The Body and Being Human   /   Summer 2001   /    Articles

Human Frailty and the Burden of Medicine

A Medical Response

Margaret E. Mohrmann

Detail from watercolor for Thomas Eakins's “The Gross Clinic” (1875).

During the initial presentation of his paper, Professor Turner mentioned parenthetically that he did not wish to be taken for a Luddite, although he acknowledged the difficulty of avoiding that label for one who wishes to voice an effective criticism, or a prophetic caution, about technology. In response, I would like to offer the possibility of further distancing the argument from the Luddite charge by considering more thoroughly the social situation of medicine, the technological institution to which Professor Turner gives most of his attention.

I do not, in general, disagree with his concerns, nor am I particularly roused to defend medical science against his casting it as one of the villains in his grim picture of contemporary society. Instead, I want to elaborate and, perhaps, complicate the arguments somewhat, using Professor Turner’s helpful and revealing model of ontological frailty, social precariousness, and compensatory interdependence. My intent is to elucidate ways in which the complex and often troubling process of medicalization demonstrates just how deeply medicine is embedded within society and affected by experiences of frailty and precariousness, experiences that it also engenders and encourages. That is, I suggest that it is important to understand medicalization and the increasing encroachment of medical technology as a reciprocal or mutual process—as a two-way street.

To begin, it will be helpful to reflect on the characterization of medicine as Cartesian, a widely accepted description that colors Professor Turner’s paper throughout. I do not dispute the claim—it is too obviously true to be arguable—but wish to draw it out a bit. When we label a practice or mode of thought as “Cartesian,” we usually intend at least two related points simultaneously. One is that there is a mind-body split of some sort in play; the other is that, in the context of that split, mind is being chosen, given precedence over body. Descartes famously did not say, “in corpore, ergo sum” [I am embodied; therefore, I am]. However, when we apply the label “Cartesian” to medicine, we should note that this second point, the preferred identification with mind, applies only to one side of the medical equation. That is, when medicine speaks of itself and its practitioners, it understands existence to be coterminous with mind: Medicine thinks; therefore, it is. Doctors are notoriously disembodied persons. But patients, who are also certainly split apart by medicine’s Cartesian wedge, exist for medicine as bodies. The good thing to say about this, as Paul Ramsey frequently reminds us in The Patient as Person, that ur-book of biomedical ethics, is that medicine has much to teach the world of abstractly cogitating scholars about the moral necessity of attending to actual human bodies.1 Although it may be something of a generalization to say simply that medicine allots mind to the doctors and body to the patients, that way of stating it gives a fuller and, I believe, more accurate sense to the use of “Cartesian” when speaking of medicine.

This view of Cartesian medicine relates directly to Professor Turner’s thesis and its implications. He has said that the body “is constitutive of our being-in-the-world, but in contemporary societies the dominance of biotechnology has brought about an erosion of a sense of common ontology.” One can also argue the reverse: Biotechnology heightens “body consciousness,” the awareness of our shared ontology and vulnerable embodiment. To make this point, we must go further into the phenomenon of medicalization than Professor Turner has taken us. For I would argue that medicalization occurs, or is triggered, when a situation of social precariousness is perceived as ontological, embodied frailty—that is, when it is read as physical disorder or affliction—and then is presented as such to medicine. Medicine’s Cartesian thinking leads it to agree with that interpretation, to identify the problems patients bring as body problems, matters of individual human physical frailty, rather than to look beyond the embodied person for the possible social circumstance that has given rise to the metaphorical, corporal concern. Over against Professor Turner’s repeated complaint about the dearth of bodily metaphors, medicine is one arena in which corporal metaphors are alive and thriving, whether they are routinely recognized as metaphors or not.

Medicine also encourages us to read our social instability as individual, physical vulnerability. It does so because that is what it works with, what it knows, and because it has what appears to be a wonderful history of success in relieving signs of frailty. We can perhaps agree that, for the most part, that record of success can more truthfully be attributed to political and economic developments and to public health ventures than to what happens in doctors’ offices or even in medical scientists’ laboratories. But the point is that “medicine” is widely perceived to be capable of assuaging the pains of human existence. Therefore, people are rewarded for reading their social shakiness as physical infirmity by having a reputable place to take it for repair.

To read the full article online, please login to your account or subscribe to our digital edition ($25 yearly). Prefer print? Order back issues or subscribe to our print edition ($30 yearly).