I started my first job (ever) as a medical scribe last month. Two days ago, I finished training and am awaiting my very own "solo" scribe shift, where I go rounds with a doctor in the ER and write his chart for him. These shifts were 8 hours long from 2 pm- 11 pm, 2-3 times a week. My experience there was very novel and fascinating. This was a world that I had always thought about living in theoretically. It was quite a different experience seeing it with my own eyes. And so the shifts were immersive for me, despite it appearing run of the mill for everyone else. I brought along some baggage with me for my mind during idle times. These were the questions that I've thought about regarding the Philosophy of medicine. I thought that the ER was the event for wrestling with the problems of the philosophy of medicine the most. To see things firsthand in real life gave a unique perspective.
Among the various thoughts that arose in me as I shuffled through from room to room with a clipboard in my hand, the problem I dwelt on the most was my encounter with the psych patients, if we were to give them enough decency to call them that. And it's particularly problematic because it appears that the medical field hasn't gotten over Descartes. I dwelt and I dwelt on this. I thought to myself, maybe I'm not even over Descartes, as I used to be his most ardent supporter in high-school. The past cringy twitter bio "Cogito ergo sum", still paralyzes me when it comes up to this day. I've since become an anti-Cartesian and then realized most of modern philosophy indeed has become so as well. And yet there's this Cartesian foundation inherent in the medical field. The fact that people who come with issues of the brain are divided into Psychiatry and Neurology patients, the classic Cartesian dualism applied in real time.
But enough with this fanaticism with Descartes. The problem of psychiatry, philosophically, isn't just about this apparent parallel. Medical decision making is a unique skill that takes into account ontology, epistemology and ethics all without realizing it. Many say that Medicine is the most "human science" as it deals with humans face to face. However, it's clear that medicine is neither a science nor a humanity. Medicine is a discipline in itself, one that appears practical but really is a lifestyle of investigation into the core of what it means to be a human. Perhaps I can't speak of psychiatry, but the way that the emergency department handles psych patients, in general, is quite problematic. If every staff member in a hospital acts itself out authentically, the most paradoxical contradiction of inauthenticity is in forced restraint of psych patients who are deemed to pose "a danger to themselves or to others". There's something about that that doesn't appear right, and the mood shifts immediately from calm to anxious. Clearly, it isn't an empathy of the rather anxious patients that poisons our mood. Rather it is in the mere act of carrying it out that we feel uneasy, the most unlike ourselves. And that kind of uneasiness forces us to inauthentically follow protocol, to submit to "the one". In feeling that mood in an altercation that occurred in the hospital, I began to ponder what kind of problems arise from them.
The medicalization of psychology has a history of ethics. Those that we have deemed "twisted" and "abnormal" not from physiology, we have cast and labeled psychotic. Governments all over have decided to "treat" these people through medicalization. It has now become quite standard for people to have "psychiatrists" for a multitude of problems. All from depression to schizophrenia. Government mandate leaves the healthcare sector as the executors of its will. This kind of angle is very unique. For the government's decision to medicalize is unlikely to have come from doctors advocating for Freud. Really, the agenda, wherever it came from or wants to go, has dictated the scope of how medicine treats these people.
This can yield to a litany of skepticism for those interested in seriously considering the metaphysics and epistemology of mental disorder from both sides. Questions flung around varying the "how can we know?" dogma will likely confuse the two fields that have received mental disorder as a problem to be treated. Ontologically we may ask, what is mental disorder? Epistemologically we may ask, how can we know if what we're looking at is mental disorder? Trying to answer a question with an epistmeological foundation will likely yield very unfruitful results vice versa.
Considering the question ontologically while trying to fit it in the medical discipline is to try to fuse the horizon of illness with this new notion of mental illness. It has been categorized in a paper that we can see illness as an "unhomelike being-in-the-world" (Svenaeus, 2014), which when considered can be quite revealing. However, trying to fuse that with metnal illness is quite problematic. If we switch over to epistemology, we would come across the problem of other minds and trying to get at the "other's" perspective. How can we know if a person we suspect as having mental illness is feeling an "unhomelike being-in-the-world"? Psychiatrists and psychologists alike can delve into this problem of quantification and diagnosis to try to bring out evidence for such a thing. But can we agree with this sentiment for those patients that aren't aware of their condition?
Things may be clear with cases like depression but fusing illness with other mental illnesses are going to take more legwork. It is the task of the physician to take the patient qua patient, and try to reveal what is wrong with the patient that causes this "unhomelike" feeling. The question of mental disorder as an illness brings back to the fundamental question about what illness is. Are risk factors of breast cancer really worthy of a diagnosis for a patient to be treated? This crosses boundaries as well from metaphysics to epistemology.
Clinical medicine may not think about this at the moment, but all these problems are dealt with when medicine is being practiced. It is the event itself. I find the problem of the medicalization of psychology very revealing to me because it exposes this unexplored horizon of medicine. Many of the problems have not been worked out, and the philosophy of medicine is a relatively young field. Even more so, my aspiration to be a doctor is unlikely to benefit from armchair theorizing about how medicine should be run. But I still think it's what makes the field of medicine so rich and laden with philosophical problems worthy of investigation. Medicine has a history that as a collective reveal not only the result of political compromises or Cartesian commitments. Rather, medicine engages with the questions of philosophy from the angle of a tradition that itself has its own philosophical problems. And this particular truth, this disclosure of being, that's left behind as it's revealed and at the same time perpetuates and adapts is why the task of thinking is itself to reveal being. It's not only philosophy of medicine, but rather a philosophy as a way of life.
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