The Mind Body Problem

One of the current debates in biomedicine surrounds the mind-body problem, which has arisen from the observation that sickness is simultaneously an objective phenomenon and a subjective phenomenon. In the language of the social sciences the objective (or bodily) component is called disease, and refers to abnormalities and dysfunctions in organs and organ systems. The subjective component is called illness, and refers to the patient's unique and holistic experience of either disease-related distress or certain other socially disvalued states, such as psychogenic mental disorders, that conventionally are bracketed together with diseases. Disease can occur in the absence of illness, as in the case of undiagnosed and asymptomatic hypertension, and illness can occur without disease, as in adjustment disorder and somatization disorder.

Anthropologists have critiqued the mind-body distinction in two ways. The first critique calls for a reconceptuali-zation of the relationship between mind and body. The argument is that people need to free themselves from the objective-subjective comparison and take account of the continuous interaction between mind and body: the capacity of the mind to affect bodily states positively and negatively, the mind's predilection for using bodily states as idioms of distress, and so on (see Csordas).

The second and more radical critique refers back to anthropology's task of translating unfamiliar meanings and experiences into intelligible concepts without subordinating them to Western assumptions about sickness, healing, and agency. Both Western culture and biomedicine assume the existence of a mind situated in the brain. In practice, the mind is one of the Western ways of talking about the self: the body's seat of consciousness, the subject of its experiences, the initiator of the body's purposeful actions, the repository of its memories, and the locus of moral agency. To anthropologists the Western mind/self is a cultural artifact; it exists because people have practices that make it exist in the same way that possession spirits exist in the Sudanese zar cult. Indeed, there are many cultures and systems of medicine that are mindless in the sense that they have no corresponding network of mental and moral meanings, and they constitute people and experiences in fundamentally different ways. Thus, the mind-body distinction has been criticized not because there is a need for more effective concepts for connecting psyche (mind) to soma (body) but because the notion of mind itself and the practices through which that notion emerges subordinate non-Western cultures and realities to a distinctively Western ontology (Good and Kleinman; Kleinman, 1988).

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