The dimensions of illness : a philosophical appraisal of clinical medicine

This study is a philosophical appraisal of clinical medicine and the dimensions of illness which constitute the concern of clinical medicine. It was my intent to illustrate the practical and theoretical orientation of traditional medicine in so far as it bears on the unde standing and treatment of contemporary health problems.

A broad philosophical analysis of medical science, medical practice and the concepts of health and disease was introduced by considerations of the place of psychiatry in medicine. Critics of psychiatry have argued that mental illnesses are problems in living rather than diseases and therefore not properly medical problems. My broader analysis of medicine suggests that the antipsychiatric movement is in error because it is problems in living that are the proper concern of medical practice. I argue that diseases are scientific abstractions used to explain these problems and that attention to them rather than to the multiple dimensions of illness results in a clinical medicine which is impracticable and poorly suited to meeting contemporary health care needs.

After criticizing what I take to be an outdated medical theory and practice, I offer the rudiments of an alternative theoretical approach which I think is better suited to the understanding and treatment of contemporary ii Ill health problems. This alternative theoretical approach is founded in systems theory. In medical science the application of systems theory is a way of organizing and accounting for the contribution, to the initiation or expression of illness, of numerous levels of an organism's structure or functioning. From the standpoint of clinical medicine, systems thought serves to reorganize clinical data and health-care services in such a way that treatment is comprehensive and appropriate to the particular patient.

My conclusion suggests some of the ethical and social consequences of this alternative theoretical approach to health and illness. In particular, I give consideration to the practical and moral responsibility of the patient for his or her own health and care.