Philosophers Question the Separation of Medicine and Culture

Radically questioning the distinction between the objectivity of science and the subjectivity of culture can give way to powerful biocultural methods of healing.

Zenobia Morrill
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An interdisciplinary team in Europe critiqued biomedical understandings of health last year in their paper published in Medical Humanities. Led by Dr. Julia Kristeva, a philosopher, literary critic, psychoanalyst, feminist, and novelist, this team of writers radically calls into question the distinction between the “objectivity of science” and the “subjectivity of culture.” They urge the medical humanities to rethink its grounding assumptions and acknowledge the healing powers of culture and the biocultural complexity of human bodies.

“Accordingly,” they write “cultural dimensions should no longer be construed as mere subjective aspects of medical care, but as being constituent of, and ‘hard’ factors behind, sickness and healing.”

Dr. Julia Kristeva is a philosopher, literary critic, psychoanalyst, feminist, and novelist. She is professor emeritus at the University Paris Diderot.

The critique begins by tracing Kristeva’s deconstruction of a Roman origin myth about the creation of man in her book Hatred and Forgiveness. Kristeva’s interpretation of this myth describes the division that underpins biomedicine and culture, separating “health” and “illness,” “nature” and “culture.”

Following this division, biomedical narratives are favored in a hierarchy of legitimized approaches to healing. Culture, on the other hand, becomes obscured in the endeavor to consider what defines illness and heath and is then rendered as a “soft,” subjective approach to healing.

The medical humanities, therefore, are confined to the “cultural” side of the nature-cultural divide. The consequence of this is that neither biomedicine nor the humanities can promise holistic conceptualizations of illness and health. Often, the attempt to bridge this gap ends up reifying its distinction. For example, attempts to apply the medical humanities to biomedicine sustains their separate status. The authors explain:

“When it [the Lancet Commission representing medical humanities] aims to create awareness about the ‘effect of cultural systems of values on health outcomes’, it implicitly reinforces the ontological divide that in the first place caused the problem and the need for translation between epistemic and ontological domains.”

Rather than placing one perspective on another, there must be a break from the culture-nature divide, the writers contend. In its place, a cross-disciplinary and cross-cultural approach that gives room to the bidirectional critical interrogation of both may emerge.

“What we should maintain from the outset, however, is that biomedicine is not only culturally produced, but that the humanities are also materially productive; they create bodies and physical conditions.”

By examining the pathological and healing powers of culture, Kristeva and coauthors highlight its potential to be an incredibly powerful and creative healing agent. They provide examples of this phenomena in psychotherapy.

Finally, the writers complete their report by announcing their launch of a “global think tank” on the medical humanities. They aim to bring together medical researchers, professionals, humanists, and social scientists to discuss the following fundamental issues:

  • A shift from acknowledging cultural dimensions as a subjective domain occurring outside of medical science to one in which “all clinical encounters are seen as cultural encounters in that they the sense that they involve translation between health as a biomedical phenomenon and healing as lived experience.” Therefore, clinical encounters must prioritize the co-construction of shared meanings.
  • A deconstruction between the “hard” and “soft” sciences.
  • A radical questioning of the production of “evidence” in medicine, and how this framing reifies nature-culture distinctions that detract from effective conceptualizations of suffering and healing.

 

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Kristeva, J., Moro, M. R., Ødemark, J., & Engebretsen, E. (2018). Cultural crossings of care: An appeal to the medical humanities. Medical humanities44(1), 55-58. (Link)

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6 COMMENTS

  1. More mush. I’m not very fond of psycho-babble, and when you add philosobabble, perhaps post-modern speak, to the mix, my disaffection is not thereby decreased.

    Thomas Szasz wanted to enforce a separation of powers when it came to medicine and the state, something the incredible expense of “healthcare” increases the difficulty of doing with every passing day. This article would go, it seems, potentially anyway, in the opposite direction.

    As I see it, framing the matter in this fashion is likely to serve such organizations as the APA and NIMH who want to blame the damage wreaked by psychiatric drugs on the victims of drugging more than it would serve anybody else. There is a great crime, and cover up, taking place here, and that is something that gobbledygook facilitates more than it relieves.

    Psychiatrists at present are talking about working more closely with medical doctors and general practitioners, and when the work they do is in the main harmful, and should be criminal, I think it’s time to reassert those boundaries that keep people safe, not bring them down. Engaging the rest of the medical profession as partners in crime only exasperates this extremely dire situation.

    We’ve got, just as we’ve got a prescription drug culture, a medicalizing and medicalized culture, especially in the realm of so-called “mental health”. Increasing it’s grip is not, in my book anyway, by any means, a good thing.

  2. I think the missing first step here is recognizing that our so-called “objective medicine” IS a culture in itself, and is a reflection of the larger culture. Pretending that it is objective in the first place is the starting point for allowing medicine to avoid dealing with the truth shown by its own research. There IS no separation of culture and medicine, so it’s impossible to “rejoin” these, since one is embedded in the other. Pretending to be objective is what gives this cultural phenomenon its unearned power.

    “Zen and the Art of Motorcycle Maintenance” is a fantastic book that takes about an ECT survivor whose personality is erased by the process. It is a true story that shows his slow recovery of himself, but meanwhile completely and effectively takes down the idea that science is somehow separate from and superior to “subjective” areas of study. (Though he places fault not with the Romans, but with the Greeks, and specifically with Aristotle). It’s an amazing read!

    • I read that book a very long time ago, even before I did my degree (the days of horse drawn carriages) and I agree with you Steve, medicine is part of the culture we inhabit, psychiatry is part of the culture our great, great grandparents inhabited, a time when women couldn’t possibly understand politics because of their biology, syphilis was rife and masturbation was a cause of insanity, the observer is participator ethos. It’s nearly 20 years since I was drugged and labelled, I did not agree with the explanation of my feelings at the time, I still don’t. Fortunately I read Toxic Psychiatry whilst going through my shit, something that was frowned upon by the medical establishment (yes it’s in my medical records!) and was only on the drugs for 4 weeks, 2 weeks on them, 2 weeks coming off them. I don’t hear voices, I don’t think I have any special gifts, I needed help not more abuse, I even had the psychiatrist come round to my house trying to push drugs onto me, if he was anyone other than a psychiatrist I could’ve had him arrested, I am a failure by psychiatry’s terms but a success as a citizen, I work hard and pay my taxes.

  3. I agree, this is a lot of psycho babble. I also agree with Thomas Szasz that there should be a separation of powers when it comes to medicine and the state. Although separation of powers is wise in pretty much all cases, since anyone with a brain knows “Power tends to corrupt, and absolute power corrupts absolutely.”

    This seems to me to be somewhat related to the question of whether medicine is a science or an art. Doctors of old were wise enough to know medicine is an art. Given the sad reality that our current “Rockefeller” medical system is at least the number three killer of all Americans.

    http://www.webdc.com/pdfs/deathbymedicine.pdf

    And even the former head of The New England Journal of Medicine, and others, confessed the medical literature is full of pharmaceutical industry funded, fraud based “scientific” literature.

    https://www.amazon.com/Truth-About-Drug-Companies-Deceive/dp/0375760946

    It seems it would be wise for the medical community to start acknowledging the reality that medicine is still more of an art, and “evidence based medicine” is really more ‘pharmaceutical fraud based medicine,’ than “evidence based medicine.”

    In other words, “A deconstruction between the ‘hard’ and ‘soft’ sciences,” or “between epistemic and ontological domains,” is still quite a mystery to today’s medical community. Since they’ve been so staggeringly deluded by today’s pharmaceutical industry’s fraud based “hard science.”

    Which would, of course, mean going back to an understanding that medicine is still more of an art, than a science, would be wise.

    Although what’s good is we now know from both the psychiatric and psychological industries’ own medical literature, historically and today, that the primary function of those “soft”/totally ignorant of the “ontological” theories/”bio-bio-bio” only believing DSM psychological and psychiatric industries. The primary function of both today’s DSM believing psychological and psychiatric industries is, and has always been, covering up child abuse and other “zipper troubles” for the religious leaders and wealthy, and covering up the easily recognized iatrogenesis of the mainstream medical community. This is, according to an ethical pastor, “the dirty little secret of the two original educated professions,” and the only reason these industries exist today.

    Perhaps those “soft” medical sciences, that have been medically proven to have iatrogenic rather than “genetic” etiologies, like today’s DSM disorder believing psychiatric and psychological industries, should be eliminated, rather than “Engaging the rest of the medical profession as partners in crime?”

    Oh, but spewing psycho babble is a much better idea?

  4. “They urge the medical humanities to rethink its grounding assumptions and acknowledge the healing powers of culture and the biocultural complexity of human bodies.”

    What exactly does that mean in terms of invented life long bi-polar and life long drug addiction?
    It’s quite easy to see in terms of heart disease, COPD and cancer as the majority of these illnesses have been caused by deluding the punters that cigarettes and sugar products are fun, healthy and a necessity.

    Thanks for this piece Zenobia, it sounds interesting although I can see the pharms jumping onto it as a way of being ‘cool’, also, it would be a lot easier to read if you translated your article before publishing, eg use the word story instead of narrative

  5. Sirs, I am a great fan of Mad in America, which I regard as an important counterbalance to the mainstream media, which in many countries are in the thrall of the Pharma business. I did not expect to see a tribute to Julia Kristeva in your pages. She is, along with Foucault, Lacan and their gang, one of the leading saboteurs of that open Western society of which Mad in America is an example. Her work is rife with infantile conspiration theories and pretentious nonsense. No one has ever succeeded in translating her ramblings into transparent, accessible language.
    Kristeva was recently revealed to have been a collaborator of the Communist dictatorship in her native Bulgaria, not the first leftist apostle of freedom to have made such a choice.
    https://www.theguardian.com/world/2018/mar/28/julia-kristeva-communist-secret-agent-bulgaria-claims
    Nathan Shachar
    Jerusalem