Monday, February 05, 2007

"Revisioning Health"

Right after I wrote my insufferably long and preachy post on health - really two posts in one, as I tackled both philosophic models of health and the health care system - the newest issue of Christian Reflection, the journal published by The Center for Christian Ethics at Baylor University arrived in my mailbox. The subject? Sure enough, it was health.

Better than that, the fist article in it, "Revisioning Healh" by James A. Marcum and Robert B. Kruschwitz, was specifically on philosophic/theological models of health. Their thesis was, very much like mine, related to comparing and contrasting what I called "pathological" and "holistic" models of health. However, their piece, as you might expect, was much better thought through, and is constantly in dialogue with both history and contemporary academic literature. In other words, unlike this blowhard blogger, these guys actually know what they're talking about.

What I called the pathological model of health they call the "biomedical model of medicine," but I suspect that we have the same set of ideas in mind. However, I think that they described this model much more succinctly, and, in doing so also managed to describe elements of this model that I left out. They noted both its exclusively negative nature, and its mechanistic approach. Here is what they have to say about it:

One of the reasons for the current crisis in the quality of our health ... is how contemporary medicine "envisions" health through a biomedical model. Patients get reduced to functioning machines, to complex golems made of their anatomical structures and molecular parts. And the focus of medical care becomes the treatment of disease, the fixing of a malfunctioning or broken body part. In the biomedical model, health is not a state of the whole person to be achieved and enhanced, it is simply a default state.

A little later they say:

The biomedical model of medicine, which lies behind the practices of most contemporary medical professionals, defines health in negative terms. Health is simply the absence of a disease entity (like a cancerous tumor) or the absence of the expression or detectible symptoms of a disease state (like the deep cough of pneumonia). It is, according to the first definition in the twenty-sixth edition of Stedman's Medical Dictionary "the state of an organism when it functions without evidence of disease or abnormality."

After exploring this model for a few more paragraphs they answer the question that may be on some of our minds: What's the problem with this? Why is this approach a bad, or at least flawed approach? After all, by focusing on functional problems in the body, it has, in fact, solved a great many of those problems, and promises to solve many more. Here is the problem, as they see it:

When the typical modern physician defines health as the absence of disease, she will address the disease state of her patient and, given the reductive clinical gaze, she usually will address only the specific diseased part of her patient. Her medical practice will ignore the whole person, especially the socioeconomic or cultural context in which the patient lives. She also will ignore or bracket the positive dimensions of health that are proactive in nature, such as exercising and proper nutrition. She will relegate instruction and care for these to other professional healthcare providers, and she may express no further concern for her patient's welfare.

The current notion of health is too myopic: it addresses only the amelioration of disease and pays no heed to the promotion of well-being or wholeness. In other words, it is basically inhumane because it does not encourage the development of patients' full potential vis-a-vis health.

Marcum and Kruschwitz then outline what they call "several recent attempts to humanize the biomedical model of medicine" which have "led to more expansive notions of health in terms of well-being and wholeness." You can find what they have to say here.

No comments: