Nature and Nurture

Trishan Panch
Sep 9, 2018 · 4 min read

Life is strange. The universe is vast and human space is small. Each of us is a universe of atoms. We somehow find meaning in shifting sands. Variation is everywhere and the only mechanism we have to make sense of it is primed for narrative coherence. Turning a corner and seeing a tiger is ok if one is able to escape the tiger and remember the contours of the corner and avoid making the turn tiger-wards in future. The happy consequence of this evolutionary story telling bounty is that we are able to find purpose, to share purpose and in so doing to care for and inspire each other. The less happy consequence is that we are plagued by things happening to us or because of us rather than things happening and us simply being around, or not. The narrative tail wags the rational dog.

We are living through an industrial revolution in making sense of the physical world. Machines are helping us to understand and manipulate our materials by learning structure from experience. I have spent most of this year looking at data from patients and writing papers on how looking at data from patients with computers might be a good idea. What is interesting to me about this machine learning is that it is the first time that I am aware of that there is a sense making machinery that can be pointed at the universe that is not derived from an evolutionary root. Why sense making works for machines is no more clear than it is for humans. In analyzing images, or voices or medical record data a deep net is abstractly inferring deeper truths. These deeper truths are the laws of physics and the truth that makes understanding complex systems possible — that the universe and creatures within the universe are compiled hierarchically — smaller units assembled into more complex structures in a causal sequence.

For the past few months, I have been looking at the trails patients create as they live their lives and interact with the byzantine health system. From looking at divergence in healthcare outcomes between groups of patients emerges the toxic effects of disparities — of violence in the fabric of society. From looking at divergence in uptake or success with care programs emerges the effect of relationships, both familial and clinical, on the abilities of individuals to modify their trajectories. And with tools less constrained by parametric assumptions, one is able to uncover ensemble interactions between these factors even if it is not possible to necessarily understand them cognitively. This is no different from neural nets deriving the laws of mechanics from video images and using those derived laws to generate future frames “independently”. When looking at the physical world we infer the laws of nature, when looking at the human world we infer the laws of meaning in life.

Night falls fast. One of us, recently committed suicide and we have all been abruptly thrust into the role of biographer — trying to understand a life through the lens of a death. Peeling back the layers it seems like the bell had been ringing for such a long time that it had become impossible to hear the individual chimes over their reverberations. Genetic loading, childhood trauma, personality traits and social factors put an awful payload in the mail and then seemingly chance events precipitated delivery. I hope that in the future these things will be understood. I hope that the structural and deterministic influence of emotional trauma on a background of a genetic predisposition to interpret trauma a certain way is understood. I hope the way that this creates the preconditions for cognitive phenomena that over time decimate higher social functioning , the functioning that is the seat of the meaning on which we all depend, is understood. I hope these interactions over time spanning the internal universe of atoms and the interactions externally of the atom in the universe will be understood. And maybe even changed. But they can’t be changed now. Now, we need to find a narrative in the dark.

Trishan Panch

Written by

Co-Founder, Chief Medical Officer and Board Director @Wellframe. Innovation Advisory Board @Boston Children's Hospital. Lecturer@MIT. Instructor@HSPH.

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