29th EUROPEAN CONFERENCE ON PHILOSOPHY OF MEDICINE AND HEALTH CARE 19 – 22 August, 2015 VENUE: THAGASTE ACADEMIESTRAAT 1 9000 GHENT "Medicalization” Organised by: The European Society for Philosophy of Medicine and Healthcare (ESPMH) and the Bioethics Institute Ghent, Belgium ABSTRACTS Mind the (Cartesian) gap: discourse analysis of subjective and objective experiences of the body in manual therapy Abbey, Hilary [email protected] Background: Chronic pain is a complex healthcare problem that impacts on patients’ experiences of ‘body as object’ and of their ‘lived body’. Biomedical treatments often fail to address individual distress but it is unclear if or how, bio-psychosocial approaches differ. ‘Patient-centred’ therapists aim to bridge the mind-body gap through ‘holistic’ interventions but it is not known how this is enacted, or what impact it has on patients’ awareness and function. The concept of embodiment developed by Merleau-Ponty and research into embodied cognition suggest there may be under-explored opportunities to work in more philosophically integrated ways that acknowledge the inseparability of mind and body experiences. Design: This paper present an analysis of philosophical discourses about the ontological nature of the body and dysfunction, and epistemological beliefs about how pain can be explained and managed. These discourses were co-constructed during manual therapy interactions between an osteopath and four patients attending an innovative chronic pain management course. The course integrated Mindfulness and Acceptance and Commitment Therapy based interventions into osteopathic treatment for individual patients. It aimed to enhance body awareness, promote flexible psychological responses to discomfort, and develop self-care skills. The study formed part of a Professional Doctorate degree and data was collected from audiotapes of individual pre-course interviews and six treatment sessions. Discourse Analysis was used to explore the context of medical discourse within which interactions took place, followed by Micro-Discourse Analysis of key interactions to explore the dynamic processes by which meaning and action were co-constructed. Results: Course aims were to promote learning by focusing on patients’ awareness of cognitive, affective and bodily experiences during physical treatments. The therapists’ stance was that patients were ‘experts’ in their own life experiences but data analysis indicated that conversations rarely focused on present moment patient awareness and both participants tended to default to a ‘practitioner as expert’ relationship. Occasionally, both participants focused on ‘here and now’ experiences and changes in discourse indicated that this made space for a more embodied sense of awareness. The practitioner moved between giving ‘expert’ biomedical explanations and providing a safe, tactile environment for exploring bodily experiences. The body was generally described as a separate object and body parts were attributed with independent autonomy and agency. Interesting interactions occurred when the practitioner ‘interpreted’ palpable clues, explaining the body to the patient. This may parallel reflective mirroring in psychotherapy, which aims to integrate fragmented aspects of the psyche. It is possible that integrating mindfulness with touch-based therapy may offer possibilities for developing more embodied understanding about chronic pain and its impact. Discussion: Despite a theoretical and philosophical commitment to patient-centred, holistic care, this data shows that it is difficult to do. Interventions were primarily based on objective, realist philosophical assumptions about the nature of the body and pain. There were moments where a more integrated, embodied approach showed promise in bridging the gap between a separated mind and body. Discourse Analysis may be a promising research method for exploring process in healthcare interventions which claim to offer a bio-psychosocial approach. We still need Virchow Ahlzen, Rolf [email protected] The fundamental changes in the scientific basis of clinical medicine that are often dated back to Virchow’s cellular pathology in the 1850´íes paved the way for massive breakthroughs in the treatment of a number of mankind’s most devastating maladies. The ever closer cooperation between the sciences and the clinical researchers, and the socialization of clinicians into the epistemology of the natural world – these became the corner stones of medical progress. For over 150 years this basic “model” has in many important respects served us well. The assumption that disease is a localized dysfunction in tissues that causes distressing symptoms or threatens life has in no way lost its relevance and potential to provide new therapies for wide-spread disorders like dementia, cardiovascular disease or cancer. When critique is levelled against “the biomedical model”, it is often simplified and does not acknowledge that this model looks different when it is a tool for medical research, from when it follows clinicians into their encounters with suffering persons. Most physicians do enter into an intersubjective exchange with those who want their help and do show interest in the lived reality of their patients. They do sense that causality is often far more complex that they have learnt. They lack a theory and often also training for handling such situations. Hence, I want to argue that “the biomedical model” needs to be refined and to be more complex so that it is capable of incorporating multifactorial and other types of complex causality. It is, however, very much alive and should so be. All clinical practice should depart from and return to the epistemology of the first person, of the lived world. The epistemology of the body, as described by the sciences, is best seen as a necessary and invaluable abstraction from the lived reality of the suffering patient. This requires a redressing of the balance of the two perspectives in medical education, clinical research and clinical practice. Biomedical enhancement: a remedy without a diagnosis Ahola-Launonen, Johanna [email protected] In this paper, I elaborate the paradigmatic literature of biomedical enhancements by conducting conceptual analysis of enhancement and medicine, and argue that the paradigm of enhancement is based on an unreal neutrality. The key concept in the literature of biomedical enhancements is making better people by the use of such technologies. It is suggested that many characteristics such as intelligence, optimism, self-discipline, a sense of humor, or general well-being, could be increased by the use of genetic engineering or chemical neuroenhancement. The paradigm of enhancement situates itself in the discipline of medicine, but it remains a question whether it shares any relevant epistemological and normative framework with medicine. Medicine has a long history, and even if it is not a unified discipline, its object appears clear: cure individuals by making them reestablish their ‘normal’ sate. The object of medicine is the pathological and normal, defined through a diagnostic pathway. In contrast, the enhancement paradigm leaves its objects undiagnosed as if there was a common agreement on their definitions. The disciplinary transfer between these two paradigms is examined by showing that enhancement only borrows from medicine the remedy-oriented language evacuating the diagnostic one. The notions used are never clearly and explicitly defined, but they can only be evaluated through a norm, especially when the aim is to intervene and manipulate these characteristics. In order to define and understand the concepts, the causes of these phenomena must be understood and diagnosed. Reductionist diagnosis is criticized in medicine and there is no reason why enhancement should escape this accusation. Medicalization and women – positional shifts between women and the medical profession Anderssen, Jorid [email protected] Medicalization is often understood as a process where a growing number of human problems are defined and treated as medical problems. Medicalization has been a topic in sociological literature since the early 1960s. Women health activists problematized the medicalization of women’s lives, and their passive role in relation to medical experts. The goal was equally for women and men. Women activists and others worked to make women problems visible, educate women about their own body, and women’s right to choose in health matters. Today there are many actors in the field of health and illness. The doctor’s dominance has been challenged. New technology and new actors provide new knowledge about illnesses. The risk conceptions and lifestyle changes alter the way we adjust to and understand health and illness. In the new public health the individual is responsible for her health choices. This opens up for individualized interpretations of health and illness, and a more consumer- oriented health care has underpinned the individual right to choose. Such changes have affected women’s relation to health and illness, and how they position themselves in relation to health care. The modern health consumption has been questioned, including modern women’s use of health services. Women’s growing use of for instant C-section and cosmetic surgery has been questioned by both doctors and others. The present paper discusses the women’s position in relation to today’s medicine and women’s position in the medicalization debate. Is medicalization a suitable description