Map of life expectancy at birth from Global Education Project.

Wednesday, January 02, 2008

Mind and Body

Continuing with the question "What is health?", let's consider the mind-body problem.

The ancients viewed the mind and body as a single entity. Hippocrates could write with equal authority about diseases we would today differentiate as physical or mental. "Hysteria," for example, was caused by movement of hte uterus, and depression by imbalance of the humors.

Modern positivist philosophy, often traced back to Descartes, has famously split mind and body. From Descartes' time until very recently, if at all, the inner workings of the mind have not been readily susceptible to empirical investigation by the standards of positivist science. (Maybe functional Magnetic Resonance Imaging is changing that -- we'll see.)

During the 18th Century, institutions that cared for the mentally ill in the Western world developed entirely separately from the rest of the medical institution. As Paul Starr wrote, "Although by the 1840s, most superintendents [of mental asylums] were doctors, they kept aloof from other physicians. And, increasingly, as mental hopsitals shifted from therapeutic to custodial functions, psychiatry became primarily an administrative rather than a medical specialty." Back then, the remainder of physicians, who delivered services in patients' homes and their own offices, could do no better than psychiatrists at curing the diseases which came their way. That didn't change until the germ theory of disease and the discovery of hygenic practices which made surgery possible with a reasonable chance of not killing the patient; and ultimately, during WWII, the discovery of antibiotics which for the first time allowed physicians to do more good than harm.

Psychiatry, however, did not benefit fromt he empirical advances of the early 20th Century. When so-called paresis was found to be in fact an infectious disease -- tertiary syphillis -- it left the domain of psychiatry. Even today, when individuals present with other syndromes of brain disease or trauma such as stroke, epilepsy, or tumor, as soon as the organic disease process is identified, psychiatrists lose control of the case and it passes on to neurology or another specialty.

While Sigmund Freud's theories lacked any real empirical support, he did provide psychiatrists with a toolkit for treating the mind. By discovering the so-called "conversion disorders," he forged a link between psychiatry and "physical" medicine which psychiatrists could exploit to enhance their prestige within the medical community. At last psychiatrists had something to offer other physicians in the diagnosis and treatment of "real" diseases. (The conversion disorders were physical symptoms supposedly caused by repressed conflicts or desires.) At last, Freud got psychiatrists out of the lunatic asylum and into private practices where they could treat paying patients.

Next: Cartesian dualism in the 20th Century.

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