Philosophical Problems in Medicine and Psychiatry

best conceptual frameworks and most practical clinical approaches in integrative medicine reflects important unresolved philosophical problems about the nature of health and illness. It is only through the analysis of philosophical problems related to observation, evidence, and causality in medicine that development of a rigorous methodology for clinical integrative medicine will evolve. This 4-part paper begins with a brief review of Western medicine’s philosophical origins, which I further develop in part II to examine the beginnings of non-Western systems of medicine. I explore the significance of the resulting “philosophical gap,” arguing that “ways of seeing” illness and health phenomena are embedded in various systems of medicine that are based on incongruent core metaphysical assumptions. These differences occur because all systems of medicine continuously evolve in the broader context of social, technological, and economic influences. In the third and fourth parts of this paper, I discuss divergent meanings of evidence in disparate systems of medicine and review unresolved philosophical problems in psychiatric classification and diagnosis. Important ontological questions pertaining to medical philosophy are discussed, exploring the point that, for many established conventional or non-conventional approaches, a determination of the existence of a postulated mechanism of action cannot be made in the framework of orthodox Western science on the basis of information obtained using established methodologies and contemporary technologies. I argue that while claims of mechanism can be verified for relatively few conventional and non-conventional medical approaches, claims of effectiveness with respect to a specified symptom or illness can be verified only for a particular approach employed in a specified system of medicine. I conclude that most contemporary biomedical and non-conventional approaches are maintained through expert consensus, but are not currently empirically verifiable according to rigorous scientific standards of evidence. Thus, in many cases selecting an appropriate clinical method when addressing a specified illness requires judgments other than the empirical verification of a putative mechanism of action.