Mykola Iabluchanskyi

 For decades, mental health has been measured in symptoms. We count panic attacks, chart the depth of low moods, and catalogue sleep disturbances as if a patient were a machine to be audited rather than a navigator trying to find their way through a storm. But if we shift our clinical perspective — from passive bearer of diagnoses to active participant in life — a different and more honest measure of wellbeing emerges: the quality of the decisions a patient is able to make every day . From Symptoms to Functional Capacity In the theory of functional systems , a decision is never a simple act of will. It is the final result of a complex neurobiological and social network striving toward a useful outcome. From this vantage point, the quality of a patient's choices is not a verdict on their strength of character. It is a mirror of the environment in which that choosing happens. When we document that a patient is depressed, we describe a static state. When we ask  why their decisio...

  Breathing is sustained without volitional input. Throughout sleep, periods of inattention, and systemic illness, brainstem respiratory networks maintain rhythmic drive to the respiratory musculature independent of conscious participation. In its automaticity, respiration resembles cardiac function — a vital cycle generated and regulated below the threshold of deliberate control. Respiration diverges from cardiac function, however, in one physiologically significant way: it is accessible to voluntary modulation . An individual can elect to pause before phonation, prolong exhalation to attenuate arousal, or alter respiratory rate in response to situational demands. This capacity for deliberate intervention reflects a structural feature of the nervous system — the convergence of automatic and voluntary control pathways within a single motor output — and has direct implications for the clinical application of breathing-based interventions. Automatic Respiratory Regulation Under base...

We have spent a century obsessed with a single number. How long did they live? Ninety-two. Eighty-seven. A hundred and one. We announce it in obituaries, track it in demographic reports, and celebrate it as proof of medical progress. But that number — lifespan — tells us almost nothing about the life it claims to measure. Two people can share the same lifespan and inhabit completely different existences. One crosses the finish line still recognizably themselves. The other stopped being present years before the body gave out. To talk honestly about aging, we need three coordinates, not one. Lifespan, healthspan , and wellspan — each asks a different question, and together they form the only framework that takes the whole person seriously. Lifespan Is Just the Clock Lifespan is time in its most stripped-down form: the interval between first breath and last. It is useful for statisticians, actuaries, and headline writers. It is far less useful for anyone trying to understand how a human...

There is a persistent fantasy in the history of thinking about intelligence: that mind is essentially weightless. That it is a pure process — reasoning, pattern recognition, information integration — that could, in principle, run on any substrate, in any form, detached from the particular physical circumstances of its operation. The history of cognitive science and artificial intelligence is partly the history of this fantasy, and of its repeated failure. The failure is not technical. It is conceptual. Mind, on the best available evidence from neuroscience , phenomenology , and biology, is not something that happens to be housed in a body. It is something a body does. Consciousness — understood as the combination of inner experience and reflection on that experience — is rooted, at its origin, in a vulnerable, metabolically regulated organism that depends on its environment to survive, that can be harmed, that is always at some level at risk. This is not a romantic claim about the s...

A medication prescribed at the right dose but the wrong frequency is not the right medication. This is a principle that pharmacology has understood in theory for decades and that clinical practice has been slow to absorb. The standard instruction — take once daily — reflects the average patient, a statistical construct that describes no one in particular. The actual patient sitting across from the clinician metabolizes drugs quickly, slowly, or somewhere in between, and that difference determines not only how well a treatment works but whether it causes harm. Most antihypertensive drugs are designed with a twenty-four-hour action profile in mind. The once-daily recommendation assumes that the drug will remain at therapeutically effective concentrations throughout that period, then be cleared and replaced by the next dose. For a patient with ordinary metabolic rate, this assumption is reasonable. For patients at either end of the metabolic spectrum, it is often wrong in ways that are ...

We have always been shaped by language. Religious texts, philosophical treatises, revolutionary pamphlets — the written word has sent people to barricades, reorganized moral universes, and structured entire civilizations around a set of sentences. The power of language to form and transform human identity is not new. What is new is the nature of the partner on the other side of that language. A book is fixed. Its sentences are the same for every reader and every reading. It can mobilize a person to risk their life, stabilize a worldview, or become the lens through which everything else is interpreted. But it does not update in response to the individual reader. All the work of interpreting, selecting, and integrating is done on the human side. The book is a powerful influence that remains outside the subject. A high-capacity language model is something structurally different. It is not a repository of words waiting to be consulted. It is an active generator — one that recombines, sele...

Guidelines are not wrong. They represent the best available synthesis of evidence at a moment in time, distilled by experts, reviewed by committees, and published with the authority of major professional societies. For a clinician facing an unfamiliar situation, a guideline is a valuable anchor. For a system trying to reduce preventable harm across large populations, guidelines are indispensable. None of what follows is an argument against them. It is, however, an argument for something that guidelines cannot provide: the judgment to know when they do not apply. The history of medicine is littered with examples of recommendations that were correct on average and harmful in specific cases, that were right for the moment and wrong a decade later, or that captured the dominant effect of an intervention while obscuring its costs in particular populations. The clinician who mistakes the guideline for the destination rather than the compass has confused the map for the territory. And patient...