Holism against Reductionism

In its relationship with society, contemporary medicine is beset by a deep tension. It is an old tension and familiar to all those who work in and study medicine. It has long been observed, for example, that the instrumental stance of scientific medicine can entail a loss of consideration for the person of the patient.1 The idealtype of the biomedical physician is a kind of applied scientist, guided by objective diagnostic criteria and deploying an armament of specific technical interventions against nature’s “real” diseases. Taking this role involves a depersonalization, a setting aside of the emotional and moral aspects of distress, and a technological focus that has in the past and continues in the present to generate considerable patient dissatisfaction and alienation.2 Perhaps one small measure of popular unease can be seen in the plethora of recent American apocalyptic films and TV shows— The XFiles, Falling Skies, The Walking Dead— wherein hospitals are without exception portrayed as menacing and inhospitable.3 To address this tension, clinicians, bioethicists, and other scholars have proposed over the years any number of strategies to “humanize” biomedicine, and fields such as nursing and bioethics define themselves, somewhat oppositionally, as patientcentered and oriented toward care. Similarly, observers have long argued that the mainstream conceptual model of disease, the “biomedical model,” for all its technical successes, tends to marginalize or exclude the crucial social and environmental determinants of illness. The model reduces the causes of disease and disorder to specific somatic malfunctions in the individual that respond to specific technological interventions and individuallevel preventive measures. Against this narrowly individualistic and highly biological