The Cartesian Doctor

Descartes is still alive; he is alive in the medical student sitting in a bench memorizing the structure of the cell today, not every student but more often than not. They struggle with the duality of substances, the body and the experience of the body, many without knowing its name; the mind body problem. The biomedical model entails a duality, and with it a new form of dualism. What does the biomedical model mean? It means that a person is plagues with an issue (disease), placed in a controlled environment, observed (tested) and given a diagnosis followed by a treatment

It is a tool that has served our society well, and created the advanced and structured modern medicine. What dualism means in this context; In dualism, the body is considered to be like a computer. You have the hardware and you have the software inside of it, they are two separate substances who each exist within same object. Cartesian Doctors are only trained to look at the hardware. If there is a fuse in the electrical system or if there is a circulatory problem, perhaps there is some flawed wiring.

The computer’s software, the experience of the body and the general consciousness is not included in the model. Now, you can have software existing independently of the hardware and vice versa (I’m fully aware that it’s not an exact descriptions since in deed the wiring creates a module for the existence of the software i.e. they interact). Why this occurs is because Doctors rarely have the time to look at the software. If (in particular primary care) Doctors would devote time to the complexity of the mind body problem they would observe patients in an extremely slow rate. In order to save the computer aka the body, you need to focus on repairing the chords, rewiring right and making sure that the hardware is fixed before you can even think about letting the software become an issue. But what when viruses occur? When there is nothing wrong with the hardware? This is where the safe and comforting cloud of the Cartesian Doctor fails; The virus in this case being chronic, somatic and incurable disease. The Cartesian doctor exists because the load of health care overrides the need to solve the modern dualism. In a day when a doctor meets 40 patients, and two of those might carry a lethal cancer that can be cured if detected by him in time, the 38 remaining being sniffles, the Cartesian doctor must endure the thought (or in many cases is thought to endure) of perhaps some of the cases being a somatic episode, giving an early prognoses of suicide. The Cartesian doctor can only analyze what he sees, not what he hears. He has neither the time nor the knowledge to read between the lines. Just like the electrician would not have time to examine the relation between the cable and the production of it. It comes down to this; open, see, find the loose parts and put them back together. Far from all doctors are The Cartesian Doctor, many are integrating the thought of a biological cause of the unexplained and complex (e.g. somatic problems) but yet the dilemma remains in those with chronic disease. Because what is the Cartesian Doctor to do when a patient will never be ok, when a patient is old and when the will to be cured does not exist. He can call a programmer, perhaps the software can be looked at. But most often, the Cartesian doctor does not see this problem. Not because he refuses, but because he has too many cables in the way.



  1. Marti · · Reply

    Almira, Nice reflections on important questions in medicine. Physicians, like other professions, ‘see’ what they are trained to see, and are often blind to what does not fit their model of the universe. We’re in the midst of a paradigm shift. Exciting, if a little confusing. Anyone who finds this blog interesting will enjoy the book The Old Age Challenge to the Biomedical Model: Paradigm Strain and Health Policy by Longino and Murphy.

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