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 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.
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 medical professionals currently assume about mind and body, to clarify problems with that picture, and to offer sound correctives. This is easier said than done, given that researchers in medicine, psychiatry and bioethics tend to use philosophical terms in confused ways.
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 allows us to fully respect those with disorders of consciousness, dementia, and cognitive differences that impact decision-making. In addition, I sometimes serve as an expert witness in cases where parents and clinicians disagree about psychiatric diagnosis for physical symptoms in children - that is, cases where clinicians alert the courts about “medical child abuse” or “fabricated or induced illness” based on parents' pursuit of biomedical care, rather than psychiatric care, for children’s bodily symptoms. In every area where the word 'dualism' currently arises 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 problems 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, this recommendation is straightforwardly unethical. We will not begin to close the medical gender gap until gender is eliminated as a factor in attribution of bodily symptoms to the psyche.
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.