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there are so many replies that i got confused as to where to place this. so i just wrote about the philosophy of medicine, as i understand.
Medicine is the only field where the tool and the patient are the same kind of things - one complex human system meeting another complex human system. That is not a limitation, which needs to be overcome. It is precisely the practice.
Medicine is basically a field where no single model is complete, and the models are always being revised.
By model, i mean it is a simplified picture of how something is or how it works. And it is useful exactly because it leaves things out. Doctors are a special kind of cartographers trying to build up better and better maps to different types of territories.
How do we build those? We started with dissecting the human body, of a cadaver precisely not alive human. Some of us had experience with dissecting a frog or cockroaches (plenty a dime at my place). if you have never seen an open frog, you would be very surprised how much empty it really is. so we cut open a cadaver slowly, methodically, and matched with the photographs in an accompanying manual. we did what it asked us to do, and we continued to match and understand the specific naming systems. the naming systems and particular language are a new language which we learnt so that we can read and talk through that new language with other doctors and nurses and be sure what we are trying to convey is correctly and unambiguously understood by them. and we use it to read books, articles, journals, all life.
Over time, we got comfortable building those new language and mental models of how some particular structure in body is seen and how it is expected to be at a certain place only and not at some other place. Then we shifted to not normal stuff aka pathology. Those normal structures - how can they go wrong. so that knowledge was built upon multiple such cuttings of not-normal structures. We built branches over our normal mental models. eg. the stomach model has this normal model and these abnormal models (which can be of a huge variety).
We also pattern matched these newer not-normal models to find patterns across multiple structures and systems. So, we found Infection Models work reasonably well across the Stomach model, Liver model, Kidney model, etc. This all works pretty well for most of the structures.
Except the brain system. The system is completely different from all other systems. For example, it has a different way of blood supply. Which we named blood-brain-barrier (just a model to say that there is some kind of barrier to normal passage of stuff between the brain tissue and blood).
Over time, more correctly in only last few decades, we have started to see the brain in exquisite detail live and we have been able to have some understanding of which side and which parts of it do what (or get active doing some particular activity).
So for brain things, the models are relatively new and they have to be assessed in terms of what the patient says about his problems, how we are able to see what is happening, what we give (by trial and error) and how it affects the patients. we keep on doing it, write the entire process and revise it more and more. since it is a relatively new field, there are lot of competing what-to-do models, including non-medicinal models and medicine-models. we have done lot of experimental stuff to name all the various little parts of all these models (namely the little chemicals which go to and fro), but they are mostly arbitrary. imo, we are a long way from deep understanding.
The brain has a different problem too. The structure of brain and the function of brain are very disjointed categories. like if you are reading this line, a combination of light pattern goes from this LED to your eyeball, to a functioning wire connecting the back of the eyeball to back of your brain, and then it lights up a particular set of other wires, which are criss-crossed across lot of other brain parts. This is just this little reading line. add the memory of this particular style of light pattern with what it means. now build upon this layer of complexity to what things are normal (the normal model). what things are out of normal (huge number of other not-normal models). and what-to-do models about all those.
When someone thinks of DSM as some sort of fixed written well defined set of maps, i think it is a wrong idea - it is like confusing the map with the territory. IMO, it is a good (at present) way to have a comprehensive set of loose maps. and it will be revised as our understanding gets better, sometimes worse before getting better. sometimes, there will be paradigm shifts.
Same with the genetics parts: yes, those are some newer models, in which we pattern-matched some particular sequences with some disease patterns, because we found few which were absolutely always associated with one particular way of the patient's model of behavior (we call them sure-shot way to label a model). and at other times, it was just found to be more common (we call them more or less probable ways of having a particular set of problem model).
But my base understanding is: Medicine is an interactive playing of what patient shows up, what lenses the doctors have, what models are used to try to change the course of patient's behavior and how it can help in changing the course. At times, it is as simple to sit and listen to the patient and the doctor needs to lend the ear and hold the hand. And at other times, it is a full fledged active working of doctor, a nurse, and 3 attendants to tie the patient and give a sleeping medicine.
So, given how much of this is model-stacking on model-stacking, where does the irreducible human encounter fit? I don't think it as a failure of science, but as the thing which makes medicine medicine and not engineering.
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