Trading Traditions of Cartesian Dualism for Pauline Anthropology in Critical Care: Understanding and Mitigating Post Intensive Care Syndrome (PICS)
Anna Berry, BS, Medical Student; Theology, Medicine and Culture Fellow, Baylor College of Medicine; Duke Divinity School
The practice of medicine is largely informed by our answer to the question “What is personhood?” Descartes’ view of persons as autonomous individuals with a separate body and mind gained popularity in the 17th century and significantly influenced modern scientific medicine. Eventually, the physical body became the domain of medical and surgical specialties, while the mind was the territory of psychiatry and psychology.
In recent years, medicine’s acceptance of Cartesian dualism has come into question. However, the notion of dualism is deeply ingrained in the traditions of scientific medicine and continues to implicitly inform its practices. This idea is especially evident in the critical care setting where reduction and mechanization of the patient results in an exaggerated focus on the corporeal.
Though the intense focus on support of the physical body is necessary for survival, it also risks neglecting or harming other aspects of the person. I propose that this harm is evident in the constellation of symptoms recently recognized as Post-Intensive Care Syndrome (PICS). Coined in 2010 by the Society of Critical Care Medicine, PICS describes the “new or worsening impairment in physical…, cognitive…, or mental health status arising after critical illness and persisting beyond discharge from the acute care setting.” A related phenomenon has also been observed among the family members of ICU patients, currently known as PICS-F.
PICS demonstrates that a patient’s experience of illness and medical intervention affects far more than the physical body. Though not directly receiving care, family members are also significantly impacted by their experience within the critical care setting. Whether overtly or implicitly, if persons are thought to be both separate and strictly autonomous, the phenomenon of PICS can neither be fully understood nor addressed.
I propose that Paul’s understanding of the body offers an alternative framework. In Paul and the Person, Susan Eastman utilizes perspectives on Paul’s anthropology to suggest that persons are “embodied and embedded.” As such, the physical body is inseparable from the mind. Though persons are individuals, they are not explicitly autonomous because they are simultaneously constituted by, and thereby vulnerable to, their environment and community.
In this paper, I will describe how an understanding of persons through the lens of Paul’s anthropology reveals interactions between the patient, ICU environment, and family that contribute to and enhance understanding of PICS and PICS-F. I will then describe how this framework can inform the care of persons in the intensive care unit, potentially mitigating the effects of PICS.
Davidson, Judy, Christian Jones, Joseph Bienvenu. “Family response to critical illness: postintensive care syndrome-family.” Critical Care Medicine 40, no. 5 (2012): 618-624. doi: 10.1097/CCM.0b013e318236ebf9.
Eastman, Susan. Paul and the Person. Grand Rapids, Michigan: Eerdmans, 2017.
Mehta, Neeta. “Mind-body Dualism: A critique from a Health Perspective.” Mes Sana Monographs 9, no. 1 (2011): 202-209. doi: 10.4103/0973-1229.77436.
Rawal, Gautam, Sankalp Yadav, Raj Kumar. “Post-intensive Care Syndrome: an Overview.” Journal of Translational Internal Medicine 5, no.2 (2017): 90-92. doi: 10.1515/jtim-2016-0016.
In recent years, medicine’s acceptance of Cartesian dualism has come into question. However, the notion of dualism is deeply ingrained in the traditions of scientific medicine and continues to implicitly inform its practices. This idea is especially evident in the critical care setting where reduction and mechanization of the patient results in an exaggerated focus on the corporeal.
Though the intense focus on support of the physical body is necessary for survival, it also risks neglecting or harming other aspects of the person. I propose that this harm is evident in the constellation of symptoms recently recognized as Post-Intensive Care Syndrome (PICS). Coined in 2010 by the Society of Critical Care Medicine, PICS describes the “new or worsening impairment in physical…, cognitive…, or mental health status arising after critical illness and persisting beyond discharge from the acute care setting.” A related phenomenon has also been observed among the family members of ICU patients, currently known as PICS-F.
PICS demonstrates that a patient’s experience of illness and medical intervention affects far more than the physical body. Though not directly receiving care, family members are also significantly impacted by their experience within the critical care setting. Whether overtly or implicitly, if persons are thought to be both separate and strictly autonomous, the phenomenon of PICS can neither be fully understood nor addressed.
I propose that Paul’s understanding of the body offers an alternative framework. In Paul and the Person, Susan Eastman utilizes perspectives on Paul’s anthropology to suggest that persons are “embodied and embedded.” As such, the physical body is inseparable from the mind. Though persons are individuals, they are not explicitly autonomous because they are simultaneously constituted by, and thereby vulnerable to, their environment and community.
In this paper, I will describe how an understanding of persons through the lens of Paul’s anthropology reveals interactions between the patient, ICU environment, and family that contribute to and enhance understanding of PICS and PICS-F. I will then describe how this framework can inform the care of persons in the intensive care unit, potentially mitigating the effects of PICS.
Davidson, Judy, Christian Jones, Joseph Bienvenu. “Family response to critical illness: postintensive care syndrome-family.” Critical Care Medicine 40, no. 5 (2012): 618-624. doi: 10.1097/CCM.0b013e318236ebf9.
Eastman, Susan. Paul and the Person. Grand Rapids, Michigan: Eerdmans, 2017.
Mehta, Neeta. “Mind-body Dualism: A critique from a Health Perspective.” Mes Sana Monographs 9, no. 1 (2011): 202-209. doi: 10.4103/0973-1229.77436.
Rawal, Gautam, Sankalp Yadav, Raj Kumar. “Post-intensive Care Syndrome: an Overview.” Journal of Translational Internal Medicine 5, no.2 (2017): 90-92. doi: 10.1515/jtim-2016-0016.