Antonio Rossin's paper at the 35th International Congress on the History of Medicine of the International Hippocratic Foundation of Kos,
Sept. 1996, Island of Kos - Greece

Abstract

Since Hippocrates' time, every doctor/patient relation is an act of communication. Every act of communication must be performed properly. Rossin focuses communication as a function not only of the power of him who speaks, but moreover of the critical capability and flexibility of him who listens. Hence the Author opens the problem of a rational use of educative language aimed at developing the autonomous flexible personality from childhood onwards, thus at the basis of primary prevention.
The Author analyses two kinds of educative family pattern which can influence, with a mechanism of environmental pressure, the formation either of the rigid psycho-dependent or of the autonomous flexible personality in children. The flexible personality is the more fortified one, among other things, against the risk of drugs addiction.
The news of Rossin's research is that of having for the first time analyzed the connection between use of language and mind framework. The general connection between communication and man's health having been previously expounded (see 'The Less Flexibility Syndrome', presented here at Kos on 1965 at the 9th Conference of the E.S.P.M.H.), Rossin here goes on to establish the nature of that connection.
Now Rossin is realizing in Italy, with the local Authority and the ANCI Veneto Health Council, a Project called "Knowledge and opposition to the 'Less Flexibility Syndrome' linked to people with a rigid psycho-dependent personality", as a social intervention of Primary Prevention.

'..It is necessary for the physician not only to provide the needed treatment, but provide for the patient himself and for those beside him and to provide for his outside affairs..'" the Father of the modern scientific medicine said this 2500 years ago: and now, at the beginning of the year 2000, the present-day medicine is looking at the interrelations of man's knowing acting and valuing, and at the cultural patterns prevailing in our society as intimately connected with health care.
Starting from the above statement, my research points out a new field in which to apply Hippocrate's teaching. Specifically, "to provide for the patient, for those beside him and for his outside affairs," it is necessary to search for the general way which every person can use to realize herself, to enter into relations with those around her, and to perform her outside affairs. I believe this general way is communication, and the use of language. Plainly, I conceive the use of language, especially even if not exclusively words, to be communication; hence the title and the reason of this paper.
The starting point of my research is pragmatical, as it regards the effectiveness of human communication. That is mostly successful when the individual who relates is free and fully self-conscious in doing it, so finding in it his/her self-assurance and self-realization. Such a condition requires open-mindedness and autonomous choosing in the listener, not the imprinted "one-way" submission to the speaker's authority which so often, if not obeyed, may turn itself into a source of stress.
In order for communication to be effective, and a source of health, people who are involved in the relation must be flexible and open-minded in their acting as well as in their reacting. For our purposes, we may say specifically, in their asking and answering, in their speaking and listening. By "effective", I mean to characterize the individual who relates well with other people, who performs her or his outside affairs for the best, and who is able to use both the spoken and the listened language with most success. Such a person is healthier than one likely to be made less successful by a rigid narrow-minded use of language in her/his relations of human communication. It seems to be the same for every physician/patient relationship, thus the increase of open-mindedness and flexibility in people should be a main topic of healing care.
In the general field of human communication, this difference is in regard to the language-producing structure and not the words produced. This is a difference regarding the container, not the contents. That is, there are two main trends in which the considered structure can realize itself in man: either the open-minded autonomous flexible personality, or the narrow-minded personality, rigidly dependent for its believing and behavioural procedures on the consent of a leader coming from the outside. The implication of the above difference for healing aims is quite obvious. I have theorized the psycho-physical mechanisms responsible for the link between mind's flexibility and man's health in my paper "The Less Flexibility Syndrome", already presented here at Kos last year.

Now the question is how to make the individual more open-minded and flexible in her/his beliefs and behavioural procedures. I searched for the age in which the young individual is more sensitive to the formative stimuli and for the particular nature of the latter. I found most sensitive the age from the O years of the child until the school age, when the family communication pattern, through an environmental pressure mechanism, selects and conditions, or imprints, the brain connections in the child. On this foundation, the building of the individual - her/his future way of life - is erected: either autonomously flexible or rigidly psycho-dependent.
At the same time, I should make it clear that, in speaking of such polarities, "rigid" and "flexible," I am only making an outline for purposes of exposition. I am not suggesting that they must be found in a "pure" form in any individual or situation. Rather, these represent poles of a continuous spectrum, and any person's behaviour can only tend towards one or the other. A multiplicity of factors - including antecedent encounters - intrude themselves in any real life situation. It is my hope that this beginning will prompt further research, leading to these being taken into account in a similar analytic way.
As soon as I theorized the connection between use of language in the first family communication patterns and the formation of children's brain frame, I realized that most parents are not yet aware of this chance, of this responsibility. Only they can solve the problem, how to make people more open-minded and flexible. Thus, I concluded, they must be made aware as soon as possible.
It was soon pointed out to me that "making someone else aware" expressed just the kind of dogmatic and "top-down" kind of perspective I wished to avoid. What can one do, then, within ordinary language, to preserve and present the flexible approach, if people are not already looking for it? This seems to be a complete philosophical dilemma. If another is already looking, they don't need to be shown, while if they are not looking, we cannot ethically force them to attend to it. But humanistically, there is no dilemma, and this contrast is at the heart of my concern. Simply put, we do cause one another to attend to what we are saying, every day, by our attending to them. Not by slavish agreement, nor by obstinate opposition, but by weighing what they say and seeking the common thread which unites us with them in making sense of a world which seems sometimes incomprehensible. It is just this attention, this open-mindedness which I speak of, that we ourselves must have first of all.

But of course it is easier for you to listen to, if I present the terms of reference as if they apply only to others, whom we shall henceforth identify as A, B, and C, and, in the description of the communicative relationship between these three parties, to again use only terms of speaking and listening.
"A" is the person who speaks first, and we may conveniently call this first speech "positive". But for a speech act to be communication, it must be directed to another, B, who also speaks, and/or C, the listener.
"B" is - at least potentially - in opposition to A - again, not in content but in voice - and is therefore our "negative". S/he could also be a person in another group, another age, another book - or even ourselves.
Finally "C", C for child perhaps, is the listener. S/he is who demands. S/he is who delegates power to A, to the leadership who answers, just because of the demand.

Note that the connection between A and B is a product only of the mind of who listens to, viz.: C. Actually, the dialectical connection {+A-B} becomes alive and fertile only if the listener C has the fit mental structure to contain it, to think of it. Indeed, reflective mental structure is all we are describing. B may be the listener's mind capability to translate into "negative language" his or her own speech, just as A may be simply an antecedent state of the same mind.
Before going on, however, now that our 'brain frame' has been established, we can immediately draw one conclusion: what we do in this process of attention or consideration is to create a context for the other's thought process. This is often referred to as 'feedback,' and it is also at the root of Gregory Bateson's emphasis on patterning, but the significance is that among ordinary mortals, at least, quite often an utterance is made with great uncertainty. I don't mean that it might not sound authoritative - we are all familiar with the disguises of insecurity - but that the purpose of the statement is legitimation or authentication of the right of the speaker to say anything. Just as one might reach out to touch a wall, not for physical but for psychological support, so one may reach out verbally, for assurance that one is where - or rather who - one is supposed to be. The context we provide in turn may be either in direct response to the sound of authority [+B] or in acceptance of the uncertainty, with willingness to collaborate in the search for certainty; that is, for legitimacy [-B].
Thus, B can speak either:
- to obtain the affirmation of A. Now, the speech of B will be also "positive" (in C's view); we can formulate this as{+A+B}. In reinforcing and empowering each other they form a majority. C, having no recourse, will be compelled to join this majority or feel rejected.
- or to discuss the statements of A. In this case the speech of B will be "negative", relative to A. Now {+A-B} will form no majority; the presence of the "negative" language of B in the same context of communication together with the "positive"one of A will empower C, and emphasize the latter's self-consciousness, self-realization and flexible autonomy. This is the condition we identify with health.

Well now, this may seem to be a minor analysis of the thought process of a mature mind. The significance of my theory is the proposal of including the real child in such a condition, by making him/her get a previous experience of how will be his/her future relations, his/her "outside affairs". As I have theorized, the real family is the training field, either {+A+B} or {+A-B} according to the parents' conscious and responsible choice. There the real child gets previously experience, after having been grown up either in the {+A+B} or in the {+A-B} family pattern, before joining the over-family groups and society which also are either {+A+B} or {+A-B}. All this starts therefore from the use of language in the first family's communication relationship.

Physically, there may be a connection between the first family communication frame and the formation of the child's brain-frame.
There is a path, a connection between the two sides of Mind, that of conservativeness and that of logical fiction, of inventivity. There is also an organic path, not only philosophical. It is called "the nervous ways of inter-hemispherical connection". Well, when a child is about 2 years old we know all her/his nervous connections are mostly opened. Then, from that age onwards, s/he starts to save the connections which serve the more remunerative thoughts-behaviourals by fixing them, and to delete the less remunerative (or more dangerous) connections by the reabsorption or block of the latter. The selection rate is likely the feed-back due to the first communication family pattern as the actual environmental pressure, whether there was agreement or repression by the parents. As the final result, the child with {+A-B} environmental pressure will maintain her/his inter-hemispherical connections opened at the most and the child with {+A+B} barred at the most, if not reabsorbed. The first will be autonomous and flexible, the second rigid and psycho-dependent on the re-assurance due to the leader's consent from outside. The first will get her/his self-consciousness from the integration work of both her/his brain hemispheres joined together, the second will likely disintegrate any self-consciousness and autonomy - together with the individual health as well as the social one - to the sole advantage of the authoritarianism of some totalitarian context.
Finally, to return to the patient/physician relationship, we may expect the open-minded subject to be more responsive to both the benefits and the limitations of modern scientific medicine. Conversely, the more rigid subject will find more appeal in "magical" treatments. Indeed, as I hypothesised here last year, the "Placebo effect" by which patient's psychological submission to the authority of medicine in itself influences their physiological response, may prove to be function of this "Less Flexibility Syndrome" - about whose prevention, and first of all the risk of drugs addiction, You will find more at my Web site in the Internet (below).

I stop here, to pass later to my next paper "The LFS Project", in which I will expose the pragmatical view of my healing-educational theory. I want to close by expressing my thanks to Professor Spyros Marketos, for having given me the chance of speaking to You at this 35th meeting of the International Hippocratic Foundation of Kos; to all of You, for Your kindness in listening; and especially to Kerry Miller, a friendly philosopher on the Internet who gave me great help in presenting this paper with a greater logical significance.

Antonio Rossin

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