In fact, this introduction to Janusian thinking can be thought of as an example of Janusian thinking in its own right. Indeed, I would wager that only a small percentage of readers are familiar with the term. At the same time, it is likely that you are intimately familiar with what I am talking about. How many times have we been in the clinic and had to reason through a scenario in which we’ve had two contradictory findings at the same time, or been conducting research and had to grapple with unexpected outcomes that directly contradict one another? As patients, how many times have we had to grapple with the duality of risks and benefits? Think about it for a moment and you’ll find instance after instance where this has held true.
Rheumatology Is a Specific Generalization
So far, what I have stated may still seem rather generic. It may even sound a little hokey since everything, if you analyze it too closely, will yield contradictions. But I assure you, Janusian thinking is both generic and specific to rheumatology (see what I did there?). After all, rheumatology is uniquely about the art of resolving paradoxes through innovative thinking. How can autoimmune diseases lead to immune deficiency, and immune deficiency lead to autoimmune disease? How can thicker bones in certain conditions lead to more fractures? How can apoptosis, a way of cell death, be vital to sustaining health?
In fact, even our origins come from some very contradictory grounds: Rheumatology is, loosely, the study of soft tissues. It comes from the ancient Greek word rheuma, meaning river or stream. But tissues are defined by structure, not particularly by softness or riverine tendencies. Generations of rheumatologists and other physicians and researchers helped resolve this dilemma by engaging in inquiry about cells and tissues that may have concrete properties but connect with one another in fluid ways. To me, it makes sense that rheumatology and immunology have become so intertwined.
In the 21st century, that becomes even more contradictory. Vast amounts of genetic information are widely available, and exciting technologies are being disseminated like never before. This is exposing some of the great underlying tensions between different concepts that we have historically thought are contradictory. One example that often provokes heated arguments in conferences is whether rheumatoid arthritis is one disease or many. Certainly, that uncertainty was part of the subtext for the ACR Convergence 2022’s Great Debate, in which the utility of treating pre-RA was discussed. Perhaps, the Janusians would contend, the answer is that RA is both one disease and multiple diseases simultaneously.
