By Afonso Carlos Neves:
The physician and historian Mirko Grmek elaborated the concept of “pathocenosis”. Pathocenosis is about several factors that work together to the inception of a disease/ilness/sickness. These are social, cultural, economic, politic and anthropological factors.
It is important to explain the difference of the three words: disease, ilness and sickness. “Disease” is the biological or biomedical aspect of the unhealthiness. “Ilness” is about how the individual patient feels or live his disease. “Sickness” is the communitarian aspect of the disease; it is about how a social or cultural group live this disease.
The nowadays pandemic of coronavirus is a pandemic of the after-postmodern times.
The Contemporaneous Era started with the French Revolution (1789) e its first consequences. The first part of this Era some can call “The Modern Period” (different of the Modern Era between 1453 and 1789). In a general way, each historical period has a dominant bias and its opposite.
At the Modern Period happened the Industrial Revolution, and a great development of Technology and Science. At the same time the Romantic Movement was a kind of opposite. During this Period, a kind of Ethics based on a principle elaborated by Thomas Aquinas gained space: “the end doesn’t justify the means”. It signifies that we cannot use any mean to achieve an objective. This objective cannot be sovereign over anything. The way to achieve this objective must be ethic.
In the Modern Period several idealisms progressed based in ethical principles (we cannot forget that all was not flowers). In the transition of 19th and 20th centuries, in the so called “Belle Époque”, it was a “time of certainties”, with a growing optimism about scientific discoveries and social development. But, the First World War (1914-1918) caused a strong cut of certainties and even a kind of ingenuity about the supposed “last war”, or “the war of wars”. The post war world became a “world of uncertainties”, like, for example, “the lost generation” of Ernest Hemingway. And this vacuum and emptiness created space for totalitarianism. So, the Nazism conducted to the Second World War. In those days, idealistic people, like, for example, the French Resistance, won the war. The world was reconstructed step by step. In this environment The World Health Organization was founded in 1948.
With the economic progress, in 1950 started the Postmodern Period that endured until 2001/2008. This Postmodern Period saw, gradually, that ethics and idealisms became secondaries to the objectives and search for results. From 1980, subjectivity lost value to objectivity. Predominated pragmatism, efficiency and results, instead of ethics, subjectivity and arts in a deep meaning.
Between 2001, the year of the WTC fall, and 2008, the year of the start of Economic Crisis, it happened a transition to the Post-postmodern Period. At this time, it started a decadency of pragmatism, efficiency and results as dominant factors, and Ethics as a central question came back, together with a revaluation of subjectivity. All these things are is coming on the way.
In all these referred periods, medicine passed through several phases. It was not the same between 1800 and 2020. So, the society changed, the survival time for human being expanded, technological resources progressed, and other factors changed.
Asclepius and his daughter Hygieia (Greek Roman Mythology). Woodcut engraving from the the book “Der Olymp oder die Mythologie der Griechen und Römer (The Olympus or the Mythology of the Greeks and Romans)”, published by A.H. Petiscus in C.F. Amelang’s Verlag, Leipzig (1878, 18th edition)
In nineteen seventies, people lived less. The medical resources were good, but less than now. It was difficult to find a surgeon that operated a patient with 70 years old, because of the great risk. Today, age is not anymore an isolated factor for decide to operate or not. In the same way, it was uncommon to intubate a patient above 70 years old, because of the risk, and the ventilators were less sophisticated than today. If in those days it appeared a pandemic like that of coronavirus, with a survival tax less than now, it would be different the focus about intubate severe cases. Although the coronavirus was already known, there were less technology to identify “the new coronavirus”.
In 2020, people live more. In this pandemic, aged people are those that suffer more. But the technology advanced enough to intubate them. Intubation for aged people is not anymore a sentence of death. So, indication of intubation is now a responsibility of medicine with these patients. Beyond them, there are more people with chronic disease than in nineteen seventies, not just because the population augmented but also because medical resources can keep these people alive for more years. The medicine has responsibility with these patients too.
The pathocenosis of the Covid-19 implies in all complexity of factors present in 2020, that make this pandemic to be a pandemic with its rules of quarantine and isolation.
Some people with a mentality of 1960/1970 years think with the medicine of those days, with the society of those days, seeing socio-cultural ghosts of those days.
Positive and negative factors always were present in the history of mankind. The Middle Ages were not the Dark Ages, as The Illuminist Period was not the Light Age. The Darkest century for mankind, for instance, is the 20th century.
In 2020, there are also negative and positive factors, but medicine is obliged to do what it must do, with its ethic imperatives. We used to say that there is not disease, there is the ill person. Diseases change, pathocenosis change. The person that suffers is always present.
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Afonso Carlos Neves:
I am a doctor graduated from the Escola Paulista de Medicina in 1979, a neurologist, master and doctor in Neurology from EPM, with a Post Doctorate in Neurology at the University of California, San Francisco. PhD in Social History of Science by FFLCH; I had published books of fiction, essays and historical research. In 2015 I had the opportunity to participate in a Workshop on Narrative Medicine with Rita Charon at Columbia University, NY. I always had a “foot” in Humanities and the Arts. So, while studying medicine, I improved a little in music and writing. Since I entered college, the question of the human “bothered me”, in situations where science, or the behavior resulting from a way of being or thinking were centered on a scientific triumphalism. I found wider paths with colleagues, with some teachers and with other people, with books, with records, with films, etc., etc. I also have a mystical / religious trait that influenced my concern with the human.
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