innate temperament
D I S R U P T I V E P R O C E S S
8 pages — 1 —
INTRODUCTION
“To create long-lasting social change,
organizations and the programs they create
must in one way or another
become embedded in the local community.”
Eric Nee (1954 – )
“I’ve learned that
people will forget what you said,
people will forget what you did,
but people will never forget
how you made them feel.”
Maya Angelou (1928 – 2014)
The opening citation, written by its Editor, appeared in the Spring 2016 edition of the Stanford SOCIAL INNOVATION Review. The “Editor’s Note” ends as follows. “Is community engagement a magic bullet? No. But it’s clearly an important component for creating programs that work. And, the engagement that is created by one program can have spillover effects into the entire community, strengthening other social programs, and creating broader social cohesion within the community itself, an essential component of creating a healthy and resilient society.”
In effect, the thrust of national healthcare reform must foster the collaborative improvement of each community’s Survival Commons in tandem with their adjacent communities as the basis to improve our nation’s Social Cohesion. This reform strategy begins with a commitment by every community to assure that enhanced Primary Healthcare is equitably available to each of its resident persons. Every community must then establish a collaborative association between a continuously enhanced Survival Commons, aka survival net, and its equitably available Primary Healthcare. Therin every community will become prepared to promote the resilience of each resident person’s Stable Health. The long-term precision of this process will depend on every community’s ability to accommodate each dominant Disruptive Process that most prominently occurs to disturb their community’s Population Health.
Any substantial Disruptive Process will likely have origins spanning multiple generations that historically span the past as well as the present and extend into the future. Each Disruptive Process will originate from within a Category involving Cosmological, Biological, and Human Dignity components. This DISRUPTIVE PROCESS Sub-Page represents an expanded explanation for its basic definition cited originally within the DESIGN EPISTEMOLOGY Sub-Page. It is printed below. — 3 —
DISRUPTIVE PROCESS may be defined for HEALTH as
^
an entanglement of Cosmologic, Biologic, and Human Dignity
disturbances, each occurring with paradoxical emergence and
diversely-intensive, time-course patterns that converge to form
a unique Cluster of disturbances which variably interacts
with a community’s resident persons to variously alter
the current and future, survival resilience
of each resident person.
HEALTH
The Disruptive Processes that underlie Unstable HEALTH have been largely identified over the last 200 years, especially during the last 50 years. Historically, a HEALTH Condition has been most easily recognizable by the sudden occurrence of injuries associated with armed conflict. Since the beginning of recorded events, the sudden effects of armed conflict have been repeatedly described for the involved participants. Besides armed conflict, the Disruptive Process list of circumstances producing Unstable HEALTH generally could be viewed as poor nutrition, epidemic infections, maternal mortality, accidental injury, and tuberculosis.
In addition to injury, the scientific attributes for assessing the attributes of Unstable HEALTH began with the measurement of weight and time, then temperature around 1600, and the stethoscope in 1819. The pace of improvement in the dimensions of Knowledge about HEALTH has now reached the level of various genetic and epigenetic anomalies, including various combinations of these anomalies. Lurking behind the genetic and epigenetic processes, each person begins their development with a unique combination of baseline homeostasis and innate temperament during their initial, immune-tolerant maternal gestation. If you are now overwhelmed by the level of complexity, you are not alone.
The ethical issues surrounding healthcare that are associated with its Human Dignity as well as its Knowledge and Resources increasingly characterize the frontiers of healthcare reform. From genetic anomalies to the scarcity allocation of healthcare resources during a regional or national disaster, there is no current strategy to consider each community’s considerations for their nationwide, locally applicable disaster preparedness. This deficiency is compounded by the steady decline of collaborative traditions among neighboring communities that collectively enhance our nation’s social cohesion.
EPISTEMIC CAUSATION — Including Quantum Mechanics
Our human survival as a biological species began its worldwide expansion at the end of our world’s last Glaciation Epoch some 10-12 thousand years ago, now referred to as the beginning of the Holocene Epoch. Its Anthropocene Era began its steadily evolving effects on our worldwide habitus about 150-200 years ago. Co-occurring, our expanding knowledge about Quantum Mechanics now increasingly expands our perceptions about seemingly unlikely possibilities. We are told that our own knowable universe exists with possibly seven other universes.
The Design Epistemology for the NATIONAL HEALTH Proposal represents the inclusion of Quantum terminology but also the inclusion of Knowledge from other realms of newly considered evidence. The career-long research of Professor Elinor Ostrom and Professor Michael Tomasello apply. Gone now, we will need to merge the institutionally siloed, scientific and humanitarian realms of Knowledge.
A newly considered, contemporary concept as in DISRUPTIVE PROCESS, aka root cause of root causes, may be described as outlined below. The formulation of a Disruptive Process, as defined above is intended as a framework for understanding Unstable HEALTH with a more “robust” array of factors. The possible alternatives for the remaining Twenty-First Century await the curiosity and energy required for thoughtful consideration. This Sub-Chapter begins by describing a hierarchy of Categories recognizable by their developmental level of cluster precision.
The concept of a cluster has applicability within many realms of knowledge, seeming without a uniform, broadly defined definition. For this epistemology, here is its most applicable definition.
A CLUSTER may be postulated as
^
two or more components that form
a sustainable capability when the components
paradoxically interact as a result of their respective
Quantum-related contributions to
the synergy occurring between the components,
the affinity between or among the prominent components, and
the salutary conditions surrounding the components.
I. HEREDITY refers to:
The genetically determined, minor to life-threatening adverse effects occurring from a genetic or epigenetic abnormality that affects one, or more than one, health system for which the changes are present *) at birth (such as Down’s Syndrome, Sickle Cell Disease, or a heart defect) OR *) at various developmental stages of life (such as schizophrenia, Hemochromatosis, sudden athletic death from a hereditary Cardiac Disorder, or certain forms of Senile Dementia). The range of abnormalities is quite large, and our current research efforts will open many new frontiers, such as, from the newly definable arena of epigenetics. — 5 —
One indication of how precarious the first trimester of a pregnancy can be is represented by a certain medication that when given to woman during a pregnancy. No longer used for premature labor, there is a medication that when given during a pregnancy, a fetal daughter will eventually be at high-risk for developing vaginal cancer during her subsequent years of fertility. The medication is Diethylstilbesterol. This effect has been further reported in 2018 as occurring for the grand-daughters of women treated with diethylstilbesterol during a pregnancy.
Uniquely, a person’s innate temperament is not totally related to a person’s genetic endowment. This is also true for a person’s baseline homeostasis, resilience. Furthermore, the functional characteristics of a person’s homeostatic control can be more or less interconnected with the person’s innate temperament. Common observations about these connections are borne out by the personalities of identical twins, with alternate personality traits. The biology of epigenetics may apply. When a sperm and an ovum unite, the person’s cytoplasm originates entirely from the person’s biologic mother including its governing RNA. How this affects the initial developmental boundaries of the evolving fetus is largely unknown, although rapidly becoming more widely acknowledged.
The definition of HEALTH for the Design Epistemology clearly separates the fundamental genetic endowment for each person’s uniquely endowed Human Capability as largely, but not completely, separate from the resilience of both a person’s innate temperament and baseline homeostasis. We would offer the hypothesis that this axis for early, prenatal development should also account for the state of immune-tolerance that exists within the mother’s uterus during a pregnancy. The studies evaluating personality characteristics to a person’s maternal, birth order may also apply to understand the origins of a person’s innate temperamentand subsequent personality.
II. CONTAGION refers to:
A contagious HEALTH Condition, i.e., an infection, occurs from self-replicating organisms that can be *) transmitted between persons as in tuberculosis, measles, polio, tetanus, influenza, or gonorrhea; *) prevented by immunization for certain infections; *) spread by food preparation, bodily fluid contamination (most commonly by a cough or sexual intimacy) or touch between persons; *) controlled by quarantine as in measles and influenza; and *) treated by medication to reduce or eliminate the reproduction where possible of a self-replicating organism.
The evolution of infecting organisms had occurred over billions of years before the evolution of terrestrial animals. This has occurred as plants and animals have adapted to their presence. The current evolution of bacterial resistance from the widespread use of antibiotics, particularly in the small animal food supply, is not alone as the cause for antibiotic resistance. The development of resistance represents a normal attribute of infectious agents as a means to continue their survival.
During human existence, our world has experienced the disappearance of smallpox. With the elimination of smallpox, we now have the Ebola virus, human immunodeficiency virus, and COVID-19. One important reason for our nation’s border security may be to have better control from the future existence of worldwide pandemics. Remember, our worldwide population will grow from 8 Billion people during 2022 to 10 Billion by 2056. It became 7 billion in 2011.
III. GROWTH and DEVELOPMENT refer to:
The HEALTH Conditions occurring from multiple interacting Disruptive Processes that are more likely to induce adverse effects at a certain age during a person’s lifetime. The potential expression of a person’s uniquely endowed Human Capability unfolds with the continued multiplication of multiple individual cell lines that slows as the genetic endowment for its homeostatic control processes unfold. Some cell lines slow down during this replacement process in ways that reflect the normal aging process. Whether or not this a reflection of entropy according to the Second Law of Thermodynamics is still not clear. During the last 5-10 years, this concept is no longer commonly cited.
More than likely, a new concept of Dynamic Kinetic Stability (DKS) will take the place of the concept of Entropy. Addy Pross, Ph.D., described this in his book titled “WHAT IS LIFE How Chemistry Becomes Biology” published in 2012. It could become the most important explanation of the basis for LIFE since Charles Darwin’s book was published in 1859 as an explanation of evolution: “ON THE ORIGIN OF SPECIES.” Think Addy Pross, a future Nobel Prize recipient.
Examples of GROWTH and DEVELOPMENT induced HEALTH Conditions include: *) congenital problems that are present at birth and related to a problem arising during the gestational process that is unrelated to any specific genetic defect of the fetal person, such as, amniotic band malformations causing a child’s absent fingers; *) fertility such as contraception, infertility, maternal health, and menopause; *) lifestyle stressors such as relationship betrayal, harmful habituation, vocational responsibility transitions, and family neighborhood transitions; *) aging as in osteoporosis, degenerative joint disease, and atherosclerotic vascular disease; and *) child neglect occurring as a substantial mismatch between the needs of the child at birth and the pervasively deficient capabilities of the child’s parents to provide for these needs. The deficient capabilities may begin prior to birth, begin at birth, or at a later stage of life. The deficient capabilities represent parental Caring Relationships injurious to the dependent person’s future development to become an independent person. Child Neglect should be considered a congenital HEALTH Condition. Child Abuse is a form of assault. Child Neglect may be a precipitating event, but not always. The precipitating factors for Child Abuse are usually quite different as compared to Child Neglect. — 7 —
IV. HEALTHCARE refers to:
The adverse effects occurring while receiving health care as in *) medication hypersensitivity, i.e., both immunological (allergic) and non-immunological reactions; *) institutional environment (i.e., an unattended fall in a hospital bathroom causing a fractured hip); *) continuity of care, e.g., inadequate monitoring for the coordination of a person’s prescribed, multiple medications ( especially when >#5-10 ), each taken at least once a day; *) variably available and accessible medical Triage; and *) deficient universal health insurance that is offered based on a person’s level of disposable income (e.g., financial debt from healthcare that is the leading cause of personal bankruptcy).
Most importantly, there is no commonly understood acknowledgment for the attributes of a Caring Relationship. Many years ago, a Pediatric Hospital examined the effects of dominant parental presence or absence on the characterization of matched hospitalizations. Chief among several observations, the hospital duration for similar health needs was shorter when parental presence was prominent. Putting aside the advocacy presence of the child’s parents, the study described a likely stress-reducing benefit for the child by their presence. This phenomenon would also explain the importance for Primary Healthcare to offer its medical Triage during office hours by a registered nurse rather than a non-licensed employee.
V. TRAUMATIC EVENTS refers to:
An isolated, time and date definable, the sudden occurrence of an external force, as in trauma, that causes, or could substantially have caused, a major physical or emotional injury as in: *) war-time service, homicide, sports, motor vehicle injuries or accidental falls; *) dependency relationships as in human trafficking, child abuse, rape, or torture; *) vocational or avocational circumstances as in motor vehicle accidents, laceration at work, or sports; or *) sentinel events and their associated halo adverse effects, such as divorce, death of a person’s long-enduring Caring Relationship (parent, child, or spouse), or a Family move to a new neighborhood that is distantly located within a community with substantially different ethnography.
Another dimension of TRAUMATIC EVENTS is represented by the clustering of multiple root causes with no evidence of Unstable HEALTH demonstrating their occurrence but eventually occurring over time in apparently random order to produce either temporary or long-lasting Unstable HEALTH. The unique connection among the contributing factors of time, infection, traumatic events, innate temperament, baseline homeostasis or environmental attributes is probably more complex than we are currently able to evaluate, such as, for the onset of cancer or an immune tolerant diseases. Similarly, emotionally severe traumatic events during early childhood are known to produce severe personality disorders and suicide during the person’s adolescence.
“Repetitive Trauma” has also been identified for certain specific work conditions, such as carpal tunnel syndrome. Also, the onset of Acute Depression by a person with no expression of Unstable HEALTH might be an example, especially if there is a recent occurrence of highly stressful events. The associated Ecologic factors such as Family Traditions, neighborhood social cohesion, community levels of Social Capital, and long-enduring Family-based, Caring Relationships then can become either preventive or causative by their presence or absence.
VI. NEOPLASIA (“Cancer”) refers to:
Uncontrolled cellular growth originating from a single Functional System such as cancer of the lung, breast, colon, prostate, or blood (leukemia). The sequence of interacting biologic events that eventually conspire to initiate a progressively harmful cancer is largely unknown. Eventually, the associated level of Unstable HEALTH is determined by the cancer’s location and the specific attributes of the uncontrolled spread from its originating location. The sequence of interacting biologic events becomes complicated by certain observations, such as breast cancer. The onset of breast cancer will rarely occur on both sides simultaneously. Evidently, the time-dependent cascade of possible interacting factors is very complex from the effects of age, heredity, the occurrence of certain infections, gestational exposure to maternally ingested chemicals, or personal exposure to certain chemicals (skin, respiratory, gastrointestinal), and weight.
VII. HUMAN ECOLOGY refers to:
Living Space
The adverse effects occurring from a person’s living space as in *) pollen concentration, humidity changes, or outside temperature variability; *) good food accessibility; water, sewage, and garbage sanitation; *) workplace safety and cultural tolerance; *) highway safety; and *) neighborhood levels of noise, access to parks and sports facilities, and community infrastructure maintenance. — 9 —
Institutional Governance for the Common Good
The continuing deficits in the level of Social Capital within cities, states, and Federal governments have led to a failure of our nation’s healthcare reform. The worsening of our nation’s health spending has evolved from 5.0% in 1960 to 17.9% in 2019 of our nation’s economy, its gross domestic product (GDP). In contrast, the other 34 OECD nations of the world are mostly clustered around an average of 10-12% or less of their GDP for their nation’s health spending. The excess health spending between 13% and 18% for our nation’s healthcare represented nearly $1 Trillion in 2018. The most demoralizing attribute of this inefficiency is represented by our nation’s maternal mortality ratio. It has worsened for nearly 30 years in a row through 2020. We would need to reduce it by 70% to rank among the 10 developed nations of the world with the lowest maternal mortality incidence.
Survival Commons
There are many factors that contribute to our nation’s high level of health spending. Probably 1/3 of the excess health spending is related to the highly variable levels of equitably available Primary Healthcare that is offered within and among our Nation’s communities. A second 1/3 is related to a very inefficient means of paying for our nation’s healthcare. The final 1/3 is related to the absence of a nationally sanctioned and locally managed process to assure a local commitment to the quality of each community’s Survival Commons, an augmented safety net, for its resident persons. Institutional Governance will need to support a local initiative to monitor the improvement of each community’s Social Capital.
Many adversities entangle the Unstable HEALTH of resident persons and thereby excess health spending is subsequently required. For a homeless person with a high level of risk factors, annual health spending for the person will decrease by 80% once the person enters supportive housing. The GLUE to improve a community’s Survival Commons is related to their ability to mobilize their level of Social Cohesion throughout their community. For perspective, it is a generational project and requires many years of commitment to adequately build and sustain.
VIII. IMMUNE–TOLERANCE refers to:
The unexpected onset of a serious health condition with a DIAGNOSIS involving substantial impairments of multiple System Functions usually associated with a variety of multiple chronic illnesses. These include: *) Insulin Dependent Diabetes Mellitus with an onset that clusters around the pediatric ages of 2 years, 5 years and 12 years; *) multiple sclerosis with onset in early mid-life and expressed by many forms; *) chronic inflammatory bowel disease with multiple forms and severity; *) Chronic Lung Disease; and *) atherosclerotic vascular disease. Of note, all of these diseases are associated with the absence of sensitive and specific diagnostic or monitoring tools that prevent the implementation of preventive care plans during the early phase of a pervasive disorder of immune-tolerance.
We currently refer to these as auto-immune disorders, as in the persons who develop antibodies for their a bodily structure. It is possible to consider it as a condition whereby there is a loss in the ability to ignore certain immunological events. A Pregnancy represents the most common example of this. Maternal gestation represents a state of immune-tolerance to the newborn’s unique set of antigens. Presumably, labor starts when the immune tolerance begins to end and induces rejection of the child’s source of foreign antigen by the child’s maternal immune system. Life-threatening, immune-based diseases can occur at the end of a pregnancy, frequently with a precipitous onset and potentially life-ending consequences.
IX. CHRONIC DISEASE refers to:
A previously identified CAUSE of Unstable HEALTH, IMMUNE-TOLERANCE, includes a group of persons with a very high burden of disability, often associated with chronic pain. Each of the other CAUSES, either alone or in combination can affect a certain number of persons with similar characteristics of pain and disability. Given the diversity of factors contributing to the resulting needs for Complex Healthcare, it is appropriate to ask how it is that a given HEALTH Condition could become so complicated. One possibility might be to postulate the idiosyncratic occurrence of Disruptive processes as noted above within the TRAUMATIC EVENTS Section above. — 11 —
This concept for the occurrence of a pervasive and disabling chronic illness has not been verified by the usual medical research processes. However, there are isolated research projects that have shown the possible role of emotional stress as augmenting the pre-clinical, asymptomatic phase of a chronic illness. I recall that this research has identified a time interval of two years between the occurrence of new emotional stress and the clinical identification of certain cancers. As of March in 2016, this multi-factorial Cause for the onset of a burdensome, complicated health condition is not widely acknowledged or recognized within the healthcare industry. The tools to assess or monitor the presence of a possibly evolving chronic illness do not exist. Most importantly, the character of long-term healthcare supervision with the goal of achieving Stable HEALTH is also largely unrecognized. This has occurred since we lack a predictably reliable test to assess the resilience of any person’s baseline homeostasis.
The attributes of this Section often involve multiple medications taken at least once a day, commonly more than 15-20. Chronic Pain, disability, illicit substance dependency, obesity, and depression often co-exist regardless of the contributing Disruptive Processes. Multiple hospitalizations occur that occasionally are associated with complicating surgical procedures.
FINAL COMMENT
As of February 2023, this is still a very preliminary effort. I would invite anyone to contact me who has a comment about the concept of Disruptive Processes. The AUTHOR BIOGRAPHY Sub-Page provides enough identifying information as a means to contact me.
My view is that the current status of healthcare research does not recognize the Frequency Domain as a means to evaluate pathophysiologic processes. We continue to remain in the Time Domain as the basis for research analysis. Our engineering colleagues probably have much to offer for an improved assessment of Disruptive Processes and how they can be assessed.