Friday, January 14, 2011

The Black and White of Biomedicine

It is a mistake to underestimate the force of Cartesian dualism in medicine today. In spite of a growing disaffection of a section of the populace with traditional approaches to health, the dualist philosophy is alive and well, the guiding light of almost all theoretical and clinical efforts of Western medicine” Dossey, (1984:15), Gordon (20)

Biology leaves unexplored an aspect of the mind-body problem that is essentially ethical. This residual mind-body problem occurs because mind and body symbolize contrasting poles in human experience: the voluntary or intentional and the involuntary or accidental. It is because the contrast between willful action and impersonal accident is central to both the private sense of self and the public concept of the person that mind-body dualism persists in Western thinking about morally significant events like sickness and disability” Kirmayer (57)

The dichotomies upon which modern biomedicine is constructed are as stark and rigid as the hues in the above images. The primary dichotomous relationships found in biomedicine include not only classic Cartesian dualism of body and mind, but also ideas of irrationality and rationality, patient and physician, and illness and disease. I argue that this scientific tendency to “rationally” classify and polarize results in the precarious construction of Western biomedicine, and ultimately perpetuates (the perhaps otherwise unfounded) authority of the institution of medicine.

Kirmayer outlines how biomedicine was founded on a “Cartesian division of man into a soulless mortal machine capable of mechanistic explanation and manipulation, and a bodyless soul” (59). Gordon furthers this notion in asserting a distinction between “naturalism,” “individualism,” and biomedicine, claiming that they thrive on mutual support. He ultimately draws several key parallels between naturalism and individualism. Both use the atom as the fundamental building block, and neither acknowledges the importance of society, culture, or the body in the construction of the atom. Thus, the individual body is alienated from exterior factors and robbed of its ability to define itself.

Although the mind/body split exemplifies a primary dualism in modern biomedicine, Kirmayer uses the metaphor of the body as a biochemical machine to illustrate how dualistic values in Western biomedicine also fixate on a rational mastery of the body. This metaphor elicits ideas of biomedical control and the value of rationality. Under this model, patients, if rational, adhere to particular guidelines given by medical professionals. Only when patients fail to behave rationally do they experience medical problems, which, according to this model, represent individual failure.

Kirmayer also describes the dualism between the “physician as active knower and the patient as passive known” (59). This dichotomy is manifested in the medical distinction between disease and illness. While disease represents the physician’s biomedical interpretation of disorder, illness merely refers to the patient’s “personal experience of distress” (59). Biomedicine deals with this divide by applying “rational techniques to sickness,” viewing the body as a machine by “distancing from the emotional significance of illness” (60). Kirmayer discusses the various ways medical practice distances from the body as a person. First, the architecture of hospitals provides concrete barriers between sick bodies and social persons. Second, physicians manipulate language (mostly in the form of “codes”) to reduce the “affectivity” of the discourse (61). This distancing further removes the patient from not only the outside world, but also from the possibility of relating to the institution on a personal or emotional level. Ultimately, medicine trumps the “bodily-felt” reality of the patient, posing sickness as a threat to rationality (Kirmayer, 61).

Gordon illuminates this distinction between disease and illness by considering the separation between the objectivity of nature and the subjectivity of the individual’s experience of the world (25). This separation can be applied to distinguishing “signs,” objective indications of the patient’s body, from “symptoms,” the patient’s complaints (25). Using this model, “disease” is defined as biological abnormality while “illness” is merely the patient’s experience. This distinction is problematic for several reasons. First, it assumes that the physician is rational and unconditionally correct, identifying and evaluating infallible “signs” of disease. Meanwhile, the irrational patient determines her illness by evaluating her subjective distress. This interpretation leaves no room for a more holistic, cultural or emotional understanding of illness.

After considering the relationship between naturalism, individualism, and biomedicine, Gordon questions whether a “holistic” approach to medicine is possible in a society so focused on atomism and the individual as separate from culture and society (42). However, she also claims that “sickness expounds a truth about the order of the world as much as the body of the sick person” (42). In stating this, she exposes her belief that the patient’s interpretation of her illness is imperative to the overall understanding of the condition.

Ultimately, in considering these various dichotomies and power structures as a whole, we see that they work together to promote the (mostly) unquestioned authority of biomedicine in our culture. The patients’ desire for answers leads to the reinforcement of the legitimacy of the answers given by medical professionals, which indirectly affirms the dominance of biomedicine and the way in which it operates. Therefore, the dichotomies and distinctions remain unquestioned, not providing an arena for change. Patients must be aware of the power dynamic and assumptions of biomedicine in order to claim their contribution to the meaning of their “disease.”

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