I have studied exercise medicine. Long ago I became interested in the rehabilitation and recovery of cancer patients. At Yonsei University in Korea, and during several research sabbaticals abroad, listening to people living with chronic illness has been part of my work. I once spent a research sabbatical at the Dana-Farber Cancer Institute, affiliated with Harvard Medical School. Studying how exercise affects cancer patients' treatment outcomes and quality of life.
In the course of that work — and in many encounters in Korea — I have run into the same question again and again. Patients diagnosed with cancer, their families, sometimes the doctor — ask:
"Why did this disease happen to me?"
There is a medical answer to this question. Genetic factors, hormonal factors, environmental factors, lifestyle. We can list specific risk factors. But — that list usually does not satisfy the one who asked. Because what they are asking is not — that list of mechanical causal links.
What they are asking — is to understand this disease within the context of their whole life. The stress of the past ten years. Wounds in relationships. The death of a family member. Burnout at work. Years of grief held down. They are asking how all of this has accumulated in their body. How their life and their disease are connected.
Modern medicine does not have a good language for this question. We diagnose symptoms and prescribe treatment. But understanding disease within the context of a whole life — is barely included in medical education. It is pushed off into a marginal category called "psychosocial factors." Footnote, not main text. The periphery of objective medicine.
And yet — patients drag us into that footnote. The essence is in the footnote. The context of a person's life — is the context of their disease. Without understanding this — whatever treatment we give, something is missing.
This chapter begins from that question. "Why did this disease come?" Reverse it and ask — "Why is the healthy person healthy?" This is the question opened by a medical sociologist in the late twentieth century. Salutogenesis.
And this question — is the door to a medical alternative to the Wetiko diagnosed in Part 3. And — it is the lens that shows how the perichoresis explored in Part 4 takes form in the field of body and health.
The roots of this chapter lie in a nineteenth-century French dispute. Almost forgotten in the history of medicine — but perhaps wrongly forgotten. The opposition of Louis Pasteur (1822–1895) and Antoine Béchamp (1816–1908).¹
Historical memory of the two could not be more uneven. Pasteur is a hero. Founder of germ theory. Father of vaccines. Pioneer of research into rabies, anthrax, cholera. His name lives on as the Pasteur Institute and as the word "pasteurization." French national hero. A pillar of medical history.
Béchamp is almost forgotten. His name is unfamiliar to the general public. Even in medical history textbooks he is mentioned only briefly. He was the one who historically lost the priority dispute with Pasteur. But — did he in fact lose? The question is being reopened lately.
The two men's commonalities and differences. Both were nineteenth-century French scientists. Both studied the existence and role of microorganisms. But — the conclusions they reached were very different.
Pasteur's core claim: Disease is caused by microorganisms invading from outside. Specific pathogens such as bacteria and viruses enter the body and cause disease. This is the "germ theory of disease."²
The implications were great. If disease is caused by specific pathogens — the treatment becomes clear. Kill the pathogen. Antibiotics emerged from this logic. Sterilization emerged from this logic. So did vaccines, in extension of it.
Most of twentieth-century medicine was built on this foundation. Tuberculosis, plague, cholera, malaria — all of these were overcome by germ-theoretic approaches. Average life expectancy doubled. Infant mortality plummeted. This achievement cannot be denied.
Pasteur himself recognized in his last years that the model was incomplete. The famous sentence said to have come from his deathbed: "The microbe is nothing; the terrain is everything (Le microbe n'est rien, le terrain est tout)."³ The accuracy of this attribution is debated by historians. But — it is plausible in context. In his late years Pasteur came to understand that more than the invasion of microbes, the state of the body (the terrain) was decisive.
But — even if Pasteur held this insight, mainstream medicine adopted a simplified germ theory. There was a reason. The simple model was easier to put to work. It was easier for the pharmaceutical industry to adopt. It was easier for hospital organization to operate. Complexity got in the way of institutionalization.
Béchamp's argument was — close to the opposite of Pasteur's. More precisely, complementary, but with different emphasis.
Béchamp's core insight: Microbes are not fixed species. They change according to the body's internal environment (the terrain).⁴
He proposed the concept of microzymas. Basic units of life present in every cell and tissue of the body. When the body's environment is healthy — these maintain the body. When the body's environment worsens — they "turn into pathogenic microbes." Not external invasion but — internal transformation. This was Béchamp's claim.
The theory could not be proved with the technology of the day. And Pasteur's simple model was more intuitive and workable. So Béchamp was forgotten.
But — the heart of Béchamp's insight was not entirely wrong. He emphasized one important thing. "Terrain matters." That is, the state of the body, the body's internal environment, the whole condition of the person is decisive in the development and progression of disease. This insight — has revived in many ways in the late twentieth and twenty-first centuries. Astonishingly so.
Make the difference clear.
Pasteur model (germ theory):
Béchamp model (terrain theory):
Which is correct? Both. Partly. For specific infectious diseases — tuberculosis, malaria, HIV — the Pasteur model is decisive. The specific pathogen must be struck.
But for most modern health problems — chronic disease, autoimmune disease, metabolic disease, cancer, depression, dementia — the Béchamp model is more useful. These diseases have no specific external invader. The whole state of the body — slowly — turns pathological. The Pasteur model's "what to kill" logic — neither understands them adequately nor treats them adequately.
The central figure of this story is Aaron Antonovsky (1923–1994). A medical sociologist born in the United States who emigrated to Israel. He created the concept of salutogenesis.⁵
Antonovsky's decisive research was carried out in Israel in the early 1970s. He surveyed the health of Holocaust survivors. This group — endured perhaps the most extreme psychological and physical stress in human history. People who had survived the concentration camps. What was the state of their health?
As many researchers expected — a substantial portion of survivors had chronic health problems. PTSD, depression, cardiovascular disease, premature aging. This was not surprising. The natural result of extreme stress.
What Antonovsky noticed was another point. A substantial portion of the survivor group was — remarkably healthy. Physically and mentally. Far more than expected. How was this possible?
Within the existing medical framework, this question was — almost impossible. Medicine was the discipline that asked about causes of disease. "Why are you sick?" Antonovsky asked the opposite question. "Why are they healthy?" "Among people who experienced the same conditions — why do some fall ill and others remain healthy?"
This shift of question was — a small revolution in the history of medicine.
Existing medicine's approach was pathogenesis. From the Greek "pathos" (suffering) + "genesis" (generation). "How is suffering generated?" This is nearly all of modern medicine. It studies how disease arises and progresses.
Antonovsky coined a new term. Salutogenesis. From the Latin "salus" (health, well-being) + the Greek "genesis" (generation). "How is health generated?"⁶
The difference between the two approaches is fundamental.
Pathogenesis: sees health-disease as a binary. Health is the default state, and disease comes from outside. The role of medicine — is to remove disease and return one to "health." Health = absence of disease.
Salutogenesis: sees health-disease as a continuum. There is no perfect health and no total disease. Every person is somewhere on this continuum. The role of medicine — is to help one move toward the health side. Health = the result of active generation.
What does this shift mean? Medicine's question changes. From "why is this person sick" to — "what generates health in this person's life." The character of intervention changes too. From drug prescription and surgery — to readjusting the whole context of life. And — the patient's position changes too. From passive recipient of treatment — to active author of one's own health.
Antonovsky tried to find what the healthy survivors had in common. What he found was "Sense of Coherence (SOC)."⁷
SOC consists of three sub-elements.
1. Comprehensibility. The feeling that what is happening in one's life is — comprehensible. Even if it cannot be fully understood, the sense that one can locate oneself within a context. The feeling that things are not random and chaotic but follow some pattern.
2. Manageability. The feeling that the challenges one faces — can be handled. Whether alone or with others, the sense that this difficulty can be worked through. Not total control — only the belief that resources exist.
3. Meaningfulness. The feeling that one's life — has meaning. The sense that even suffering — lies within some context of meaning. This is perhaps the most central of the three. It is similar to the insight Viktor Frankl reached from his experience at Auschwitz. If there is meaning, almost anything can be endured.⁸
What Antonovsky's research showed: under the same conditions, people with high SOC are healthier. Both physically and mentally. The effect was statistically robust. And — it was repeatedly confirmed in subsequent studies of various populations in many countries.⁹
After Antonovsky, the concept of salutogenesis — has been extended in many directions.
School health. Educational environments that raise students' SOC. Not mere transmission of knowledge but — meaningful learning, challenging tasks, comprehensible evaluation. Such elements affect students' health.
Workplace health. A workplace culture that contributes to workers' SOC. Meaningless repetitive labor, uncontrollable demands, an incomprehensible organization — produce burnout and physical disease. Conversely, meaningful work, autonomy, transparent structure — generate health.
Social policy. The role of government is not simply to provide medical services. Building the social conditions that raise citizens' SOC — is the heart of public health. This developed into the discussion of the so-called "social determinants of health."¹⁰
As an exercise-medicine scholar, I have long been refining a concept. Perichoretic Salutogenesis. With Antonovsky's salutogenesis as the spine, and the eighth-century Byzantine theological concept of perichoresis (mutual indwelling) grafted on as the ontological frame. Several Korean translations are possible — "health-generation that dwells within one another," "mutually-indwelling salutogenesis," "relational health-generation." In this book I switch among them as the context requires, but I keep the original term Perichoretic Salutogenesis consistent.
The reason I came to combine these two concepts began in clinical practice. When you see the body of a patient as a field where many systems work within one another, the "generation of health" of salutogenesis gains far richer explanatory power. Body and mind, individual and community, human and environment, physiology and meaning — only when one presupposes the ontology that these dimensions are not separate but dwell within one another, can one explain the clinical phenomena in which intervention in one dimension restores another.
Place the structures side by side:
Perichoresis: many beings dwell within one another while remaining themselves. The dance of relation that is neither separation nor fusion.
Salutogenesis: health is generated. Not state but process. When social, psychological, and physiological resources come together to produce SOC (comprehensibility, manageability, meaning), health is generated.
Perichoretic Salutogenesis: combine the two, and health becomes something many systems generate together while dwelling within one another. Change in one dimension seeps into another. When exercise promotes mitochondrial biogenesis it shifts BDNF concentrations in the brain, which shifts mood, which shifts the capacity for social relation, which in turn shifts the sustainability of exercise. This circulation is perichoretic. And in that the circulation itself generates health, it is salutogenic.
The opposite direction is separation. Body separated from environment, physiology from mind, individual from community, symptom from the meaning of life. The more separation, the more disease. This is observable.
Loneliness lowers immunity. Meaninglessness summons depression. Disconnection from environment damages metabolism. The collapse of community raises suicide rates. Perichoretic salutogenesis says — the recovery of relation is identical with the recovery of health. This is not metaphor but a measurable biological effect.
The field of contemporary science that has confirmed salutogenesis's insight most dramatically is — microbiome research.
Until the late twentieth century — medicine viewed the microbes of the body mostly as enemies. An extension of the Pasteur model. Bacteria cause disease. Kill them. Antibiotics carry out that mission.
But — from the early twenty-first century, research changed dramatically. With advances in DNA sequencing — scientists have been able to systematically catalog every microbe in the body. The result was shocking.
Inside our bodies there are as many microbial cells as there are human cells. About 39 trillion microbial cells against 30 trillion human cells.¹¹ In species count — thousands of species of bacteria, fungi, viruses, archaea live in our bodies. In the gut, on the skin, in the mouth, in the lungs, in the genitals.
All these beings — are deeply involved in our health.
Gut microbes — are involved not only in digestion but in immunity, neurotransmission, and hormonal regulation. About 90 percent of serotonin is produced in the gut. The connection between depression and gut health lies here.¹²
Skin microbes — maintain the skin barrier, prevent pathogenic invasion, and modulate immune responses. There is research suggesting that modern excessive hygiene disrupts the skin microbiome and increases atopy, psoriasis, and acne.
Oral microbes — are deeply linked to cardiovascular health. Poor oral hygiene increases the risk of cardiovascular disease.
These findings — call for a reassessment of antibiotics, the principal weapon of twentieth-century medicine.
Antibiotics treat bacterial infection. This cannot be denied. Countless lives have been saved by antibiotics.
But — antibiotics do not target. When you take antibiotics — not only the pathogenic bacteria die but the beneficial bacteria as well. A single course of antibiotics disrupts the gut microbiome for several months. The long-term health effects of repeated use are a subject of recent research.
The generation that received many antibiotics as children — has been shown in some studies to have higher rates of obesity, diabetes, allergy, and autoimmune disease as adults.¹³ Causation is not yet fully established, but the correlation is strong. The possibility that twentieth-century medicine's victories — produced new problems for the twenty-first century.
This is — the limit of uncritical application of the Pasteur model. The logic that "killing the pathogen solves it" — was too simple. The body is a complex ecosystem. Disturb that ecosystem, and unforeseen consequences arise.
All these findings — confirm the nineteenth-century Béchamp's "terrain theory" — in a new way. Béchamp's "microzymas" do not exactly correspond to the concepts of modern microbiology. But his core insight was astonishingly accurate.
The body is not a subject with fixed boundaries. The body is a community with trillions of other beings. Health depends on the balance of this community. Not "killing the invader" but — tending the relations.
This is — the quiet revolution of twenty-first-century medicine. Even mainstream medicine now uses the term "holobiont." The notion that an individual is — not an independent organism but — a complex of many species in symbiosis.¹⁴ The human is a walking ecosystem.
This view — resonates directly with perichoresis. We ourselves already are — a community of many beings dwelling within one another. Microbes and human cells — are not separated. They are within one another. Yet — they remain distinct. This is the healthy state. When one side dominates excessively — there is disease. The dance of balance.
In the early twenty-first century, the largest challenge in world health is — chronic disease. Cardiovascular disease, diabetes, cancer, dementia, depression. They — account for over 70 percent of global deaths.¹⁵
What these diseases have in common is — no single cause. Genetics, environment, lifestyle, social conditions — many factors operate together. And — these factors accumulate over time and surface as disease.
The Pasteur-model approach to such diseases is — limited. Killing a pathogen will not solve them. Gene editing is in most cases not yet practical. Individual organ transplantation — is possible only at end stage.
So — a different approach has emerged. Lifestyle Medicine. This is not merely advice that "exercise and diet matter." It has established itself as a systematic medical field.¹⁶
The six pillars of lifestyle medicine:
These six are — concrete expressions of a perichoretic life. Through food, we relate to other lives (nutrition). Through the body, we relate to ourselves (physical activity). Through sleep, we relate to nature's rhythms (sleep). Through the mind, we relate to our inner life (stress management). Through people, we relate to community (social connection). And by keeping self-destructive habits at bay, we relate to ourselves (avoidance of harmful substances).
If one lives balanced across these six axes — many chronic diseases are prevented or improved. This is the strong consensus of contemporary medical research.
Here I must add a personal note. I have studied exercise medicine for nearly thirty years. I completed my doctoral studies at the University of Alberta in Canada, did postdoctoral research at Harvard, and have taught and researched as a professor at Yonsei University in Korea. Mainly — the relation between cancer and exercise, chronic disease and physical activity.
What I have repeatedly seen in this field:
Exercise is medicine. This is not metaphor. Regular exercise is — more effective than many drugs. For depression, diabetes, hypertension, and the prevention of recurrence in some cancers — the effect of exercise has been established by large clinical studies.¹⁷
But — why is exercise so effective? The answer is interesting. Because exercise does not act through a single mechanism. Exercise regulates many systems simultaneously. Hormones, neurotransmitters, inflammatory markers, gut microbiome, gene expression, mitochondrial function. Exercise affects all these dimensions at once.
That is, exercise is a perichoretic intervention. It does not strike a single point. It adjusts the whole network of the body in a healthy direction. So its effect is broad-spectrum.
This is the real answer to "why exercise is a panacea." Not because it directly attacks specific diseases. Because it returns the body to healthy perichoresis.
The results of cancer-patient exercise intervention studies are remarkably consistent. Patients who exercise regularly during chemotherapy — respond better to treatment. They experience fewer side effects. Recurrence rates fall. Survival lengthens.¹⁸
Why? Several reasons. Maintained muscle mass buffers chemotherapy toxicity. Exercise strengthens anti-cancer immunity. It modulates inflammation. It eases stress. It improves sleep. It helps appetite and digestion. Social connection (the exercise group) provides psychological support. All of these factors operate at once.
That is — exercise is not a "supplementary treatment." Exercise is an intervention that moves the patient's whole system toward health. The most concrete form of salutogenesis.
And — part of the answer to the question I opened the chapter with — "why did this disease come?" — lies here. The whole life of the patient is the context of the disease. Stress, broken relations, lack of sleep, sedentary work, loneliness. All of this accumulated — and pushed the body in the direction away from health. There is no single "cause." It is a tilt of the whole network of relations.
And — the path of healing is the same. Chemotherapy is needed (the place of the Pasteur model). But that alone is not enough. The whole life — must be readjusted in the direction that generates health (the salutogenic model). Exercise, nutrition, sleep, relations, meaning — in all these dimensions.
This approach — under the name of Integrative Medicine — is being accepted ever more widely. Dana-Farber, Johns Hopkins, the Cleveland Clinic — all run integrative medicine centers. What was treated as "marginal alternative medicine" twenty years ago — is now part of the mainstream.
This is the quiet revolution.
One part of this revolution is — the reassessment of East Asian medicine.
Until the 1970s, mainstream Western medicine largely ignored East Asian medicine. On the grounds that it was "unscientific." But — as scientific research accumulated — the effectiveness of some East Asian medical techniques was systematically established.
Acupuncture. Hundreds of clinical studies have confirmed its effectiveness in chronic pain, migraine, nausea, some allergies, and elsewhere. The exact mechanism is still under investigation — but the effect cannot be denied.¹⁹ The U.S. Food and Drug Administration recognizes acupuncture as a medical device, and many insurance plans cover acupuncture.
Traditional herbal medicine. Many medicinal herbs — have become objects of modern pharmacological research. The most famous example is artemisinin — an antimalarial isolated from the Chinese herbal medicine sweet wormwood. For this discovery, Tu Youyou (屠呦呦) received the 2015 Nobel Prize in Physiology or Medicine.²⁰
Meditation. Thousands of studies have confirmed positive effects of meditation on stress, depression, anxiety, even immune function and gene expression. Programs like MBSR (Mindfulness-Based Stress Reduction) have been integrated into mainstream medical systems.²¹
These are not merely success stories of alternative medicine. At a deeper level — they bring with them a wisdom Western medicine had lost. And that wisdom is — perichoretic and salutogenic.
The theoretical basis of acupuncture is the flow of qi (氣). The energy moving through the body. Something that does not exist in Western anatomy. But — the effect of acupuncture is real. Even if not exactly explained in terms of qi — some regulation at the level of the body's network takes place. This is the subject of contemporary neurophysiological research.²²
The effect of an herbal formula is — not the effect of a single molecule. A single herb contains hundreds of compounds. A formula combining several herbs contains many more. This compound mixture — acts on several systems of the body at once. The opposite of the Western pharmaceutical logic of "one drug, one target."
The mechanism of meditation is — not one thing. Regulation of the autonomic nervous system. Reduction of stress hormones. Changes in brain structure (neuroplasticity). Modulation of immune function. Changes in gene expression. All of this happens at once.
That is — many approaches in East Asian medicine — work by not striking a single point but tuning the whole system. A perichoretic intervention. This is what twenty-first-century science is rediscovering.
So — how should the two medicines relate?
The approach that only one is right is wrong. Each has its place. To put acupuncture on an acute myocardial infarction is foolish (the Pasteur model is clearly more useful). To use only strong painkillers for chronic stress headaches is also foolish (a salutogenic approach is needed).
A medical system in which the two dwell within one another is ideal. Each preserves its strengths and complements the other. This is the vision of integrative medicine. And this vision itself — is the medical embodiment of perichoresis.
Korea — interestingly — could be a laboratory for this integration. In Korea, Western medicine and Korean medicine coexist institutionally. The national health insurance covers both. This is rare in the world. The experience of this coexistence — could contribute to world medicine. If the two systems can come into a truly perichoretic relation. We have not yet reached that ideal — but the possibility is open.
One of the most challenging implications of salutogenesis is — that health is not mainly an individual problem.
The dominant twentieth-century discourse — tended strongly to view health as the responsibility of the individual. "If you take good care of yourself, you are healthy." "Bad habits make disease." This view is partly correct — but only partly.
What salutogenic research has consistently shown: social structure is one of the largest determinants of health. Social inequality directly produces health inequality. Poor people live on average 10 to 15 years less than the wealthy. Residents of low-income areas suffer more chronic disease than residents of high-income areas. This gap — cannot be explained by individual choice alone. Structural conditions determine it.²³
The British physician Michael Marmot's Whitehall Study is a classic. A study tracking groups of British civil servants over decades. The result: the lower the rank, the worse the health outcomes. Even after controlling for traditional factors like smoking and obesity — the gap remained. The decisive factor was — a sense of control over one's work and a sense of meaning. That is, the core elements of SOC.²⁴
One study has shown the social implications of perichoretic salutogenesis most dramatically. Michael J. Chandler and Christopher E. Lalonde of the University of British Columbia tracked youth suicide in Indigenous Canadian communities for decades.²⁴ᵃ
What they discovered was striking. Across all Canadian Indigenous youth, the suicide rate is many times that of non-Indigenous youth. But — beneath this average lies an extreme variation. In some communities suicide was nearly unknown; in others it was tens to hundreds of times the national average.
What made the difference? Chandler and Lalonde identified six indicators of cultural continuity:
The result was clear. Communities meeting four or more of these factors had a youth suicide rate near zero. Communities meeting none had a rate about 137 times the national average. Same country, same era, same language family, same "Indigenous" category — yet depending on how a community sustained the continuity of its culture, there was a 137-fold difference of life and death.
The study can be summed up in a single sentence: culture is medicine. From the perspective of perichoretic salutogenesis, this result is natural. When a community loses the meaning and continuity of its existence — the three elements of SOC (comprehensibility, manageability, meaning) collapse simultaneously. Conversely, when a community sustains language, ritual, self-government, land, and intergenerational connection — the body of each individual youth gains the resources to survive within that network.
This finding goes beyond medicine. It is a political question. To make a healthy society — recommending exercise to individuals is not enough. We must reduce inequality, create meaningful work, restore community, and recover the sense of control over life. This is the real domain of public health.
From this perspective — neoliberalism is an enemy of health. The effects of neoliberalism on health:
All these factors — destroy the conditions of salutogenesis. The three elements of SOC — comprehensibility, manageability, meaning — all weaken. Result: rising chronic disease, worsening mental health, rising suicide.
This is — how neoliberalism, at the medical level, dismantles the body. Neoliberalism makes the body sick. This is not political rhetoric but a measurable epidemiological fact.
Korea is the extreme case of this phenomenon. The world's highest suicide rate. The world's lowest birth rate. The longest working hours in the OECD. A youth mental health crisis. All of this — is the result of the social destruction of the conditions of salutogenesis.
So — true medical reform is inseparable from political reform. There are things one doctor and one hospital cannot solve. To restore health — society must be restored.
This is — the political dimension of medicine. For a long time medicine has retreated from this dimension. The attitude that "politics is not our domain." But — from the perspective of salutogenesis — medicine cannot retreat from politics.
This is what Rudolf Virchow (1821–1902) — the great German physician and politician of the nineteenth century — said. "Medicine is a social science, and politics nothing but medicine on a large scale."²⁵ A century and a half later — this insight still holds.
I began this chapter with the question patients ask again and again. "Why did this disease come?"
I close with — a medical researcher's answer. Not a complete answer, but the answer I can give now.
To fall ill is — not because of one cause. Genetics, hormones, environment, lifestyle, stress — each plays a partial role. But fundamentally — the whole life of a person is the context of that disease. Relationships, work, wounds, dreams — all of this has accumulated in the body.
And — healing too is the same. Chemotherapy helps. Surgery may be needed. But those alone are not enough. The whole life — must be adjusted, little by little, in the direction that generates health. Move, eat well, sleep, tend relations, find meaning. And — this is not the work of one person alone. The people around them, the community, society — must move together.
This is the salutogenic answer. Not complete. But — closer to the truth, I believe, than the pathogenic answer.
Finally — let me note where this chapter sits within the book as a whole.
In Part 1 I saw the relational ontology of the Inca civilization. The water of Tipón. Yaku. Ayni. The sense of the cosmos as a single flow.
Now — the salutogenesis seen in this chapter is — the recovery of that ontology in the language of medicine. Instead of seeing the body as a separated machine — we see it as a network of relations. Instead of seeing disease as external invasion — we see it as disturbance of relation. Instead of seeing healing as removal of an invader — we see it as restoration of relation.
We are — relearning what the Inca already knew. In a different language. In a different context. But the essence is the same.
And — this rediscovery is ground for hope. What Western medicine is now newly discovering — is the recovery of wisdom humanity already had. We have not entirely lost what we lost. We can return. By a different path. More richly.
In this chapter we have seen how perichoresis is embodied in medicine and health. But — the most urgent challenge of the twenty-first century remains. What becomes of human existence in the age of artificial intelligence?
In the final chapter we hear this question — beside the sound of the water that has been flowing at Tipón for five hundred years. In an age in which AI is fundamentally changing our lives, our work, our relations, our cognition — what new form does Wetiko take? And — how does the possibility of perichoresis open? I will leave the question open rather than offer answers. But — before reaching the conclusion of this book, this is a question we must pass through.
¹ For historical study of the dispute between Pasteur and Béchamp, see Gerald L. Geison, The Private Science of Louis Pasteur (Princeton: Princeton University Press, 1995); Ethel Douglas Hume, Béchamp or Pasteur? A Lost Chapter in the History of Biology (London: The C.W. Daniel Company, 1923).
² On the history of germ theory, see Nancy Tomes, The Gospel of Germs: Men, Women, and the Microbe in American Life (Cambridge, MA: Harvard University Press, 1998).
³ The deathbed remark of Pasteur, "le microbe n'est rien, le terrain est tout," is of unclear historical origin. Cited in many sources, the direct documentary evidence is limited. Many scholars consider it consistent with his late thinking.
⁴ On Béchamp's theory, see Hume (1923), op. cit. For more academic reassessment, Kendall Pearson, Pasteur: Plagiarist, Imposter (Pomeroy, WA: Health Research, 1942, reprint).
⁵ On Aaron Antonovsky's life and work, see Aaron Antonovsky, Health, Stress, and Coping (San Francisco: Jossey-Bass, 1979); Aaron Antonovsky, Unraveling the Mystery of Health: How People Manage Stress and Stay Well (San Francisco: Jossey-Bass, 1987).
⁶ The original of the term "salutogenesis" is in Antonovsky (1979), op. cit., especially the introduction.
⁷ On the concept and measurement of Sense of Coherence, see Antonovsky (1987), op. cit.
⁸ A classic on the health effects of meaning is Viktor E. Frankl, Man's Search for Meaning (Boston: Beacon Press, 1959/1992). Korean translation: Jugeumui suyongsoeseo, trans. Lee Si-hyeong (Seoul: Cheong-ah, 2005).
⁹ On the cross-cultural validity of the SOC scale, see B. Lindström and M. Eriksson, "Salutogenesis," Journal of Epidemiology and Community Health 59 (2005): 440–442.
¹⁰ On the social determinants of health, see Michael Marmot, The Health Gap: The Challenge of an Unequal World (New York: Bloomsbury, 2015).
¹¹ On the comparison between human cell counts and microbial cell counts, see Ron Sender, Shai Fuchs, and Ron Milo, "Revised Estimates for the Number of Human and Bacteria Cells in the Body," PLoS Biology 14, no. 8 (2016): e1002533.
¹² On the relation between gut microbes and neurotransmitters, see Emeran Mayer, The Mind-Gut Connection (New York: Harper Wave, 2016).
¹³ On the correlation between early antibiotic exposure and chronic disease, see Martin J. Blaser, Missing Microbes: How the Overuse of Antibiotics Is Fueling Our Modern Plagues (New York: Henry Holt, 2014).
¹⁴ On the holobiont concept, see Scott F. Gilbert, Jan Sapp, and Alfred I. Tauber, "A Symbiotic View of Life: We Have Never Been Individuals," The Quarterly Review of Biology 87, no. 4 (2012): 325–341.
¹⁵ On the global epidemiology of chronic disease, see World Health Organization, Noncommunicable Diseases Country Profiles 2018 (Geneva: WHO, 2018).
¹⁶ On the systematization of lifestyle medicine, see James M. Rippe, ed., Lifestyle Medicine, 3rd ed. (Boca Raton: CRC Press, 2019).
¹⁷ A large-scale synthesis of the effects of exercise on chronic disease: Darren E.R. Warburton, Crystal Whitney Nicol, and Shannon S.D. Bredin, "Health Benefits of Physical Activity: The Evidence," Canadian Medical Association Journal 174 (2006): 801–809.
¹⁸ Synthesis of the evidence on exercise in cancer patients: Kathryn H. Schmitz et al., "Exercise is Medicine in Oncology: Engaging Clinicians to Help Patients Move Through Cancer," CA: A Cancer Journal for Clinicians 69 (2019): 468–484.
¹⁹ A systematic review of the scientific evidence for acupuncture: Andrew J. Vickers et al., "Acupuncture for Chronic Pain: Individual Patient Data Meta-analysis," Archives of Internal Medicine 172 (2012): 1444–1453.
²⁰ On the discovery of artemisinin, see Tu Youyou, "Artemisinin — A Gift from Traditional Chinese Medicine to the World" (Nobel Lecture, 2015).
²¹ A synthesis of the health effects of meditation: Madhav Goyal et al., "Meditation Programs for Psychological Stress and Well-being," JAMA Internal Medicine 174 (2014): 357–368.
²² On research into the neurophysiological mechanisms of acupuncture, see recent work by Maiken Nedergaard and colleagues, e.g., Longhui Chen et al., "A vagal-brainstem-insular cortex pathway mediates the development of visceral hypersensitivity induced by colonic inflammation in mice," Gut (2023).
²³ On the epidemiology of health inequality, see Richard Wilkinson and Kate Pickett, The Spirit Level: Why More Equal Societies Almost Always Do Better (London: Allen Lane, 2009).
²⁴ On the Whitehall Study, see Michael Marmot, The Status Syndrome: How Social Standing Affects Our Health and Longevity (New York: Henry Holt, 2004).
²⁴ᵃ Michael J. Chandler and Christopher E. Lalonde, "Cultural Continuity as a Hedge against Suicide in Canada's First Nations," Transcultural Psychiatry 35, no. 2 (1998): 191–219; Michael J. Chandler and Christopher E. Lalonde, "Cultural Continuity as a Protective Factor against Suicide in First Nations Youth," Horizons 10, no. 1 (2008): 68–72. The "137-fold" figure comes from the original 1998 data, comparing communities scoring zero on the cultural-continuity indicators with the national average; the pattern has been confirmed in subsequent research.
²⁵ Rudolf Virchow's remark is grounded in his arguments in his 1848 paper "Die Medicinische Reform" and elsewhere.