The body as object versus the body as subject: the case of disability

This paper is prompted by the charge that the prevailing Western paradigm of medical knowledge is essentially Cartesian. Hence, illness, disease, disability, etc. are said to be conceived of in Cartesian terms. The paper attempts to make use of the critique of Cartesianism in medicine developed by certain commentators, notably Leder (1992), in order to expose Cartesian commitments in conceptions of disability. The paper also attempts to sketch an alternative conception of disability--one partly inspired by the work of Merleau-Ponty. In particular, three key Cartesian claims are identified and subjected to criticism. These are as follows: (a) The claim that the body is an object, (b) what is termed here 'the modularity thesis', and (c) the claim that the body cannot be constitutive of the self (i.e. since the soul/mind/brain is). In opposition to these claims, it is argued that the body is properly viewed as a subject; that there are neither purely mental, nor purely physical disabilities; and that selves are constituted, at least in part, by their bodies.

Medicine, symbolization and the "real" body--Lacan's understanding of medical science

Throughout the 20th century, philosophers have criticized the scientific understanding of the human body. Instead of presenting the body as a meaningful unity or Gestalt, it is regarded as a complex mechanism and described in quasi-mechanistic terms. In a phenomenological approach, a more intimate experience of the body is presented. This approach, however, is questioned by Jacques Lacan. According to Lacan, three basic possibilities of experiencing the body are to be distinguished: the symbolical (or scientific) body, the imaginary (or ideal) body and the real body. Whereas the symbolical body is increasingly objectified (and even digitalized) by medical science, the phenomenological perception amounts to an idealization of the body. The real body cannot be perceived immediately. Rather, it emerges in the folds and margins of our efforts to symbolize or idealize the body, which are bound to remain incomplete and fragile. In the first part of the article (section 1-section 3), Lacan's conceptual distinction between the symbolical, the imaginary and the real body will be explained. In the second part (section 4-section 5), this distinction will be further clarified by relying on crucial chapters in the history of anatomy (notably Mundinus, Vesalius, Da Vinci and Descartes).

On the Szaszian argument

The Szaszian argument claims that psychiatry is a rhetorical enterprise aimed at providing justification for involuntary treatment. Such treatment, the argument holds, is just when provided to those suffering from demonstrable brain lesions, but it is unjust in cases of "mental illness" because such "illnesses" lack objective histopathology and are therefore fictional. It is here argued that this distinction is irrelevant to the morality or immorality of involuntary treatment, since such treatment inevitably rests on a subjective determination of competency or dangerousness, which is not rendered substantially more objective by the criterion of histopathology. The Szaszian argument subscribes to a naturalistic fallacy in this regard, which leads it to inconsistencies in its philosophy of mind.

Organic unity theory: an integrative mind-body theory for psychiatry

The potential of psychiatry as an integrative science has been impeded by an internal schism that derives from the duality of mental and physical. Organic unity theory is proposed as a conceptual framework that brings together the terms of the mind-body duality in one coherent perspective. Organic unity theory is braided of three strands: identity, which describes the relationship between mentally described events and corresponding physically described events; continuity, which describes the linguistic-conceptual system that contains both mental and physical terms; and dialectic, which describes the relationship between the empirical way of knowing that is associated with the physical domain of the linguistic-conceptual system and the hermeneutic way of knowing that is associated with the mental domain. Each strand represents an integrative formulation that resolves an aspect of mental-physical dualism into an underlying unity. After the theory is presented, its implications for psychiatry are briefly considered.

Mind-body therapies for primary care physicians

Evidence is accumulating that mental and emotional processes can affect disease states. Mind-body therapies are effective adjuncts to conventional medical treatments, and they are easy to teach and learn. This article offers a review of relevant literature and introduces several mind-body techniques.

Beyond the body: an emerging medical paradigm

As with so many other aspects of American society, the baby boom may be the catalytic factor that ultimately changes the way we treat our health.

A biopsychosocial model of metaphor therapy with holistic cultures

For centuries western cultures have adopted a dualistic perspective toward people's health. The "self" has emerged as an independent entity from others as well from the body. Human distress has been psychologized and depression and anxiety have been attributed to intrapsychic structures and processes. Nevertheless, many nonwestern cultures still adopt holistic perspectives. Within these cultures, distress is manifested through physical rather than psychological complains. Therefore, psychological approaches, based on the independence of the self, may not be fitting for these societies. Instead, based on the assumption that nonwestern cultures are holistic and less psychologized and their problems are social rather than intrapsychic, a biopsychosocial approach is suggested. In addition, nonwesterners have a different concept of reality. For instance, within some communities fantasies and delusions are appreciated, constitute part of a normal life, and are considered to be the "real reality." Furthermore, complains are often described in metaphoric language. Accordingly, a biopsychosocial model of metaphoric therapy is proposed in which therapists would incorporate their clients' metaphoric imaginative culture. Metaphoric intervention also allow for changes in the biological, psychological, and sociocultural reality of the client.

Nurse complementary therapists. A return to healing

As chronically ill patients take more responsibility for their own health and well-being, they are requesting information about complementary and alternative treatment options. Through training in complementary care techniques, nurses can better serve such clients.

[In the gray area between body, psyche and social difficulties. II: Psychiatric assessment of somatoform disorders (exemplified by chronic pain patients]

Medico-legal assessment for long-term disability benefits in patients with mainly somatoform pain disorders is in increasing demand. Since impairment does not explain the loss of function in somatoform disorders, the expert must determine to what extent the patient is able to cope more actively with pain in order to attain a higher level of functioning. Consistency of behavioral signs, flexibility and initiative in the way of coping are helpful criteria in this respect. Special attention is given to problems in the assessment of migrants with these disorders. We strongly support the concept of an interdisciplinary approach in medico-legal assessment. Postgraduate medical training in this field should receive greater attention accordingly.

[In the grey area body body, psyche and social difficulties. I: New developments in diagnosis and therapy of somatoform disorders (exemplified by chronic pain patients)]

The so-called psychosomatic or functional conditions (notably somatoform pain disorders) often cause difficulties in diagnostic classification, clinical management and assessment of disability. Recent trends in diagnosis are reviewed. We describe our first clinical experience of interdisciplinary evaluation of pain patients by functional capacity evaluation and an ergonomically oriented rehabilitation program. This interdisciplinary approach could constitute a new field of close collaboration between physiatry/physical medicine, physiotherapy and psychiatry.

Impact of a Body-Mind Treatment Component on Alcoholic Inpatients

1. A group of alcoholic patients who were treated with a physical fitness program as an adjunct to the usual program showed significantly less craving for alcohol than members in the standard treatment group. 2. The group treated with physical fitness as well as therapy saw themselves as having more internal locus of control and being less controlled by powerful others. 3. Nurses are the hospital professionals most likely to be involved with important roles in exercise programs with alcoholic patients.

A therapy to live by: public health, the self and nationalism in the practice of a north Indian yoga society

In this article I focus on the relationship between concepts of self and health in modern North India. Drawing on field research in a popular yoga society, I argue that yoga therapy, as practiced by the Bharatiya Yog Sansthan of Delhi, provides a reconceptualization of what can be meant by public health. Using studies that challenge both the essentialist and epistemological facticity of the self, I show how the discourse and practice of yoga is implicated in, and derived from, a complex search for self definition in terms of health; health which is conceived of as a public regimen that seeks to reconnect that which modernity has broken apart: mind and body.

Freud and consciousness: the first one hundred years of neuropsychodynamics in theory and clinical practice

Psychoanalysis emerged out of Freud's neuropsychologic studies of consciousness and cognition. This article describes the historical development of neuropsychodynamic theories of consciousness and personality, and traces their application to several neuropsychiatric syndromes of intense contemporary clinical interest. Even in this era of narrow syndromic differentiation and classification, an appeal is made for a more integrated approach to the evaluation and treatment of neurobehavioral syndromes.

The mind/body connection: improving health through nontraditional approaches. Interview by Mary Jane Gore

Sound, touch and other stimulants to the senses can trigger a visceral response that aids-or impedes-the healing process. At mind/body centers like the one at Mid-Columbia Medical Center, patients work with nontraditional forms of therapy that help them deal with their physical and mental health problems.

Emergent models of supple dynamics in life and mind

The dynamical patterns in mental phenomena have a characteristic suppleness--a looseness or softness that persistently resists precise formulation--which apparently underlies the frame problem of artificial intelligence. This suppleness also undermines contemporary philosophical functionalist attempts to define mental capacities. Living systems display an analogous from of supple dynamics. However, the supple dynamics of living systems have been captured in recent artificial life models, due to the emergent architecture of those models. This suggests that analogous emergent models might be able to explain supple dynamics of mental phenomena. These emergent models of the supple mind, if successful, would refashion the nature of contemporary functionalism in the philosophy of mind.