Aus einer mehrjährigen Zusammenarbeit der Klinik für Psychosomatische Medizin und Psychotherapie der Universität Freiburg (Ärztlicher Direktor: Michael Wirsching) und einer Arbeitsgruppe in Isfahan im Iran, an der neben der dortigen Universitätsklinik für Psychosomatik auch ein familientherapeutisches Weiterbildungsinstitut beteiligt ist, ist die Idee eines wissenschaftlichen Journals entstanden, das die Verbindung von körperlich-leiblichen, seelischen und kulturbedingten Dynamiken als zentrales Thema begreift. Programmatisch heißt es: „Modern medicine is supposed to be in a paradigmatic crisis in terms of the accelerative demographic, epidemiologic, social and discursive Aspects. The ontological, epistemological and methodological gaps in biomedicine lead to a chaotic condition in health believes and behaviors. Body, Mind and Culture is focused on interdisciplinary, cross-cultural and conceptual research; Theoretical papers, review articles, case reports and clinical trials which address biopsychosocial interchanges and interactions in the field of health and Medicine will be welcomed. The researches should focused on paradigmatic shift and/or humanizing medical practice. All interdisciplinary researches such as social sciences (e.g., sociology, anthropology, psychology), humanities (e.g., literature, religion, history, and philosophy and arts (e.g., music, cinema) which have an impact on medical education and practice are acceptable.“
Die Zeitschrift ist als Open Access Journal konzipiert, erscheint zweimal jährlich und steht kostenfrei online zur Verfügung. Start war 2014, die zweite Ausgabe ist soeben erschienen. Chairman des Journals ist Prof. Dr. Michael Wirsching, Editor-in-Chief is Farzad Goli MD. aus Isfahan, Co-Editors sind Carl Scheidt (Freiburg) und Alireza Monajemi (Tehran). Eine vollständige Übersicht über das Editorial Board findet sich hier.
Für die zweite Ausgabe habe ich folgendes Editorial verfasst:
Tom Levold: Transdisciplinarity
With this second issue of „Body, Mind & Culture“ the journal is making the next step forward towards the challenging prospect to transcend the biomedical model in the medical field in favor of an interdisciplinary, or better: transdisciplinary discourse on issues which comprise bodily, mind related an socio-cultural phenomena.
The history of science and its academization in the last centuries has led to a continous differentiation of academic disciplines und subdisciplines which developed and followed their own paradigms and methodologies, gained specific (organizational, economic and legal) forms of institutionalization and careers, formed quite homogenous scientific communities and produced a corpus of codified, consensus-based and teachable knowledge. All these processes contributed to the emergence of clear disciplinary identities which are more or less distinguished from other fields of knowledge.
As the history of science shows this evolutionary process brought about a powerful system of specialized scientific knowledge which accelerated developments in almost any societal domain. However, specialization ist not only a verhicle for scientific progress, is has some serious pitfalls and blind spots.
First of all we are faced today with complex scopes (ecology, health, globalized communication etc.) which are difficult to examine from a single discipline-specific perspective. Furthermore – and even more problematic – specialization can make it impossible to even recognize certain complex problems since many specific scientific research procedures don’t derive from the nature an the context of their subject but from the methodological repertoires and competence claims of the respective disciplines.
The famous cybernetician Heinz von Foerster once indicated that the etymological core of the word science is the indo-european „sky“ which means „to split“ (this is also part of the word „schizophrenia“!). As an opposite term he proposed to use the concept of „system“ (greek for entirety, aggregation). A systemic orientation leads to an transdisciplinary approach.
While interdisciplinarity is focusing on the communication, the interface between different disciplines, which allows an exchange of different perspectives on shared subjects, transdisciplinarity goes even further. According to Gregory Bateson transdisciplinarity is the search for „patterns that connect“. It deals with circularities which cross the boundaries of matter and energy, of mind and nature. Instead it asks how phenomena in different realms of observation can be brought together in respect of a deeper understanding of the complexity of our live.
In the medical field Thure von Uexküll (1920-2001), a German medical doctor, philosopher, and one of the founders of the biosemiotic approach, can be adressed as a trailblazer of transdisciplinary thinking in psychosomatics. Sima Atarodi, Shahram Rafieian and Mohammad Salavati visited his Wife, Marina von Uexküll, in her home in Freiburg and talked with her about the scientific life of her husband. Taking alone his references to other researchers and thinkers makes clear how broad his intellectual spectrum was: S. Freud, M. Balint, Winnicott, J. Piaget, D. Stern, L.v.Bertalanffy, N. Wiener), F.Varela, H. Maturana, G. Bateson, H.v.Foerster, E.v.Glaserfeld, and others.
Alireza Monajemis Paper on the role of biomedical knowledge in clinical reasoning tackles the „split“ of medical knowledge which is produced in the academic and research field and the knowledge the experienced clinician takes as a road map for diagnostics and treatment. He suggests that the primacy of clinical practice in medicine vividly shows that it is not possible for medicine to be grounded only in pure science.
In an impressive paper on the placebo response which can’t be explained within the domain of the biomedical approach alone Shahram Rafieian uses as an alternative framework a non-dualistic philosophical conception of mind-body-society which refers to the phenomenological work of Merleau-Ponty. The social-relational as well as psychological dimension of the placebo response is considered by incorporating the concept of semiosis (the process of sign interpretation) as a translator of the flow of information between different domains of experience.
Azadeh Malekian, Gholamhosein Ahmadzadeh, Mohsen Maroufi, Abbas Attari, Amitice Bahramian and Aleksandar Janca present a replication of a study designed by the University of Western Australia (UWA) which asked in how far deteriorating mental functioning can be identified in an early stage in the form of altered sensitivity to expected rituals and an altered ability to perform the rituals appropriately. Rituals are here understood as the correct performance of culturally based practices of everyday life (personal appearance, dress code, hygiene, eating habits, sense of privacy etc.). They report interesting discussions within the researchers group how far you can go in defining deviant behavior in these domains as risk factor for mental disturbances. The conclude: „Cross cultural applicability of the social rituals concept and its applicability in reinterpretation of the concept of prodrome are crucially important in psychiatric diagnosis. It instantly incorporates the idea of ‘culture’ into prodrome and hence psychiatry must ask about the utility of western diagnostic instruments/techniques in non-western settings or in western settings with non-western people as would be the case in most parts of our increasingly multi-cultural world“. As it turns out, this approach is quite delicate, when you don’t take a clear understanding of the term „culture“ into account. Although mental disturbances can surely manifest themselves in early „misperformances“ of cultural rules, culture is not a stable objekt. Particularly there is always a difference between the „public“ discourse or mindset of culture and the practices of the people who are members of that culture. Cultural evolution all over the world occurs through deviations from the cultural paradigms which are – in this respect – no signs of individual pathology. May this paper open up an interesting cross cultural discourse.
Besides these more conceptual articles this issue contains some interesting research studies relying more on quantitative data. Fatemeh Asadollahi, Hossein Ali Mehrabi, Hamid Taher Neshatdoost, Mehrdad Kalantari, Hamid Afshar, and Hamed Daghaghzadeh found that a setting with 8 sessions of Mindfulness-Based Cognitive Therapy in cases of Irritable Bowel Syndrome in women allowed significant reduction was noted in anxiety, depression, and somatization symptoms after the intervention and in anxiety and obsessive–compulsive disorder (OCD) at follow-up. Interestingly the treatment had not any impact on the severity of physical symptoms.
Minoo Yaghmaei, Alireza Monajemi and Kamran Soltani Arabshahi trained medical students with 10 sessions, each for two hours, with storytelling and use of literature to enhance their ability to empathize with their patients. Obviously this kind of empathy training needs further evaluation. The authors conclude: „Storytelling courses are possibly (!) effective in maintaining the level of medical students’ empathy toward patients and might prevent the reduction of empathy during their educational course.“
The last contribution to this exciting issue is a study of Hamidreza Roohafza, Shamila Mosharraf, Ghafour Mousavi, Azam Khani, Elham Andalib, Mitra Reihani, and Ali Abbasalizadeh who collected demographic and psychosocial data of all patients in a local hospital of a rural region in central Iran who tried to commit suicide in one year (466 cases). Interestingly, about one third were male, two third female, the peak age of suicidal attempts were 15-24 years, followed by 25-34 years. A closer look at the data suggests that this is a most exciting subject for a cross-cultural and transdisciplinary discourse. The authors, for example, suggest as a stressor for suicidal behavoir: „In addition, family conflicts, increased expectations and individualism; and changes in adolescent transitions (particularly the importance of a youth culture that isolates young people from adults and increases peer group influence, more tension between dependence and autonomy, and more romantic relationship breakdowns) will occur in this period of life.“ While this is certainly often the case in different cultures, it is interesting to compare suicidal behavior between different cultures. For example, suicide in Germany is statistically in the first line a phenomenon later in life (there are no data about suicidal attempts, only suicides!). The suicide rate for men from 20-25 years is 11,9 (women 3,2!), for men from 85-90 years 73,2 (women 15,1). Obviously the reasons are very different regarding social and cultural contexts – and, presumably, the dynamics of cultural stability and change – which marks a demand for further comparative discussions.
We see that producing data may not give answers in the first line but lead to more and maybe different questions. This is what an interdisciplinary, cross-cultural and conceptual journals like „Body, Mind & Culture“ is about. It diversity, the broad range of perspectives, the qualitative as well as qantitative data and the openness to new ways of thinking is what this issue has to offer to all professionals in the medical field who are curious to leave their trodden paths of daily routines.