Starving to death and the anorexic frame of mind

Because some forms of self-starvation such as hunger striking are exempt from attributions of pathology, and due to incomplete understanding of its etiology, anorexia nervosa (AN) is and must presently be defined by psychological criteria as well as behavioral and bodily measures. Although opaque, typical motivational frames of mind in AN lack the apparent cognitive and volitional dysfunction usually indicating disorder. In contrast to other conditions that exhibit more evident dysfunction, this distinguishes AN from the perspective of medical epistemology: the opacity of AN motivation jeopardizing the epistemic warrant for assigning it to the category of a mental disorder (and so influencing decisions over diagnosis and recovery). This seems to invite non-medical approaches to its prevention and care.

Medicine

This chapter provides a look at the philosophically interesting aspects of Razi’s abundantly extant works on medicine, which were heavily influenced by Galen but also independent-minded and informed by Razi’s own medical practice. After surveying the range of his medical works and their various purposes, the chapter examines specific topics including his anthropology and anatomical theory and his medical epistemology, under which heading it is asked how far medicine is based on empirical evidence as opposed to theories taken over from natural philosophy. Finally, the chapter examines Razi’s authorial persona in his medical output. This is itself based on Galen’s self-presentation as an unusually skilled doctor who could correct the judgments of both contemporaries and ancient authorities.

Medical Epistemology

Deductive approaches in medical decision-making have an air of certainty borrowed from philosophical deduction, as for example, in the hypothetico-deductive approach. However, deduction, although certain, is limited because it cannot contribute to new knowledge other than proving some claims to knowledge as false (using modus tollens). Syllogistic deduction requires modification to gain utility, such as the partial and practical syllogisms. However, these forms are logically invalid in that they do not ensure certainty in the conclusions. The partial syllogism can be rendered more certain by the use of probability. However, the necessity of a medical decision requires dichotomization of the continuous probability variable. A cutoff threshold applied to the probability is necessary to enable a dichotomous decision, such as whether to treat or not treat a patient. The practical syllogism introduces the notion of cause and effect, which also may influence medical decisions, although often in a counterproductive manner.

Hellenistic medical epistemology

During the Hellenistic period (323–31 bc), there arose, largely in Alexandria, a profound debate in medical methodology. The main participants were the Empiricists, committed to an anti-theoretical, practical medicine based on observation and experience and the various Rationalists, such as Herophilus, Erasistratus, and Asclepiades, who held that general theories of physiology and pathology were both attainable and essential to proper medical understanding and practice. Dispute about the nature of scientific inference and the status of causal explanation mirrored and to some extent conditioned the contemporary debate between Stoics and sceptics about epistemology.

Afflicted

While many commentators have pointed to the lack of compassion and empathy in medicine, their critiques, for the most part, have not considered seriously the deeper philosophical, psychological, and ontological reasons why clinicians and medical students might choose to conceive of medicine as an endeavor concerned solely with the biological workings of the body. Thus, this book examines why it is that existential suffering tends to be overlooked in medical practice and education, as well as the ways in which contemporary medical epistemology and pedagogy not only perpetuate but are indeed shaped by the human tendency to flee from the reality of death and vulnerability. It also explores how students and doctors perceive medicine, including what it means to be a doctor and what responsibilities doctors have toward addressing existential suffering. Contending that the being of the physician is constituted by the other who calls out to her in his suffering, this book argues that the doctor is, in fact, called to attend to suffering that extends beyond the biological. It also discusses how future physicians might be “brought back to themselves” and oriented toward a deeper sense of care through a pedagogy that encourages intentional reflection and values the cultivation of the self, openness to vulnerability, and a fuller conception of what it means to be a healer.