Structured Psychosocial Stress and Therapeutic Intervention: Toward a Realistic Biological Medicine

Using generalized 'language of thought' arguments appropriate to interacting cognitive modules, we explore how disease states can interact with medical treatment, including, but not limited to, drug therapy. The feedback between treatment and response creates a kind of idiotypic 'hall of mirrors' generating a pattern of 'efficacy', 'treatment failure', and 'adverse reactions' which will, from a Rate Distortion perspective, embody a distorted image of externally-imposed structured psychosocial stress. This analysis, unlike current pharmacogenetics, does not either reify 'race' or blame the victim by using genetic structure to place the locus-of-control within a group or individual. Rather, it suggests that a comparatively simple series of questions to identify longitudinal and cross-sectional stressors may provide more effective guidance for specification of individual therapy than complicated genotyping strategies of dubious meaning. These latter are likely to be both very expensive and utterly blind to the impact of structured psychosocial stress -- a euphemism for various forms of racism and ethnic cleansing -- which, we contend, is often a principal determinant of treatment outcome at both individual and community levels of organization. We propose, to effectively address 'health disparities' between populations, and in contrast to current biomedical ideology based on a simplistic genetic determinism, a richer program of biological medicine reflecting Lewontin's 'triple helix' of genes, environment, and development, a program more in concert with the realities of a basic human biology marked by hypersociality unusual in vertibrates. Aggressive social, economic, and other policies of affirmative action to redress the persisting burdens of history would be an integral component of any such project

Predicting Health Impacts of the World Trade Center Disaster: 1. Halogenated hydrocarbons, symptom syndromes, secondary victimization, and the burdens of history

The recent attack on the World Trade Center, in addition to direct injury and psychological trauma, has exposed a vast population to dioxins, dibenzofurans, related endocrine disruptors, and a multitude of other physiologically active chemicals arising from the decomposition of the massive quantities of halogenated hydrocarbons and other plastics within the affected buildings. The impacts of these chemical species have been compounded by exposure to asbestos, fiberglass, crushed glass, concrete, plastic, and other irritating dusts. To address the manifold complexities of this incident we combine recent theoretical perspectives on immune, CNS, and sociocultural cognition with empirical studies on survivors of past large toxic fires, other community-scale chemical exposure incidents, and the aftereffects of war. Our analysis suggests the appearance of complex, but distinct and characteristic, spectra of synergistically linked social, psychosocial, psychological and physical symptoms among the 100,000 or so persons most directly affected by the WTC attack. The different 'eigenpatterns' should become increasingly comorbid as a function of exposure. The expected outcome greatly transcends a simple 'Post Traumatic Stress Disorder' model, and may resemble a particularly acute form of Gulf War Syndrome. We explore the role of external social factors in subsequent exacerbation of the syndrome -- secondary victimization -- and study the path-dependent influence of individual and community-level historical patterns of stress. We suggest that workplace and other organizations can act as ameliorating intermediaries. Those without acess to such buffering structures appear to face a particularly bleak future

The ecology of suffering: developmental disorders of structured stress, emotion, and chronic inflammation

'Punctuated equilibrium' models of cognitive process, adapted from the Large Deviations Program of probability theory, are applied to the interaction between immune function and emotion in the context of culturally structured psychosocial stress. The analysis suggests: (1) Chronic inflammatory diseases should be comorbid and synergistic with characteristic emotional dysfunction, and may form a collection of joint disorders most effectively treated at the individual level using multifactorial 'mind/body' strategies. (2) Culturally constructed psychosocial stress can literally write an image of itself onto the punctuated etiology and progression of such composite disorders, beginning a trajectory to disease in utero or early childhood, and continuing throughout the life course, suggesting that, when moderated by 'social exposures', these are developmental disorders. (3) At the community level of organization, strategies for prevention and control of the spectrum of emotional/inflammatory developmental disorders must include redress of cross-sectional and logitudinal (i.e. historical) patterns of inequality and injustice which generate structured psychosocial stress. Evidence further suggests that within 'Westernized' or 'market economy' societies, such stress will inevitably entrain high as well as lower stutus subopulations into a unified ecology of suffering

Natural language processing and advanced information management

Integrating diverse information sources and application software in a principled and general manner will require a very capable advanced information management (AIM) system. In particular, such a system will need a comprehensive addressing scheme to locate the material in its docuverse. It will also need a natural language processing (NLP) system of great sophistication. It seems that the NLP system must serve three functions. First, it provides an natural language interface (NLI) for the users. Second, it serves as the core component that understands and makes use of the real-world interpretations (RWIs) contained in the docuverse. Third, it enables the reasoning specialists (RSs) to arrive at conclusions that can be transformed into procedures that will satisfy the users' requests. The best candidate for an intelligent agent that can satisfactorily make use of RSs and transform documents (TDs) appears to be an object oriented data base (OODB). OODBs have, apparently, an inherent capacity to use the large numbers of RSs and TDs that will be required by an AIM system and an inherent capacity to use them in an effective way

The Role of Indexing in Subject Retrieval

On first reading the list of speakers proposed for this institute, I became aware of being rather the "odd man out" for two reasons. Firstly, I was asked to present a paper on PRECIS which is very much a verbal indexing system-at a conference dominated by contributions on classification schemes with a natural bias, as the centenary year approaches, toward the Dewey Decimal Classification (DDC). Secondly, I feared (quite wrongly, as it happens) that I might be at variance with one or two of my fellow speakers, who would possibly like to assure us, in an age when we can no longer ignore the computer, that traditional library schemes such as DDC and Library of Congress Classification (LCC) are capable of maintaining their original function of organizing collections of documents, and at the same time are also well suited to the retrieval of relevant citations from machine-held files. In this context, I am reminded of a review of a general collection of essays on classification schemes which appeared in the Journal of Documentation in 1972. Norman Roberts, reviewing the papers which dealt specifically with the well established schemes, deduced that "all the writers project their particular schemes into the future with an optimism that springs, perhaps, as much from a sense of emotional involvement as from concrete evidence." Since I do not believe that these general schemes can play any significant part in the retrieval of items from mechanized files, it appeared that I had been cast in the role of devil's advocate.published or submitted for publicatio