Psychosomatic subjects and the ‘duty to be well’. personal agency within (original) (raw)

On illness and value: biopolitics, psychosomatics, participating bodies

Medical Humanities, 2019

In its heyday, around the mid-twentieth century, psychosomatic medicine was promoted as heralding a new science of body/mind relations that held the promise of transforming medicine as a whole. Sixty years on, the field appears to have achieved no more than a respectable position as a research specialism within the medical status quo. This paper articulates the problematic of psychosomatics through a number of propositions that reconnect its promise of novelty to the present and to contemporary concerns. In contrast to classic approaches to 'psychosomatic problems', which typically set out by denouncing the conceptual inadequacy of mind/ body dualism, the focus proposed is on the resilience of dualism as an empirical datum deserving closer analysis. The paper thus asks: what is the character of dualism considered under the aspect of what it achieves, and thus as an expression of value? Drawing on the thought of A N Whitehead, Michel Foucault and Viktor von Weizsäcker, the argument formulates a set of 'psychosomatic problems' informed by the concept of biopolitics and introduces their relevance in relation to the politics of participatory medicine. There are stories that need to be ceaselessly reactivated in order to be relayed with new givens and new unknowns. 1

A theory of psychosomatic medicine: An attempt at an explanatory summary

Semiotica, 2000

This article investigates issues in psychosomatic medicine that could broadly be seen as concerned with the status of 'subjective' and 'objective' realms. Initially, it considers two seemingly opposing perspectives, the biomedical model and the constructivist/semiotic model. The bio-medical model has all the setbacks of a positivistic and deterministic model: there is an unambiguous reality that can be ascertained given a detailed enough analysis. It furthermore assumes that observations can be explained by the application of linear causal relationships between the single components of reality. The constructivist perspective and the semiotic way of thinking view life and individuals moving through their life as dealing with particular signs; by applying semiotic thinking we understand why certain elements were selected out of the environment and why they were given a specific meaning. It suggests that some of the di‰culties arising from these models can be ameliorated with reference to the neo-phenomenology of Hermann Schmitz. In particular, the concept of the lived body (Leib) assists in understanding the relationship between a patient and his environment.

A Defence of the Phenomenological Account of Health and Illness

Journal of Medicine and Philosophy, 2019

A large slice of contemporary phenomenology of medicine has been devoted to developing an account of health and illness that pro- ceeds from the first-person perspective when attempting to under- stand the ill person in contrast and connection to the third-person perspective on his/her diseased body. A proof that this phenom- enological account of health and illness, represented by philo- sophers, such as Drew Leder, Kay Toombs, Havi Carel, Hans-Georg Gadamer, Kevin Aho, and Fredrik Svenaeus, is becoming increas- ingly influential in philosophy of medicine and medical ethics is the criticism of it that has been voiced in some recent studies. In this article, two such critical contributions, proceeding from radic- ally different premises and backgrounds, are discussed: Jonathan Sholl’s naturalistic critique and Talia Welsh’s Nietzschean critique. The aim is to defend the phenomenological account and clear up misunderstandings about what it amounts to and what we should be able to expect from it.

Health as a Theoretical Concept

Philosophy of Science, 1977

This paper argues that the medical conception of health as absence of disease is a value-free theoretical notion. Its main elements are biological function and statistical normality, in contrast to various other ideas prominent in the literature on health. Apart from universal environmental injuries, diseases are internal states that depress a functional ability below species-typical levels. Health as freedom from disease is then statistical normality of function, i.e., the ability to perform all typical physiological functions with at least typical efficiency. This conception of health is as value-free as statements of biological function. The view that health is essentially valueladen, held by most writers on the topic, seems to have one of two sources: an assumption that health judgments must be practical judgments about the treatment of patients, or a commitment to "positive" health beyond the absence of disease. I suggest that the assumption is mistaken, the commitment possibly misdescribed.

Phenomenology of Illness H.Carel, 2016 Oxford, Oxford University Press xi + 248 pp, $50.00 (hb)

Journal of Applied Philosophy, 2018

Havi Carel's new book is the culmination of over a decade of thinking about illness. Her engagement with the subject is both academic and personal. After being diagnosed with a life-limiting lung disease, Carel published a powerful reflection of her own experiences of illness in Illness: The Cry of the Flesh (Durham: Acumen Publishing, 2008), and has written a number of academic articles developing a phenomenology of illness since. The Phenomenology of Illness contains the best of both these approaches, blending together personal anecdote and rigorous philosophical analysis to deepen our understanding of what it means to be ill. Written for an academic audience, the book has two aims: 'to contribute to the understanding of illness through the use of philosophy, and to demonstrate the importance of illness for philosophy' (p. 2). What motivates a phenomenological approach to illness? Carel offers three rationales: as the study of lived experience, phenomenology is a natural approach to understanding the variety of illness experiences; it provides a non-prescriptive framework free of conceptual restrictions; and it underscores the centrality of the body to understanding human experience (p. 7). The structure of the book can be divided into roughly two sections. The first five chapters develop the general framework for a phenomenology of illness, with the final chapter in this half applying the framework to respiratory illness. The second section of the book explores the relationship between illness and other key philosophical topics, namely, wellbeing, death, and epistemic injustice. Thus, the structure aptly mirrors the two-part aim of her project, leveraging the conceptual tools of phenomenology to examine illness, and conversely, exploring how illness may illuminate traditional debates in philosophy. A brief note: many of our thoughts in this review developed during a term-long seminar on Carel's book. This was attended by philosophers (both analytic and continental), social scientists and clinical practitioners, among others. The value of Carel's project was evident throughout the discussions. The book not only reframed issues traditionally viewed under the scope of Anglo-American philosophy; it also offered a shared language and perspective for engagement between the social sciences, humanities, and the medical sciences. Carel's approach is based on a definition of illness as 'serious, chronic, and lifechanging ill health, as opposed to a cold or a bout of tonsillitis' (p. 2). Illness is something which changes the subject's way of being, in a way that a simple cold does not. Following others, Carel contrasts this with disease, whereby disease is seen as physiological dysfunction. The book makes great use of this distinction and it no doubt

The critical role of psychosomatics in promoting a new perspective upon health and disease

Journal of medicine and life, 2009

In an evolutionary model, health and disease are regarded as successful and respectively failed adaptation to the demands of the environment. The social factors are critical for a successful adaptation, while emotions are means of both signaling the organism's state and of adapting the physiological responses to environmental challenges. Hence the importance of a biopsychosocial model of health and disease. Psychoemotional distress generates and/or amplifies somatic symptoms. Somatization may be viewed as an altered cognitive process, inclining the individual to an augmented perception of bodily sensations and to an increased degree of complexity in reporting negative experiences (hence the greater cognitive effort allocated thereto). Somatosensory amplification and alexithymia are key elements in this process. The brain's right hemisphere is more involved in the generation of emotionally conditioned somatization symptoms. Somatic symptoms have various psychological and social functions and are strongly influenced by the particular belief system of the individual. Inappropriately perceiving the environment as an aggressor and excessively responding to it (by activating the cytokine system in correlation with the arousal of the psychic, nervous, and endocrine systems) may be a key element in the altered cognition conducive to ill health.

Psychosomatics, The Lived Body, and Anthropological Medicine: Concerning a Case of Atopic Dermatitis

Drew Leder (ed.), The Body in Medical Thought and Practice. 139-154. 1992 , 1992

I. Psychosomatic Medicine: A Critical Appraisal: The modern medical practitioner attempts to account for the various aspects of illness by considering them all together and, in doing so, adopts a biopsychosocial approach. As a general medical orientation, psychosomatic medicine finds its main purpose in pursuing such an approach. The psychosomatic physician postulates "that mind and body are two inseparably linked aspects of man" ([9], p. 12). Such an approach is 'holistic', "in that it implies a view of the human organism as a whole, a mind-body complex" ([9], p. 12). Lipowski distinguishes several themes in current psychosomatics: the search for physiological mediating pathways between psyche and soma in fields such as neuro-endocrinology and neuroimmunology; the search for correlations of psychological "stress" and physiological effect; and the investigation of the psychosocial response to physical illness ([9],' pp. 8-9). In addition, psychosomatics is concerned with the interaction of psychological, social and physiological factors in health and illness and with the therapeutic consequences issuing from this holistic, i.e., biopsychosocial view ([9], p. 12). According to Lipowski, in psychosomatics, the "old" notion of causality is abandoned and replaced by the notion of "reciprocal interaction" so that it is impossible to say that physical events are caused by psychological events, or vice versa ([9], p. 14). Since every illness is invariably physiological' as well as psychological, all disorders are psychosomatic and there is no privileged list of psychosomatic disorders. Ironically, if this were to be generally acknowledged, the very term "psychosomatic" would be quite superfluous [22,.23]. . But given the holistic starting point of the psychosomatic approach, how can medical research effectively proceed? Out of his concern that holism cannot conceivably allow for research, Lipowski sees a need to split and reduce this holism through "methodological reductionism": "Furthermore, one needs to draw a distinction between methodological and theoretical reductionism. The former implies a research strategy involving a deliberate decision to abstract from, and hence disregard one or two classes of variables so as to be able to study the effects on behavior of variables belonging to only one class, say biological or psychological. This is a heuristically .valuable investigative strategy, one that appears indispensable for progress in our field ([10], p. 61)." Hence, psychosomatics can be characterized by a holistic (i.e., biopsychosocial) starting point, the abandonment of classical "causality", psychophysiological correlations and methodological reductionism. We may ask if this psychosomatic approach is able to offer a genuinely complete account of patients and their environment in health and in illness. And if not, are we able to suggest an alternative?