Dr Nick Read

Chaos in the Bowels

Jules Henri Poincare (1854 – 1912) was in trouble.  The most famous mathematician of his generation,  he set himself the task of predicting accurately the orbits of the earth, moon and sun.  His solution was brilliant. It was nominated for a prestigious international prize, but just before he was due to present his theory and collect his award, he found he had made a mistake.  If he had used different assumptions at the outset, he would get very different results.  Mortified, he wrote a follow up paper explaining his mistake, but in so doing, made the first mathematical contribution to what became known as chaos theory,  though this aspect of his work was largely ignored until the 1970s when ‘chaos’ became the rule for many systems.    

Chaos is evident in all aspects of life.  Weather forecasting is an exercise in probabilities because we can never be sure of the starting conditions.  We can’t factor in  all the variables.  This is why it is said that a butterfly flapping its wings in West Africa will result in a typhoon is south- east Asia.  It’s not meant to be taken literally, just a mathematical possibility to illustrate how small unconsidered variations can cause enormous effects.   

And take sport.  They said England had a good chance of winning The World Cup this year, but what went wrong?  Could a glance across the table by a teammate’s wife have set in train a sequence of events that unsettled the captain, led to a players revolt against the coach and culminated in a catastrophic collapse of confidence?

And what about politics, computing, and the stock market?  Somebody can’t sell his house in Wisconsin and we end up with a global recession.   Or the rail network.  The wrong leaves on the line in the Home Counties and business in the City of London slithers to a halt. Small variations can have massive effects.  A tiny wobble in the orbit of an asteroid could destroy all life on earth. 

And in medicine, a small change in environmental conditions, a particular event, can so easily bring about illness.   Perhaps a tune on the radio could revoke a memory that could upset the gut and result in an argument that ends a marriage.  With no chance at resolution the gut upset persists as unresolved IBS.   When scientists do trials of treatment, they try to hold all the conditions constant.  This is what is called a controlled study.   It relies on certain  assumptions about which factors are important.  Age and gender may be controlled,  diet might be in a few studies, emotional factors almost never and yet these may be crucial.  So they can never really control the outcome.  If they make the same measurements 100 times in the same patient and they will come up with a hundred different results.  So what do they do?  Employ a statistician to tell them an answer they might (or might not) be able to rely on!  But  they still might be ignoring certain crucial factors because they don’t think they count or they are impossible to control.  As Albert Einstein declared, ‘Not everything that counts can be counted.  And not everything that can be counted, counts.’  

Irritable Bowel Syndrome is an idiosyncratic disease.  It is more an expression of the personality, life experience and life style than those variables that can be easily measured.  Moreover it can’t be easily defined because there is no identifiable change in body structure or chemistry.  It is whatever doctors say it is.  No wonder treatment is so variable and so personal.  It’s an exercise in chaos; a bit of a lottery.  What works for one person may not necessarily work for another.  But you can cut down the variability by reading the self management programme and getting to know about your illness, yourself and with some guidance managing your own symptoms.