Being Scientific in the Human Domain: From Biomedical to Biopsychosocial
We include as biology not only the data obtained by observing other individuals and things but also those that we reach through [our own inner experiences of living]. The biologist is himself of the same material of which are composed the living things that he studies.
H.S. Jennings, 1933
Biologist Herbert Spencer Jennings’ early insistence that “inner experiences” are proper data for biology was my first encounter with the idea that the use of subjective data need not violate the conventional requirement for scientific respectability. Quite by chance, in 1937 as a college student, I had stumbled on Jennings’ Behavior of the Lower Organisms.1 As a biologist, Jennings deemed his inner experience as a living organism no less integral for understanding living systems than his outward observations that were customarily relied on for information about the physical (nonliving) universe. However, some 20 years would pass before the complementarity of outer observation and inner experiencing fully took hold for me as a physician and helped me define the requirements for being scientific in the human domain.2–9
As a profession and an institution, medicine owes its origin to three distinctively human attributes. First, we humans are aware of death and its inevitability and we realize that feeling and/or looking bad (“sick”) may be its portent. Second, we suffer when our interpersonal bonds are sundered and we feel solace when they are reestablished. Third, we are capable of examining our own inner life and experience and of communicating them to others via a spoken and written language. Critical for all three and for the work of the physician is the distinctively human capability of using words to communicate both what is being observed in the outer world, as well as what is being experienced within the inner world. For each of us the distinction between sick and well is preeminently manifest as inner experience, which must be communicated verbally in characteristic ways to become known. Surely, as scientists dedicated to organizing our experiences and formulating observations, we should be careful to define science in such a way as to be able to include verbal reporting as legitimate data.
From biomedical to biopsychosocial refers to an historical transition in scientific thinking that has been taking place over the past century and a half.6 Particularly pertinent for medicine is its explicit attention to humanness. That alone identifies biopsychosocial as a more complete and inclusive conceptual framework for guiding clinicians in their everyday work with patients. Physicians have always depended on what patients have been able to tell them about the experiences that led them to seek medical attention. This is testimony that the importance of verbal exchange between patient and physician is the primary source of the data required for the clinician's task. Scientists studying sick, ...