAS have local or proximity interactions, from neighbor to neighbor: It is characteristically that interactions in a CAS impart on direct neighbors; in other words on very short distances. The balance disruptive stimulus (information) thus always comes from the direct environment of the CAS. The multiplicity of stimuli or interconnections and the state of the system will make that the impact of the stimulus or information is modified along its route. (For example: All of the communication systems in their hierarchic chronology do nothing else but communicating to their direct neighbors the environment (interstitial fluid) and thereby another Cas: see autocrine, paracrine, telocrine, endocrine or neurocrine communication. The quantifiable parameters in cellular and neuro-endocrine physiology, as well as blood tests, are the result of chain reactions that convey and modify the information along the route.)

•      CAS are open systems: Energy, matterand therefore information pass continuously through the systems’ frontiers (import and export). These constant changes make that CAS are continuously dys-balanced, nevertheless they demonstrate a remarkable impression of congruency and stability with a certain local and general resilience. (In a limited timeframe). (For example: All living organisms are open systems: they are continuously submitted to balance disruptive stimuli from their environment: physical, chemical stimuli and information. (air, temperature, food, liquids, sounds, light, cosmic radiation, etcetera…as entering stimuli ; defecation, urine, sweat, exhaled air, infra red radiation all emitted by the organism as exiting stimuli for the environment. All living organisms have emissions in the environment caused by a stimulus of the environment on the organism as balance disruptive stimulus.)

Figure: self-organization of a complex system evolving towards a complex adaptive system demonstrating emergent behavior. (www.santafe.edu/selforganising systems/faq, www.wikipedia.com/complexity)

CAS are self-organizing systems which evolve towards a configuration or state, which is the best adapted to their continuously changing environment; moreover they tend to evolve towards the source of the stimuli in the environment. Once there they are even more submitted to stimuli from the environment.  This remarkable behavior is often referred to as evolving (moving) towards the edge of Chaos.[43]

« The Edge of Chaos » is the environment or intermediairy region that is situated between the zone of Chaos[44] and the zone of Order[45].

Goethe, Spencer or Still would probably have described macroscopically the concept of the Edge of Chaos as: “Life develops between the frenetic chaos of the skies and the crystalline order of the mineral earth, but as any tree, striving towards the edge of the chaotic skies». Or in a more romantic poetic version: “Life planted its roots in the crystalline order of the earth but tended its vertex towards the chaos of the skies.” These are two descriptions which are symbolically similar but formulated different than the dry Edge of Chaos.

The concepts of «The CAS that self-organize and evolve in order to evolve on the edge of Chaos» offer a possible epistemological solution to the potentially schismatic paradox between the “vitalist-mystic” and “reductionist-scientist” factions within the osteopathic profession, in our opinion.

Citation for example of: Peter Conveney and Roger Highfield, from their “Frontiers of complexity”[46]:

“Life is not some sort of essence added to a physico-chemical system, but neither can it simply be described in ordinary physico-chemical terms. It is an emergent property which manifests itself when physico-chemical systems are organised and interact in particular ways.”

These are the words of the former Archbishop of York, John Habgood, a one-time physiologist who believes that the scientific world-view afforded by complexity is in many ways a more theologically comfortable notion than old ideas about ‘vitalism’.

In his address to the 1994 annual meeting of the British Association for the Advancement of Science, Habgood voiced the opinion that the creative work of God can be found in the growing complexity of organisation during the development of organisms: “Indeed, there is a hint of this in the very first words of the first chapter of Genesis where God is seen as bringing order out of chaos.”

Especially the last sentence is revelatory from a philosophical point of view; the authors do not support the chosen terminological choice, in which self organization and emergent behavior are accredited to the Divine intervention (exactly the inelegant choice A.T. Still used). On the contrary, but there is another way to look at it; “When individuals with such different convictions and conceptions of the world are able to communicate on identical phenomena, with a neutral terminology that enables them to stay loyal to their identity and personal convictions, than this whole approach may indeed offer an epistemological solution.”

As this example demonstrates, the use of this concept permits to leave everyone in his own loyalty, while opening the communication channels and proposing a “neutral” language that can cross the growing rift in our world. If we can make sure that intimate conviction, personal interpretation and the terminology referring to it can stay in the domain of the individual thought.

Complex Systems Theory and its specific but neutral terminology, may offer to the osteopathic profession a possible, conceptual reasoning and communication way, to all opposed factions and the silent majority in between, while defusing the emotional explosive danger of the themes and their actual language.

This way of reasoning and its rational, neutral terminology, when communicating on systemic complexity, permits to leave “vitalistic belief” and “Cartesian reductionism” where they belong: in the individuals’ neural networks of both cerebral hemispheres.

The authors hope for the future of the CAS, which is in this case the Osteopathic profession, to facilitate this approach in its spread and use. Less conviction and more self-questioning for all factions is compulsory.

As suggests the agnostic philosopher Leo Apostel[47], in his book Atheïstische Spiritualiteit[48]: (free translation)

“All of us situate ourselves within a tradition.

We are all continuing something.

But it is essential to understand that he who situates himself in a tradition should recreate this tradition for himself.

Life is not a repetition.

Continuing a tradition is not to repeat it blindly.”

Or in the words of Gustav Mahler:

«Tradition, is to keep the fire going and not to worship the ashes»

The osteopathic profession could by choosing this route conserve and valorize its philosophical foundation, which in the authors opinion, is not obsolete, neither in contradiction with scientific thought, according to the criteria of evolutionary Biology and Complex Systems theory.

On the other hand the profession needs urgently an actualization of its thought, its terminology and the formulations that arises from these.

The only fractions, for whom this call will probably never be acceptable, are the dogmatic scientifics and the Creationists of this world.

On an educational and therapeutic level, this line of thought, grounded on evolutionary biology and complex systems theory, offers other practical advantages.

For example: it offers a systematic chronology with inherent hierarchy, as well for the educational training, as for diagnostic or therapeutic intervention; which can all be founded on the genesis, the evolution and the complex system behavior of the human Form.

The new terminological platform proposed, if it manages to pass the level of just conceptual thought, can improve dramatically the therapeutic approach of the patient and its health.

In 1998, conscious of the increasing paradox positioning in the osteopathic profession, the authors were in search for the possibility of a new approach to find a solution. The authors had the opportunity to test the feasibility of this epistemological solution, by organizing an experimental philosophical postgraduate course for D.O.’s. The first invitation, to present this line of thought to a public of D.O.’s and M.D.’s, came from the South African Register of Osteopathy, in Johannesburg in the year 2000. This philosophic course was and still is titled:

“Evolutionary medicine within the Osteopathic field”.

Today it is an open course, as we consider it’s experimental – developmental phase over but not closed. The participants are interested osteopaths that contribute to the heuristic development of this line of thought for Osteopathy. Our participants and collaborators are residents of South Africa, Namibia, France, Switzerland, Germany, Scandinavia, Italy, Spain, Netherlands, UK and Belgium that all gather at least twice a year for four days.

Remarkable observations until today

When the different groups of the Fellowship meet and mix, everyone can observe that: despite the fact that the professionals come from both factions (‘vitalism’ & ‘reductionism’) and are of very distinct personal convictions (Reformed Protestants, Evangelists, Moslims, Catholics, Buddhists, Free Masons, Agnostics and Atheists), they usually succeed to exchange views while in the discussion transcending to the level of phenomena, mechanisms and complex systemic behavior.

Here some examples of, Evost Fellowship, suggested reformulations of Stillian terminology, which are still in use but are irritating words with a nebulous concept:

Osteopathic terminology 1874

1.   Creation

2.  Divine perfection

3.  Breath of Life

4.  Architecture or machinery of Life

5.  Health

6.  Potency

7.  Life

8.  Dis-ease

9.  Harmony, harmonious function

10.  Health maintenance

Actualized      Platform terminology

1.   Self organization

2.  Natural selection adapted outcome

3.  First emergent behaviour from the CAS(see 4)

4.  Complex adaptive system’s tensegrity

5.  System’s optimal resilience

6.  Systems stability & congruency behaviour

7.  Complex adaptive emergent behaviour

8.  Environmental pressure, chaos ≥Resilience

9.  CAS maintaining on the “Edge of chaos”

10.   CAS self regulation & self maintenance

1997 version of the Consensus Declaration of Kirksville, with complexity added could give this for example:

1. Human organisms are complex adaptive systems that self organized and evolved in “Form”, with consciousness, mind and spirit as emergent behaviour, as an indivisible whole.
2. Complex adaptive systems like human organisms demonstrate health maintenance and resilience by means of self-regulation, self-repair mechanisms and replication; individually and as a species.
3. Self organisation, micro and macroevolution composes interrelated structure and function as “Form” while natural selection favours the best adapted “Forms” to the environmental conditions.
4. Rational treatment is based upon an understanding of the complex adaptive systems and the basic principles on which they behave, being: “Form” unity, “Form” resilience (self-maintenance and replication) and “Form” adaptation to the environmental conditions.

These propositions are certainly not fixed or inalterable as a dogma, but still under philosophic discussion within the Fellowship, the exercise is done over with each synthesis seminar in discussion form.

The observation of the majority of the Fellowship is that within the Fellowship we behave as a CAS, which evolves out of the conceptual and convictional war-trenches towards the dynamics at the edge of philosophic, conceptual and scientific chaos. Or like W.G. Sutherland used to put it after a particularly successful treatment: “The Boss has come home”. (Patternless dynamic balance is back again).

The authors sincerely hope from the bottom of their hearts that this introduction into another osteopathic line of thought may help to open the discussion between rivaling fractions and eventually offer a platform for discussion to «enlightened osteopaths» of good will, who too often are the silent majority…

Sincerely and con-fraternally yours,

Max Girardin D.O., EVOST Fellow, with the enlightened intensive collaboration of

Jean-Marie Cortoos D.O., EVOST Fellow

Etienne Deslee D.O. EVOST Fellow

for the Evost Fellowship 2008.

Cheers, and don’t forget Still’s words:

“Never surrender, but die in the last ditch. 

This is a war not for conquest, popularity, or power. 

It is an aggressive campaign for love, truth, and humanity”

[1] A.T. Still, Philosophy of Osteopathy, published by A.T. Still, Kirksville Missouri 1899, P 28.

[2] A.T. Still, Philosophy of Osteopathy, published by A.T. Still, Kirksville Missouri 1899,P 27, Introductory remarks.

[3] C.Trowbridge, ‘Andrew Taylor Still, The Thomas Jefferson University Press, Northeast Missouri State University, Kirksville, Missouri, 1991. pp 112

[4] «He was outspoken in his disbelief in a personal God and his distaste for all church organizations» C.Trowbridge, ‘Andrew Taylor Still, The Thomas Jefferson University Press, Northeast Missouri State University, Kirksville, Missouri, 1991. pp 120

[5] Andrew Taylor Still,‘Autobiography of A.T.Still’, Published by the author, Kirksville Missouri, 1908, pp 203, 205, 208-9, 308-9, 392.

[6] C.Trowbridge, ‘Andrew Taylor Still, The Thomas Jefferson University Press, Northeast Missouri State University, Kirksville, Missouri, 1991. pp 121

[7] C.Trowbridge, ‘Andrew Taylor Still, The Thomas Jefferson University Press, Northeast Missouri State University, Kirksville, Missouri, 1991. pp 139

[8] « Manipulative therapy : A Historical perspective from Ancient therapy. » Lomax E., A workshop at the National Institutes of Health, February 24, 1975. Edited by M.Goldstein, National Institute of Neurological and Communicative Disorders and Stroke, Bethesda Maryland, 1975.

[9] Alfred Russel Wallace, «On the Law Which Has Regulated the Introduction of New Species”Annals and Magazine of Natural History in September 1855

[10] C.Trowbridge, ‘Andrew Taylor Still, The Thomas Jefferson University Press, Northeast Missouri State University, Kirksville, Missouri, 1991. Chapitre 4, 5 and 6 are practically dealing with the fundamental relationship between the discovery of Osteopathy and the evolution theory on which she was founded.

[11] C.Trowbridge, ‘Andrew Taylor Still, The Thomas Jefferson University Press, Northeast Missouri State University, Kirksville, Missouri, 1991. pp 118

[12] « Osteopathy in the Light of Evolution »Mc Connell Carl P., Journal of the American Osteopathic Association n°12 (May 1913): pp500-32

[13] C.Trowbridge, ‘Andrew Taylor Still, The Thomas Jefferson University Press, Northeast Missouri State University, Kirksville, Missouri, 1991, pp 164

[14] Memetics is an approach to evolutionary models of cultural information transfer based on the concept of the meme. Starting from a metaphor used in the writings of Richard Dawkins, it has since turned into a new area of study, one that looks at the self-replicating units of culture. It has been proposed that just as memes are analogous to genes, memetics is analogous to genetics. In his book The Selfish Gene (1976), the ethologist Richard Dawkins used the term meme to describe a unit of human cultural transmission analogous to the gene, arguing that replication also happens in culture, albeit in a different sense. In his book, Dawkins contended that the meme is a unit of information residing in the brain and is the mutating replicator in human cultural evolution. It is a pattern that can influence its surroundings – that is, it has causal agency – and can propagate. This created great debate among sociologists, biologists, and scientists of other disciplines, because Dawkins himself did not provide a sufficient explanation of how the replication of units of information in the brain controls human behaviour and ultimately culture, since the principal topic of the book was genetics. Dawkins apparently did not intend to present a comprehensive theory of memetics in The Selfish Gene, but rather coined the term meme in a speculative spirit. Accordingly, the term “unit of information” came to be defined in different ways by many scientists. The term is a transliteration the Ancient Greek μιμητής (mimētḗs), meaning “imitator, pretender”, and was used in 1904 by the German evolutionary biologist Richard Semon, best known for his development of the engram theory of memory, in his work Die mnemischen Empfindungen in ihren Beziehungen zu den Originalempfindungen, translated into English in 1921 as The Mneme.  (www.wikipedia.org/ memetics)

[15] C.Trowbridge, ‘Andrew Taylor Still, The Thomas Jefferson University Press, Northeast Missouri State University, Kirksville, Missouri, 1991. pp 145

[16] A.T. Still, «Experiences along the road» Journal of Osteopathy 2, September 1895.

[17] C.Trowbridge, ‘Andrew Taylor Still, The Thomas Jefferson University Press, Northeast Missouri State University, Kirksville, Missouri, 1991. pp 174

[18] Personal Communication with J.Stark D.O., during the friendly ‘Peer review’ of her article: « The basic principles of Osteopathy: as outlined by A.T. Still.».

[19] J. Martin Littlejohn, « The prophylactic and curative value of the science of Osteopathy » address presented to the Royal Society of Literature, London, reprinted in Journal of Osteopathy 6, February 1900: 365-84.

[20] American Osteopathic Association, R.C. Ward editor, «Foundations for Osteopathic medicine» Williams & Wilkins Baltimore1997, pp 4

[21] C.Trowbridge, ‘Andrew Taylor Still, The Thomas Jefferson University Press, Northeast Missouri State University, Kirksville, Missouri, 1991 pp 159-161, chapitre 6

[22]Creationism: Creationism is the theory that man, the earth, and the rest of the universe were originally created rather than randomly exploding from nothingness into chance existence.(Source: http://www.creationism.org)

[23] Kansas school board’s evolution ruling angers science community. CNN.com (1999). URL accessed on August 12, 2005.

[24] Evolution and Creationism In Public Education: An In-depth Reading Of Public Opinion PDF (481 KiB), www.pfaw.org/pfaw/dfiles/file

[25] “Public Acceptance of Evolution”. Science 313 (5788): 765-766. doi:10.1126/science

[26] Richard Dawkins, «The Selfish Gene” Oxford University Press 1976(ISBN 0192860925)

[27] Principle named after the metaphor from the book by Lewis Carol «Through the looking glass»; in which Alice sees that the Red Queen must constantly run in order to stay in place in the shade of the oak tree.

[28] Van Hoven, W. 1991, Mortalities in kudu (Tragelaphus strepsiceros) populations related to chemical defence in trees. Journal of African Zoology. 105: 141–145.

[29] C. Trowbridge, ‘Andrew Taylor Still, The Thomas Jefferson University Press, Northeast Missouri State University, Kirksville, Missouri, 1991, pp 117, 118

[30] C. Trowbridge, ‘Andrew Taylor Still, The Thomas Jefferson University Press, Northeast Missouri State University, Kirksville, Missouri, 1991, chapters 4,5,6

[31] R. Nesse, G. Williams, “Evolution and the origin of disease” Scientific American, November 1998

[32] American Osteopathic Association, R.C. Ward editor, « Foundations for Osteopathic medicine » Williams & Wilkins Baltimore1997, pp 4

[33] «Form» = structure & function as one. The Evost Fellows generally prefer the use of the word “behavior” instead of the word function. Why? The word function has a “free will” connotation that we dislike utterly because a complex system like a molecule has no function, it has a behavior. The term function has a goal directed connotation which is a human perception additive. When the Hypofisis produces TSH the hormone does not know that it should go to the thyroid and make it start producing T3. Every complex system has the behavior that corresponds to its state of complexity it has in a specific environment and the impact of the ‘disruptive’ stimuli it gets from this environment.

[34] S. Wolfram: Emerging Syntheses in Science: Proceedings of the Founding Workshops of the Santa Fe Institute, Addison-Wesley (1988) 183-189 (www.stephenwolfram.com/publications/articles/general/84-complex/index.html)

[35] Santa Fe Institute: see www.santafe.edu

[36] Simon A. Levin, “Ecosystems and the Biosphere as Complex Adaptive Systems”, Ecosystems, 1998, n°1, pp 431-436, Princeton USA

[37] Dr. Christopher Bassford, «Non-linearity in Marine Corps Doctrine», http://www.mnsinc.com/cbassfrd/CWZHOME/Complex/DOCTNEW.htm

[38] The primary goal, because the analysis of the Gordian knot was selfexplanatory: the osteopathic profession, the professional associations, the osteopaths etc. behave as comples adative systems. The knot has thus to be a memetic problem (behavior) within a complex adaptive system.

[39] www.insead.edu/facultyresearch/faculty/profiles/shared_documents/curriculum_vitaes/cv

[40] John Horgan, “From Complexity to Perplexity”, Scientific American, June 1995

[41] Donald E. Ingber, The Architecture of Life, Scientific American Magazine, January 1998

[42] Americans are often unhealthily “pseudo-sensitive” in both directions (+ & -)to the word Negro, probably because of there slavery, civil war and racist antecedents, for clarity Negro (Nero) had only originally to do with color when the Portuguese landed in that region of Africa (±1419 AC), in the mean time this region around the river Niger, from which the whole Bantu tribes migrated over almost the whole of Africa, has given its name of origin to all the populations originated from that region. (Negroid population is neither more negative as would be Caucasian or Asian except for American readers)

[43] Lewin, Roger. Complexity, Life at the Edge of Chaos. New York: MacMillan Publishing Co., 1992

[44] Chaos = the zone of a-periodic stimuli and interactions without any form of stability or congruency and so impossibility to Form a stable system.

[45] L’Ordre étant la stabilité et congruence extrême, quasi sans dynamique comme l’on trouve dans un cristal par exemple.

[46] www.geocities.com/templarser/complexity.html (Frontiers of complexity)

[47] Curriculum Vitae Prof. Leo Apostel – http://logica.rug.ac.be/biografie/cv.html

[48] Leo Apostel, “Atheïstische Spiritualiteit”VUB Press Brussel Belgium, 1998, pp 23