2.4.1 Reductionism and ‘ownership’ of the body
Social scientists interested in changing relationships between workers and users of health care often draw attention to what is termed the loss of ownership or loss of governance of the body. These terms mean that a person's body is treated in some health situations as more important than the person themselves. It is almost as if they are purely a case, an example of a type of disease, or a set of symptoms. Traditionally, such criticisms were levelled against biomedical approaches to the body, and medical historians sought to demonstrate that power over the body is central to the development of medical authority. The work of the sociologist and historian David Armstrong is important to debates in this area (Armstrong, 1987, 1993). He argues that modern medicine developed its power in society through its knowledge of the body and through mapping physiology, anatomy and the biology of disease processes. As the inside of the body was investigated, medicine could claim knowledge about how it worked, giving medicine a monopoly over these new understandings. The science of the body and of disease became the preserve of the medical establishment. The study and treatment of the ill and diseased body moved into medically dominated settings such as hospitals and clinics (Foucault, 1973).
One effect of this focus on the diseased body and the medical ‘case’ was that the individual person could easily become hidden behind a disease label or a set of medical notes. The focus on parts of the body, rather than the whole person, is called reductionism. A reductionist attitude towards healing and treatment means the patient becomes little more than an object of medical treatment and a battleground on which to fight disease. How patients feel about their treatment and the role of the patient's mind and emotions while in health care settings become side issues to the imperative of treating the body.
Reductionist medicine is a direct product of Cartesian ideas about the body, specifically, the long-held view that the mind is separate from the body. The philosopher René Descartes (1596–1650) argued that minds and bodies are made of totally different substances: minds are spiritual matter and bodies are material matter. Within conventional scientific thinking, there was no way to link the activities of the mind with the functions of the body. As Mitchell and Cormack explain:
As translated into biomedical practice, there has been a focus on the physical aspects of illness, with diseases being understood as biological phenomena in which signs and symptoms are manifestations of underlying pathology. Social and psychological aspects of illness may have been recognized and viewed as significant in themselves, but there has been no philosophical or theoretical framework for links between the psychosocial and the physical.
(Mitchell and Cormack, 1998, pp. 63–4)
In theoretical terms, concerns about the limitations of the reductionist biomedical model gave rise to the emergence of the biopsychosocial model of health and illness, proposed by Engels (1980). This model, which now underpins conventional training and practice, recognises that behaviours, thoughts and feelings influence a person's physical state. Engels argues that psychological and social factors influence biological functioning and also play a role in health and illness. However, even the biopsychosocial model fails to provide a scientific basis for exploring treatments or approaches to considering the patient as a whole. The discovery in the 1980s of a rich supply of nerves linking the brain with the immune system led to a new branch of science: psychoneuroimmunology or PNI (Evans, 2003). Finally, a theoretical basis was established to support a relationship between the brain and the immune system, which some CAM practitioners cite in support of their philosophy that the mind can influence events in the body. The science of PNI is in its infancy, but developments in this area will be highly influential in the shift away from biomedical approaches in which personal meaning and bodily processes are viewed as distinct and separate.