by John Aitken

I suppose everything is real to the cat. I was watching our cat sleeping the other night, and he suddenly started twitching in his sleep. He appeared to be dreaming. Maybe our cat can distinguish between the reality of waking life and the world of the dream.  In all probability, he cannot grapple with abstract concepts. He probably doesn’t wonder at all about where the food on the plate came from prior to being placed in his bowl in the morning. For our cat, reality is very concrete.

For a Crohn’s disease patient, reality is far from concrete. The reason they have become ill is not yet understood by the medical profession, and there are any number of theories that can be presented to the patient to explain the age old question, “Why me?”

I recall reading a paper many years ago correlating toothpaste swallowing with Crohn’s disease. Later another writer provided data to suggest that cornflakes in the morning was the culprit. Not to be outdone, another scribe attributed the disease to sugar and referenced the cornflake as additional proof, since sugar was usually sprinkled over the offending cornflakes. For the patient, trying to understand the reality of the disease that has overtaken them must be extremely confusing. It is of small comfort to point out that this is precisely how science works. Each reality is replaced by a new, and equally believable, reality.

For example, it is quite simple to call Crohn’s disease an autoimmune disease. The superficial explanation for an autoimmune disease is that “the body is attacking itself.” The concept that the body attacks itself leads to a number of therapies based on stopping this process. Damping down the immune response provides some respite and can put some patients into remission. Thus, a successful treatment of a Crohn’s disease flare reinforces the perception of reality – that the body is attacking itself. Is that sufficient to explain the cascade of events that leads to a petulant body picking a fight with itself?

Is celiac disease an autoimmune disease?  If the patient avoids gluten, then the celiac disease often goes into remission. There is a cause and effect.  Certainly, were gluten not implicated, then celiac disease would be another autoimmune disease, similar to Crohn’s disease, without a known trigger. The discovery of the association with gluten changed that perception of reality.

A disease without a known cause is sometimes referred to as “idiopathic.” This is not an admission of failure on the part of science. It is more like leaving the spaces blank in a crossword puzzle in the certainty that you will return to the particular clue later. Let’s look at the Crohn’s disease crossword clue in more detail. It is now “generally accepted” that the main driver for Crohn’s disease is inflammation and the inflammatory response. A simple example of the inflammatory response using a wood splinter in your finger is that the splinter is the trigger for the inflammation and the inflammatory response is the driver. The complicated approach for this complaint would be to try to control the inflammation, but common sense tells us to pull out the splinter. Cause and effect.  Inflammation is the effect, not the cause.

In Crohn’s disease, the effect is seen and experienced by the patient, but the cause remains elusive. One underlying assumption is that the mechanism triggering the disease presentation is extremely complex. Broadly, there are three schools of thought:

1. A foreign protein is triggering an allergic reaction.
2. A microorganism is causing an infection.
3. A genetic mutation.

These options represent three separate perceptions of reality.  There is fourth option, however. It might be 1, 2 and 3, acting together. The perfect storm.

The microorganism may be producing a foreign protein, and that protein may trigger the inflammation. A defect in the immune system of the body may provide an entry point for the microorganism. Such organisms exist.  I have seen them.

These are all hypotheses. They are perceptions, based on available evidence. They come from the same place as our thoughts, dreams, and our imaginations. That is how we solve crossword puzzles. We think outside the square, and we do not accept that the current version of reality is the right one. Sometimes the eventual breakthrough to a new view of reality occurs through imagination. Einstein’s great leap of discovery came to him as in a dream. He imagined himself travelling on a beam of light, and realised that the speed of light must be a constant value.

As knowledge changes, so does the view. Our perception of reality is changed by science, and in doing so, reality itself changes. That is the dream.