Compos Mentis

A Sign

(Eds. Note: I was working very hard on Thanksgiving, and when I finally decided to take a break the break took the form of me crashing on the couch and watching tv. The best thing on was a House marathon, so I stepped in to the exciting and misanthropic world of diagnosis for a couple of hours. Here are some of my thoughts, on second look rather disjointed as they may be.)

House is an effective base for a story because of the puzzle that diagnosis presents doctors. These puzzles have been at the heart of medicine since its founding in ancient times. It struck me how some things remain completely unchanged by time and technological improvements; no matter how advanced the tests get, the basic strategy remains the same; interpret the signs the body gives you and treat the illness that best fits the sign. In fact, the etymology of our word "sign" is derived from the Greek Seme, which was a derivation of medical signs.

Of course, medicine is not the only area which deals with interpreting signs. Seme gave its name to semiotics, which is a set modern philosophical disciplines looking at the way communication works. Umberto Eco, in his monumental Theory of Signs, outlines some of the uses of semiotics: studies of musical codes, of formalized languages, of code breaking, of visual, olfactory, and tactile non-linguistic communication. Among his list he includes medical semiotics. The drama of House is increased because all of the episodes are focused on issues of life and death (not to mention the personal issues of the main characters) and so the interpretation of the signs becomes top priority and is generally very urgent. House and his team are shown to be brilliant because of the way they know diagnoses instantly, the same way our comprehension of language is tested in how fast we read or in our understanding of rapid speech.

But the function of the doctors on House seems to be a little different from our interpreting a book. It becomes more complicated as symptoms seem to contradict other symptoms. Occasionally having every symptom of a disease leads to the idea that something else is happening - since it is rare that every symptom will ever be shown. What we seem to have, then, is a language (the set of diseases) that is known fairly well (there are no new diseases that show up on House; otherwise diagnostics would have no place) but the expression of that language is fuzzy or indistinct.

It is somewhat similar to when I try to read Japanese poetry. If I try to read printed Japanese, I can get a little ways. Often, I'll have no clue about context or specifics but given my knowledge and the ease of getting general ideas from Japanese characters, I can get the gist of the text. More to the point, if there are characters I am unfamiliar with, I can look them up in a dictionary, something most diagnosticians outside of television surely avail themselves of. But Japanese poetry, written by hand, generally uses calligraphic script. The characters, while more beautiful, become almost illegible, at least to me. Not only do I have to decipher the meaning I have to decide what part of the squiggles that I am seeing are meaningful and which are not. Similar instances occur when listening to Gregorian chant or Japanese chant - trying to interpret a foreign language that is then given in an unfamilar way.

Given this difficulty in interpretation, any correct diagnosis seems incredible; the odds seem monstrous. Fortunately we have several things on our side: twenty five centuries of medical history to draw upon, and the fact that there is a relatively small pool of common diseases that make it easier to diagnose. On House, of course, these two aspects are shooed away: the medical history is suppressed by the genius of the doctors, since they never consult books or anything else to help aid their memories; and the small pool, since the drama is heightened by the exotic diseases or circumstances used.

The drama is also elevated by the strategy of having some patients die. Here the difference between television and reality must certainly step in. Most people survive on House. Surely, most people with the diseases presented on House die in real life. But let's leave the difference aside for a moment. Assume that a single case happens in real life the way it happens on television - the same race against time, the same difficulties in diagnosis, and eventually, the same victory. What does that say about humanity?

Pascal said that a man is a reed, weaker than anything in the universe, but that he is a thinking reed, which makes him better than the whole universe. We are cut down by so much, but we have learned nearly as much as we have lost. Our mistakes, on certain fronts, become fewer and less severe as time goes on and we learn from them. It's true that we will never be able to solve every problem, but it is enlightening, when we despair of solving anything, to look back and see how much we have solved.

posted by Emmett @ 15:33