What is the biomedical model #7

The last in the series looking at the biomedical model focuses on perhaps the most important aspect of the model for physiotherapists – the body-as-machine.

If you’ve read anything in critical physiotherapy over the last decade, you will almost certainly have come across the idea of the body-as-machine.

Dating back perhaps as far as René Descartes and the idea that the body could be understood as separate from the mind, the body-as-machine became a specially powerful metaphor for medicine after the Industrial Revolution. Machinery, it seemed, provided the perfect metaphor for how body should work, because if industrialists could organise the production of food, fabrics, and tools, then surely the body could conform to the same logic?

Using the established sciences of geometry, mathematics, and physics, doctors in the 17th and 18th century began to pay particular attention to the cadaver and the ways in which the body could be understood in terms of levers, fulcrums and forces.

Similarly in physiology, the processes and mechanisms through which the body performed its functions were increasingly understood mechanistic terms. And so, by the time of the discovery of normal circulation, arterial-venous gas exchange, sarcomere function, and the processes of nerve conduction, physicians had already accepted the view that the body could be understood mechanistically.

One of the distinct advantages of this model is that it separated out the mind, emotions, and thoughts, and allowed the practitioner to view the body as a sort of animated cadaver. This resonated very closely with the other principles of biomedicine (specific aetiology, normalisation, reductionism, etc.), and reinforced medicines claimed objectivity.

At a time when masseuses were looking for ways to touch people without scandal, and also align themselves closely with the powerful medical profession, taking up the idea of the body-as-machine was perhaps an obvious and necessary solution.

The body-as-machine has continued to be a powerful discourse in medicine, and, despite attempts over the last half-century to develop more holistic models of practice, the “body” remains as a subdomain of many models. Note for instance the ‘bio’ in the biopsychosocial model, and the body/mind/spirit focus for the socio-ecological model of health.

In many respects, then, the body-as-machine holds the threads of all of the other principles of biomedicine together, and serves as an umbilical cord between physiotherapy and medicine. Finding an alternative to the body-as-machine – one that sufficiently accounts for a person’s holistic sense of well-being, without separating out the body from other dimensions of the health – represents one of the greatest challenges for medicine in the 21st-century. And as yet, no radical new paradigms has emerged to challenge the dominance of the body-as-machine in medicine.

Perhaps the advent of ‘prosthetic’ technologies that increasingly allow us to intervene in all sorts of bodily forms and functions in the future, will disrupt the hegemony of the biomedical body in Western healthcare. But for now, it remains supreme.

This post concludes the series on the biomedical model. In the following post, I will try and summarise some of the critiques of this model and explore some of the reasons why it has been problematic for physiotherapy.

Image reference: The image used here is from Arthur Keith's classic 1919 text The Engines of the Human Body, which can be downloaded in full here.