The End of Modern Medicine

'We think of ourselves as conscious, free, mindful, rational agents in a world that science tells us consists entirely of mindless, meaningless particles'. This quotation from John Searle sets up the dilemma for modern biomedicine: given its presuppositions, an account based on exclusively bottom-up causation can be defined as scientific – but it is mindless - while an account that does justice to the findings of mind-body medicine cannot be scientific on these terms. This dilemma is the starting point of this seminal book, which argues the case for a new psychobiological paradigm that is both truly scientific and incorporates the conscious human dimension. How can one put the mind back into the 'machine' in a scientifically acceptable fashion?

The current biomedical model or medical ontology is based on mechanistic ideas dating back to the 17th century. This leads to a certain 'grammar of biological systems' in which we speak of mechanisms and speak of people as homeostatic automata or complicated machines. The focus is on cure of the diseased body rather than treatment of the patient. Naturally, physicians are always making personal escapes from the logic of the paradigm but it exerts a powerful mental hold: they like to think of themselves as scientists. Scientifically, the medical has been assimilated to the biological, in good reductionist fashion. The mind is defined as a causally ineffectual epiphenomenon.

Foss picks this model apart and shows how it rests on a series of metaphysical commitments that imply corresponding methodological directives. As Thomas Kuhn points out, the metaphysical component tells scientists what kind of entities there are in the universe, while the methodological aspect specifies the nature of laws and corresponding explanations. The modern natural science paradigm has two world properties – the notions of fundamental level and external permanency, which in turn imply biomedical world properties about the mechanism of disease and the physical nature of the patient.

Over against this deterministic view, Foss, like Paul Davies, places the self-organising science of complex systems – res autopoietica as he puts it, entailing holism, levels of organisation and upward-downward mutual causation. This view leads to a new formulation of world properties in terms of self-organisation and co-evolution, which translates into a corresponding picture of the nature of disease and of the patient. He calls this view 'infomedicine', a term originating in his previous book with Kenneth Rothenberg, The Second Medical Revolution. Mind becomes an evolutionary directive, while matter is reconceptualised as 'systems of energy and information transductions'. Psychobiology gives a role to symbols as stimuli of meaning, so that information actually modulates biological processes in living systems. David Bohm expressed a similar thought when he spoke of a signa-somatic process, striving to find a non-divisive vocabulary. The new paradigm enables the placebo effect to be logically incorporated and frees medicine from the straitjacket of determinism. Its active orientation points to a methodological emergentism and what Foss calls a 'relational biology'. Consciousness then becomes integral to the health and disease equation, and, mirabile dictu, subjectivity is admitted into science. Organisms can 'act upon themselves, using information to intervene in their own healing process…in some cases…consciously, voluntarily, intentionally – adverbs methodologically interdicted from modern scientific discourse'. The adoption of a self-organising systems view is a liberating move, but does it go far enough? Certainly it does as a first step, but phrases like 'conscious matter' make one wonder if it is not a more sophisticated form of materialism. Foss's analysis corresponds to what Larry Dossey calls 'Era 2' medicine but does not touch on his 'Era 3' – non-local medicine, which is a logical next step. Proponents of this type of view argue that consciousness is primary and that it cannot be localised in the brain. They point to healing and parapsychological research as a support to their argument, an area eschewed by materialistic thinkers whose very presuppositions rule out the existence of such phenomena. As soon as one reintroduces subjectivity and consciousness into science, a wholesale reassessment of the nature of science is called for. Foss does an excellent job in Phase 1 of the operation – which is an enormous achievement in itself – but further vistas beckon which will enlarge our ideas of both science and medicine, not to say our understanding of the complex, multi-levelled nature of the human being.