It happened during the second-to-last slide of my first Biobehavioral Health class of the semester. I was engaged in a lecture about the biomedical model* and the subsequent healthcare advances that resulted from its development in the 20th century (as opposed to the ancient/medieval notion of disease being caused by demons or an imbalance of the bodily humors), and we were now looking at the shortcomings of the model. Then, the word jumped out at me like the heading of a controversial Wikipedia page: reductionism. One of the problems with the biomedical model, I learned that day, is that it relies on reductionism. In other words, it attempts to find a single, primary, causative factor for disease, and for that to happen all it takes is more understanding and more research. I thought it interesting that something as reliable as the model that guides our approach to health and disease would be criticized for not being sufficiently considerate of complexity. In the margins I scribbled: ”grey area in health vs. in life”. At that moment I thought of PLA and our love of the grey! I made a mental note to structure my first blog post on the topic.
So this past Thursday while Dean Brady was prompting a multifaceted discussion of the Ice Bucket challenge, I was rapt yet silent, in awe of how each person’s perspectives and contributions generated even more perspectives and contributions. How do we decide which charities and organizations deserve our money? Should there be criteria? If so, would we be implying that some causes are more worthy/important than others? The hour went by quickly, and although there might have been an increase in understanding on the matter of health-related organizations and the effectiveness of donation campaigns, there was no final resolution that reduced the dilemma into a simpler form and neatly identified a solution. Such a breakthrough would have made the conversation redundant (yet also really boring actually). That Thursday was about the intricacies, the non-obvious statements, the ideas that affirmed, challenged and provoked our thoughts all at once. To my mind it was a celebration of the grey area, that indissoluble swath of factors that stretches out between two opposing assertions.
Should we take the same approach to health? Much of the literature on Reductionism in the health fields seems bent on embracing it (read this as an example) and critical of the urge to hastily find a single cause for a certain ailment. Perhaps nowadays, when the threat of smallpox and cholera aren’t weighing over us and germ theory has made sure we wash our hands, it is easier to realize the impact that the more intangible aspects of our lives (i.e. family, work, social life etc) have on health and well-being. Thus, professionals have now devised the Biopsychosocial model which recognizes psychological and sociological forces that affect us. I am attracted to this notion, especially as a Psych major interested in the complexities of mental illness as well as an English major who enjoys novels specifically because they start discussions that are not black and white. Personally however, I find it difficult to believe that a productive appreciation for the grey areas will establish itself within most health and science professions. After all, it is more rewarding to claim to have found a possible cure for cancer or the possible cause of schizophrenia than it is to admit that such a cure or such a cause are impacted by personal and environmental factors that we cannot yet measure or explain. Perhaps in other areas of life and in PLA classes, we can indulge in lack of conclusive results. For the health professions upon whom human lives depend however, that opportunity might not be so available.
* the biomedical model suggests that disease always has a biomedical cause
External references:
http://qjmed.oxfordjournals.org/content/103/9/721.full
http://www.relevantmagazine.com/god/deeper-walk/features/23137-the-problem-with-black-and-white-thinking
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