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An Inquiry Into the Nature and Role of Medical Concepts Durham E-Theses Is it Psychosomatic? - An Inquiry into the Nature and Role of Medical Concepts Puustinen, Raimo How to cite: Puustinen, Raimo (2011) Is it Psychosomatic? - An Inquiry into the Nature and Role of Medical Concepts, Durham theses, Durham University. Available at Durham E-Theses Online: http://etheses.dur.ac.uk/657/ Use policy The full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-prot purposes provided that: • a full bibliographic reference is made to the original source • a link is made to the metadata record in Durham E-Theses • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders. Please consult the full Durham E-Theses policy for further details. Academic Support Oce, Durham University, University Oce, Old Elvet, Durham DH1 3HP e-mail: [email protected] Tel: +44 0191 334 6107 http://etheses.dur.ac.uk 1 Abstract Raimo Puustinen Is it Psychosomatic? - An Inquiry into the Nature and Role of Medical Concepts Medical diagnoses define the possible modes of being ill from the medical point of view. Medical diagnoses are theoretical concepts that gain their meaning as a part of the prevailing medical theory. As medical theories change over time, also medical concepts change, as can be seen in the long history of medical thinking. The purpose of this essay is to illustrate medical thinking through examining the formation and use of one example of a particular medical concept “psychosomatic” in medical theory and practice. The approach taken in this essay reflects the writings of Lev Vygotsky, who argued that scientific concepts are tools for scientific thinking. Since all conceptual tools have their own developmental history, to understand the content of any scientific concept to the full we need to understand the processes leading to adoption of that particular concept for scientific inquiry at that particular moment in history. Vygotsky’s approach for analysing the development of science through analysing its concepts is reflected to the writings of Kuhn and Fleck on the development of science. It is argued, that Kuhn’s theory does not apply to the development of medicine. While Fleck’s approach seems to fit better to analysing the theoretical development in medicine, it remains somewhat superficial in analysing the nature and role of concepts in medical thinking. The use of medical concepts in medical practice is discussed in the light of Mikael Leiman’s ideas on the therapeutic encounter as a dialogical process. While Leiman also draws from Vygotsky he takes the issue further toward semiotic understanding of clinical dialogue by using Bakhtin’s and Voloshinov’s ideas of the semiotic nature of human communication. 2 Is it Psychosomatic? - An Inquiry into the Nature and Role of Medical Concepts Raimo Tapio Puustinen PhD-thesis School of Medicine and Health Durham University 2010 3 Table of Contents Acknowledgements...................................................................................................... 5! Introduction................................................................................................................. 9! The structure of the argument ................................................................................. 15! Note on concepts used............................................................................................. 18! Note on abbreviations ............................................................................................. 19! Chapter 1 - Medicine and conceptual thinking in science..................................... 20! Role of concepts in biological theory ..................................................................... 22! Concepts as tools for thinking................................................................................. 25! On historical method............................................................................................... 33! Chapter 2 - Psychosomatic, a word ......................................................................... 38! Chapter 3 - Mind and body in early medical theory ............................................. 44! The Hippocratic Corpus .......................................................................................... 44! Galen ....................................................................................................................... 50! Chapter 4 - Passions, imagination and the body .................................................... 55! Body and soul.......................................................................................................... 56! Mechanistic vs. spiritual doctrines.......................................................................... 59! Physics, psychology and medicine.......................................................................... 63! Chapter 5 - Psychosomatic, a concept..................................................................... 69! “Indispensable tool”................................................................................................ 71! Conversion .............................................................................................................. 74! Birth of a Journal..................................................................................................... 83! The concept psychosomatic defined ....................................................................... 90! Chapter 6 - On the development of science ............................................................ 99! Science as a socio-historical endeavour................................................................ 108! Chapter 7 - Psychosomatic theory in the making ................................................ 116! Formulating fundamentals .................................................................................... 118! A concept goes abroad .......................................................................................... 128! 4 Chapter 8 - Fundamentals questioned .................................................................. 132! Three psychologies ............................................................................................... 134! A quest for conceptual clarity ............................................................................... 135! Fundamentals falling............................................................................................. 145! Chapter 9 - “…the very term psychosomatic has lost its meaning”.................... 151! In search of conceptual coherence ........................................................................ 154! Dualism revisited .................................................................................................. 160! Chapter 10 - “Praise Be to Psychosomatic Medicine”......................................... 170! Concepts crowding in............................................................................................ 171! Biopsychosocial model ......................................................................................... 171! Psychoneuroimmunology...................................................................................... 174! Behavioral medicine ............................................................................................. 175! Psychosomatic outmaneuvered ............................................................................. 177! Chapter 11 - From scientific concept to everyday word...................................... 180! The scientific status of psychosomatic research ................................................... 182! Concept deflated ................................................................................................... 184! Life of a medical concept...................................................................................... 186! Implications for medical historiography ............................................................... 190! Chapter 12 - Concepts in medical thinking .......................................................... 193! The concept of concept ......................................................................................... 194! Clinical dialogue ................................................................................................... 199! Polyphony and monologue.................................................................................... 202! Consultation as a joint activity.............................................................................. 205! Patient’s history..................................................................................................... 208! From symptom to medical concept....................................................................... 212! As concepts go by ................................................................................................. 215! Conclusion................................................................................................................ 219! Epilogue.................................................................................................................... 222! Literature................................................................................................................. 224! References ...............................................................................................................
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