Unorthodox route to excellent science

Case

Unorthodox route to excellent science

Jenny Slatman argues for more attention to be paid to the body in healthcare

Although (or perhaps because) philosopher Jenny Slatman was made a professor at Tilburg University early this year, she retains a pleasing sense of perspective. ‘It’s a megalomaniac discipline, that philosophy of ours. We might study colossal questions, but I don’t need to make any investments. My most expensive purchase? A voice recorder for my interviews’, she chuckles.

Photo Jenny SlatmanJenny Slatman. Photo: private collection

Her appointment as professor at the beginning of this year was, at the very least, a prestigious achievement – the NWO Vici grant of 1.5 million euros which arrived a month later, on top of the earlier Vidi and Aspasia grants, crowned her scientific success. The baker’s daughter from Gramsbergen in the Dutch province of Overijssel – the Saxon spiced gingerbread produced by the Slatman Bakery still enjoys regional fame – smiled humbly at the compliment. ‘If you concentrate as much as you can on the things you think are the most important and waste as little energy as possible on side issues, you can make a lot of progress. That would be my message.’

Attention to the body

In her Vidi project, Slatman conducted research into how people deal with unwanted changes in the body, such as scars following breast, head and throat cancer. The main question was whether and how they are able to identify with their new appearance. Slatman and her PhD students conducted countless interviews – hence the voice recorder – with patients who had undergone breast surgery (mastectomy or breast-conserving surgery) and patients who used facial prosthetics, such as a silicone nose or ear.

In her new Vici project, Slatman has shifted attention from the after-effects of cancer to other enormous contemporary health problems: medically unexplained physical symptoms (MUPS), obesity and depression. The title of Slatman’s project is Mind the body: a witty reference to the overarching theme in the philosopher’s flow of ideas: more attention needs to be paid to the body in healthcare. There is a strict dualism in healthcare between mind and body: if the cause of a complaint cannot be found in the body, the search for a cause then moves quickly to the psyche – a dead end, thinks Slatman.

‘When I was still teaching medical students’, Slatman recalls one autumn afternoon in Tilburg, where a watery sun even manages to brighten up the workspace, ‘I would often ask them: what do you think the psyche is? Or the mind? They would invariably reply: “Everything that isn’t somatic.” Well, that doesn’t get you anywhere, does it.’

Mind-body dualism

On Friday 24 November, Jenny Slatman (1969), Professor of Medical Humanities, delivered her oration: Beyond the mind: Reflections on healthcare from the perspective of the Humanities. In this oration, the brand-new professor will demonstrate, with an appropriate dose of humour, that healthcare must not get stuck in the cul-de-sac of ‘mind-body dualism’. Thinking in terms of ‘our mind’ should be a thing of the past; medicine ought to embrace a broader understanding of physicality.

Did you know? Of all the patients GPs see in their consulting rooms, 40 percent are suffering from ‘medically unexplained physical symptoms’ (MUPS): symptoms they feel physically, but for which there is no clinical explanation

‘Medically unexplained physical symptoms’ (MUPS) are symptoms you feel physically, but for which there is no clinical explanation. Such symptoms might be fatigue, pain, headache, back pain, joint pain, tinnitus, dizziness and so on. And it is estimated that 40 percent of cases GPs encounter in their consulting rooms are of this nature.

Slatman is fascinated by this. ‘Masses of people in the sector recognise this. When I went for my interview to defend my proposal, the Vici committee happened to comprise a large number of doctors, and they sat there nodding vigorously at this. Because the mind-body dualism is so strong in medicine, these types of “unexplained” symptoms are attributed to the psyche or the mind; it’s all in the head, people often say… Well, I reckon it’s a bit more complicated than that.’

Photo: René Descartes (ss)Photo: René Descartes (ss) Shutterstock

Cartesian dualism

Did Jenny Slatman follow a straight and neatly paved path to a career in science? Not at all, given her unorthodox history. ‘I went from secondary school (Dutch havo) to study physiotherapy at the University of Applied Sciences in Deventer’, the friendly prof recounts. ‘And after that, I spent a long time in practice delving into the human body! However, physiotherapy is a positivistic study. Anatomy books are shoved in front of you telling you: this is how we fit together. Well, I very soon discovered that patients don’t fit together like that at all. Don’t forget I was very young then, and timid too; people I saw in my practice had been declared unfit for work or were in the middle of a burnout, and they had all sorts of physical symptoms. That made me think: goodness, there must be more going on here.’

Jenny Slatman went to study philosophy at the University of Amsterdam. Three years into her studies, she was overwhelmed with an enormous drive, she remembers. After graduating with full marks for her dissertation, she was awarded a grant to do a PhD. ‘My thesis (cum laude – ed.) discussed Maurice Merleau-Ponty, a contemporary of Jean-Paul Sartre. This French thinker disputed “Cartesian dualism”, the divided worlds of mind and body: between subject and object. He wrote that, of course, the body is an ‘object’ which you can observe and which can fail. But it is also a subject! Through “embodiment”, you are the baseline for all actions and observations. According to Merleau-Ponty, it isn’t a hypothetical psyche or intangible rationale that gives significance to our lives and the world; we do that primarily from that embodiment.’

The Anatomy Lesson of Dr Nicolaes Tulp by Rembrandt: one of the most popular paintings in the Mauritshuis museum in The Hague. Photo: Hollandse Hoogte / Fred HoogervorstThe Anatomy Lesson of Dr Nicolaes Tulp by Rembrandt: one of the most popular paintings in the Mauritshuis museum in The Hague. Photo: Hollandse Hoogte / Fred Hoogervorst

A tendency nowadays is to relate all sorts of problems, including health problems, to problems in the brain. After all, if our bodies are such wonderful machines, with the brain at the controls of a complex system of cells and blood vessels and neural connections, illness must just be a malfunction of that machine.

Slatman laughs again. ‘By taking that view, the mind is “bypassed”, or in fact the “mind” is replaced by the brain. Quite a simplistic idea, since the fact that the brain is “embodied” is entirely ignored: that it functions in a particular way because it is embedded in a particular body, and because it gets its input from a particular interaction between the body and its environment. A philosopher cannot be content with this. Nevertheless, this way of reasoning is fairly dominant in modern-day healthcare.’

À la Nicolaes Tulp

The name of the seventeenth-century thinker René Descartes did not come up by accident. Back then, he was the one who argued that body and mind encompassed two worlds. You could cut open the body and make all sorts of repairs inside it à la Nicolaes Tulp. The mind had nothing to do with that. Surgery, which for centuries prior to that was a sort of fairground attraction which the patient usually did not survive, underwent rapid development and became a sensation.

Slatman: ‘Three centuries have passed. Just look at all the incredible developments in the fields of transplantation and reconstruction! A success story. The body as object is perfectly consistent with that. And is even desirable as such, in a certain sense. But here too, we are still assuming this distinction, whereas the steady stream of patients with complaints such as obesity, burnouts, depression and so on seems almost unstoppable. Clinical practice is more complicated than just taking an objective look at the body.’

Back pain is different for an inactive person who likes solving cryptic crosswords than for a keen amateur gardener
- Jenny Slatman

Almost everything a healthy person does is done unthinkingly. Sitting, walking, scratching your head, making tea… Slatman: ‘Do I think of something and then do it? Of course not! I do things, I act, without thinking about it. Very physical actions. But people whose bodies are in pain notice that their lifeworld is troubled by this. Back pain can be very different for an inactive person who likes solving cryptic crosswords than for someone who is a keen amateur gardener. Are we aware of that? I am trying to find answers to these and countless other questions.’

For the time being, Jenny Slatman is a contented person. ‘Vici gives me the opportunity to work across different disciplines, at the interface of philosophy, anthropology and humanities. It represents confirmation and recognition. My opportunities to expand are enormous!’