Medicine isn’t just about the body - or at least it hasn’t been since the 1980s. At that time medical professionals of all sorts recognized that bodily health is deeply interwoven with psychological health and social health. Since then we’ve worked to reimagine medical practice in a way that “integrates mind and body” so that clinicians will continually recognize patients as whole persons.
Unfortunately, the movement of holism has been driven by popular buzzwords rather than sound philosophical reasoning. I hope to change that. Surprising as the idea might be, we cannot optimally improve health without a sound position on the place for mind in medical science.
My work takes three forms, though all of them seem like the same single project to me.
In philosophy of mind I try to sort out what the medical profession currently assumes about the existence of minds or mental properties, to clarify problems with that picture, and to offer sound correctives. This is easier said than done, given that clinicians and researchers in medicine, psychiatry and bioethics often use philosophical mind-body terms in confused ways. In the end of the day, I think optimal clinical practice requires naturalistic dualism.
I try to show how bioethics has been misdirected by philosophical confusion about mind and body. My work suggests, for example, that consciousness might be a better foundational idea for bioethics than personhood, because it is bodily experience, rather than decision-making capacity, that shapes medical science. Moreover, when bioethics is grounded in consciousness, we are able to fully respect those with disorders of consciousness, dementia, and cognitive differences that impact decision-making.
I sometimes serve as an expert witness in cases where parents and clinicians disagree about diagnosis at the mind-body line in children. In every area where the word ‘dualism’ comes up in bioethics, philosophical clarity can improve our understanding.
I often write and speak about safe, ethical management of undiagnosed symptoms. Much of this work is focused on contested conditions like ME/CFS (“chronic fatigue syndrome”), fibromyalgia, Ehlers-Danlos syndrome, and chronic Lyme disease. I don’t have the scientific expertise to make determinations about disease in any patient group, but we don’t actually need expertise of that kind to see that medicine should maintain its usual standards for caution as it approaches the mind-body line. This principle is becoming increasingly important in health policy, and I’m proud to have played a role in that change.
The most impactful area of my work in the clinical realm may be the effort to show how medicine relies on mind-body confusions to support outdated social ideas about women. Clinical recommendations currently suggest that women’s bodily symptoms should be attributed to psychological causes ten times more often than men’s (see “somatic symptom disorder”). As we now have clear evidence that women struggle to access healthcare readily available to men, that recommendation is straightforwardly unethical. To close the medical gender gap, we need to learn to distinguish philosophical doublespeak from philosophical clarity in medicine.
Diane O'Leary, PhD
Center for Philosophy of Science
University of Pittsburgh
Adjunct Full Professor in Philosophy
University of Maryland University College
Rotman Institute of Philosophy
London, ON Canada
Kennedy Institute of Ethics
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.