Systems View of Health: From Parts to Whole.

German word Gestalt: The Whole is More than the sum of its parts.

I have been a practicing Oral Maxillofacial Surgeon and an academician for more than two decades. In these twenty years, my understanding of illness and health has seen a sea change.

While pursuing my BDS in a Dental College in the early 90s, we were taught every aspect of tooth and jaws and diseases related to it and how to fix them. But my mind wandered elsewhere. As a curious being I wanted to know more about the human being sitting out there holding those teeth in her mouth and jaws. And that led me to a lifelong quest of interconnectedness of parts to whole.

The whole of a human phenomenon is very different from an individual part of the body. Just the whole of a car is very different from its individual part. The whole is different and much more complex than the individual parts. Yet when it comes to the understanding of human bodies and diseases afflicting it, the current biomedical model of medicine does this in the form of parts. With specializations and super specializations, the human form is broken down into smaller and smaller parts. In this reductionist view, mind and cognition are separated from the body.?

The implications of such an approach are, one, a lot of technology has entered into medicine which is helping doctors to get insights into deep dark places of human bodies in search of sickness . Two, pharmaceutical breakthroughs have enabled us to kill and cure the deadliest of viruses and cancers. But all this progress has come at a cost.

?The complete focus on smaller and smaller parts has led us to lose sight of the context of a human being. Chronic autoimmune illnesses are on the rise. Even though we are able to treat most forms of cancers, their incidence is higher than ever before. The rate of anxiety, depression, and addictions is at its peak. The healthcare system is struggling everywhere to provide "health" to the dis-eased.

?How did all this come through? On dwelling deeper into the search of the history of modern medicine, one comes across paradigm shifts from holistic approach to reductionism, and currently, once again, interest in holism is observed due to widespread dissatisfaction with the medical field as practiced today.

?The reductionist or mechanistic approach initially started emerging in the 17th century through the work of several thinkers, philosophers, in which the name of René Descartes stands prominent. He was not only the first modern philosopher but also a brilliant mathematician.Cartesian thought, as it is widely known, was based on mathematical principles which were definite in its nature. Certainty of nature and natural phenomena was achieved through mathematical equations during his time. His most celebrated statement, "Cogito, ergo sum," meaning "I think, therefore I exist," through clear analytical thinking, truth could be deduced.

Descartes' "cogito" made the mind more certain for him than matter (body), which led to the conclusion that the two were separate and fundamentally different. This was the great Cartesian split. René Descartes influenced scientific thought and physics of his time. Eventually, as we entered the industrial age, this Cartesian split entered into other scientific fields like biology and economics.

?The consequence of Cartesian reductionism on the advancement of biology was that the human body was understood like a clock, a machine. And the concept of disease then developed as a fault in some part of the clock which needed to be diagnosed and repaired. Once repaired, the clock (here human body) would resume its function normally. This is how the modern Biomedical model of medicine came into existence in its current form. While the reductionist approach focuses on the parts, on the other hand, the systems approach looks at the interconnectedness of these parts through processes. It focuses on the disease in the context of an individual, which is her society and culture.

?The other day, I was sitting with a friend of mine, sipping hot coffee in this lovely weather, and our conversation took us in various directions... our past and histories... that's when she revealed her ordeal with the medical system when she was diagnosed with Rheumatoid arthritis at the age of 19-20 right after a stressful life event (in this case, marriage)... In search of the right treatment for this painful debilitating condition, several doctors and specialists were consulted... in one such encounter, the doctor looked at her reports (and not her) and coldly clinically said, "looking at these, all that I can say is, you are at high risk of cardiac failure." She was mortified and left the clinic in shock, deciding never to go back to that doctor.

Well, this is the state and fate of modern-day medicine, where the doctors sitting across the table, with laptops and mobiles all around, have lost touch with real human beings... Technology has replaced all human needs and emotions efficiently. With artificial intelligence and all things complicated, technology is now on the verge of replacing human doctors completely.

So, a while back, I had asked this same question with a few of my patients and colleagues... Whom would you like to see and meet if you were to wake up in an ICU after surgery? A bunch of wires and machines analysing and calculating all your vitals and giving accurate readings of every second, or a compassionate smiling fallible human doctor who is holding your hand gently and making you feel, don't worry, everything is okay.

?We all know what our answer would be. While the reductionist model of medicine, heavily aided by technology, is something that cannot be avoided, the healthcare system can strive to bring some holism in its workings by making hospital atmospheres more humane and less intimidating, and doctors can attempt to connect with their patients as fellow human beings, gently nudging them towards the path of healing and recovery.

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Let our patients say more often to us... 'Doctor, most of my sickness disappears when I meet you and talk to you.’