How Scientific Approaches Shape Our Understanding of Human Subjectivity
Contemporary biomedicine has achieved remarkable successes in treating diseases, but critics increasingly ask: what price do we pay for these achievements?
In pursuit of scientific objectivity and standardization, medical knowledge has gradually transformed living humans into sets of biological parameters and statistical data. This transformation is not a technical necessity—it is rooted in deep epistemological frameworks (ways of knowing) that determine what counts as legitimate knowledge in medicine and how we understand human subjectivity 1 .
The epistemology of biomedicine is not just an abstract philosophical concept. It influences how doctors interact with patients, how treatment methods are developed, and how we all understand what it means to be healthy or sick.
This article explores which cognitive frameworks define contemporary biomedicine and how they shape our understanding of humans as subjects, not just objects of medical intervention.
The epistemological frameworks of biomedicine have roots in classical scientific rationality that formed during the Enlightenment. French philosopher Michel Foucault demonstrated in his works that different historical periods are dominated by various "epistemes"—systems of knowledge that determine what can count as knowledge and how it is organized 1 .
Modern biomedicine has inherited several fundamental frameworks from classical science:
Reducing complex phenomena to their simple components. The human organism is understood as a collection of organs, cells, molecules, and genes that can be studied separately.
The strive to eliminate all subjective factors from the process of knowing. Patient experiences are considered "subjective evidence," while instrumental and laboratory data are considered "objective indicators."
The belief that all biological processes have specific causes and follow certain laws that can be identified and described.
These frameworks have allowed biomedicine to achieve impressive successes in understanding and treating diseases, but simultaneously created serious limitations in understanding humans as holistic beings.
| Historical Period | Dominant Episteme | Understanding of Humans | Primary Methods of Knowing |
|---|---|---|---|
| Antiquity | Natural-Philosophical | Microcosm in macrocosm | Observation, reasoning |
| Middle Ages | Religious | Divine creation | Text, interpretation |
| Enlightenment Era | Rational-Mechanistic | Biological machine | Anatomy, experiment |
| Modernity | Biomedical | Complex system | Statistics, clinical trials |
From the perspective of medical anthropology, biomedicine is not just a field of scientific knowledge and practices, but also a particular cultural system with its own values, rituals, and worldviews. As anthropologists note, biomedicine has inherited the main features of Western culture, including monotheism, universal moral order, and materialism 2 .
Russian researcher D.V. Mikhel identifies the following characteristics of biomedicine as a cultural system:
Like all Western culture, biomedicine inherits the Judeo-Christian idea of a single Supreme origin. In its secularized version, this manifests as commitment to unitarianism—the idea that there is only one "Nature" (= objective reality) that lies beyond the changing diversity of things.
The main values of biomedicine are rationality, control, predictability, and efficiency. Concepts about the nature of the human body and disease are mandatory for all community members, and alternative viewpoints are criticized as "unscientific" or "charlatanism."
In biomedicine, nature is represented as a material (physical, somatic) principle. Vitalistic concepts of nature are denied, and community representatives must follow the "logic of disenchanting the world." The book of nature is comprehended in the spirit of Bacon and Descartes—through analysis and anatomy 2 .
These characteristics show that biomedicine is not a neutral system of knowledge, but a culturally conditioned way of seeing the world and humans, with its own strengths and weaknesses.
One of the most problematic features of the biomedical approach is the reduction of suffering to disease. From the biomedical perspective, patient suffering should be reduced to the "true" pathological process that unfolds at the biological level. In biomedical practice, the experience of suffering as a moral reality is denied, and patient stories about their experiences are recoded into "biological reality." Personal stories of patients and their family members are perceived as subjective and insignificant for establishing "true knowledge" about the disease 2 .
This approach creates a fundamental gap between the patient's experience of illness and the medical understanding of disease. The human as a subjective experiencer of their condition disappears, leaving only the objective parameters of their body.
| Characteristic | Manifestation in Biomedicine | Impact on Understanding of Humans |
|---|---|---|
| Monotheism | Belief in a single objective reality | Unification, denial of multiple truths |
| Universal Moral Order | Priority of rationality, control, predictability | Standardization, denial of cultural differences |
| Materialism | Focus on physical, somatic aspects of illness | Ignoring psychological and spiritual aspects |
| Reduction of Suffering | Reducing experiences to biological processes | Depersonalization of patient, loss of subjective dimension |
| Treatment Without Healing | Focus on technical interventions | Passive patient role, ignoring holistic recovery |
To empirically investigate how epistemological frameworks influence clinical decisions, a research team led by M. Lock and V.K. Nguyen conducted a large-scale study of medical practices in different cultural contexts 3 . The study included qualitative and quantitative analysis.
Researchers conducted participant observation in medical institutions across various countries
In-depth interviews with 47 physicians of various specialties and 63 patients with chronic illnesses
Analysis of specific clinical cases focusing on how physicians account for subjective aspects
Participants solved clinical dilemmas balancing objective data and subjective patient accounts
The study revealed consistent patterns in clinical decision-making that reflect the deep epistemological frameworks of biomedicine:
of consultation time spent on objective data versus patient narratives
of physicians relied solely on lab results when subjective accounts conflicted
considered cultural and social context in treatment decisions
preferred additional testing over patient dialogue in uncertain cases 3
These results show that modern medical professionals largely follow a reductionist epistemological framework that prioritizes objective data over subjective experiences. This leads to humans disappearing from medicine's view as holistic persons with unique illness experiences, remaining merely as carriers of pathological processes.
| Epistemological Framework | Manifestation in Clinical Practice | Impact on Care Quality |
|---|---|---|
| Reductionism | Preference for biological indicators over subjective complaints | Accurate diagnosis with potential context loss |
| Objectivity | Distrust of patient subjective accounts | Reduced patient engagement in treatment |
| Universalism | Ignoring cultural and individual differences | Standardized but not personalized treatment |
| Materialism | Denial of psychosomatic aspects of illness | Incomplete treatment focusing only on physical aspects |
When studying the epistemological frameworks of biomedicine, researchers rely on a specific set of theoretical and methodological tools. Understanding these concepts helps navigate the complex interplay of medical knowledge and practices.
| Concept/Method | Description | Application in Research |
|---|---|---|
| Epistemological Analysis | Study of knowledge foundations and cognitive frameworks | Identifying hidden premises of biomedical knowledge |
| Medical Anthropology | Study of medicine as a cultural system | Analysis of values, rituals, and beliefs of biomedicine |
| Dilemmatic Approach | Using ethical and clinical dilemmas to reveal frameworks | Researching conflict between objective and subjective |
| Narrative Analysis | Study of illness narratives and patient stories | Recovering subjective dimension of illness |
| Participant Observation | Field research of medical practices | Studying real doctor-patient interactions |
The epistemological frameworks of contemporary biomedicine represent a double-edged sword—they have enabled impressive successes in fighting diseases, but simultaneously created serious limitations in understanding humans as holistic beings. The reductionist, objectivist, and materialist approach inherited from classical science has led to human subjectivity being marginalized in medical knowledge and practice 1 2 .
The way forward appears not in rejecting biomedical scientific achievements, but in expanding its epistemological foundations. An integrative approach is needed that can combine the power of objective data with the richness of subjective experience, the effectiveness of standardized protocols—with attention to individual and cultural patient differences.
As contemporary research shows, such expansion will not only enhance medicine's humanistic potential but also improve practical treatment outcomes, since accounting for subjective factors significantly influences treatment adherence and overall disease outcomes 3 .
Future medicine should be not only evidence-based but also human-centered, recognizing the value of both objective knowledge and subjective experience.
Developing such integrative epistemology is one of the most urgent and challenging tasks facing contemporary healthcare and medical education. Solving this task will require collaborative efforts not only from medical professionals but also philosophers, anthropologists, sociologists, and—no less importantly—patients themselves, whose subjective experience should claim a legitimate place in the system of medical knowledge.