Physiotherapy, and biomedicine generally, owes a lot to René Descartes (for a refresher on an earlier post on the critical issue of Cartesian Dualism in PT, go here). But Descartes’ influence extends much further than just the body-as-machine, and has fundamentally shaped medicine and physiotherapy practice ethics for more than 100 years.
400 years ago, Descartes set out to discover what could be known beyond doubt. His method was to doubt everything, from the existence of physical objects around him, to dreams and ideas. What was left, he surmised, would be the basis upon which all knowledge could be built. The first thing Descartes believed he could trust was that he himself was thinking – hence ‘cogito ergo sum’; I think therefore I exist.
But Descartes also went on to surmise that if knowledge began with the self, then all understanding of the world must originate in the person’s own mind, and that we were each fundamentally detached from others in coming to know the outside world. Knowledge was formed in the private theatre of our minds; in the vacuum of our own consciousness. Descartes’ idea gave birth to the idea of the ‘outside world’, and popularised the belief that the individual subject, or citizen as they later became, might be considered to have rights and responsibilities, autonomy and self-determination. He was partly responsible for early ideas of government and the vox populi, and modern medical science built on this idea, concentrating on the individual body of the patient as an isolated, atomistic entity.
Criticism of this approach came some years after, most notably from Georg Hegel (1770-1831), who argued that Descartes had been completely wrong. Thinking and knowledge of the world didn’t happen in the minds of people isolated from one-another, but in relation to others. Descartes, he said, couldn’t have thought up his idea of cogito ergo sum without the help of language or an education system, and both of these were simple examples of how he had come to know the world through human relations. So, Hegel argued, there was no such thing as a self-conscious isolated individual.
Hegel claimed instead that we can only make sense of the world in relation to others, and that to see myself as part of the world I must see myself reflected inthe world and, especially, in other people. But this idea led Hegel to an interesting problem called the Master-Slave Dialectic that is particularly relevant to health care practice.
Hegel said that when we try to gain a better understanding of the world, we look to the ‘other’ for recognition. But they will always appear foreign to us because we realise that they aren’t us. Because they are foreign to us, we never receive the quality of recognition we crave; we see ourselves as dominant to them and create the master-slave dialectic (or binary state). At the same time, the other (here the ‘slave’), seeks recognition from the master, but knows that consider them inferior, so know the master’s recognition will always be slightly indifferent.
Given this, Hegel resolved that we can only develop a fully rounded sense of ourselves and the world we inhabit if we fully embrace and acknowledge the other’s distinctiveness and difference. There can be no inferior/superior relationship, because this will always lead to an incomplete sense of self.
Now, replace the language of master and slave, with therapist and patient, surgeon and healthcare assistant, or registration authority and practitioner. In each case, a master-slave dialectic exists and presents a challenge to how we make sense of the world, and Hegel teaches us that only by entering into a relation of equals can we fully know ourselves.
Whereas Descartes’ ideas continue to have influence in healthcare (particularly in those areas that privilege the body-as-machine, the biological sciences, quantitative measurement, objectivity, detachment and value-neutrality), Hegel’s ideas have come to the fore in recent decades, most notably the social sciences, critical theory, feminism, disability activism, qualitative research, the humanities, politics, ethics and questions of power.
Perhaps most importantly, we should remember that the roots of these approaches lie in very different philosophies, which is one reason why we should be very cautious of any model or theory that claims it can just simply link the bio, psycho, and social together. If the model is underpinned by Hegelian ideas, it will have a very different idea of what it means to be a person, than if it harks back to Descartes.