The Body Speaks: What Do Nurses Hear?

The nursing discipline has a rich legacy in understanding disease in human terms. Efforts to strengthen this understanding are reflected in calls for holistic, person-centered care. Person-centered care, however, will remain largely aspirational as long as the biomechanical paradigm of the body that descends from Descartes' thought is privileged in health care. This paradigm treats disease as an anatomic fact while disregarding patients' illness experiences. The biomechanical body speaks in the scientific language of disease via lab values, vital signs, radiographic studies, algorithms, guidelines, and "care bundles" while the lived body, as described by Merleau-Ponty, expresses the patient's experience of illness. We describe the philosophical origins of the biomechanical and lived body paradigms; illustrate both paradigms by referring to the medical and nursing care of a patient with ovarian cancer; and identify forces that privilege the biomechanical body in contemporary health care. While we applaud efforts to strengthen patient-centered care by melding conceptions of the medicalized and lived bodies in nursing education and clinical practice, we fear that these efforts will gain little purchase in corporate health care systems that closely align with the Cartesian paradigm of the body.