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To understand what we are as human beings – to make sense of our place as vibrant, morally conscious individuals in the physical world – there is no better place to look than medicine.
It’s taken me a long time to see this and say it out loud, because it’s taken philosophy such a long time to look in this direction. Whatever we might learn from science about our physicality, and whatever we might learn from art, from ethics, or from love about our humanity, we are accustomed to a certain distance between these two kinds of perspectives. In medicine, though, we must see through both lenses at once. We address in great scientific detail the sense in which we are physical things, as we address in great humanistic detail the sense in which each of us is a unique individual with experiences that matter.
As the two come together in medicine they force us to a philosophical conundrum, the “hard problem of consciousness”, the question of how to make scientific sense of private human experiences. As I see it, we arrive in medicine at the mind-body problem in its truest and most meaningful form – because here the stakes are as high as they could be. While in philosophy we can entertain the wildest explorations of what experience might amount to, in medicine when we get it wrong, real people suffer. When medical doctors or psychiatrists entertain incoherent ideas about mind and body, they make bad decisions about how to assist us in being well.
My work takes three forms, though all of them seem like the same project to me:
(1) Philosophy of Mind
Medicine is in a real fix when it comes to mind and body because basic terms like “dualism” have been misunderstood. While medicine is free to use any terminology as it sees fit, it will never work to use terms in ways that are actually self-refuting. I do my best to sort out and explain what’s gone wrong with medicine’s mind-body picture, and to put things in order. Because confusions about mind spill over from medicine into psychiatry and bioethics, I have a hard time keeping up with the ramifications of my efforts in this area.
(2) Clinical Medicine
We can track medicine’s mind-body confusions into recommendations for practice, and we can track the errors they cause in diagnosis and treatment. My work in this area centers on cases where patients have medically unexplained symptoms that could be caused either by bodily disease or by psychological distress. Surprising as it may be, cases of this kind are roughly as common as all the cases of diagnosis combined! Unexplained symptoms are the bread and butter of everyday medicine, but as things stand, doctors’ directives for managing these symptoms are guided by incoherent mind-body jargon rather than science. This is not good for any of us, and we can see that plain as day with the urgent challenge of long covid. (Click here for a recent lecture I gave on this kind of thing at Johns Hopkins' Berman Institute of Bioethics.)
(3) Gender Equity
Women are uniquely threatened by medicine’s mind-body jumble, because doctors’ training on women’s healthcare is focused on this kind of thing. Medical gaslighting, as most women know it, does not arise from doctors’ personal biases, in other words. It arises from medical training that uses vague mind-body jargon to encourage outdated social ideas about women and their uncontrollable emotions. For this reason, I often write and speak about safe, ethical care for medical conditions that mostly affect women, like long covid, autoimmune disease, ME/CFS, fibromyalgia, Ehlers-Danlos syndrome and chronic Lyme. I do my best to contribute to health policy that affects patient care in these areas, and sometimes I testify as an expert witness on behalf of mothers charged with “medical child abuse” after rejecting psychiatric care for their children’s unexplained symptoms.
Click here for a terrific article in Vice News, by Alan Levinovitz, that features my work: "The Medical System Should Have Been Prepared for Long Covid".
And here's a productive debate I had with Adam Gaffney on the STAT News First Opinion Podcast: "A physician and a philosopher on long Covid's mind-body mystery".
For the philosophically minded, here's my "5-Minute Fellows" video from the Center for Philosophy of Science at University of Pittsburgh.
Diane O'Leary, PhD
Independent Researcher (episodically disabled by chronic disease)
Adjunct Full Professor in Philosophy
University of Maryland University College
Visiting Fellow (faculty)
Center for Philosophy of Science
University of Pittsburgh
Visiting Fellow (faculty)
Rotman Institute of Philosophy
London, ON Canada
Kennedy Institute of Ethics
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The brain is wider than the sky,
For, put them side by side,
The one the other will include
With ease, and you beside.
The brain is deeper than the sea,
For, hold them, blue to blue,
The one the other will absorb,
As sponges, buckets do.
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