3/30/2023 0 Comments Paradigm shift in medicine![]() ![]() While Maté views himself as working within the biopsychosocial and social medicine paradigms, his contribution is to elucidate the epigenetic, psychological, neurologic, and immunological mechanisms by which oppressive social structures and the toxic culture of “hypermaterialist, consumerist capitalism” (p. Howard Waitzkin, Alina Pérez, and Matthew Anderson provide us with a how-to manual on how to become a social medicine practitioner in Social Medicine and the Coming Transformation. The late Paul Farmer was a practitioner of social medicine. The social medicine practitioner continues to ask questions until she gets down to the fundamental causes of illness-the social structure. Social medicine practitioners take a step back and examine the root causes of why the people become sick. Indeed, the role of large-scale social forces on health and illness has long been the concern of social medicine. the underlying mechanisms were insufficiently fleshed out by Engel. (See figure.) As such, the biopsychosocial model is all-encompassing and potentially powerful in its explanatory reach, but the details of its workings, i.e. Engel incorporated the atoms, cells, organs, cognitive and emotional factors, and social influences such as family, community, even the nation-state into the model. The biopsychosocial model was formulated by the psychiatrist George Engel in the 1970s in opposition to the biomedical model. The biomedical paradigm is reductionist in the sense that it seeks explanations in more and more fundamental levels of analysis: Thus, the search for genes that cause this or that disease, or dysregulated neurotransmitters as explaining this or that psychiatric disorder. In the conventional medical curriculum, medical students learn basic sciences such as anatomy, physiology, pathology, and pharmacology before they learn clinical medicine. ![]() Premedical students must take basic science classes such as biology, physics, chemistry, and organic chemistry as prerequisites for medical school. The biomedical paradigm is reflected in traditional medical education. Thus Maté seeks to transcend conventional biomedical modes of analysis. “my cancer” or “my bipolar disorder”), Maté views disease is a temporal process with roots in the toxic culture within which we all live, as well as in events that might not even be subject to conscious recall. Rather than an entity that one possesses (e.g. Of note, this account of disease is dynamic, changing over time. This trauma then leads to the somatic and psychological dysfunction that becomes manifest as both bodily and psychiatric disease as well as problematic behaviors such as attention deficit and addiction. By this definition, trauma is primarily what happens within someone as a result of the difficult or hurtful events that befall them it is not the events themselves. What is trauma? As I use the word, “trauma” is an inner injury, a lasting rupture or split within the self due to difficult or hurtful events. As manifested by behaviors seemingly as trivial as not picking up a crying infant to crimes such as sexual abuse, the toxic culture of contemporary capitalism, patriarchy, and white supremacy leads to trauma. Maté reviews the scientific basis for how our toxic culture leads to disease. The author, activist, and playwright V, who wrote The Vagina Dialogues, recounts to Maté how abuse by her biological father led to her endometrial cancer. Maté presents a number of case examples of how such past events become manifest as disease, not just psychological but also physical. In its ugliest form, this takes the form of sexual abuse and rape. The stresses of working while pregnant, or the infant’s need for nurturing and attention, receive little attention.Īnother component of the toxic culture is patriarchy, the control exerted over women and children’s bodies by men. They return to their workplaces within weeks of giving birth. Under capitalism, in order to stay financially solvent, pregnant women stay on the job until they go into labor. One component of the toxic culture that Maté identifies is the capitalism, the valuing of corporate profits over human life, the relentless drive to extract private wealth while killing our ecosystem. What might such a healing practice look like?įirstly, the healer takes the side of the patient and the family – against the toxic culture that surrounds us. Maté’s formulation implies that those of us who work in health care should be practicing differently. Perhaps it is fair to call it a paradigm shift. In The Myth of Normal: Trauma, Illness, and Healing in a Toxic Culture, family physician Gabor Maté presents a new formulation for understanding health and illness.
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