Abstract
Consideration of mind/body phenomena in health care has been grounded in the constraints of overt and covert paradigmatic assumptions and the mechanisms of power/knowledge that poststructuralists pose as characteristic of empiricism. This article examines the development and conceptualization of mind/body phenomena within the context of evidence considered fitting in health care, that is, within the disciplinary matrix of empiricism. Discussion focuses particularly on inference, probability, and cause and effect, significant components of empiricism, as they have influenced the direction of the mind/body debate in health care during the 20th and early 21st centuries. A focus on disciplinary structure and rules of force subtly grounding empiricism may be the best we have for grasping the place of a phenomenon like mind/body within nursing and the health care disciplines, if such grasping is warranted at all.
MIND/BODY phenomena have been of concern to health care practitioners and researchers since at least the 17th century, the time of Descartes. Does the brain serve as the organ of mind? If so, how are mind and brain related? Does psychopharmacology offer the best pathway to management of mental illness? If so, why do drugs work variably across individuals? How do we know if someone is really mentally ill? Could society be taken in, victims of a rouse, when a defendant claims to be not guilty by virtue of insanity? These are complex and difficult questions with significant implications for the way we deal with people and their responses in health care. Despite their relevance, however, these questions are difficult to address, in part because of their potential inherent complexity, and in part because of the way we think about things in health care and nursing.
This article examines the development and conceptualization of mind/body phenomena within the context of evidence considered fitting in health care, that is, within its disciplinary matrix. Discussion focuses particularly on inference, probability, and cause and effect, significant components of empiricism, as they have influenced the direction of the mind/body debate in health care during the 20th and early 21st centuries.
Like knowledge in general, knowledge of mind/body phenomena did not, as Foucault noted, "slowly detach itself from its empirical roots, the initial needs from which it arose, to become pure speculation subject only to the demands of reason." 1(p96) Instead, knowledge of mind/body phenomena, or more accurately, mind/body discourse accorded legitimacy, developed against a stage of predominating beliefs, over time.
Notions of inference, cause and effect, and probability that ground and are essential to validating ideas associated with Cartesian dualism ground health care as well. If, as Cartesianism suggests, mind and body are completely unalike, it is not possible to understand their interaction. Yet, as Merleau-Ponty 2 suggested, conceptualization of mind/body phenomena, or more broadly stated, "the mind/body question," may be a matter of the variety of the conceptual levels-physical, biological, mental and I would add, political-involved in the study of human behavior. As one takes a position regarding mind/body issues within the disciplinary matrix of health care, a forum for debate is established. A poststructuralist challenge evolves and a contest emerges between the disciplinary structure of health care itself, driven by empiricism, and the development of relevant discourse within health care. That contest is the topic of this article.
The article begins with a discussion of poststructuralism as an approach to analysis of mind/body phenomena. Next, it presents a poststructuralist analysis of the debate surrounding mind/body phenomena in health care. The analysis, itself, includes consideration of the history of knowledge development in health care, the mechanisms by which mind/body discourse has been defined, some relevant examples of the process, and, to close, an overview of the mechanisms through which mind/body phenomena continue to be discussed in health care, despite the influence of health care's disciplinary matrix on the direction of that discussion.