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Tallis in Wonderland

Reflections on Taking My Blood Pressure

Raymond Tallis finds himself within himself.

Those who meet your columnist face to face rather than through the mediation of the printed word may note some changes in his appearance. The informal carbon dating of a glance suggests that he will in the not too distant future start losing his battle with the most universal of the habits of the material world, of which the body he has taken for granted is a small sample. The habit in question is captured in the Second Law of Thermodynamics, which says that the disorder of a closed system tends to increase. In other words, things tend to get messier over time. Appearances notwithstanding, your columnist’s body is a highly ordered system. It is therefore a miracle that it has maintained that order for so long, transforming relatively disordered stuff such as fish and chips or inhaled air into elements that are themselves individual miracles of order – cells, tissues, and organs. These work collectively to mop up the side-products of the processes of maintaining stability and material constancy in the face of the slings and arrows of everyday fortune. This ‘tidying up as I go along’ is necessary to deal with the consequences of going along whilst maintaining the very possibility of a life shaped at least in part his ideas of what it should be. Thus, astonishingly, he has remained a going concern, and one that looks (very) roughly the same from day to day. Even people who last saw him decades ago recognise him – perhaps after a moment or two of hesitation – when they bump into him in the street.

Alas, the exquisitely constructed network of dynamic equilibria that make up the human body is sustained only for the briefest of blinks in the eye of eternity. Things start to drift beyond the point of correction. But RT will not give up without a fight. He does whatever he can to keep himself at a distance from the formless chaos of entropy. The fight takes many forms – none stranger than the action flagged up in the title of this piece: measuring his blood pressure with a view to keeping it within certain limits. But before we focus on this way of curating one’s own body, we need to step back a little.

Matter Matters

One way we can look at our bodies is as portions of matter. When we do so, something we otherwise take for granted becomes visible and surprising: that unlike 99.99999 etc % of the other items in the universe, these pieces of matter matter to themselves.

We still have no idea how this could have come about, given the standard story, according to which the universe has for most of its history consisted of insentient stuff. Pieces of matter mattering to themselves – things that mind what happens to the matter of which they are composed and which surrounds them inasmuch as it impinges on themselves – have been very recent arrivals in the order of things. We can be confident that it took matter billions of years to start bothering about itself. It took even more time for it to matter in the way your columnist matters to himself; for stuff to give rise to persons like him fretting over their own future.

At what point bits of matter came to suffer or enjoy their own states and became preoccupied with seeking opportunities for and avoiding threats to themselves is not clear. Despite what animists and panpsychists claim, we may be sure that planets, rocks, rivers, or bacteria do not worry about themselves. But what makes it even more puzzling is that most parts of the human body (kidneys, lymph glands, heart…) are not concerned about themselves either, even though they add up to something that does. How and why, in the rather monotonous story of the unfolding of a universe indifferent to itself, fretting entered the picture is not clear. It is not even clear whether the question is one that is best approached by empirical enquiry or by abstract reflection. In any case, we have no idea how the nonconscious mechanical evolution of material objects – of stuff and energy and forces – generated entities that awaken out of dead mechanism, at least temporarily – such that little parishes of deliberate doings, sparks of agency, awoke in the boundless desert of mere happenings.

What is particularly striking is the sheer variety and complexity of the ways that fretting has developed in us humans. Heidegger’s Dasein – ‘that being whose being is an issue for itself’ – has so many issues, and so many ways of pursuing them. Which is my cue to examine the extraordinary business of taking one’s own blood pressure. This action is not only a manifestation of a piece of matter mattering to itself, but is remote from those main manifestations of ‘mattering to oneself’ – the four Fs of fleeing, feeding, fighting, and sexual behaviour – that are seen elsewhere in the kingdom of living entities that matter to themselves.

The Pressure’s On

The first thing to note about taking one’s blood pressure is that it is a reminder of the many complex modes in which we engage with our own bodies. While we are identified with our flesh and bones, we are at the same time distanced from them in numerous ways – ways that are multiplied and expanded by the collective consciousness of our fellow humans and the discourse through which collective humanity endeavours to apprehend itself. This distance allows us to approach our own bodies as instances of a class of entities; a class that sometimes extends beyond the species to which we belong to encompass other kinds of living creature – as when we see ourselves as organisms.

At any rate, making my body the object of measurements performed by that body is an odd way of being an embodied subject. And recording our own blood pressure is even more strange than counting our fingers, measuring our step length, or taking our pulse. Even these simple actions can get very complicated when we use our fingers to count, walk to pace out a distance, or use our own pulse to time an event. Think of the iconic moment, crucial to the scientific revolution, when, using his pulse as a chronometer, Galileo timed the movement of a pendulum – according to legend a chandelier swinging in a cathedral – and thus made a discovery fundamental to mechanical science and to the development of accurate, reliable clocks – in short, to the emergence of the modern world. Taking our blood pressure, however, is yet more exotic, exemplifying how we inspect our own bodies by the torchlight of so many intersecting bodies of knowledge.

The blood pressure story goes back to Stephen Hales, a clergyman and polymathic scientist, who in 1733 first measured blood pressure, in a horse’s neck, by inserting fine tubes into its arteries and recording the height to which the column of blood rose (an odd use of a horse, admittedly). It was a long time before his egregious and seemingly idle curiosity bore medical fruit. But in the following centuries it became clear that elevated blood pressure was associated with changes in arteries that could cause strokes and heart attacks and other medical disasters. Subsequently there have been countless vast population studies of the influence of hypertension on cardiovascular health. The most notable followed three generations of the people of Framingham, USA. It generated over three thousand peer-reviewed scientific papers, and led to the guidelines for the control of blood pressure. This is the great hinterland behind my strange interaction with my body.

blood pressure check
Blood pressure check Delael 2016 Creative Commons 4

I apply the sphygmomanometer cuff and press a button on the machine. The cuff tightens its grip on my left arm as if I am about to be taken aside for further questioning. Since I am determined that anxiety about the result shall not be a confounding factor elevating that result, I mobilise the magic of modern technology: I have Bill Evans’ ‘Peace Piece’ playing gently in the background (notwithstanding that the infinitely wise and sensitive fingers of that genius of the piano have long since lost touch with their owner and dissolved in the rain). The cuff continues inflating itself, puffing and panting against the resistance of my arm, finds what it is looking for, and allows itself to deflate. Figures fill the little screen on the machine. I note the systolic pressure (when my heart is contracting), and the diastolic pressure (when my heart is dilating).

These numbers, capturing certain facts about the body attached to my name, remind me that what goes on inside my skin is utterly impersonal, though its consequences are quite the reverse. It would be an understatement to say that the ‘It’ and the ‘I’ of RT are joined at the hip, even though there is a different story attached to each. The stories told in RT’s biography, his CV, his toings and froings as he lives out his ‘being an issue for himself’, are remote from the fluctuations and corrections that constitute the life of the polyphasic system in dynamic equilibrium that is RT’s body, upon which the stories depend. Sometimes there are dramatic intersections of the I and the It – as when his blood sugar or blood pressure falls so much that he loses consciousness. Otherwise, although the life of the one depends on the life of the other, RT’s body is largely a Dark Continent hidden from the person whose body it is.

Measuring my blood pressure is a response to a rather abstract fear, though nothing could be more overwhelmingly concrete than the realisation of that fear. The transformation of my life, of my sense of who and what I am, even of my very capacity for ‘I amming’ the It of my body, resulting from a bite being taken out of my brain by a stroke, or the ontological rebadging from conscious subject to material object delivered by a fatal heart attack, could not be more serious. To populate that future with quantified possibilities drawn from the studies on the good people of Framingham, and the many millions of other individuals unknown to me who have participated in clinical trials, is one of the most striking manifestations of the distinctive mattering-to-itself of an embodied subject who tends his body with an eye to its future and his own.

The story does not end with me recording my blood pressure. As Marx might have said, it is not enough to interpret one’s blood pressure; the point is to change it. So I add my findings to the chart provided by my GP so that they can inform our discussion as to what to do next. As a compliant subject, I will pop the pills. They will vanish into the intimate unknown, where, hopefully, they will head off any cardiovascular catastrophes that will so damage the material object that is my body that it will no longer matter to itself, and the flow of columns will cease.

© Prof. Raymond Tallis 2023

Raymond Tallis’s latest book, Freedom: An Impossible Reality, is out now.

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