The search for physical and emotional behavioral patterns

James Fleck, MD, PhD *

In clinical practice, diagnosis and treatment are based on predefined morphological and pathophysiological changes, which combined with the biological behavior of the disease create easily identified clinical patterns. Doctors are trained to recognize these parameters, which usually show some degree of similarity or affinity. These patterns can be translated into narrative. 

Narrative is a pedagogical methodology very useful in the development of the physician's skills. It is a valuable tool not only for medical students, but also in the process of continuous learning throughout clinical practice. Fictional stories can also show how doctors learn from patients who overcome disease-induced limitations. Progressively, these coping models can be reproduced by other patients and family members, tending to expand and improve them in search of greater efficiency. The methodology is based on empathy, which is a bidirectional cognitive process applied to the doctor-patient relationship. A constructive relationship of trust and mutual learning emerges. This creates a favorable emotional flow, which will contribute to better outcomes.

Despite the specificity related to each clinical case, is there any similarity or affinity associated with the emotional flow expressed by the patient? No one really knows, but it is an interesting field of research in behavior science. Emotion is a biochemical process and can also be expressed in some degree of self-similarity, following the same natural laws that regulate fractal geometry. 

In 1980, Benoît Mandelbrot went to IBM and at the very beginning of computer science he described what is now called the Mandelbrot set. Based on the simple formula of quadratic polynomials f(z) = z2 + c and feeding new coordinates into a computer program, the iteration created an interesting and beautiful image, composed of larger numbers that progressed to infinity and smaller numbers that decreased to zero . This program was the backbone of fractal geometry, which, in contrast to Euclidean geometry, is able to explain most of the living forms of nature. In its iterative path, a fractal has high levels of organization, irregular shape and self-similarity. These are properties generally found in biological structures, both in healthy processes and in diseases. Physiological, morphological and pathological dynamics can be recognized as fractals. A fractal dimension can be seen in most of the cells, tissues and organs that make up the human body. The fractal dimension can also be found in tumor cells, and may be responsible for their biological behavior. Modern neuroscience identifies fractal properties in the human brain. Advanced methods that use artificial intelligence and deep learning can theoretically integrate fractal morphological properties of the brain with behavioral patterns. 

We decided to create an experimental model. Patients’ behavior patterns are illustrated throughout clinical vignettes, which cover the most frequent types of cancer. Each one of the vignettes addresses both the physical and emotional challenges faced by those battling cancer. The methodology is inclusive, and patient-centered. The physician is the storyteller, alternating technical information and empathy, aiming to build a strong and personalized relationship with each patient. The narrative of each short story reflects the emotional flow, following a stepwise, problem-solving approach. Supported by a personalized psychological framework, clinical simulations inspire the patient to build essential attitudes while acquiring the most important skills to better cope with cancer.

Is there any self-similarity associated to the patient’s emotional flow? Could it be described by fractal dimension? Are emotions reflecting morphologic patterns? 

Nobody knows, but today we already have advanced computational tools that allow us to explore this intriguing twilight zone. After 35 years in clinical practice, we are now using narrative to describe putative patterns of behavior in cancer patients.

We are looking forward to your participation on this new biopsychosocial project. Just go to the link below and embark in our first clinical simulation:


1.     Mandelbrot BB. The Fractal Geometry of Nature. San Francisco, CA:WH Freeman & Co; 1982.

2.     Losa, GA: Fractals and their contribution to biology and medicine, Medicographia, 34 (3): 365 - 374, 2012

3.     You Tube: Deepest Mandelbrot Set Zoom Animation ever - a New Record!                                        



* James Fleck, MD, PhD is a full Professor of Clinical Oncology at the Federal University of Rio Grande do Sul, RS, Brazil 2020