In preparation for my talk next Wednesday April 9th at Albert Einstein College of Medicine [my alma mater] I have been pondering the relationship between metaphysics and medicine.
Metaphysics, the philosophical inquiry into the nature of reality, has two subdivisions. Ontology refers to the actual truth about something–what it actually IS. Epistemology refers to the process by which we obtain knowledge of something, a believe, a knowing. It has to do with how our minds work and how the mind filters and creates our sense of reality.
19th century philosopher Immanuel Kant is often credited with ending the way metaphysics had been approached. He was the first to distinguish between what he referred to as the noumen the ‘thing itself’ and the phenomenon which is what we perceive to be the ‘thing’.
He was essentially speaking of ontology and epistemology.
I am extending this analogy or metaphor to the practice of medicine. The ontologic component is the actual disease process itself. What it truly IS. The epistemologic approach is the process of coming to make a diagnosis and determine what we believe the diagnosis to be.
In the real world, it is the epistemologic approach that has meaning. As physicians we often struggle to put the clues together in order to make a diagnosis. Often we are frustrated by our inability to grasp the nature of the disease process. Human beings are infinitely complex and the awareness of the relationship between the body, mind and spirit only exacerbates the difficulties.
Often we make assumptions about what is wrong, presumptive diagnoses which enable us to begin treatment. We depend on feedback from the patient, how they are responding, to gauge our progress. It is hardly the rational, logical, hard-core scientific approach that many would desire. But it is the best we can do. Our epistemology requires us to use intuition, logic, and feedback from a cooperative patient in order to approach the ontologic truth.
Our epistemology may lead us to improve the patient without truly knowing for sure what the ontology of their diseases process actually was.
But in the real world and as desperately as we would like to know what we are treating, we would rather have a successful outcome without knowing than the opposite.
We would gladly sacrifice the ontology for a successful epistemology.