The Process

This celebrated masterpiece by the UK psychiatrist and polymath Iain McGilchrist, MD offers, within its panoramic view of science and western culture, the most penetrating and beautifully articulated explanation of why the dominant standard of care can be so disappointing for complex chronic disorders; and how, as a culture, our drift so far from the ability to bring the fragmented mechanistic parts together into a living whole (the systems biology/functional medicine model) is driven by the profoundly different functions of our two brain hemispheres and the ‘hijacking’ of our attention by the left hemisphere in modern times.

The two brain hemispheres give rise to two different experiential worlds and are characterized by two different ways of paying attention.

The functional medicine model corresponds to McGilchrist’s perspective: first obtain a view of the whole, then investigate the discrete parts, and finally bring the now illuminated parts back to life in the right hemisphere. The quotes below are from The Master and His Emissary: The Divided Brain and the Making of the Western World and the more recently published magnificent The Matter With Things: Our Brains, Our Delusions, and the Unmaking of the World.

“The LH (left hemisphere) is principally concerned with manipulation of the world; the RH (right hemisphere) with understanding the world [and the patient] as a whole and how to relate to it [them].”

“The LH deals preferentially with detail, the local, what is central and in the foreground, and easily grasped; the RH with the whole picture; including the periphery or background, and all that is not immediately graspable. The importance of the global (RH)/ local (LH) distinction cannot be overstated.”

“The RH is on the lookout for, better at detecting and dealing with, whatever is new, the LH with what is familiar.”

“The LH aims to narrow things down to a certainty, while the RH opens them up into possibility. The RH is able to sustain ambiguity and the holding together of information that appears to have contrary implications, without having to make an ‘either/or’ decision, and to collapse it, as the LH tends to do, in favor of one of them.” (Such as the diagnostic label that is the simplest explanation for a person’s symptoms and limited test results, as is the usual standard of care.)

“The LH tends to see things as isolated, discrete, fragmentary, where the RH tends to see the whole. The LH tends to see things as put together mechanically from pieces, and sees the parts [the dominant fragmented biomedical model], rather than the complex union that the RH sees.”

“The LH’s world tends toward fixity and stasis, that the RH towards change and flow.” (Biology is a continuous flow of responsiveness.)

“More general categories are dealt with preferentially by the LH, more fine-grained ones, as one approaches more closely uniqueness, by the RH. Damage to the RH [or inhibition by LH dominance] can lead to a loss of the sense of uniqueness or the capacity to recognize individuals altogether” [as in a patient’s identity being defined by their diagnostic label].

“The RH contains the ‘body image’ (…not just a visual image, but to a multimodal schema of the body as a whole). The LH tends to focus on parts - arms, legs and so on - out of which the body must then be constructed. [This also pertains to the siloing effect of medical specialties.] The RH tends to process in a more embodied, less abstract fashion than the LH.”

“The RH is essential for empathy.”

Both are necessary, and “this division of our attention works to our advantage when we use both. However, it is a handicap — in fact, it is a catastrophe — when we use only one.”

“Linear explanations cannot express the reticulate web of biological function and felt experience.” The typical, necessary linear conceptual notes in a medical case record can never, on their own, offer a satisfactory explanation of what is going on with an individual human being.

An algorithm is what the left hemisphere wants, but the parts and the algorithms that use the parts data become separate from the gestalt of their lived experience (the form of the whole that cannot be reduced to its parts without the loss of something essential to its nature). This is why insurance company algorithms, the diagnostic nomenclature, and the industrial practice of health care do not fit the functional medicine model. It also is why a typical linear narrative can be misleading; and almost impossible to embody the wholistic FM perspective.

It doesn’t mean that we should abandon language and discrete details—they are necessary; but “we have to be constantly vigilant to undermine language’s attempt to undermine our understanding.” This applies especially when we attempt to appreciate another human being.

“Because our use of a term such as ‘being’ makes us feel that we understand what being is, it hides the sense of radical astonishment we would have if we could truly understand it, and it subverts our attempts to do so.”

“Love is pure* attention to the presence of another.”

*non-dual (self-less)