Molly Pieri
April 6, 2008
Mind-Body Dualism/Unity in Medicine

For centuries, history has observed an overarching trend in Western culture and society favoring mind-body dualism over unity, moving towards the complete separation of the psyche from the soma. One field in which this modality of thought is particularly noticeable is medicine. Conventional modern Western medical practice holds bodily illness to be separate from and unaffected by the patient’s consciousness, while a second profession, that of psychiatry attempts to treat mental maladies independently of a patient’s physical health. However, within the last few decades, there has been a movement within the medical community searching for a more holistic method of healing, which would bring the psychological and the physiological into union with each other. To accomplish this, doctors and patients alike must re-think the way in which they categorize mind-body phenomena, and establish for themselves a logical unity between body and mind.

The 1970’s saw a renewed interest in psychosomatic phenomena in medicine. Since then, there has been an increase in the use of alternative-traditional, more holistic medicinal practices, such as acupuncture and reflexology, throughout America and the rest of Western civilization. In addition to the increased acceptance of Eastern medical theory, there has also been a movement within traditional Western medicine towards a more unified conception of the mind-body relationship. Many doctors and patients alike feel that treating the mind and body separately inherently limits modern medical practices, both biomedical and psychiatric, to fully treat illness. However, there is significant resistance towards accepting the idea of a unified mind and body, even from patients who might be helped by such a shift in the cultural mind-frame.

In his essay “Mind-Body Dualism and the Biopsychosocial Model of Pain”, Grant Duncan uses methods of treating and ways of conceptualizing pain as a measure of mind-body dualistic mentality present in Western medicine. He explains that conventional modern Western medicine defines pain as “a simple bodily sensation, the function of which is to avert the organism from harm…[this] reflects an overly somatic orientation in modern medicine. This orientation has often neglected significant psychological factors in health and illness.” This statement is echoed by others throughout the medical field. “The medical literature privileges objective somatic processes, and it enshrines them as the agent that produces pain. The psychological literature takes the opposite position: it imputes agency to the subjective mind… Both traditions tend to ignore how a person’s immediate experience of pain unites its bodily, psychological and social origins.” Furthermore, Duncan explains, it is not just medical professionals who work to perpetuate the privileging of body over mind in medicine— patients, as products of our modern dualistic culture also enforce such a mentality. “[M]any chronic pain patients persistently pursue a ‘legitimate’ (or legitimating) medical diagnosis to justify the pain and to avoid the label of ‘psychogenic’… if the pain does not fall into that ‘physical’ category, then it is likely to be treated with skepticism and moral disapproval…” It is here that we see the problem presented to the medical community today. On the one hand, some physicians are becoming aware of the limitations inherent in a dualistic approach to medicine; however, the cultural connotations of holistic medicine make patients and even other doctors feel that any unification of mind and body in dealing with illness and health must be illegitimate and unscientific in nature. This creates an environment in which patients feel that if they accept a psychosomatic explanation of their illness, it becomes an invalid malady; while doctors feel they cannot diagnose a psychosomatic illness because his or her patient and colleagues will not accept such a diagnosis. Thus, the cultural modality of dualistic thought perpetuates itself, even when there is significant medical evidence to suggest a more unified conception of mind and body serves as a more accurate depiction of the human condition.

Examples of such medical evidence abound. A study conducted by the College of Dentistry at Ohio State University found “that psychological stress has adverse consequences for immune function.” In the study, students were given minor wounds in analogous locations on their hard palate on the right and left sides of their mouth. The first wound was delivered during the summer, while the second was given 3 days before the students’ exams. Both wounds were treated identically, apart from the time that they were inflicted upon the students. The second wound took an average of 3 days (40%) longer to heal than did the first wound. “These data suggest that even something as transient, predictable, and relatively benign as examination stress can have significant consequences for wound healing.” Further evidence of the relationship between the body and mind can be seen in an interesting study performed at Wake Forest University. This study explains that “emotional pain… activates two brain regions that are also important in the response to physical pain. Pain activates the anterior cingulated cortex which signals… an individual to act to stop the pain; [emotional pain] similarly triggers activity in this region. Activation of the right ventral prefrontal cortex appears to help dampen the distress of both physical [and emotional] pain.” These studies, and others like them, clearly point to an integrative mind-body connection. Yet the prevailing logic still holds mind and body as separate and distinct phenomena. But unmistakably, when an emotional phenomenon has physical impact, the logic behind holding these two things separate no longer applies. The reasoning used by Descartes and so many logicians since has been that as a non-spatial entity the mind cannot exist in unity with a physically extended item, like a body. However, when emotional stress can be seen not only to stimulate the brain in the same way as physical stress does, but also to have concrete physical consequences for the body, which are not a result of the will, these assumptions can no longer be accepted as wholly correct. Clearly, the mind has physical manifestations. If this is not accepted, then the reverse must be said to be true. When physical activities of the body, such as exercise or the consumption of certain drugs (such as anti-depressants) can have an effect on the mind’s emotional and reasoning functions, it must be concluded that the body is able to affect the mind. As the mind is held to be a non-physical entity, thus the body too must have a non-physical manifestation.

The solution to this paradox, it seems, heralds back to the Aristotelian model of a physically extended rational spirit incorporated in the human body. A person cannot be said to be contained in either the mind or the body alone. We do not call a ghost, or Descartes bodiless rational mind, a person, we call it a spirit. Similarly, we do not call a dead body a person, we call it a corpse. A person can only exist when both these components come together to make one whole, living, conscious being. If neither of the separated components can be said to be a person, then the combination of mind and body must synthesize an entirely new thing: one to which the old category separation does not adhere. It is this new territory in which we must envision the person to understand psychosomatic phenomena such as the emotional-physical connection seen in science today. In other words, in order to accurately understand and treat human beings as patients, medicine must not break them down into separate pieces; this only strays farther and farther from what defines an individual. Rather, we must understand a person through a new logical category, one that respects his or her status as a conscious, thinking, and physical being.



References:

1) Duncan, G. (2000) “Mind-Body Dualism and the Biopsychosocial Model of Pain: What did Descartes Really Say?”, Journal of Medicine and Philosophy, 25:4, 485-513

2) Kleinman, A., et. al. (1992), “Pain as human experience: An introduction”, in M.J. DelVeccio Good, et. al. (eds.), Pain as Human Experience: An Anthropological Perspective, University of California, Berkely, pp. 1-28


3) Marucha, P.T., Kiecolt-Glaser, J.K. and Favagehi, M. (1998); “Mucosal wound healing is impaired by examination stress”, Psychosomatic Medicine 60:3, 362-365

4) Vastag, B. (2003) “Scientists Find Connections in the Brain Between Physical and Emotional Pain”, Journal of the American Medical Association, 290:18, 2389-2390

I would also like to take this opportunity to credit Mr. Grant Duncan with much of the research that aided me in writing this paper. In writing his article, he found and cited many resources, which proved to be most helpful in my own work. Without the references made in his article, it is unlikely I would have found many of the texts I have cited in this paper.