Mind-Body Dualism and the Biopsychosocial Model of Pain: What Did Descartes Really Say?

Abstract

In the last two decades there have been many critics of western biomedicine's poor integration of social and psychological factors in questions of human health. Such critiques frequently begin with a rejection of Descartes' mind-body dualism, viewing this as the decisive philosophical moment, radically separating the two realms in both theory and practice. It is argued here, however, that many such readings of Descartes have been selective and misleading. Contrary to the assumptions of many recent authors, Descartes' dualism does attempt to explain the union of psyche and soma - with more depth than is often appreciated. Pain plays a key role in Cartesian as well as contemporary thinking about the problem of dualism. Theories of the psychological origins of pain symptoms persisted throughout the history of modern medicine and were not necessarily discouraged by Cartesian mental philosophy. Moreover, the recently developed biopsychosocial model of pain may have more in common with Cartesian dualism than it purports to have. This article presents a rereading of Descartes' mental philosophy and his views on pain. The intention is not to defend his theories, but to re-evaluate them and to ask in what respect contemporary theories represent any significant advance in philosophical terms.

Pain and dualism: Which dualism?

“…The basic version of the alleged Cartesian view of the mind‐body dualism is the idea of an individual being split into 2 different entities, a transcendent, non‐material mind and a material body with mechanical functions. The legacy of this notion of the human being in medicine has been extensively remarked upon and has been identified as the source of the main problematic issues in the medical approach to disease.…”

The essence of the experience of chronic pain – a phenomenological study

“…In fact, Descartes tried to explain the integration of psyche and soma in more depth, which can be summarized as following: pain is a bodily sensation which prevents more harm or damage and signifies an underlying pathology, and ethics require alleviating pain as much as possible (Duncan 2000). Despite advances, the traditional biomedical approach has its limitations, such as the following: (a) the intensity of pain is not proportional to the underlying damage, (b) recovery of the tissue damage does not necessarily abolish pain, and (c) the biomedical model does not account seriously for the influence of the psychological and social factors on the experience of pain (Keefe & France 1999).…”

The biological side of randomness. A starting point to rethink causation of diseases and prevention as a strategy

“…Before building the clinic of randomness, it might be useful to consider patients not only as cases of a statistics but like mind-body unities with a psychosocial individuality and all physicians are invited to do a serious reflection on Descartes (6). When considering the series of events leading to the neoplastic drift they are possibly non-linear or truly-random showing a kind of evolution which reflects the changes of the environmental pressure on the individuals and their adaptive responses, following a pattern that was defined, not surprisingly, deterministic chaos (7).…”