The Biomedical Disease Concept
and the Dualistic Concept of Man
The biomedical disease concept presupposes a dualistic concept of man. Dualism here divides a human being into two compartments which are viewed and described separately. Therefore this concept condemns us to recognizing the compartmentalized, dualistic concept of man, and will continue to do so. My point is not to discredit knowledge gained about the body and mind as separate compartments. Scientific reductions are useful, necessary, and often even desirable. In medicine the search for the existence of organic aberrations is quite important. The practitioners of different branches of medicine whose job it is to determine the existence of these aberrations benefit from the biomedical concept as a reductionist concept. This could be called a sub-concept: one of various, alternative sub-concepts possible inside an all-encompassing concept. This is acceptable as long as the reduction is abandoned where and when it is no longer relevant or when the aberrations found in the sub-concept no longer adequately and satisfactorily explain a person’s being ill. When the biomedical disease concept is not used as a reductionist sub-concept but as a definition of disease this definition will constantly compel us to view man as consisting of two separate, co-existing compartments.
The distinction of ill-healthy precedes the distinction of mind-body (see 2.3). The latter can serve only as a temporary reduction. It is useful in limiting the area of examination and in directing the examination. When the reduction is not canceled but used as a basis for defining disease, then an apparently objective basis for the definition is gained, but the realization is lost that man consists of solely his body only in death. In an effort to achieve objectivity the baby is thrown out with the bath water. Disease disappears from the picture. Lost is man as a biopsychosocial entity, as an entity which can be structured, but in which there is no longer a point to the structuring if it goes beyond the distinction of different levels of organization and integration.
The biopsychosocial disease concept restores the ill person to his existential unity. This advantage is gained at the price of objectivity in the physical scientific sense of the word. Fabrega describes the wondering attitude of the Ladinos in Mexico, who themselves have an integrative view of being ill and illness, towards official medicine and its biomedical disease concept. This difference in views is the source of estrangement, broken contacts, and dissatisfaction with the official medical services. It seems to me that much of the criticism of established medicine in our own society is rooted in this same dissatisfaction. The ill person is not a duality, and clashes with a medicine that tries to turn him into one.