Medicine
Introduction
When we become sick, and seek comfort and cure, we are acting
on assumptions which we derive largely from our culture assumptions
about:
- our bodies
- how they work and what makes them sick
- what sorts of treatment options we have
- who makes the medical decisions
- who we allow to make medical decisions.
Our understanding of medicine, illness and health are culturally
bound and our approach to medicine and medical practice is based
upon assumptions that are fundamental to our ontology.
There are other ways that people look at the concepts of health
and illness that incorporate broader perspectives on what influences
health and well being. Some cultures perhaps incorporate a spiritual
element into health. Others would see their connection to the land
and the strength of their relationship to their land as fundamental
to physical well being.
That's not to say that modern medicine is not useful and functional.
Many of us owe a prolonged life-span and 'healthier' lives to modern
medicine, but shouldn't we be asking some questions:
- Are there elements of modern medical practice that could
be broadened or enhanced, by an engagement with the knowledge
systems of other cultures and knowledge systems?
- Are there ways that different knowledge systems can
work together to try and deal with issues of health and
illness on a broader front?
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What is at stake?
Questioning and challenging medicine challenges:
- our perceptions of our bodies
- how they work and
- what constitutes an illness.
Even the concept of being ill is perhaps a construct that is based
upon an ontology that focuses on cures rather than, perhaps, prevention.
That's not to say that current medical research should be scrapped
and we should head for the nearest naturopath, but it is important
to be aware of the sorts of things you are assuming and taking for
granted when you involve yourself in the modern medical system.
You are taking on board a number of assumptions about how your body
works when you submit yourself to that system and when you take
on treatment.
Think about:
- What sort of picture of your body are you using when
you talk about illness and sickness?
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What is the status quo?
The human machine
Western medicine tends often to see the human body as a machine
- with individual parts that need to be kept in optimal condition.
The 'machine
metaphor' allows us to think of the body in terms of inter-connecting
but essentially independent organs that operate as parts of a whole.
Each organ contributes to the efficient running of the body as a
whole. In a sense, the sum of the parts of the body is equal to
their whole.
Treating symptoms
Medicine involves treating illnesses and curing disease. When one
of the parts breaks down, then it needs to be fixed to return to
optimal condition. Medicine is the mechanical process of returning
the system to a functioning capacity. It is often considered that
medicine is not about dealing with healthy people, but ones that
are sick and making sure that the symptoms that are expressed by
an illness are treated and prevented from re-occurring.
The cost of medicine
This has placed the medical profession in an interesting position.
Increasingly money is spent on developing new and more efficient
and effective ways of treating the symptoms of disease. The costs
of these treatments are often enormous and may be taking the profession
down a path from which it may be difficult to return. The expenditure
of huge sums of money, then requires further spending to 're-coup
the investment' of diagnosis or initial treatment.
If you have CAT scans available to you, then you find out information
that requires expensive drug treatment or surgical operations. Increasingly,
the expertise of the medical profession is more and more specialised,
requiring years of preparation and study.
- What if this money was spent on the prevention of problems
in the first place?
- Where would that leave the medical profession and our
health system?
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The metaphors used in our understanding of the body and how it
functions have led to a controversial increase in hugely expensive
medical technology, which many believe diverts valuable resources
away for keeping the population healthy, and which keeps human bodies
alive long after natural causes would have taken them. In some senses,
it seems as though, medicine, dependent upon science and technology
and as one particular branch of health, has become the dominant
paradigm under which other potential ways of dealing with issues
of illness and the prevention of illness have been sidelined or
'othered'.
What are the alternatives?
Other cultures - for example some Aboriginal cultures - see individual's
health as integrated with their spiritual well being, as well as
their connectedness with their kin and land. They may have very
different attitudes towards life and death. They also often have
traditional medicines the use of which are integrated into cultural
practices. When pharmaceutical companies 'discover' and exploit
the medical knowledges of Indigenous peoples, issues of intellectual
property are raised. Alternative systems of medicine may focus upon
the ways of preventing disease and allowing for the links between
physical and spiritual wellbeing to be more fully explored.
What happens when different knowledges systems
speak to each other?
Examining the state of medicine in a post-modern world is important
to a profession increasingly reliant on science and technology within
a society increasingly distrustful of such a modernist approach.
At the turn of the century the prospect of the new age of technology
heralded hopes of a better world, free of disease and social inequality.
Yet at the dawning of the new millennium, the fact that these promises
have not been fulfilled has led to increasing doubt about the ability
of science to heal and liberate.
Although science has generally improved human health and comfort,
scientific advances, such as the prolongation of human life have
resulted in a mass of other problems which medicine and science
have difficulty addressing. Large and important moral issues are
currently being ignored in the move to develop medical technologies
and allow infertile people to have children, choose the characteristics
of our offspring, treat hitherto incurable diseases and postpone
death. The widespread use of unconventional therapies in many illnesses
shows that patients are seeking treatment which conventional scientific
medicine cannot provide.
If society believes that the rational, objective truths and certainties
of science and medicine are not as true and certain as they once
may have seemed, where does that leave the practice of modern medicine?
One that 'fails' Aboriginal health outcomes? Clearly medicine is
changing. Yet, the current foundation of medical knowledge (evidence-based
medicine) and its essence of practice are significant constraints
which will inhibit its ability to change with the times and is one
that future doctors will be forced to reconsider in an increasingly
post-modern world.
Resources
These readings will provide you with a starting point for looking
at the contestation of knowledge in medicine.
Reading 5.4
Capra, F. 1982 'The Biomedical Model' in The Turning Point:
Science, Society and the Rising Culture, Bantam, New York, pp
123 - 163.
Other references
Chan J.J. & Chan J.E 2000 'Medicine for the millennium: the challenge
of postmodernism' in Medical Journal of Australia, Vol 172,
3 April 2000.
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