Empathy and the Mind-Body Problem (1)

The N-body problem is one of the most famous in classical physics, first posed by Isaac Newton in his most important book Principia Mathematica (1687).  The problem is to describe the motion of bodies in space once their velocities, masses and initial positions are known.  Two hundred years later a work describing the relatively simple case of three bodies (sun, earth and moon) ran to 1800 pages.  The N-body problem refers to any number of objects and gets even more complex if velocities approach the speed of light.  Approximate solutions were developed in the 20th Century.

In health care we have an even more difficult dilemma called the Mind-Body Problem, which has been recognized since the time of Hippocrates (who died in 377 BCE) but could be solved in this century.  The M-B Problem is that stresses that affect the mind can cause physical symptoms indistinguishable from symptoms due to disease of body organs.  Diagnosing the latter depends on ability to identify abnormal organ physiology.  Diagnosing the former depends, fundamentally, on empathic ability.  Empathy, by the way, is not sympathy.  As defined by psychologist Carl Rogers, empathy is the clinician’s ability “to perceive the internal frame of reference of another with accuracy, …  as if one were the other person, but without ever losing the ‘as if ‘ condition.” (1)  In other words, empathy is feeling what it is like to be another person.

Both skills are needed to sort out whether a symptom is due to stress illness or to an organ disorder and both skills exist.  So, theoretically, we can solve the M-B Problem for most patients.  Unfortunately, in our current health care system the two skills exist in separate worlds that orbit each other but communicate poorly.  Why is this?  More in the next post.

1. quoted in Shea SC. Psychiatric Interviewing (1998), p 14. WB Saunders.

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