This edited volume proposes the framework of fixing and healing to think about the tension between reductionist and holist orientations toward health and illness. In Joseph E. Davis’ introduction, he defines healing as an integrative, humanistic approach opposed to individualizing and decontextualizing tendencies within medicine, public health, and bioethics. In contrast, Davis uses fixing to describe biomedical and social scientific approaches in which disease is treated as an isolated mechanical problem in the individual body. While acknowledging the advances made possible by the reductionist fixing method, the authors in this volume argue that it is ultimately insufficient for addressing the medical and bioethical challenges of the present. Holism, or healing, is presented as a compelling but often overlooked alternative.
The book, which includes historical, philosophical, sociological, and psychological perspectives, is divided into three parts. Part I, “Reductionist Medicine in Cultural Context,” seeks to understand the moral and cultural logics and enduring persuasive power of the reductionist biomedical model. By analyzing the deep-rooted assumptions that prop up reductionism, the authors hope to create more space for holistic perspectives. In chapter one, Joseph E. Davis argues that the cultural authority of biomedicine rests on “an image of objectivity and moral neutrality” (35) that has proven particularly impervious to critique. Davis traces this image historically, revealing its origins in seventeenth-century notions of nature as an orderly collection of law-obeying facts and nineteenth-century therapeutic optimism that diseases – newly understood as discrete entities – could and would be precisely targeted by disease-specific treatments. The following chapters in this section look to the more recent past. Christina Simko analyzes the American depression memoir, a genre that first emerged in the 1990s in tandem with SSRIs and an increasingly biochemical framework for understanding mental illness. Simko describes how “biomedical accounts” serve as powerful but double-edged narrative devices, giving authors the ability to reframe depression as something other than a moral and social breach, while failing to capture the experiential complexity of mental illness. Luis E. Echarte and Robert Dingwall’s chapters take strong critical stances as they follow the biomedical model as treatment bleeds into enhancement and reemerges as a consumer good. Echarte is opposed to human enhancement and wonders if the nontherapeutic use of psychopharmaceuticals might lead to “alienating people from themselves and undermining their capacity for effective resistance” (104). In a similar vein, Dingwall critiques the rise of the “model of the patient as the active consumer of a luxury good” (110), pointing to a close fit between reductionist medicine and the politics of individualism to explain the relative neglect of holistic approaches grounded in notions of moral and collective responsibility.
Part II, “Reductionist Medicine and the Disease Burden,” examines global shifts in responses to disease and disorder. The first two chapters trace trajectories in which holistic approaches have been overshadowed by reductionist methods. Anne Hardy’s chapter looks at how public health interventions have changed in emphasis from cure to prevention as focus has shifted from infectious to chronic diseases. Hardy argues that if infectious diseases were seen as suitable objects for state intervention, the prevention of chronic diseases appears to demand an individualizing focus on lifestyle choices. Deborah Lupton makes the related claim that digital technologies that allow individuals to gather data about their bodies and behaviors with an eye to improving health and preventing disease are perhaps the inevitable outcome of the public health policy shift from environment to individual and from social justice to personal responsibility. The following two chapters look at urgent challenges in public health and argue that they demand holistic responses. Jon Arrizabalaga’s chapter points to the HIV/AIDS pandemic in sub-Saharan Africa and the “irresponsible use of biotechnological innovations by elements of the pharmaceutical, cosmetic, food, and agricultural industries” (177) as evidence of the inadequacy of the biomedical model for addressing infectious diseases on a global level. Bruce K. Alexander makes a similar argument about what he sees as the medicalizing and moralizing tendencies in mainstream biomedical views of addiction. Instead, he argues that addiction is best seen as a consequence of social fragmentation that leads to “dislocation,” which may become increasingly prevalent as “the steamroller of modernity systematically crushes societies everywhere” (226).
The final section, “The Need for a More Holistic Ethical Discourse,” takes on bioethics and questions of responsibility. John H. Evans’ chapter takes a close look at the development of public bioethics in the United States, arguing that the field’s institutional and ideological embedding within the medical and scientific professions has rendered it “incapable of offering an effective critique of medicalization” (242). Jeffrey P. Bishop offers a similar take on bioethics in a chapter examining the history of reform movements. Bishop suggests that all of the reform efforts he analyzes – including theological, humanistic, and biopsychosocial movements – end up “reproducing the very thing they seek to reform” (265) as they become subsumed by biomedicine and reorganized to serve its purposes. Where Evans and Bishop point to the limitations of professional bioethics, Ana Marta González makes a case for maintaining an ethical language. González’s chapter argues that the increasing use of medical vocabulary to discuss the ethical, emotional, subjective, and social aspects of human experience blurs discursive boundaries between the healthy and the good. If substituting the seemingly uncontroversial concept of the healthy for the more politically charged question of the good is often an effort to avoid conflict, González argues that questions about health, responsibility, and resources in society are always ethical questions that therefore require public discussion.
Ultimately, as Davis notes in the conclusion, while the contributors to the volume do not “[portend] a seismic shift toward holistic approaches,” they do “offer hope for change” (310). Readers who support a more holistic orientation to health and illness will find both reasons for optimism and ammunition against reductionism. At times, however, some of the critiques of reductionist biomedical models veer into hyperbole – is society really the kind of thing that can be “crushed” by a “steamroller of modernity”? Nevertheless, To Fix or to Heal is an exciting and interestingly eclectic volume and a valuable contribution to the scholarship on ethics, public health, and justice.