Academic journal article Contemporary Psychoanalytic Studies

One: The Medical Discourse: The Exclusion of Psychic Reality

Academic journal article Contemporary Psychoanalytic Studies

One: The Medical Discourse: The Exclusion of Psychic Reality

Article excerpt

Psychiatry and its core discipline, psychopathology, both have intimate ties with medical science. Psychiatry is a specialty taught at medical schools whose impact, despite its essentially limited basis, is remarkably broad. Within the vast field of mental health care, its medical background serves to effectively legitimise any practice labelled as 'mental health care'. Thus, its sphere of action extends well beyond the medical field. If we wish to explore the relationship between psychiatry and medical science, or the medical characteristics of psychiatry, first we shall need to identify the nature of medical science itself. An attempt will be made to establish whether a coherent 'medical' type of observation, thought, reasoning and action exists at all. Which raises the question: is medical science - both today and in the past - actually underpinned by a coherent conception or vision?

This question, which itself inquires into the foundations of the medical field, transcends medical science and is therefore not medical in nature. Originating in what may be termed the philosophy of medicine, it does not constitute an inquiry in a narrowed-down historical sense either. Nonetheless, it should be the objective of any scientific discipline's philosophy to inquire into its own origins, following two paths: the nature of the scope of reality addressed by this science, and the way this science deals with its scope of reality, respectively.

Two quite opposite stances may be adopted here. The first considers medicine - both today and in the past - to be a conglomerate of disparate subjects. In this view, medicine or medical science is little more than a cluster of isolated topics, bound together at best by biology as a common denominator on the one hand, and by psychology on the other. Yet they lack any real degree of unity, the inevitable conclusion being that medical science merely has a derived status (Shaffer, 1975). This view would turn out to be the undoing of medical science as a coherent discipline.

We should ask ourselves whether this position is tenable - if perhaps we can find a way after all to structure this multitude of themes, indeed even bring about some degree of unity. For example, we may argue that medicine does include fundamental disciplines (like physiology and anatomy) in addition to clinical sciences (like internal medicine and surgery), but that the specific nature of medicine is reflected in the convergence of those disciplines in medical practice, i.e., in the interaction between doctor and patient. Theory and practice combined could define the objective, which is found in the spheres of health promotion and curative care, respectively (Pellegrino and Thomasma, 1981, p. 26). Following Aristotle, medicine might be conceived as one of the so-called productive sciences - sciences that actually produce something, in this case physical and mental well-being.

Yet either position fails to plead its case convincingly. Medicine is more than a hotchpotch of disciplines that have a raison d'être found well outside the medical realm itself. In fact, it is governed by a unifying principle that addresses health and disease, remedying disorders. From this perspective, medicine could in fact be interpreted as a 'productive science'. However, where the former vision lacks ambition, this vision is rather over-aspiring. In the medical field, the definition of 'health', rather than describing physical and mental well-being, in a Platonic sense (Kenny, 1969), is commonly narrowed down to a purely somatic view. It is also doubtful whether the doctor/patient encounter actually merits the pivotal position it has been allocated here. In the following we shall argue that medical science - by necessity - strives to minimise, or even abstain from doctor-patient interaction, because that is precisely the reason why this discipline rose to fame in the first place. How exactly would we describe the nature of the encounter between patient and medical science? …

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