Medicine and. semiotics THURE von UEXKULL Attempt at describing the object Medicine is the science of the sick human being. It deals with the identification of disease, the circumstances of its appearance, and the factors that affect its development — with the intention to prevent disease and to help the sick Semiotics is the science of signs. It deals with the exchange of information and the sign systems on which it is based (Sebeok 1979). What do signs and sign systems have to do with the field of medicine? The famous British surgeon John Hunter (1728-1793) suffered from a discase of the coronary vessels (coronary heart disease). He knew that his heart trouble (angina pectoris) was marked by paroxysmal attacks which were symptoms of his disease. He was aware of the danger they indicated and he knew they were bodily responses to occurrences in his environment interpreted in an affective manner. He succinctly summed up this diagno- sis: “My life lies in the hands of any lout who is determined to infuriate me’. A short time later this prognosis proved to be right. He died after a heated argument with a colleague in St. George’s Hospital in London. The Canadian internist Sir William Osler (1849-1919) writes about Hunter's death: “In a silent rage and in the next room he gave a deep groan and fell down dead’. (Adler, et al. 1985) In this medical report we come across the words: symptom, indicate, response, interpret, diagnosis, and prognosis. They denote sign processes or imply them and refer to such diverse areas as communication between physician and colleagues, physician and patients, cognitive and affective Tesponses to occurrences in the environment and processes which take their course within organic systems, organs, and cells of a body of a human being. They obviously run through areas differing completely from one another. In each of these we come across sign processes of very different nature and meaning. However, as long as we do not define the term ‘sign’ precisely, doubts remain as to whether these observations are Semiorica 61-3/4 (1986), 201-217. (0037~1998/86/0061-0201 $2.00 © Mouton de Gruyter, Amsterdam202 Thure von Uexkiill really comparable or whether an indistinct terminology is possibly only misleading. The levels The social level On the social level we come across linguistic signs in particular which establish the communication between human beings. The physician formulates his diagnosis by means of linguistic signs as did the surgeon Hunter by describing the state of his health. For the communication between human beings, however, nonlinguistic signs are also of great importance. The ill-mannered person, who Hunter called a ‘lout’, was able to infuriate the surgeon by his manner or corresponding gestures. Participants in this exchange of signs within the area of medicine are physicians, patients, their relatives, and the nursing staff. The sign systems applied are various professional terminologies (according to the physi- cians’ professional fields) and patient languages, the differences in which often lead to problems of communication. The nonlinguistic sign systems cover a large area that has been researched by cthnologists, social anthropologists, ethological biologists, and developmental psychologists (Eibl-Eibesfeld 1984). A special case are those signs which do not serve as communication, but merely as information for a participant (for the physician and, in a broader sense, for the patient as well) about another participant's state of health without the latter being necessarily aware of it or intending to expose the information (behavior, facial expression, muscular tonus, skin color, sound of voice, odors, and many more). Signs like these are called ‘symptoms’ (von Uexkiill 1984b). ‘The messages that are transmitted (between individuals) through these ‘media’ can be classified into cognitive and affective pieces of information. The individual level The next step is to define a sphere that includes the individual as well as those parts of the environment which are of significance to the individual’s experience and behavior. This sphere can be described as the individual reality of man (Uexkiill and Wesiack 1979), which also comprises his body insofar as it is consciously or unconsciously experienced.ee Te Medicine and semiotics 203 Here the participants in the exchange of signs are the experiencing, perceiving, and behaving subject. regions of his body which force themselves on his experiencing or which influence his perception and behavior, as well as those parts of the environment which, as animate or inanimate objects, make up his sensorially percepted world. ‘The sign systems consist of the manifold messages transmitted by the body, which inform us about the condition of our organs, the position of our limbs, about moods and needs (such as hunger, thirst, satiety, tiredness, etc.) as well as about the sensory signs of our sense organs, which give us knowledge of the spatial and chronological conditions of our environment. Along with the body-produced information, they form the subjectively experienced reality. ‘The messages refer to the meaning that occurrences in our environment OF processes in our body have for us, the problems they confront us with, and the possibilities of solving these problems For the physician John Hunter, heart trouble was a sign that informed him about his disease, about pathogenic factors as well as about the prognosis. The feeling of pain in his heart is an example of signs that can only be experienced by the patient himself. (In our example physician and patient were one and the same person.) The patient must talk about these signs which only he can receive, if the physician is to know about them. In German medicine signs like these are described as ‘subjective symptoms? and are distinguished from ‘objective symptoms’, which the physician can diagnose with the help of his sense organs. Subjective symptoms are pain, dizziness, nausea, etc.; objective symptoms are changes of the skin color, heartbeats, an enlargement of the liver. the smell of acetone in the air, etc. The English language uses the words ‘symptom’ and ‘sign’ respectively, for subjective and objective evidence of disease. This leads to difficulties as to a semiotic terminology. First, the general term ‘sign’ is used for a specific case of a sign; the fact that symptoms of a subjective nature are signs as well, is blurred. Second, it also becomes difficult to explain that both objective and subjective evidences of a disease — symptoms and signs — are symptoms and are therefore signs that do not serve communication. Mead (1934) described this fact by coining the term “unintelligent gestures’ which do not form an act of communication, and : contrasting it with the term ‘intelligent gestures’, which do. This difference has far-reaching importance for the medical profession: it characterizes the individual as an integrated whole who must get in contact with other individuals by way of signs. Against this background it is only possible to define the concepts of information, communication, and sign, in their vital and existential significance. This seemingly simple fact, with which every student of medicine is familiar and which is takennme 204 Thure von Uexkiill for granted by most, raises epistemological questions of great importance They bring about special significance for medicine since it is possible to almost limitlessly increase the number of objective signs through the use of machines (X-ray equipment, ECG, EEG machines, etc.) as well as chemical procedures (laboratory methods). This development of an anonymous world between physician and patient threatens to give the medical profession the quality of a technical service business The biological level The overwhelming majority of objective evidence of a disease belongs to those types of processes taking place within the body, which, in turn, are divided into subsystems (organ systems, organs, tissue, cells, cellular organelles). The participants in the exchange of signs that takes place on the biological level are thus given. Sebeok (1976) described this fact by using the term ‘endosemiotic’. The sign processes use chemical, thermal, mechanical and clectrical processes as sign carriers. They make up an incredible number. If one reflects upon the fact that the human body consists of 25 trillion cells, which is more than 2000 times the number of people living on earth, and that all these cells have direct or indirect contact with each other through sign processes, one. gets an impression of the amount. Only a fraction of them are known to us. Yet this fraction alone is hardly comprehensible. The messages that are transmitted include information about the meaning of processes in one system of the body (cells, tissues, organs, or organ systems) for other systems as well as for the integrative regulation systems (especially the brain) and the control systems (such as the immune system. How do I proceed from the subject of medicine to the subject of semiotics? To this point I have assumed that which is ‘principally comparable’ is dealt with when we speak of sign processes on the social level, on the level of the individual reality of a person, and on the level of his body. We must now turn to the question of whether this assumption has not misled us as a result of its indistinct terminology. The development of a biosemiotical concept that can solve this problem is the task of all disciplines which dealMedicine and semiotics 205 with the examination of living systems — from the field of cytology to the social sciences. The specific contribution medicine makes (towards the solution of this problem) is based on the physician's experience that subjective and objective signs exist This experience forces him to reconsider, under this aspect, the usefulness of the models and concepts which have been developed in semiotics. The model of transmitter and receiver One model which — because of its simplicity and its ability to reduce life processes to technical functioning — is particularly common is the model of a transmitter or source that produces signs and of a receiver that registers the signs. This model is obviously very useful in interpreting objective evidences of a disease. According to it these evidences (as index signs) denote the location of the transmitter in the patient’s organism and at the same time reveal (as iconic signs) something about its state of health. Heartbeats, a wider cardiac apex beat, a deviation in the ECG, and the increase of a certain ferment (GPK) in the serum are signs the physician can perceive with his ear, his palpating hand, and his eye (assisted by a machine and a laboratory test). In this case the heart is the transmitter (the source that produces the signs) and the physician the receiver, even if a number of (amplifying, modifying, and transmitting) technical media are involved The capability of improving the physician's sense organs through the use of machines has been an essential contribution to the progress of medicine and can be expected to play a significant role in future developments. It deceives us into thinking that the diagnostic process could be adequately described by means of the technical model of transmitter and receiver and thus that the problem of the subjective signs could easily be eliminated: the conscious perception of a patient is interpreted as the indicator of a machine or as a chemical reaction which can indicate changes. in the body that cannot be perceived by the physician’s sense organs without any aids. It is assumed that a linear cause-effect chain exists which leads from the transmitter within the patient’s body through a number of parallel or series-connected relay stations (in principle, of any amount) to the physician’s sense organs (Figure 1). This seemingly plausible interpretation, however, overlooks an essen- tial point: by eliminating the problem of the subjective sign (interpreted as the swing of an instrument) it not only eliminates the patient’s subject —206 Thure von Uexkiill ‘CG. EEG laboratory, microscope Tomclous sense organs of physician pereeption of patient transmitter receiver Figure t. The diagnostic act as a flow of signs from a transmitter to a receiver. and in the end that of the physician as well — it also ignores the existence of illnesses that make up, by far, the biggest part of all disorders. This results in a science of medicine that solely deals with objective evidences of a disease and ignores the great number of patients whose illnesses are indicated by subjective symptoms (Weiner 1985). This one-sidedness. which is characteristic of modern medicine, is caused by a flaw in the reasoning, which — like all serious mistakes — however, has roots of psychological nature: it ignores the fact that a subjective sign — in contrast to the indicator of an instrument of a chemical reaction — in principle cannot be perceived by an outside observer. The swing of an indicator on a scale or the change of color of a liquid in a test-tube can be perceived by any number of observers. The feelings of pain. dizziness, nausea, exhaustion or fear are strictly privately felt phenomena. No one is able to experience the feelings of pain, dizziness, or nausea of another person nor can he feel his fear. These are signs which can only,be registered by the person affected, and nobody else. Receptor and effector Through his experiments with simple forms of marine animals, especially sea urchins, Jakob von Uexkiill found that physical and chemical Processes in the environment can only have an effect on the animal by way of ‘producing the combination of stimuli that are specific to the respective living being. ... Beyond that the objects (of the environment) do not exist at all for the sea urchin’ (1905). This underlines the subjective nature of signs that are received by a living organism. In his later work he wrote of a connection that does exist between the signs the receptors of a living organism receive (he terms them ‘perceptual signs’) and the responses of its effectors (which he terms ‘operationalMedicine and semiotics 207 signs’), which he reduces to the short formula: ‘The operational sign extinguishes the perceptual sign’ (Uexkiill and Kriszat 1936), and this extinguishing can be of subjective or objective nature: (An animal that has had enough to eat does not respond to stimuli of food any more, the perceptual signs are subjectively extinguished, or if it has just eaten the food, then the perceptual signs are objectively extinguished). This connec- tion can neither be explained with the traditional stimulus-response model nor with the model of a transmitter and. receiver which interpret the processes of life as a linear chain of cause and effect. Only a circular model can fulfill this, in which the response (the effector or operational signs) and the stimulus (the receptor or perceptual signs) effect each other. With his model of the functional circle (1920) he anticipates the principle of the feedback system, which later was mathematically formulated by Rosen blueth, et al. (1943). (See Figure 2.) perceptual organ receptor (perceptual sign) ‘meaning-receiver perceptual cue carrier (subject) ‘meaning carrier (object) effector (operational sign) effector organ Figure 2. The functional circle. The importance of replacing linear models with circular ones (for sign processes) was emphasized by Piaget (1975) on the basis of his develop- mental psychological studies of children. His concepts of assimilation and accommodation are based on a circular model, the sensori-motor circular response, which, even in its simplest form, applies to reflexes. The decision in favor of the circular model, at the same time, means supporting the idea of the subjective nature of the reception of signs. Morcover, this implies that all descriptions of sign processes which only consider a part of the circular processes must remain incomplete. The realization of the subjective nature of the reception of signs means the introduction of the observer problem into semiotics: the universes which living organisms form on the basis of the signs they receive through their sense organs are subjective universes. This — under biological aspects — also applies to the human observer. Sign theory and system theory The model shown in Figure 2 does not inform us how an act of communication between two living organisms (for example, between a208 = Thure von Uexkiill living being and its observer or between a physician and a patient) emerges. In the model, transmitter and receiver are not different, but the same individual. However, it is this precise difficulty, which in reality is only the reflection of the actual facts, that permits us to ask what communication is and how it is realized in a meaningful way. According to system theory, along with the integration of elements into a system, qualities emerge which do not exist on the level of elements. The sudden appearance of new qualities has recently been described as ‘emergence’ (Popper 1977; Medawar and Medawar 1977). Christian von Ehrenfels, the founder of gestalt psychology (1890), already described this fact almost one hundred years ago and reduced it to the simple formula: the whole is more than the sum of its parts. This ‘more’, which emerges as a new quality when a system is formed from a number of elements, is based on an arrangement of restrictions which reduces the possibilities the elements have outside the system to those activities which maintain the system (Medawar and Medawar 197) Thus, the possible activities of physical and chemical elements that make up a cell are restricted to the relatively few activities that serve the maintenance of the cell. If these restrictions fail to function, the cell will die. Analogous interrelations can be found in groups of cells of which organs and organisms are composed. Here the possible activities of free living cells, such as the possibility of unrestricted cell division, are strictly limited. Only those cell activities which sefve to maintain the organ or organism are allowed to take place. In this case, too, a failure of the restriction results in the destruction of the living organism. On the level of the free-living individual. the restriction of the countless possibilities of the environmental factors is achieved by a subjective universe (Umrwelt) in which only those factors are integrated that are vital for the system, all others however, are excluded from it. A failure of this selection would cause the death of the individual. On the level of social systems the possibilities which individuals have outside the social unit are restricted by the rules of the social system, the keeping of which is essential for the existence of the social system. On each level we realize an arrangement of restrictions for the activities of the systems, which, as elements, form more complex units. These arrangements are specific to each level. Thus, a hierarchy of levels of integration becomes apparent, from which new phenomena constantly emerge that cannot be derived from the level under it. In order to describe them we are forced to develop — for each level — a specific scientific discipline with a specific terminology: physics, chemistry, biology, psy- chology, and sociology owe their right to exist only to this fact.Medicine and semiotics 209 The close connection of this system-theoretical concept with the theory of signs is derived from the following consideration: the terminology for the various sciences — irrespective of whether they are physical, chemical, biological, psychological or sociological terms — are signs which denote something that is not identical with them (Th. von Uexkiill 1986). These terms can be interpreted as translations (Jakobson 1971) that physicists, chemists, biologists, psychologists and sociologists worked out to trans- pose sign processes of their fields of phenomena into the human language. Thus, a hierarchy of signs and sign systems becomes evident, in which, on each level, the phenomena of the level under it are used as sign carriers and are encoded into more complex signs according to a specific code for each case. On the biological level, for instance, cells and organs encode physical and chemical phenomena as sign carriers that communicate knowledge to other cells and organs. As well, the central control systems know about processes that take place on the level of cells and organs. On the psychological level, information from inside the organism and information coming from the environment by way of the sense organs is encoded as sign carriers into information in the central nervous system, which informs the individual about its individual reality. Finally, on the social level, information about occurrences in the realities of single organisms is encoded as a sign carrier into superindividual signs. The problem of communication between different systems is — from the system theoretical perspective — a problem of forming general (supra-)systems which have a general code. On eich level, physical sign carriers are enclosed with a new integument of meanings, which on each new level correspond with new references. A sign hierarchy as stages of ‘envelopment” Based on this model the analysis of a complex sign has the aim of identifying, step-by-step, the sign carriers (which, as it were, are enclosed on each level with ever new meanings), until we finally come upon physical or chemical processes on the lowest level, which have been encoded by the receptor of some cells into-the simplest-signs. Waisssle (1984) depicts how the optic system of the eye (which can serve as an example of a sense organ) produces the visible qualities of the objects of our environment: the physical light waves, which are projected by the Jens on the retina through the vitreous humor, are linked as sign carriers there with the first biological meanings. Particular cells of the retina (so-called ON and OFF cells) produce, when stimulated, the qualities ‘bright’ and ‘dark’ or black and white. (Here there is an analogy210 Thure von Uexkiill to the skin, where individual sensory cells also produce the feeling of ‘warm’ and ‘cold’ temperatures.) Also the visible qualities of ‘nonmove- ment’ and ‘movement’ as well as the direction of movement are produced by specific ganglion cells in the retina of the eye. The first signs are then transmitted as neural action currents through several relay stations to the primary optic centers of the cortex. There through the interaction of specific cells they are combined with more complex biological meanings in the form of primitive patterns, which represent the qualities ‘long’, ‘short’, ‘narrow’, ‘broad’, ‘diagonal’, or ‘straight’ (Hubel and Wiesel 1962). The processes in the optic areas which are superordinate to those centers are still partly unknown. However, the principle of integration of simpler sign processes (as sign carriers) to more complex units with new meanings (or qualities, for example, in the form of more differentiated patterns) can also be discerned here. This is a very rough description of the extremely subtle interrelations within the nervous system of higher forms of organisms where during “stages of envelopment’ more and more complex signs emerge and the cognitive and affective meaning-carrying signs of other brain areas (for example, the limbic system) must be added. The reason for its great importance to the science of medicine is the fact that the structure of the nervous networks, which are responsible for the coding into complex signs, is only partly genetically determined. It is not yet known how much of it is structured in the course of the ontogenesis, j.c. biographically determined dividual differences. However, animal experiments (by Harlow and Zimmerman 1959) with monkeys, Weiner (1977) with rats, and Henry (Henry and Stephens 1977) with mice speak for themselves. They show that even with reference to higher mammals combinations of meanings in the form of conditioned reflexes, as Pavlov described them, are essential for the interaction between infant and mother after birth in order to induce the connections necessary for a healthy development. This explains why the effective meanings that are linked with the sensory patterns are so extremely different from person to person and why deprivations in early childhood in the interhuman exchange of signs between infant and mother can make them susceptible to illnesses later on. Vegetative, animal, and human sign systems At the beginning of this paper, I asked whether phenomena described as sign processes on the social, psychological, and biological levels, are really comparable, or whether an indistirict terminology is simply misleading.Medicine and semiotics 211 To protect the terminology from being wrongly used by means of more precise definitions, I suggested employing a circular model to describe the sign process and the concept of the stages of envelopment for the characterization of the level on which a sign process takes place. Thus, it is possible to delimit three stages of envelopment and to compare each sign process with the other. Furthermore, for the introduction of semiot- ics into the science of medicine, it is essential to describe the connections that exist between the different levels and their sign processes. The vegetative signs Plants do not have a nervous system nor do they possess locomotor behavior. That is why they are not able to form subjective universes, but only ‘dwelling integuments’ (J. von Uexkiill 1940). Their interaction with the environment takes place between receptors and effectors of the cells on their surface. Since operational signs extinguish perceptual signs, perceptual signs mark a deficit of operational signs on the vegetative stage and induce an increase of operational activity. They are not signs for occurrences outside the plants, as there is no ‘outside’ for vegetative systems, We can understand this state if we remember that temperature, tactual, and pain receptors in our skin also do not signal influences from ‘outside’, but rather a change of feeling in our skin, that — in other words — our skin, too, is just a dwelling integument. Deaf and blind children are only then able to build an outside world when they have learned to connect their contact sensations with motor sensations Plants are solipsistic systems. Since they do not know about objects there is no point of describing them as subjects. They are only able to distinguish ‘self’ and ‘nonself”. The signs which enable them to do this are iconic signs, i.e. perceptual signs for a decrease, operational signs for an increase of the similarity to ‘self’ (the reference value in terms of cybernetics). In the code of solipsistic systems differences of intensity are linked. From his point of view, the observer may mistakenly interpret index signs as determining the behavior of plants,.(e.g. in-connection with phototaxis or signalling of pest infestation of one plant to other plants, for the plant these remain solipsistic responses to iconic signs; or to differences of intensity in the modification of receptors caused by factors of an environment that does not exist for the plant). These facts also apply to the systems within our body. Cells are Solipsistic systems as well, and endosemiotic signs are iconic signs of such systems. The solipsistic systems in our body are chiefly connected with212 Thure von Uexkiill each other by means of chemical signal substances. These substances act on the receptors in the cell membranes and spread out in the watery medium of the interstitial liquid through diffusion (Karlson 1984). Animal signs New signs appear with a central nervous system, senses of distance, and locomotor behavior and something new emerges: space which perceptual signs produce in the form of perceptual cues that as index signs point the direction of movement for the motor behavior. Thus, as we have seen, the perceptual sign ‘movement’ emerges in the receptor of the visual sense of distance. In this way a three-dimensional subjective universe is formed that, as a second skin, so to speak, envelopes the body which is covered by skin, experienced as a dwelling integument. Jakob von Uexkiill depicts the ‘anatomy’ of the subjective universe, the ‘Umwelt’, as follows: Each human being, taking a look around in the open countryside, stands in the middle of a round island with the celestial globe above. This is the concrete world man is determined to live in and which contains everything he is able to see with his eyes. Those visible objects are arranged according to the significance they have for his life. Everything that is near and can have an effect on the human being is present in lifesize; all distant and thus harmless objects are small. [...] Objects that approach him invisibly because they are concealed by other objects produce noises or a smell which can be noticed by his ears and his nose respectively, and when they are very close by means of his sense of touch. The near environment is marked by a protective wall of senses that becomes thicker and thicker. Sense of touch, sense of smell, sense of hearing, and sense of vision enwrap the human being like four layers of a cloak that get thinner and thinner towards the outside. (1936: 11, 12) The indexical perceptual cues of the senses of distance include the iconic perceptual signs (of the vegetative stage), as it were, ‘enveloped’ in itself. One can easily convince oneself of this: when we stroke a tabletop with our finger, we feel ‘table’ (perceptual cues). When the finger comes upon a splinter, we feel ‘finger’ (perceptual signs). We perceive loud sounds in our car and do not hear them ‘outside’. We perceive glaring stimuli of light in the eye and do not see them as bright perceptual cues of objectsMedicine and semiotics 213 Human signs Along with the human ability to develop ideas of objects and their qualities on the basis of sensory signs, new signs emerge: the symbols. Symbolic concepts which represent absent objects, (e.g. temporarily nonperceptible ones) can have iconic similarities or include indexical references, they can be arbitrary memory labels. such as words; they have a new meaning in each case — they keep absent objects present. Thus new forms of the subject-object relation emerge. - In the animal stage, subjects do not maintain distance from their objects. As long as the objects remain in their self-worlds, they are tied to them. The dog must chase the hare until it has disappeared from the horizon of its self-world. Objects do not possess constancy in this When they have disappeared from the self-world, they simply do not exist any more. Only in the human stage does the constancy of objects and distance to objects emerge: ‘neutral objects’ emerge (Th. von- Uexkiill 1984c) The ability to form symbois means that the direct connection between perceiving and operating is interrupted. The sensory signs lose their absolute unambiguity. They become as it were, un-homely (‘un-heimlich’). An inner world separates perception and operation, in which test operations are needed to find out whether one’s senses can be trusted or whether it is dangerous to follow their demands. Between the instinctual demand and the act of satisfaction the ego inserts the activity of thinking, which after orientation in the present and exploiting earlier experiences tries to predict the success of the planned activities through test operations. Thus, the ego decides whether the attempted act of satisfaction shall be carried out or postponed or whether the instinctual demand has rather to be suppressed as being dangerous (principle of reality). (Freud 1933: 524) What the incorporation of the capacity of representation means for the immediately experienced subjective universe, can hardly be imagined radically enough. Piaget (1975) speaks of it as a ‘Copernican revolution’ which begins with the second year of life. Henceforth the sensory signs lose their reality of compulsion toward immediate action. Perceptual cues no longer denote operational cues but ideas, and these ideas turn into symbols of objects that are now constant, independent of us, and — paradoxically enough — equipped with our subjective sensory qualities It was the danger of a nature that longer spoke in immediately comprehensible signs that forced man to construct — in his imagination — the reality of a world in which occurrences became calculable by means214 Thure von Uexkiill of the rule of cause and effect. This was finally so successful that the sign nature of objects was forgotten. Though it was Kant who reminded us not to take objects for ‘things-in-themselves’, one also forgot that the objects which our symbols refer to are systems of interaction, which in their simplest form follow sensori-motor programs in which the human subject is incorporated with his perceptual and operational experiences, which in turn include the animal and vegetative sign relations of his biological organization. Problems and possibilities of a science of semiotic medicine For the science of medicine, the forgetting of the sign nature of objects resulted in a concept of the body based on the model of the machine, and not on one of a living organism. Through this, however, the diagnostic and therapeutic process is only half understood. Only the economical and not the ecological interrelations are recog- nized. An analysis of the cause-effect relations does not consider inter- relations between meanings and concentrates on relations between mass and energy, whereas an analysis of relations between signs shows interrelations in which something has a meaning for something else. According to Peirce, a sign is something that stands for an aspect or function of something else (CP 2.228). Something that has the meaning of a sign for a living system bears an ecological or complementary relation to it. J. von Uexkiill (1940) speaks of a ‘contrapuntal’ relation or rule of counterparts. Thus, for living systems wing and air, fin and water, hoof and ground, eye and sun, bear a relation, in which air, water, ground, and sun stand as an aspect of or function for wing, fin, hoof, or eye. A reduction to mechanical interrelations does not do justice to the problems on any level. It shows the interaction of two elements (cause and effect). A relation of signs, however, requires the description of interac- tions between three clements (a sign, an object, and its interpreter), and, as Peirce stresses, ‘this threefold influence can in no way be reduced to interactions between pairs’ (CP 5.484). In other words, sign processes describe relations in which two elements complement cach other as a joint function for a third. They show what (under a particular aspect) goes together and what does not. Under this aspect, arrangements of restriction which the formation of systems and the emergence of new qualities are based on, can be interpreted as sign relations or rules (codes) for sign processes. Systems are ecological structures in which the state and the behavior of one element (subsystem) has a meaning for the state and behavior of allMedicine and semiotics 215 others. Ecological structures are formed, preserved, and changed by way of information exchange. They can be disturbed by the interruption of the exchange of information, the transmission of wrong information, or, when accurate information is wrongly encoded. According to the model of the living system, symptoms of an illness are not technical faults, but they indicate a disrupted flow of information in which objective and subjective evidences of an illness (signs and symp- toms) appear, and whose meaning for the patient and for the physician must be distinguished. Sign processes between living systems proceed in three steps: (1) The effector of a system produces (through a particular behavior) signs (gestures, sounds, secretions); this produces (2) physical sign carriers (light or air waves, chemical or electrical processes) which (3) are encoded by the receptor of his own or of another system as a sign. Of these steps, only the sign carrier (2) is accessible to the outside observer who has to try to encode the meanings by finding the code according to which the effector of system | and the receptor of system 2 assign the meaning of signs to sign carriers. In other words, only the physical sign carriers (step 2) are objective evidences of an illness. The behavior of the effector (in its meaning as an operational sign), as well as the encoding of the receptor (into perceptual signs) are subjective evidences of an illness which have to be analyzed and decoded by the physician on each level of the exchange of information. The machines the physician uses in order to improve his sense organs only inform him about sign carriers whose meaning as information in each case requires an analysis of the sign processes in which they are encoded as information. Physics, chemistry and biochemistry are, how- ever, no more than indispensable auxiliary sciences. The actual task of the physician is the semiotic analysis of the subjective meaning which objective evidences of illness imply as information carriers in the biologi- cal systems of a patient's body (endosemiotic), as well as individual reality (psychosemiotic), and in the social groups (anthroposemiotic or socio- semiotic) relevant to him. In the medical report of the English surgeon, which served as an introduction to my considerations, the complaint about the subjective symptom of heart pain is an anthroposemiotic and sociosemiotic sign process in the interaction with other physicians. In a first step, the semiotic analysis studies the context in which the symptom appears and finds that it is the response of the body to the behavior of another person, which is interpreted as an insult against which one must not defend oneself. In a second. step, the analysis tries to reconstuct the situation in which the code for such a coding of the behavior of other people was learned in order to understand the psychosemiotic signs which form the216 Thure von Uexkiill patient's individual reality. What we are dealing with here are always ecological interrelations. In the third step of the analysis, which attempts to examine the endosemiotic signs responsible for a state of alarm in the patient's body, the ecological problems are initially all-important as well. When a state of alarm overtaxes the energy metabolism of the heart, it becomes evident that a disturbance of the ecological balance can result in economic problems which the body tries to counterbalance ecologically, with the feeling of pain as a warning of more stress. The analysis shows clearly that disturbances of the exchange of information on different levels endanger ecological balance. The im- balance can result in economic consequences, with the objective evidence of the illness taking the form of anatomic damages, which then threaten the existence of the whole system. References Adler, R., Rasseck, M. and Schmidt, Th. (1985). Arterielle Verschlusskrankheiten. In Psychosomatische Medizin, Uexkill, Th. v. (ed.). Miinchen: Urban and Schaarzenberg. Ehrenfels, Ch. v. (1890). Historisches Worterbuch der Philosophie 3. Base\, Stuttgart Schwabe. Eibl-Eibesfeldt, J. (1984). Biologie des menschlichen Verhaltens. Miinchen: Piper Verlag. Freud, $. (1933). Newe Folge der Vorlesungen zur Einfiihrung in die Psychounalyse Wien: Internationaler Psychoanalytischer Verlag. Harlow. H. F. and Zimmerman, R. R. (1959). Affectional responses in infant monkeys. Science 130, 421 Henry, I. P. and Stephens. P. M. (1977). Stress. Health and the Social Environment. New York. Heidelberg. Berlin: Springer. Hubei, D. R. and Wiesel, T. H. (1962). Journal of Physiology 160, 106. Jakobson, R. (1971). Language in relation to other communication systems. In Collected Writings Vol. 2. The Hague: Mouton. Karlson, P. H. (1984). Evolution der chemischen Kommunikation in Tierreich. In Informa- tion und Kommunikation. Naturwissenschafiliche, medizinische und technische Aspekte. Verhandlungen der Gesselschaft Deutscher Naturforscher und Arzte. Nirnberg. Mead, G. H. (1934). Mind, Seif and Society from a Standpoint of a Social Behaviourist. Chicago: University of Chicago Press. Medawar, P. B. and Medawar, J. S. (1977). The Life Science. New York, London: Harper and Row, Peirce, C. S. (1931-1966). Collected Papers, Hartshorne, Weiss, and Burks (eds.) Cambridge, Mass: Harvard University Press. Piaget. 3. (1975). Gesammelte Werke. Stuttgart: Klett Popper. K. R. (1977). Kritik des Materialismus. In Das Ich und sein Gehirn, K. R. Popper. and J. C. Eccles (eds.). Miinchen: Piper. Rosenbleuth, A., Wiener, N. and Bigelow, J. (1943). Behaviour, purpose and teleology. Philosophy of Science 10, 18-24, Sebeok. T. A. (1976). Contributions 10 the Doctrine of Signs. Lisse: The Peter de Ridder Press.Medicine and semiotics 217 Uexkiill, J. v. (1905). Leitfaden in das Studium der experimentellen Biologie der Wasserticre, Wiesbaden, —{1920). Theoretische Biologie (Ist edition). Berlin: Springer Verlag. —(1940). Bedewtungslehre. Leipzig: J. A, Barth. English version (1982). Jakob von Uexkiill’s The Theory of Meaning. Semiotica 42 (1) Special Issue. Uexkiill, J. v. and Kriszat, G. (1936). Streifziige durch die Umwélten von Tieren und Menschen. Berlin: Springer Verlag. English version (1957). A stroll through the worlds of animals and men. In Instinctive Behaviour, C. H. Schiller and K..S. Lashley (eds.). New York: International Universities Press. Uexkiill, Th. v. (1984a). Semiotics and the problem of the observer. Semiorica 48 (3/4), 187-195. —{1984b). Symptome als Zcichen fiir Zustinde in lebenden Systemen. Zeitschrift fiir Semiotik 6 (12), 27-36. —(1984c). Zeichen und Realitat als anthroposemiotisches Problem. In Zeichen und Realitit, Akten des dritten semiotischen Kolloguium Hamburg. Ochler, K.. (ed.). Tiibingen: Stauffen- berg Verlag. —(1986). The Mind-Body Problem in Medicine. (forthcoming). Uexkiill, Th. v. and Wesiack, W. (1979). Lehrbuch der Psychosomatischen Medizin. Miinchen: Urban und Schwarzenberg. sle, H. (1984). Auge und Gehirn, Informationsverarbeitung im visuellen System der Saugeticre. In Verhandlungen der Gesellschaft Deutscher Naturforscher und Arzte 113 Niimnberg: Versammlung. Weiner, H. (1977). Psychobiology and Human Disease. New York: Elsevier. —(1985). A proposal for a curriculum in behavioral biology and medicine in medical schools. Symposium on Medical Education, Kiawah Isiand, South Carolina. w ‘Thure von Uexkiill (1908) is a doctor of medicine and Professor Emeritus at the University of Ulm. His principal research interests are the relationship between psychosomatic medicine and semiotics, and internal medicine. His publications include Wirklichkeit als Gehemnis und Aufirag (1945, with E. Grassi), Von Ursprung und Grenzen der Geisteswissen- schaften und Naturwissenschaften (1950, with E, Grassi), Der Mensch und die Natur: Grundzuge einer Naturphilosphie (1953), Grundfragen der Psychosomatischen Medizin (1963), and Lehrbuch der Psychosomatischen Medicen (1979).