Anatomy, physiology, and the art of motorcycle maintenance

Zen. This weekend, I finished Robert Pirsig’s Zen and the Art of Motorcycle Maintenance. The unfinished task of reading this book has followed me through my entire academic career. It was initially given to me as a gift for being an anatomy tutor in medical school. Independently, I received it as a gift when I passed my German child neurology boards. I started this book several times, but never finished it, and reading this book took me 25 years. As my professor’s thoughts about various approaches to studying medicine have echoed with me since I was a student tutor, this book deserves its own blog post and an enquiry into values (as Pirsig would say) of anatomy versus physiology.

Figure 1. AI-generated image on motorcycle maintenance. Robert Pirsig’s Zen and the Art of Motorcycle Maintenance is a book that I finished after taking roughly a quarter of a century to read it. More importantly, it took me back to the first time I heard of this book, reminding me of the eternal conflict between anatomy and physiology in the early years of medical school. And even though function (physiology) is often prioritized over the structure that this function requires (anatomy), I consider myself an anatomist rather than a physiologist. In fact, this tendency echoes in many aspects of what our lab is doing in the area of neurogenetics [image generated with]

Anatomy. If you typically read this blog to find easy-to-digest facts about epilepsy genetics, please skip this post and save your time! I keep writing occasional blog posts that veer off into the more philosophical aspects of neurogenetics, as I think that it is important to reflect upon the foundations of what we are doing and what our motivations are. For example, a few years ago, I made the statement that the age of gene discovery is over, and genes will find themselves. This is not entirely correct – in both instances, people are involved who have their own motivations to either find genes or let them find themselves. And, I think that it sometimes helps to dig a little deeper and see where our thought patterns initially came from. Here is a quick spoiler: I am an anatomist.

Books. Before I start diving into anatomical versus physiological thinking, let me quickly celebrate the books that I never finished. There is Thomas Mann’s The Magic Mountain that I dutifully carried around in my backpack during my first year of medical school. In the end, Mann’s lengthy, drawn-out style clashed with the speed of my medical school classes, and I put it away after roughly 200 pages. Plus, it was very heavy. Likewise, I abandoned Robert Musil’s The Man Without Qualities after a few hundred pages – I lost interest in the detailed description and ennui of the last days of the Austro-Hungarian empire. Book Number 3 was Zen & Cycle that I finally completed on Saturday morning after a pretty eventful week.

Quality. What is Zen & Cycle about? It is a fictional autobiography of a motorcycle trip from Minnesota to California, combined with philosophical explorations of various topics, trying to reconcile a romantic, naturalistic worldview with the modern, technological life. Pirsig develops the concept of “Quality”, the undefinable something hidden behind our logical thoughts that will lead us to solutions when either our logical or emotional approaches fail. Sounds confusing? Correct, Pirsig keeps making the point that Quality cannot really be defined, but it is something that you can perceive when you approach things such as fixing a motorcycle with a beginner’s mind. In today’s world, his thoughts about Quality can at least partially be covered by concepts such as mindfulness or flow, which brings me right back to epilepsy genetics, and the idea of anatomy versus physiology.

Flow. There are sometimes hours that pass when we are fully engaged in an activity. Flow is the state of being fully engaged in a fulfilling yet challenging task. The more we can adjust our work towards “flow states”, the more satisfying our work will be. For example, I still remember being in a very productive flow state writing the first draft of “Navigating the channels and beyond” in Berlin in 2006 at the Starbucks next to Checkpoint Charlie. Pirsig would probably say that this was Quality at work.

Cramming. My initial thoughts about Zen & Cycle lead me back to the time when I was anatomy tutor in my second year of medical school. The lecturer who gave me this book as a gift for being a tutor in his gross anatomy course had discussed the importance of anatomy in one of his prior lectures. Unfortunately, this was such a long time ago that I have forgotten his name. Anatomy: knowing all the bones, muscles, and blood vessels of the body, is often perceived as a field where a student needs to excel at cramming facts for an exam without really making any real connections. The foramina of the skull base? Cramming, making up creative mnemonics, and trying to visualize what goes where. But its importance? Anatomy, my lecturer said back then, is like a Christmas tree. Physiology has all the ornaments, but they don’t mean anything if you don’t know where to hang them. Bam – this slightly cheesy analogy stuck with me for the last 25 years. When studying medicine, students often feel more drawn towards anatomy or physiology – you’re either an anatomist or a physiologist. It was clear to me at this point that I would always be an anatomist.

Today’s world. I would think that my personal inclination to anatomy (structure) over physiology (function) shows in how our group approaches things. I like talking about genetic architectures and genetic landscapes and try to visualize longitudinal electronic medical record (EMR) data as a structured object that can be dissected metaphorically. Anatomy over physiology explains my preference of structured data harmonization and biomedical ontologies over rote machine learning approaches. And, anatomy over physiology also shows in the way that we approach electrophysiological data – in our FENICS ontology, we separate complex physiological results into smaller elements that we can analyze individually, using a metaphorical anatomical scalpel. Genomic research has a strong anatomy mindset.

What you need to know. Let me summarize this wide-ranging post. Celebrating my completion of reading Zen and the Art of Motorcycle Maintenance after 25 years, my thoughts brought me back to medical school and the question of whether students prefer anatomy or physiology. Typically, many people are more drawn to function, especially in the epilepsy genetics field where we often deal with functional experiments. In contrast to the bias towards physiology, I am realizing that I have remained an anatomist at heart all the time while Zen & Cycle had been sitting on my bookshelf.

Ingo Helbig is a child neurologist and epilepsy genetics researcher working at the Children’s Hospital of Philadelphia (CHOP), USA.