A PHILOSOPHER AND A DOCTOR IN CONVERSATION: Health. Illness. Pain.
Illustration: Vsevolod Shvaiba. The Eternal Rook. Paper, ink, pen.
Participants in the conversation:
Yevhenii Volchenko, physician, PhD in Psychology, founder of the Aurum Rehabilitation Center.
Serhii Forkosh, Ukrainian thinker, Doctor of Philosophy, founder of the Institute for Socio-Cultural Transformations.
Some of the questions discussed during the conversation:
Key issues in modern medicine. How has COVID affected it (what has changed)? Can philosophy be useful for medicine?
On the philosophical questions of medicine. Is it important for a doctor to answer the question: «What is a human being?» If so, why?
How important is the reflection on historically established concepts of medicine for shaping a deeper approach to human health?
On the topic of health and illness (definitions, issues). Diagnosis and the treatment process. What does it mean to heal? Is there meaning in illness? Who is the doctor in today’s world?
Serhii Forkosh: Hello, Yevhenii! Thank you for taking the time to have this conversation. First of all, I’d like to say that medicine — both as a practice and as a concept — is of extraordinary interest to me. For instance, I’m primarily interested in understanding the methodological features of medical practice.
It’s clear that a surgeon has one kind of methodology, a family doctor another, and a psychiatrist yet another, but still, it seems to me there must be a set of principles and approaches that define how a doctor understands their practice.
One could say, to anticipate a bit, that I’m interested in the question: «How does a doctor understand health and illness?» — and that leads to a more fundamental one: what is the human being as the subject of medicine?
Yevhenii Volchenko: You’ve immediately raised complex and layered questions that require thorough exploration. For now, I can only say that, from my perspective, modern medicine can roughly be divided into protocol-based and individualised approaches — and for now, I’ll focus on the latter.
In my view, a doctor must possess at least two core competencies. The first is a specialised competence tied to their field of medical practice. The second relates to the development of an understanding of what underpins that practice — that is, a modern doctor must also, in a certain sense, be both a methodologist and a philosopher.
S.F.: Are you saying that the modern doctor should be something like the ancient healers — like Hippocrates or Paracelsus?
Y.V.: Well, that wouldn’t be a bad thing. What I mean is that medicine often takes for granted concepts that today call for deeper reflection..
S.F.: Could you explain?
Y.V..: I would say that our understanding of terms like health, illness, human corporeality, the formative forces of organs, physiognomy, and the physical image of disease, the symptom complex depending on the stage of pathogenesis, and, accordingly, the diagnosis itself as the recognition of the essence of a pathological process — all of these need to be reconsidered.
S.F.: What has changed? Why should this be done now? Could it be related, on the one hand, to the development of medical technologies? MRI, PET-CT, advanced blood analysis, genetic research, and even the artificial cultivation of organs? Not to mention the pharmaceutical boom?
Y.V.: I believe that the methodology and, let’s say, the philosophy of medicine have always gone hand in hand, but today, due to technological progress, there’s a certain gap between the understanding of therapeutic principles — which has remained rooted in history — and the medical practice itself.
S.F.: We can also add that the issues pertaining to philosophical anthropology—namely, what constitutes the essence of the human as human, in other words, where the boundaries of the human lie — are becoming clearly visible in medicine.
For example, what is an artificial organ or a prosthesis? What if we start talking about a prosthesis of memory, imagination, or even of thought itself? This clearly highlights the need to return to classical questions such as «What is a human being?», «How is a human different from an animal?» or in a new variation, «How is a human different (or supposed to be different) from a robot?» Are we witnessing human evolution or its degradation — the loss of the human?
Y.V.: When it comes to medicine or even therapy itself, the question «What is a human being?» — or at the very least, how the essential characteristics of the human are manifested (say, in their structure) — directly affects how therapeutic approaches are shaped. In particular, an important question is: «Does the patient’s consciously active participation in therapy influence their recovery process?»
S.F.: In that sense, let’s talk a bit about health since medical practice is aimed both at preserving health and restoring it in case of illness. Would we even speak of health if we didn’t get sick or injured, and so on? In our normal state, we don’t really feel healthy — it’s as if it remains hidden and only reveals itself through our experience of its disruption, that is, when its boundary is broken.
Y.V.: First of all, defining health merely as the absence of illness tells us nothing about the actual nature of health. To me, health is an active and fluid foundation of human vitality that enables a person to realise themselves as a human being. In other words, health is tied to the very possibility of human existence as human.
So, for me, health is not simply the «satisfactory physical condition» of the body — it’s more like the shared meaning of body and mind or, perhaps, the conscious body and embodied consciousness. In lived experience, health — as vitality — is the restorative capacity of both physical and mental activity.
Of course, this process is dynamic and individual. For example, the ability to create is one of the important aspects of health.
S.F.: Wonderful. But in that case, what is illness or disease?
Y.V.: As the word suggests, «illness» is related to the phenomenon of pain — though, of course, not always. As I mentioned earlier, health is a hidden creative activity, not a passive state, so illness is a disruption of that creative process. But it’s not that straightforward.
Illness, in its various manifestations — beyond the obvious harm and pain — also reveals certain boundaries that we experience through both pain and therapy. I would say that illness is a natural process that occurs in the wrong place or at the wrong time.
In a certain sense, illness relates to self-knowledge — but not just conceptual self-knowledge. It’s a kind that includes the experience of one’s own limits.
S.F.: You mentioned pain and the notion of a boundary. These are particularly interesting to me. Let me say a few words about how I understand pain. This doesn’t directly relate to what we’ve been discussing, but I’d still like to hear your thoughts since you constantly deal with the phenomenon of pain.
So. Pain, as I see it, has a trans-immanent structure. In other words, pain is a pure boundary in which the integrity of the body and the reality of the world are united. More precisely: pain signals such a unity. But pain is also a boundary in and of itself. Symbolically speaking, pain is an abyss into which sensation falls, forced to go beyond itself.
Furthermore. One interpretation of pain is suffering. Pain — if it is intense enough—takes over consciousness entirely, making self-awareness difficult. In enduring pain, we find ourselves at the border between consciousness and the world. We become, in a way, semi-conscious. What hurts is first recognised and localised, but then the pain may fill the entire consciousness, replacing acts of self-reflection, leading to a state of pure endurance.
Poetically speaking, I’d say pain is a constantly unfolding fall. I might also add that pain can give rise to intersubjective experience. The experience of pain brings consciousness to the edge of its own nature, where it begins to undo itself. Complete pain is as alien as it is one’s own.
Thus, pain is an experience of the self from within the self, in which the Other is structurally present. As I’ve mentioned, pain is trans-immanent — meaning that the experience of pain holds both intensity and persistence. Pain has traits of both the ideal and the real; it exists both within time and outside of it. Perhaps pain lies at the origin of our awareness of time.
Y.V.: I would say that pain is active consciousness where it is not supposed to be. It’s the manifestation of consciousness in the realm of the unconscious — a boundary experience where consciousness enters a domain it typically doesn’t access. The intensity of this experience is individual. In this sense, let me give an example of one of the earliest experiences of pain: the physiological process of teething.
One child experiences teething with crying, fever, pain that lasts several days — especially at night (a time when physiologically conscious activity is dormant, asleep). Another child goes through the same process with no apparent distress; those around hardly notice any change in behaviour. This, of course, raises the question of how significant the experience of bodily formation is in the individual development of the human being.
S.F.: I find the concept of the symptom extremely interesting. First and foremost, a symptom is something that is encountered (detected) by the patient through self-observation or self-awareness. That is, a symptom is a sign or indication that, by appearing, points to something it itself is not.
It’s intriguing that a symptom related to the body appears on or in the body — it is a kind of bodily sign. That means it is more than a sign, since it has essential characteristics of its own, and yet less than the disease itself, as it conceals its underlying cause. I think the fact that a symptom is a special category of signs is something that philosophy and semantics still need to fully explore.
All right — so a symptom is a sign of disturbance. In and of itself, it draws attention. That is, the symptom is the field or «dimension of encounter» between illness and the person — both the patient and the doctor. It possesses two qualities: on one hand, each symptom is unique (for example, a skin rash has an unrepeatable pattern); but on the other hand, it has typological features that not only allow it to be recognised as a phenomenon, but also linked to a specific illness.
Headache, abdominal pain, skin eruptions, and so on — they all draw attention and then are identified. After examination, it turns out that the symptom is not primary but rather a derivative of the underlying processes that gave rise to it — what initially caught the attention. Of course, some symptoms remain hidden, not manifesting through pain or visible changes in the body, behaviour, etc.
Once discovered — for example, during a routine check-up — these detected symptoms become the basis for deeper investigation into their causes. So, a symptom is a sign of disruption that presupposes a search for its cause.
One could also say this: a symptom is what appears first, but after investigation, it becomes the last because its cause turns out to be primary. So, the symptom leads to the necessity of examining its own cause.
And it’s clear that the more typical the symptom, the broader the range of possible causes. A headache can be due to something as minor as fatigue or as serious as a malignant brain tumor. How do you understand the symptom?
Y.V.: A symptom in medicine is one of the indicators of a change in a person’s state of health. I would say that symptoms can be specific—characteristic of certain diseases and manifested in the same way in all affected individuals (for example, with chickenpox, a rash appears as small fluid-filled blisters)—as well as non-specific, which may be common to many conditions, like the headache you mentioned. That’s why they require further in-depth examination to understand the essence of the problem occurring in the body.
S.F.: So, in this case, one must combine the typical with the particular?
Y.V.: Yes. In both specific and non-specific symptoms, an experienced doctor can always detect individual features of how they manifest in the body. This is precisely what matters in diagnosis and in forecasting the course of a disease in each particular case.
We can also speak of serious illnesses that develop silently, without any noticeable symptoms and are discovered only during routine check-ups. But the opposite also happens. For instance, a malignant kidney tumour might be detected during a full-body PET-CT scan (a rather toxic and expensive procedure, by the way), which was done at the patient’s own initiative.
In such a case, we cannot rule out the possibility that the patient’s self-perception or self-observation — some kind of inner «vision» of the self — was what prompted the additional examination and led to the discovery of a hidden illness.
S.F.: So, a hidden illness can somehow secretly make itself felt? Influence us?
Y.V.: Of course. It’s entirely possible that a hidden illness can even awaken in a person the desire to change their lifestyle, daily routine, diet, or value orientation — and over time, the body may cope with the illness on its own through self-regulatory processes, without specific medication. For example, this might be evidenced by healed stomach ulcer scars found during a routine examination or calcifications in the lungs as traces of past tuberculosis infection.
S.F.: Medicine is full of riddles and mysteries! But I’d like to suggest we move on to another no less complex concept — that of diagnosis. A diagnosis, as it seems to me, is a judgment (an art of forming judgment) aimed at revealing the essence of an illness. That is, diagnosis connects the concept of disease with the process (phenomenon) of disease itself.
The essence of the disease, then, is revealed in its very concept. The essence relates to its origin—to the first disturbance that later led to the symptoms. Identifying the essence of an illness is one of the most important goals of diagnosis.
So, on the one hand, we have the concept of disease; on the other — the patient, with their unique physical and emotional traits, who presents with specific symptoms. The task, then, is to examine the patient until the grounds for concluding the essence of the disease become both necessary and sufficient.
The more data we have, the higher the «probability» of uncovering the true cause (the essence) of the disease. But can the essence of the illness be derived solely from data? Overall, how do you understand the diagnosis and the diagnostic process?
Y.V.: First and foremost, a medical diagnosis is the physician’s conclusion regarding the disease present in a patient. In conventional medical practice, it is formulated in accordance with the accepted nomenclature and classification of diseases.
In this sense, for the most part today, the doctor acts as a collector of diagnostic data obtained either directly or through instrumental methods (stethoscope, microscope, ultrasound, CT scan, etc.). Based on this data, the doctor then formulates the diagnosis. Diagnosis tends to be more descriptive in nature — focused on summarising the data collected. The condition that currently poses the greatest threat to the patient’s life is typically listed as the primary diagnosis.
In this regard, doctors are more oriented toward the bodily manifestations of disease — toward what has already been revealed as the outcome of the illness. In this sense, diagnosing the body and diagnosing the organism are two different types of diagnostics.
S.F.: And what’s the difference between them?
Y.V.: When we diagnose a fracture, we describe it based on radiological examination data — we are operating within the domain of the physical body. But when we speak about the organism with a fracture, we are diagnosing how quickly and smoothly the tissues might regenerate, depending on the individual characteristics of the organism — how fragile it is, how the patient copes with the trauma psychoemotionally, and what other health issues might emerge in the context of the injury. Sometimes, a fracture can have a fateful significance in the patient’s life. In this approach to understanding the organism, we are much closer to the conceptual, essential level of diagnosis.
S.F.: So you mean that both levels of diagnosis should complement each other?
Y.V.: Yes. I’d like to share an example of this kind of diagnosis from the history of medicine. It remains quite relevant even today. Paracelsus once described a scene in which a group of doctors were discussing the cause of death of a patient who had died from cholera:
First Doctor: It’s clear—the cholera bacillus entered through drinking water, multiplied in the body, and led to death.
Second Doctor: That’s strange because not everyone infected with cholera dies. His powers of self-healing were too weak to overcome the infection.
Third Doctor: No, it was predestined in his horoscope for him to die at that time.
Fourth Doctor: Not convincing—many people live under the same star alignments. He was weak in his «I». He was deeply afraid of cholera. Many physically weaker patients survived the disease because they were more courageous and didn’t lose hope.
Fifth Doctor: Illness and suffering are the scourge of God. If the Lord had wished, He would have helped him recover.
Sixth Doctor: Each of you is right—but only if you do not deny the truths contained in the others’ views.
To sum up:
A deep understanding of the causes of illness and the possibilities of healing lies at the integrative level of comprehending human existence.
S.F.: Wonderful! But tell me — what is the patient for the doctor? Is the patient given to the doctor as a whole phenomenon? If so, how does the doctor form the phenomenon of the patient within themselves? In other words, how can one form an understanding of the patient that corresponds to their individual characteristics?
It seems to me that, in a certain sense, the patient — in both their bodily and conscious dimensions — must «emerge» before the doctor as if for the first time. The doctor must, in a way, internally recreate that original, singular essence of what the patient is as a unique individual. This process consists, as we know, of at least two parts: perception and communication. The first is realised through observation, palpation, percussion, and auscultation; the second through dialogue — about complaints, medical history, and even life history.
Once the patient has «appeared» before the doctor in their unrepeatable form, the symptoms stop being merely formal — they begin to acquire richer meaning, taking on the necessary context.
Then, if needed, the doctor conducts further laboratory (indirect) investigations and makes a judgment about the presence or absence of disease, as well as the specific nature of that disease. Thus, the doctor connects the general (the concept of illness) with the particular (the manifested phenomenon).
How do you work with the patient? What do you pay attention to?
Y.V.: When meeting a patient, the first thing I do is perceive their physical appearance. I pay attention to how the body is generally formed — for example, whether the head is large, or the torso is dominant with short limbs, or, conversely, long limbs; the width of the wrist bones, and overall proportions.
The facial structure: what stands out most — the forehead or the expressiveness of the eyes; the nose, or a strongly protruding lower jaw, the skin tone — the incarnate. How the patient moves, how they speak, how they breathe. Even the way they are dressed matters.
S.F.: And what happens next?
Y.V.: During communication with the patient, the perceived information is enriched with details from their medical history, including biographical features. This helps form a more complete picture of the patient — how their complaints and symptoms relate to their individual characteristics, considering age, and so on. Quite often, the complaints may actually be a healthy reaction of the body to the situation the patient has found themselves in.
S.F.: Alright, let’s return to the diagnosis itself and the diagnostic process. Even from my own experience as a patient, I can say that I’ve observed a problem in diagnosis, which is that doctors often confuse or fail to clearly distinguish between sufficiency and necessity as logical criteria for justifying conclusions about the nature of a disease.
Here’s a simple example. Let’s say we have the statement: «The rise in body temperature is a process that unfolds over time.» From the fact that temperature is a temporal process, it doesn’t follow that time itself affects the rise in temperature. But temperature cannot fail to progress over time — it’s a necessary condition. However, a sufficient condition for the temperature to rise is, for instance, physical activity or illness. Thus, the necessary condition must be complemented by a sufficient one.
Here’s another example from criminal law. The statement: «The person is at the scene of the crime.» Just because the person was at the scene of the crime doesn’t mean they committed it, though being present is a necessary condition for committing a crime (if we’re talking about a crime that requires physical presence, say, hooliganism).
A sufficient condition for determining that the person committed the crime could be, for example, witness testimony, fingerprints on a weapon, etc. What logical errors in making a judgment about the essence of a disease have you encountered in your practice?
Y.V.: This is a very interesting question. In my practice, I’ve often observed a tendency to confuse what is necessary for diagnosing a condition with what is sufficient to make that diagnosis. For instance, one might observe that a patient’s fever is a necessary condition of many infections, but it doesn’t mean it’s sufficient to diagnose the specific infection. The same applies to symptoms — they are often seen as necessary conditions, but by themselves, they don’t provide a complete picture of the disease.
I have encountered situations where doctors, seeing a symptom or set of symptoms, hastily make a diagnosis without considering all possible causes, sometimes neglecting to look at the full context, including the patient’s medical history, lifestyle, and psychological factors. This is where the distinction between necessary and sufficient conditions becomes crucial — symptoms alone may not be enough to form a complete and accurate diagnosis.
Y.V.: This is a good, but not simple question. I’ll try to explain how I see it. Of course, the first necessary condition for the onset of a disease process in a person is the person themselves — this is where the process actually takes place.
The sufficient condition is the presence of a disease agent in the person’s body. The person, as a necessary condition for the manifestation of, say, the herpes virus or chickenpox, has a specific form of activity (general symptoms characteristic of that virus), and the activity of the virus itself is a sufficient condition for the disease to occur.
In diagnosis, it is important to identify the causative agent of the disease and, accordingly, direct the therapy against it, or to understand the patient’s body and support it in its fight against the pathogen, taking into account the individual characteristics of the patient.
I’d like to note that when I speak of a disease agent, I’m not only referring to a substance (such as an infection, toxin, or undifferentiated tissue), but also to information that can traumatize the psyche.
Y.V.: To illustrate, I’ll refer to the famous dispute between Max Pettenkofer and Robert Koch, which took place in 1892. Pettenkofer, the founder of hygiene, publicly drank water containing cholera vibrio cultures from Koch’s laboratory to prove his point, and did not contract cholera. This shows that the body’s conscious self-sufficiency can resist the activity of the pathogen.
An example of how the presence of a pathogen in the body is not always a sufficient condition for the onset of disease is how the herpes virus behaves. It is known that around 90% of people are infected with this virus, but what’s interesting is that for some it manifests every month, for others once a year, and for still others once every 5–10 years.
S.F.: Alright. Based on what you’ve said, it seems to me that a correct diagnosis depends on both the level of «knowledge» the doctor has about the patient and the «ability to judge» — that is, the doctor’s skill in connecting the general with the specific over time.
The phenomenological (perceived image of the patient) and the logical (cognitive procedures) go hand in hand here. It can also be added that since any disease progresses over time and thus changes, the diagnostic process should be conducted (or clarified) at least several times, which allows for tracking the disease’s dynamics (if it has been identified).
What is the most important aspect for you when establishing a diagnosis?
Y.V.: I adhere to the position that it’s important to consider both of the aforementioned procedures in diagnosis and therapy. However, diagnosing (recognizing) the person — taking into account their age, sex, constitutional type, and life history — in each individual case contributes to more effective therapy.
S.F.: Now I’d like to look at medicine from a slightly different angle. Imagine this picture. While walking through the city, I pass various buildings. Among them, there are buildings that represent certain social and state institutions. I walk past a school — it’s recess, the air is filled with the sound of children’s chatter. The school is an institution of primary education, and it has its own spirit, its own unique atmosphere.
I pass by a church — it’s quiet, peaceful, and the special architecture is designed to help a person step away from the everyday cares and immerse themselves in the atmosphere of something eternal. But then I walk by a polyclinic, and outside the entrance, there are people in white coats who’ve stepped out for a smoke. If you dare to go inside, the first thing you’ll notice is the characteristic smell — this is the scent of the world of medicine. What does it consist of?
Medicines, alcohol, the stale air from hospital rooms, the refined air of the operating rooms. Medicine is a special world. I remember, in school, when we were getting our vaccinations and the nurses entered the class, the whole class would anxiously watch their every movement.
One nurse placed a metal box on the table, opened it, and inside was an endless array of needles. They crossed in such a frightening way that it created a sense of sharp, pricking energy. These needles were probably floating in alcohol.
Tell me, what does medicine look like from the inside, through the eyes of a doctor?
Y.V.: Medicine from the inside, through the eyes of a doctor — this is an interesting question. I think it’s important to add: we may idealize the situation through the eyes of a doctor who loves their profession.
Medicine as a space: glass, metal, tiles. White, light blue, metallic colors. The distinctive smell of a quartz lamp, medications, alcohol, cleaning agents.
In all of this, there is a sense of coldness, tension — like you said, the pricking energy — and now a medical worker appears (I don’t focus solely on the doctor, I started as a junior medical worker, then moved on to mid-level roles, and later as an intern — this is a synthesis of experiences that live within me).
The medical outfit, the white coat. When you put it on, your personal emotional life takes a back seat; clarity of thought, cold reasoning, clean, well-groomed hands, warmth in the heart, sometimes turning into a spasm (it’s through the heart that contact with the patient happens).
And if that contact happens, then the atmosphere of coldness, fear, and prickly energy won’t arise, and the experience of this special world of medicine will align more with its purpose — the atmosphere of warmth, trust, and kindness.
This is precisely what those who live and work in medicine should strive for. If it’s not like this, then they don’t belong there, as they harm themselves and the very essence of medicine.
S.F.: Alright, so we’ve painted a picture of medicine. Now, I’d like to return to the topic of pain. We previously discussed the essence of pain, but it seems to me we can also talk about the sociology of pain or even the politics of pain. I mean, pain is a unique tool of power. To stop or ease pain — that is the power of the doctor.
Just think about why a patient goes to a doctor. Is it of their own will? If I have a toothache, do I have a choice? Does the doctor know this? After all, every doctor is also a patient! I want to say that at the heart of the doctor-patient relationship, there is initially some form of coercion. But on the other hand, a doctor often insists that without trust, treatment may fail.
One could say that here we’re talking about the power of the doctor and medicine (as the politics of pain). Is it important for you that the patient trusts you? And it’s worth considering that trust between a priest and a parishioner is one thing, between a lawyer and a client is something else, and between a doctor and a patient — something entirely different?
Y.V.: The doctor brings life to consciousness, while the priest brings consciousness to life. The lawyer works within the legal framework of society. I would say that the relationship between a doctor and a patient, as well as between a priest and a parishioner, is more intimate than the relationship with a lawyer, and is grounded, if I can say so, in the bodily essence for the priest and the essence of the body for the doctor.
Thus, the nature of pain can be either, let’s call it, essential-body (for example, the agony of conscience, dissatisfaction with oneself or one’s work), or, according to the terminology I’ve chosen, body-essential (toothache, burn wounds).
Each person has a different pain threshold. One person, for example, is more prone to body-essential pain due to heightened sensitivity, and they tolerate physical pain easily, while another cannot even endure a light touch and faints at the sight of a syringe (a protective reaction—consciousness leaves the body).
In this sense, trust in the priest or doctor plays an important role, and earning that trust is difficult, but the weight of responsibility is directly proportional to it.
One could say that a person exists within the dynamic interaction of these two polar types of pain and naturally requires support from either the doctor or the priest (when the body cannot handle the pain alone). This raises a complex question: «Do we suffer because we sin, or do we sin because we are ill?» The theme remains open.
The question of the abuse of power over people through the church and through medicine, which is especially evident in modern society, also remains open. One could even speak of a kind of socio-political «medical papacy.»
S.F.: But how much pain does our society feel? If we try to identify the symptoms of society’s illness — if we imagine society as a patient who came to us by chance and isn’t complaining about anything, believing it is healthy, and attributing whatever does bother it to a temporary disorder with an external, insignificant cause — what symptoms could we highlight from the initial examination?
Y.V.: First, let’s clarify the symptoms.
S.F.: Alright, so we’re examining our patient. His eyes are slightly bulging, and his pupils are dilated; on one side, he has a neatly shaved beard, but for some reason, his eyes are painted. Our patient is hunched over, yet actively engages in sports. His teeth are unnaturally white.
He speaks very quickly. Sometimes, it’s hard to tell where one sentence ends and another begins. He swallows some letters and leaves words unfinished.
No matter what you ask him, all his answers seem to come back to himself. But I’m saying «he,» and that’s not quite right. This is hard to understand, despite the apparent simplicity of the question. And don’t let the beard confuse you.
Let’s say, to avoid complicating things, that this patient has no defined gender. Of course, there are traits that suggest he belongs to one gender, but you’ll immediately find opposite traits that suggest otherwise. The patient refers to himself as «he,» «she,» or even «they.»
Furthermore, he has long stopped believing that anything is above him. In general, he is irreligious. Our patient is very inconsistent: sometimes he strives for perfection and order, other times, he falls into chaos and wild barbarism; sometimes he plans to fly to the Moon, yet struggles to afford food; sometimes he sees himself as the center of the universe, at other times as a small piece of moss grown on a swamp; sometimes he looks to the future with optimism, other times, with nostalgia, he remarks that the best and most important things happened to him in childhood. In short, an unconventional patient.
What should we do with him? Send him for further tests, or can we immediately make a diagnosis?
Y.V.: You’ve presented a composite image of a person — a typical representative of modern society, setting the tone and striving for leadership. In medical terms, this is the symptomatology of someone with a dominant influence of the sympathetic nervous system.
In other words, a person under stress, fundamentally insecure (the symptom of slouching is very characteristic in addition to the described symptoms). Stress, the blood flow to vital organs (those the person deems vital at that moment) — based on this, one can trace their orientation in socio-cultural life.
A person-bodybuilder. I’m exaggerating a bit — but I like this comparison, as it carries the root of the word «culture.» Modern bodybuilders are nominalists.
S.F.: So, what’s the diagnosis?
Y.V.: I’ve already to some extent diagnosed your patient. If we go deeper, we can uncover many interesting things in this direction. For example, the parasympathetic nervous system, which also has its own symptomatology.
As long as the parasympathetic system compensates for the body’s functioning in the imbalance of the sympathetic nervous system’s dominance, the person attributes everything that bothers them to temporary disturbances. But when the compensation period ends, disease follows.
At this point, a request for help arises, and the quality of the diagnosis, and consequently, the therapy offered in terms of the body’s essence from the doctor’s understanding of the body’s essence, plays a crucial role for this organism. I speak of the organism both in relation to the individual and in terms of the social organism.
S.F.: But our social organism was consumed by the COVID pandemic. Our social organism learned a lot about itself. It seems to me that, for the most part, the pandemic revealed aspects of society’s life that existed in a kind of «self-evident dimension.» For example, isolation.
Isolation showed the level and degree of our dependence on the social. One could say that, to a large extent, we saw (experienced) the power of the social over the individual (psychologically, as well as economically).
The social here is not something «in» us, but something that exists between us and for us. Interestingly, during the pandemic, people began to reproduce real social interaction virtually.
Here is a person alone in a room. All of their thoughts are directed toward interaction, toward something that is not themselves, and only from there do they draw an understanding of what they are. But this «from there» was interrupted, exhausted. Our person no longer knows «who» they are. Anxiety, panic.
But the other side of the pandemic showed us medicine as politics, which implements its own power strategies. For instance, vaccination issues turned into questions of the boundary of power’s application.
It immediately became clear that medicine, as a social system, is no different from the prison or school system. Remember Foucault and Deleuze! For power, the private is merely an excuse to expand the general, itself, onto new, re-emerging grounds.
Y.V.: Yes, there’s a lot of overlap here.
S.F.: This is what interests me. Why is society ill with power? Is it a chronic condition, or is it seasonal? Does it flare up due to a lack of belief? And what kind of virus is this — the virus of power? How does power multiply? By spores?
If you step on a poisonous plant (for example, encounter a corrupt or even a «decent» official), can its spores enter through the respiratory system into the lungs, and from there affect the heart? Or is it through pollination?
I imagine a fat-bodied bumblebee, barely dragging its body from one flower to another. Airborne transmission? A sneeze from the Minister of Culture, and that’s it! Everyone is infected! Or is it through contact? A deal sealed with a handshake.
And, in the end, is there a vaccine against this plague? (Honestly, I’ve always thought that the only vaccine against power is philosophy as a meaningful, volitional practice of freedom).
Y.V.: Regarding our dependence on the social, I would like to add something. A person learns about themselves through what is not them — they interact with it indirectly, through a computer, for instance, and lose themselves in the vastness of the informational abyss, in the virtual-social realm. I noticed that after a year of the pandemic, many people longed for live communication, while being in a state of depressive emptiness.
When we are in isolation and «hanging» in social networks, in the social-virtual space, no one steps on our toes, no one pushes, no one whispers in our ears, we don’t smell the unpleasant or pleasant scents coming from the people around us, we don’t shake hands firmly, we don’t embrace, and we are not embraced. There is no physical contact between people.
We don’t fully perceive those we interact with, and as a result, our experience of ourselves as individuals suffers. We can’t fully touch ourselves without engaging in direct contact with another person. From here comes anxiety, panic, confusion, and emptiness.
S.F.: Did the pandemic affect the process of diagnosis and therapy itself?
Y.V.: Regarding Covid, in my view, the pandemic revealed a multitude of problems, not only purely medical ones. In diagnostics, for example, the understanding of the symptom complex of a disease depending on the stage of pathogenesis, therapy issues — frequent changes in recommended treatment regimens due to their insufficient effectiveness; vaccination as prevention also raises many questions (one of my acquaintances has had Covid five times, despite regular vaccinations in accordance with recommendations, and this is far from an isolated case).
Foucault’s ideas are very relevant in this regard, particularly his thoughts on «political medicine.» The epidemic is a tool for conquering the «public body.» Disciplining society through isolation and control, regulated movement, etc. I found it interesting to observe how it was reported that China (a totalitarian state) quickly dealt with the problem through isolation and control. We all saw what happened next.
I completely agree with you that philosophy, as a meaningful, volitional practice of freedom, strengthens the individual as a whole. One could say that it forms the foundation of a person’s choice in their individual path to development within harmonious unity.
As a doctor, I believe that modern medicine urgently needs philosophy, which it has gradually lost since the 20th century.
Y.V.: Thank you, Yevhenii, for the fascinating conversation. We’ve touched on some global topics, and I hope that in the future, we can continue this discussion. I’d be interested in exploring the ethical questions of medical practice, euthanasia, for example.
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