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then, is better grasp of the functioning of medicine as such - a proper philosophy
of medicine. Here the insight of medicine as a deontic discipline, the account of
disease and illness based on a theory of the patient as well as the close analysis of
the clinical encounter are reframing the field of the philosophy of medicine. The
adjustment of the coordinates in the title of this paper is referring to this conceptual
shift.
Key to this change in emphasis in the philosophy of medicine is the inversion
of the relation between patient and disease. Rather than understanding the patient
from disease and illness, the suffering of the patient is taken as the starting point
for the exploration of diseases. The first part of this paper is to explore the newly
adjusted realm of health, illness and disease. The consequences of this readjustment
get especially visible when read before the background of Arthur Kleinman' med-
ical anthropology. This is the second part of this paper. The third part is reading
this account of the clinical encounter based on the specific understanding of illness
and disease in front of the background of Michel Foucault's archeology of medical
knowledge.
Thus, my modest attempt in comparison with this titanic task is to read the “an-
alytic philosophy of medicine” from the background of the margins of the medical
system. From psychiatry and medical anthropology; one might say from the per-
spective of the psychic, social and cultural influences to medicine. But first let me
start with an account of the shift of the concepts illness and disease suggested by
Sadegh-Zadeh.
6.2
Mapping the Current Discourse on Health and Disease
Discussing illness, health and disease requires a philosophical foundation; a foun-
dation that in many of the accounts in contemporary medical theory is missing. The
theory of disease is founded in the concept of the patient, thus ultimately based on
anthropology. Traditionally such definitions of the human being tend to be strongly
normatively biased and thus might be challenged on ideological ground. Sadegh-
Zadeh' understands the human being becomes a patient by virtue of his suffering.
It is from there medicine as a whole gets its legitimacy. The human being in turn is
defined as a bio-psycho-social agent, as an endopoietic system, i.e. a system capable
of creating inner worlds (such as the psyche) but structured also through social dis-
courses. The organization of these inner worlds, i.e. of the psyche, is conditioned by
external discursive influences. Psychosomatic diseases thus turn out to be as much
psychosocial in origin as they actually are psychosomatic [13, p. 314]. Already this
brief account of the social factors of medicine enlarges the traditional account given
of medicine.
The understanding of the suffering human being as a living body, which in turn is
framed as a fuzzy system able to create inner worlds, serves as a background for the
following discussion of the concepts of health and disease, which has been a main
focus of the philosophy of medicine. Knowing the background of this discussion
and the unsettled dispute sheds light on Sadegh-Zadeh's exploration of field. Large
