Mental Notes Magazine - UW Family Medicine - University of ...

patient becomes a subject similar to an object.
Medicine has defined diseases as universal pathological
entities, with a set of fixed characteristics that transcend
history and society, because they are independent
of where or when they occur. The epistemological
orientation towards biochemistry, biophysics and
statistics makes doctors perceive different diseases as
minimal variations of the same pattern of traits, which,
by themselves, are ‘objective’, that is, real and noncontingent.
Departing from this definition
and assumptions, doctors are not inclined
to accept subjective conceptions of
diseases as reported by patients or their
relatives.
But, the disease lived as an illness
impacts on the patient’s beliefs, that is, on
his representations, his will, his cognitions
and feelings, his ideology, etc. The illness
is a personal matter of uttermost
importance. The patient’s viewpoint
interferes in what the disease ‘is’ because
the disease, when lived by a person,
becomes ‘his’ or ‘hers.’ The patient’s
perspective in relation to the origin,
cause, development and/or solution of
his/her symptoms may have no scientific
basis. Nevertheless, the individual has
rights, the right to be taken into account.
Physical pain may be considered the
A disease can change a person
most tragic fact. A simple diet
can be considered a total
punishment. A medication
can be seen as a ‘demoniac’
danger, leading the patient to
interfere with its prescription.
Crossed-eyes can be total
destruction of the selfesteem
of a woman. A
small biologically irrelevant
mutilation, such as the loss of
the fingertip, may represent
the difference between
happiness and depression.
So, the subjectivity of the
patient is always awake in the
process of illness, and cannot
be erased from his/her
encounter with doctors.
The man or woman who
suffers is struck by the disease
in his/her heart, and this is
not only metaphoric. A disease can change a person, and
severe diseases change more extensively. This is why the
ill person needs much more than simply to be attended
using the most modern, precise and sophisticated
techniques, the patient needs to be understood.
The relationship between a person and a disease has to
be mediated by another individual. The physician must
interact not only with the ‘fact’ of the disease, but with
the person, the suffering and demanding person. At this
Doctors must be aware of the meanings lived by patients
while they are suffering their diseases
Summer 2012 / Mental Notes / 9