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sweating. The physiological mechanisms (the black box) that trigger hotflashes are

still not understood (Archer et al. 2011 ), and diverse measurements give different

information about what is going on. Some of the factors (input) that trigger hot

flashes are measurable, such as increasing ambient temperature (Kronenberg and
Barnard 1992 ), intake of alcohol (Hunter et al. 2012 ), or smoking (Gallicchio et al.

2006 ; Whiteman et al. 2003 ). Hotflashes can be measured with ambulatory monitors

as rapid rates of increase in sweating (objective output). Hotflashes can also be

measured by asking women to self-report the severity of hotflashes (subjective

output). As Fisher and Thurston explain (Chap. 11 , this volume), the two types of

output are often not concordant. It is quite possible that the experiences of vasodi-

lation and sweating arefiltered through cultural expectations. In this way, the

physiological changes of hotflashes may not be noticed, labeled, or reported (Brown

et al. 2009 ; Mann and Hunter 2011 ) by all women. Subjective report and objective

physiological measurement provide different information about what is going on

inside the body and mind when a woman experiences a hotflash (Fig.15.1b).

Weber and Maki (Chap. 13 , this volume) illustrate how lapses in memory can be

examined as a subjective complaint and compared with objective measurements. In

one study, women with subjective memory complaints did not differ in terms of

cognitive performance from women without subjective memory complaints, but

those with complaints did show increased activation in parts of the brain that are

critical for working memory (Dumas et al. 2013 ). According to Weber and Maki,

individuals with subjective memory complaints may be working harder to obtain

the same level of memory performance. In this case, imaging studies opened a small

door into the black box.

It is surprising, perhaps, that the human body can be treated as a mysterious

black box because we live inside our bodies for decades. But, how much do we
consciously know about what goes on in our bodies? There are aspects that we can

see and experience, count and measure, but there are parts that we cannot feel, or

see, or know at all. Sometimes, it is interesting or necessary to step back and ask,

what can we know about ourselves? And, then, what can we know about others?

This book is about living in a body that was built with a genetic code inherited

from our parents, but we know only a part of that code—our blood types, the shape

of our noses and toes, our ability to digest milk (or not), and our patterns of fat

(a)

burning heat

(b)

hot flash trigger

nerve fibers

First pain

Second pain

Subjective hot flashes (perceived, reported)

Objective hot flashes (sweating, temperature)

Fig. 15.1 Imagining the black box for (a) burning heat and (b) hotflash trigger

312 L.L. Sievert and D.E. Brown