Extract

Sir, In their original and provoking paper Hazemeijer and Rasker [1] conclude: “Science has had and will have much to offer for the diagnosis and treatment of diseases. But society and medicine have to turn to philosophy rather than to science for the solution of treating and preventing ‘syndromes’ like fibromyalgia”.

Being a philosopher, I am honoured by this statement, but, more importantly, I am impressed by their analysis. The authors try to escape three reductionist strategies in handling a complex of vague complaints, as in the case of fibromyalgia: a reduction to physical causes, a reduction to psychological processes, and a reduction to labelling activities. They introduce a convincing argument in putting forward a much more intricate concept, borrowed from the philosophy and sociology of science: the concept of the therapeutic domain. In this domain, symptoms and laboratory results, the behaviour of doctors and of patients, personal expectations and messages in the media, language and organization, are co-evolving in a number of looping processes.

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