Medicine is deeply philosophical, particularly when it comes to mind. First, in our time medicine has embraced the goal of “integrating mind and body”. Second, on that basis, it has become routine for clinicians to attribute bodily symptoms to the psyche. Unfortunately, on both counts the profession has been guided by popular buzzwords rather than sound philosophical thinking. I hope to change that. Surprising as the idea might be for philosophers and clinicians alike, medicine is an area where philosophical clarity has a direct impact on human suffering and well-being. We cannot optimally improve health without a sound position on the place for mind in medical science.
In bioethics our assumptions about the mind ground everything we do – so when our mind-body thinking is improved, we improve ethical understanding across the board. My work invites us to reconsider, for example, how bioethics excludes those with cognitive disabilities and disorders of consciousness. In addition, I sometimes serve as an expert witness in cases of “medical child abuse”, where clinicians challenge parents’ decision to pursue medical rather than psychiatric care for undiagnosed symptoms in children. Finally, my work suggests that in every area where we assume the boundaries between medicine and psychiatry should be ambiguous, we undermine our ability to improve patients’ quality of life. Recognizing this can help resolve professional debates about the nature and goals of psychiatry.
The most impactful area of my work by far is the effort to show how mind-body confusions have been enlisted in service of outdated social ideas about women. Clinical recommendations directly suggest – here and now – that women’s bodily symptoms should be diagnosed as psychiatric problems ten times more often than men’s. (See gender ratios for “somatic symptom disorder”.) As we now have firm evidence that women face obstructed access to healthcare that men readily receive in similar circumstances, these recommendations are unethical. Until we have scientific support for the idea that women need medical care less often than men, gender should be eliminated as a factor in psychiatric diagnosis for bodily symptoms.
As a speaker and advisor, I work for improvements in practice and health policy related to diagnostic uncertainty. In this capacity I’ve spoken to or advised organizations concerned with women's health, chronic Lyme disease, rare disorders, myalgic encephalomyelitis/chronic fatigue syndrome, Ehlers-Danlos syndrome, periodic paralysis and others. I do my best to contribute to health policy decisions related to mind and body, including proposals responding to pending changes in the International Classification of Diseases, and changes to national guidelines for managing contested conditions like ME/CFS and chronic Lyme disease in the US and UK.
Diane O'Leary, PhD
Center for Philosophy of Science
University of Pittsburgh
(beginning August 2020)
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.