The Metaphysics of Modern Medicine Series: Part I – Worldviews
The philosophy of medicine describes the fundamental nature of medicine, though it is not just about theory but about medical ideals and consequences. Although the Hippocratic philosophies are studied, there are many other perspectives to understand, as they have made significant contributions to the principles of how medicine is practiced. Therefore, this article will explain the basic worldviews existing in modern medicine today. This will elucidate the way diagnosis is approached and provide a better grasp into the fundamental nature of our patients and their experiences in a holistic manner.
Aristotle developed the field of metaphysics, which is the branch of philosophy that deals with the very first principles, for example the existence of the mind separate from that of the brain. This branch is particularly important as many medical disputes pertain to the nature of an organism.
Metaphysical notions are perceived through worldviews, a term coined by Immanuel Kant. He explained that beliefs let us make sense of the world and dictate how to act. Originally, Kant meant the term worldviews to be about sensory perception, but over time, it has developed a deeper meaning. A worldview is not just about what is known about the world, but about how this knowledge can be judged. For example, the Newtonian worldview is that the world is a large machine and the Darwinian worldview is that the world is made of ever evolving entities.
There are three components to a scientific worldview: the position, the assumption and the commitment. The metaphysical position defines the basic attitude towards the components of the world. The assumption in the context of metaphysical medicine is important to include since physicians might presuppose a specific diagnosis and direct further questioning of a patient’s chief complaint based on that presupposition. This can allow a physician to frame and organize their diagnostic process. Finally, each position must be committed to an ontological notion, or a commitment to an idea of what the world is made of.
The worldview of modern medicine is split between two different models: the biomedical and the humanistic model.
The biomedical model holds the position of mechanistic monism, assuming the philosophy of reductionism, and is committed to materialism. Mechanistic monism is the idea that the universe consists of a collection of parts with specific functions, each part or entity being made up of one ultimate substance, which is matter. Therefore, everything in the universe is physical. Based on this position, the biomedical model assumes reductionism, where anything that is non-physical can be reduced into a simplified form by dissecting it’s individual components. The ontological commitment, then, would be materialism, where chemistry and physics are enough to explain biology, and that math is capable of explaining the very foundation of the universe. It views entities as a series of details that create a large picture.
On the other hand, the humanistic model holds the position of dualism, assumes the philosophy of emergentism, and is committed to the idea of organicism. This model appreciates the biomedical model, however, it goes one step further to include a non-physical element into the universe. This allows the separation of the mind from the brain. It makes room to account for the experience of a patient and for the consideration of etiologic and therapeutic factors such as psychology, sociology, and culture. Traditionally, this model was explained through Cartesian interactionism, where the mind influences the body through non-physical thoughts, and the body influences the mind through sensory perception.
The humanistic model allows a physician to treat the patient as a whole and takes any social or psychological disruptions into consideration. It also grants a dual dimensional view of illness, where there is the objective and the subjective, recognizing the patient’s position in the diagnostic narrative. Dualism, therefore, assumes the philosophy of emergentism, where entities are viewed as a whole before they are dissected into their individual properties. Emergence acknowledges that two different complex entities can have a similar environmental trigger, yet behave diversely. For example, the digestive and reproductive systems both emerge from the same biological organism. They are two completely different entities, behaving in completely different ways, but are part of the same big picture. This assumption commits the humanistic model to the opinion of organicism, where there is organic unity within the universe. It views entities as a big picture before observing individual properties.
Medicine is usually taught through the humanistic lens, as it takes subjective factors into account when attributing a diagnosis to an illness, yet the actual philosophy is rarely even mentioned. Its importance lies in acknowledging the duality of our patients – that they are both mind and matter and that the lived experience is vital in diagnosis and treatment. It reconfigures our duty to our patients and provides a different perspective on attentiveness to subjective involvement.