Holism and Reductionism in the Illness/Disease Debate
Michael Stuart (with M. Buzzoni and L. Tesio)
A new article by Professor Mike Stuart (with M. Buzzoni and L. Tesio) is recently published in “From Electrons to Elephants and Elections: Exploring the Role of Content and Context” edited by S. Wuppuluri and I. Stewart.
Motivation/Summary of the Article
How can medicine reconcile its scientific and humanistic sides? Is there a notion of medicine that can mediate between the analytic-reductionist perspective and the normative-holistic one? One central locus for this debate is the distinction between “illness” (something perceived and managed by the whole individual in concert with their environment) and “disease” (a “mechanical failure” of a biological element within the body). Discussions of this distinction usually revolve around ethical concerns. This paper argues that it is also an epistemological distinction. Evidence-based bio-medicine employs experimental and statistical techniques which eliminate important differences in the ways that conscious humans evaluate, live with, and react to disease and illness. However, it is precisely these experiences that underpin the concepts and norms of bio-medicine. To bridge the gap, we argue that humanistic disciplines have the resources to investigate these experiences in an intersubjectively testable way. Medicine, therefore, cannot afford to ignore its nature as a human science; it must be concerned not only with disease and illness, but also with the ways in which patients as persons respond to malady. Insofar as attitudes and expectations influence the criteria of illness and disease, they must be studied as part of the genuine subject matter of medicine as a human science. In general, we urge that this is a necessary step to overcome today’s trend to split evidence-based and clinical medicine.