Epistemology in How Doctors Think   1 comment

Montgomery introduces the epistemological questions relevant to medical professional practice by appealing to the enormous complexity of causal relations at work in the human body. The familiar, positivist epistemology on which simple sciences are based must be reconsidered in light of the almost perverse multiplicity and interrelated complexity of things relating to human bodies. She writes that

biology is multileveled and more contingent than the physical sciences. . . . Seen in a systems-theory progression from microbe to cultural context, biomedical science is even more complex than the rest of biology, even less capable of certainty, because illness exists on so many levels. Medical events and conditions can be described as cellular, organic, organismic, personal, familial, and cultural, and their causes can be too. What’s more, cause runs both ways on the scale from cell to society since illness behavior is also social behavior, and microbial activity often depends upon it. (71)

I encountered this depiction of the complexity of the human life world in readings for Sean Gallagher’s “Philosophies of Embodiment” course that I took this spring. In this context, the argument is that it is incredibly difficult to mark the boundary between the human body and the rest of the world, favoring instead a perspective like the one here in which “cause runs both ways on the scale from cell to society.” A recurring theme, then, is the tension between the faith that science can answer all questions, given time and technological advances, and the evidence that human bodies, and minds, in particular, are so deeply embedded in their environment that traditional, positivist scientific accounts that may be satisfactory for Newtonian physics are totally inadequate. Montgomery reiterates this point again and again throughout her text. The underlying epistemological complexity of the human body feeds deeply rooted tensions in clinical practice, such as the tension between parsimonious, single cause explanations of symptoms and the reality that “the quest for an elegant single solution is contradicted by the very real possibility, especially among the elderly and the poor, that one patient really does have two new diseases” (114). Another manifestation is the invocation of maxims and anecdotes in clinical training. Montgomery is quick to point out that for many of the social sciences “an appreciation of interpretive rationality has replaced earlier aspirations to become an exact science” (41). She invokes Richard Rorty’s notion of “abnormal discourse” and Bruno Latour’s concept of hybrids to describe this revised nature of medical thinking. The answer to how doctors think includes terms like “narrative rationality,” “wholisticness,” and “clinical intuition,” pointing to the need to more thoroughly probe the epistemological prejudices affecting current practice and education, to look towards “real benefits if clinical education included some attention to medicine’s epistemological predicament, its phronesiology, and the use of competing maxims as interpretive strategies for coping with uncertain knowledge” (136) rather than leaving medicine’s epistemology naiveté alone.


Posted August 31, 2010 by jbork in Uncategorized

One response to “Epistemology in How Doctors Think

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  1. These arguments from Montgomery and Gallagher also connect to those by Katherine Hayles about the radical specificity and contextuality of embodiment and why this makes it impossible (or at least unlikely) that computers can ever be human or, in the context of medical practice, adequately make diagoses.

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