The understanding of health and illness has evolved and changed throughout historical and societal development processes, reaching the present day. For thousands of years, humans perceived illnesses as "divine punishment" and sought solutions to health problems through offerings, sacrifices, magic, and prayers. During periods when the influence of religion/metaphysics on societal life relatively weakened and rationality began to strengthen, science became dominant in medicine, and health issues began to be associated with earthly causes.
By the nineteenth century, the monumental advancements in science and technology completely transformed traditional medicine and the understanding of health. The discovery of the microscope made infectious agents visible, and new models explaining health problems began to be developed (von Engelhardt, 1999: 1 – 7).
MECHANISTIC CONCEPT OF HEALTH
The mechanical (or biomechanical) approach to health defines health simply as the absence of illness. The source of this understanding generally stems from the positivist ideology and the mechanistic causality approach that dominated the scientific world after the Middle Ages (Campbell, 1999: 1274; Kneebone, 2002: 516; Bunniss, 2010: 359).
The mechanical concept of health, established by René Descartes (1596–1650), suggests that humans are designed by God to function like a perfect clock. According to this view, humans consist of body (res extensa) and mind (res cogitans). The general laws of mechanics are applicable to the human body as well.
Descartes laid the foundations of the mechanical concept of health. He divided the world into two distinct substances: matter (that does not think but occupies space) and mind (that does not occupy space but thinks). Thus, Descartes conceived the world in a completely mechanistic manner.
Descartes viewed nature as a machine. Everything that happens in nature occurs as a result of an external influence. This applies to both inanimate nature and living beings. While animals and plants are considered machines, humans have a different position. Although humans are also machines, unlike other living beings (plants and animals) that lack souls, humans exhibit voluntary movements directly influenced by the soul alongside involuntary movements that can be mechanically explained (such as respiration, circulation, etc.) (Gökberk, 1990: 261 – 272).
With positivism, the patient became the 'object of medicine', and the patient's story was reduced to the 'story of the illness'. Anatomy and physiology became interconnected, and cells replaced tissues as the focus of attention. Experimentation, statistics, and causal thinking became the basis of medical research. Diagnosis and treatment were based on Cartesian (mechanical) structure and function (von Engelhardt, 1999: 5).
According to positivism, science must start from individual cases to reach generalizations, and health problems must be treated like natural events dependent on natural laws. Causality can be established and explained based on observable facts. Positivism is most evident in medicine when the human body is divided into parts (specialization based on tissue/organ/system).
According to the mechanical model, illnesses are caused by one or more observable factors. Health issues are approached by looking at the micro-level, while societal determinants of health are excluded from etiopathogenesis (Navarro, 1986: 69).
For example, the mechanical approach defines tuberculosis as a disease that emerges following exposure of the human body to the tuberculosis bacillus. Exposure leads to pathological changes in the body, observable in chest X-rays. The bacillus can be identified through blood or sputum culture. The disease presents symptoms such as coughing, hemoptysis, weight loss, and fever. The cause of the disease is the bacillus, and its treatment involves eliminating the bacillus from the body using medications (Bury, 2005: 4).
The mechanical model encourages individuals and society to view health as an individual problem. Events outside the individual's body (working conditions, environment, etc.) remain beyond the scope of the physician's professional interest. In the physician-patient relationship, the authority in the health domain is given to the physician's specialization and skill used primarily for diagnosis, leaving the patient with a passive role. Moreover, the individual, who is passive in their relationship with the physician, is left to deal with their health independently when it comes to preserving their health or regaining it, as the problem is their individual issue (Zerda, 2002).
In summary, the mechanical-individual approach to health:
Focuses on the individual rather than the societal and environmental context in which the individual exists.
Divides humans into body and mind, then dissects the body into parts (cells, subcellular levels).
Places emphasis on the biological cause of illness, giving less importance to other factors (environmental, psychosocial, etc.).
With this understanding, the role assigned to physicians and medical education is to identify the biological cause of the illness and combat it, ultimately restoring the individual's health.
Akif Akalın
Citation: Akalın, A. (2015). Sağlığa ve Hastalığa Toplumcu Yaklaşım. İstanbul: Yazılama. Pp. 103 - 106. ISBN: 978-605-9988-35-3
REFERENCES
Bunniss, S., Kelly, D.R. (2010). Research Paradigms in Medical Education Research. Medical Education. 44(4): 358 – 366.
Bury, M. (2005). Health and Illness. Cambridge: Polity Press.
Campbell, J.K. ve Johnson, C. (1999). Trend Spotting: Fashions in Medical Education. British Medical Journal. 318(7193): 1272 – 1275.
von Engelhardt, D. (1999). Teaching History of Medicine in the Perspective of “Medical Humanities”. Croatian Medical Journal. 40 (1): 1 – 7.
Gökberk M. (1990). Felsefe Tarihi. 6. Basım. İstanbul: Remzi Kitabevi.
Guilbert, J.J. (2012). Sağlık Çalışanları İçin Eğitim Kitabı. Altıncı Baskı. İstanbul: Nobel.
Kneebone, R. (2002). Total Internal Reflection: an Essay on Paradigms. Medical Education. 36(6): 514 – 518.
Navarro, V. (1986). What Is Socialist Medicine? Monthly Review, 38(3): 61 - 70.
Zerda, A., Velásquez, G., Tobar, F., Vargas, J.E. (2002). Health Insurance Systems and Access to Medicines. Case Studies from: Argentina, Chile, Colombia, Costa Rica, Guatemala and the United States of America Washington, D.C. PAHO. http://apps.who.int/medicinedocs/en/d/Jh3012e/. (Erişim: 12 Temmuz 2013).
Original article can be reached at https://toplumcutip.blogspot.com/2015/01/makinenin-bozulmas-olarak-hastalk.html
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