causality in medicine

From Big Medical Encyclopedia

CAUSALITY (synonym causality) in medicine.

Causality — the philosophical category reflecting objectively necessary genetic linkage of the phenomena from which one phenomenon (reason) under certain conditions with need causes emergence of other phenomenon (the investigation or action). Development of theoretical concepts in medicine is directly connected with character and depth of understanding of the Item.

The traditional understanding of P. as the relations of «necessary generation» of the phenomena as a result of material interactions goes back to an extreme antiquity.

V. I. Lenin wrote: «The millennia passed since the idea of «communication of all», «chains of the reasons» arose (V. I. Lenin. Half-N of SOBR. soch., t. 29, page 311). Crucial importance in formation of the concept «causality» in the childhood of the world was played by practical activities. The comparative analysis of etymology of the words expressing the concept «causality» of classic languages which is carried out by O. V. Masliyeva (Sanskrit, Ancient Greek, Latin, some Romance, Slavic and other languages), shows communication of values of these words with designation of practical actions, instruments of labor or any parties of production. It convincingly shows justice of Marxist situation, according to Krom «... thanks to activity of the person idea of causality, idea that one movement is the reason of another» (K. Marx and F. Engels is also proved. Compositions, t. 20, page 545).

Having arisen at a certain historical step of development of public practice, the category P. along with other philosophical categories acts as the fundamental concept of scientific knowledge displaying the most general parties of interrelations of processes and the phenomena of the real world. Specifics of understanding of P. define the general orientation of scientific research. Being very closely connected with the solution of the main question of philosophy, P. knows «... especially importance for definition of the philosophical line of this or that latest «-ism»...» (V. I. Lenin. Pauly. SOBR. soch., t. 18, page 157). Depending on what is chosen researchers as a source of knowledge of causal relationships (objective pattern of reality or property of our mind and ability inherent in it to learn the world surrounding us) and the immemorial issue of any philosophy of the relation of thinking to life is resolved (see. Materialism and idealism ), what, in turn, predetermines character and an orientation of scientific research.

Materialists, proceeding from recognition of primacy of matter, life and secondariness consciousnesses (see), thinking (see), claim that our knowledge P. reflects objectively existing bonds and interaction of things, phenomena of the real world. At the same time supporters of materialistic understanding of P., starting with Ancient Greek naturalistic philosophy representatives and, first of all, the atomist who created the doctrine about system of causal relationships in the nature proceeded from idea of the world, in Krom «natural causality» reigns. Therefore the materialistic direction in science (including in biology and medicine) was constantly oriented on studying of the real, objectively existing causal relationships in the nature.

Unlike materialistic concepts subjective-idealistic philosophical systems of various sense considered P. as the priori concept based on subjective belief in empirically observed uniform sequence of the phenomena. Believing that the concept «causality» is only a convenient learning tool, subjective idealists deny the objective nature of the cause and effect relations, calling thereby into question a possibility of scientific knowledge of the nature. Objective idealists consider as the reasons operating in the nature, supermaterial entities — soul, absolute spirit, god, etc., bringing thereby essential distortions in process of knowledge of the real world.

Consistently materialistic deterministic interpretation of natural phenomena, society and human thinking was given by K. Marx and F. Engels who dialek tichesk coordinated materialistically understood idea of causal conditionality of the phenomena of the real world to the idea of development. The Marxism considers causality as the central kernel and the basis of all-philosophical doctrine about material and natural bonds of natural phenomena, society and thinking. At the same time it is necessary to emphasize that though P. also is a basic element of all material interactions, however it is only a part of general communication of the phenomena. Therefore, disclosure of how P. naturally fits into general communication appears objective contents of the cause and effect analysis or is isolated from it. Therefore, that «... to understand the separate phenomena, we shall pull out them from general communication and consider them separately, and the movements which in that case are replaced address us — one as the reason, another as action» (K. Marx and F. Engels. Compositions. t. 20, page 546). The dialectic understanding of P. differs from mechanistic and metaphysical not in denial of «isolation» of the causal relation, but its consideration as a relative method of the description of the phenomena in the real world. Objectivity of relative character of P. reveals during universal interaction where cause and effect are interchanged the position that is visually shown, e.g., in systems with a feed-back.

Thus, materialistic dialectics (see) claims that distinction between cause and effect carries not absolute, but relative character. Each investigation in a certain relation is the reason, and each reason in the corresponding relation is the investigation. At the same time essence of metaphysical approach to P.'s understanding is idea of the motionless, stiffened character of the relations between cause and effect. Therefore supporters of a metaphysical view of P. do not understand that «... cause and effect an essence of representation which matter, per se, only in use to this separate case»... (K. Marx and F. Engels. Compositions, t. 20, page 22). The materialistic dialectics overcomes limitation of metaphysical understanding of P., proving that communication of cause and effect .nosit the nature of interaction: not only the reason generates the investigation, but also the investigation can affect the reason and change it. Therefore as F. Engels emphasized, interaction is true causa finalis (final cause) of things.

The concepts «reason» and «investigation» of thinking of the person display the major zakonomernist objective reality, knowledge a cut is necessary for practical activities of people. Learning the reasons of the natural phenomena, the person has an opportunity to influence them, artificially causing or preventing their emergence.

Causality in medicine. Problems of emergence and development of diseases are closely connected with philosophical aspects of studying of general universal relationship of objects and phenomena of the objective world and their causal conditionality. Thereof the category of «causality» appears the major logiko-methodological case of formation of scientific approach to judgment of cardinal concepts of medicine: entities diseases (see), it etiologies (see) and pathogeny (see), statements diagnosis (see) and choice of methods therapies (see). «... Knowledge of the reason... the most serious business of medicine — I. P. Pavlov wrote. — First, only knowing the reason, it is possible to direct neatly against it, and secondly, and it is even more important, it is possible not to allow its actions before invasion of century an organism. Only having learned all reasons of diseases, the real medicine will turn into medicine of the future, i.e. into hygiene in a broad sense». Therefore the medicine has long and independent traditions in consideration of problem P.

The idea of causal conditionality of diseases of the person was shaped in an extreme antiquity (see. Meditsina ). And further evolution of the concept «causality» of medicine proceeded in close connection with formation and development of the general theory of pathology. That is why even in the modern literature devoted to the analysis of the theoretical bases of development of medical knowledge, researchers quite often identify causality and an etiology. Between 4 subjects, as shown in V. D. Zhirnov, V. P. Petlenko, A. I. Strukov, O.K. Khmelnytsky's works, etc., the doctrine about origins and development of diseases (etiology) and P.'s concept as the gnoseological basis of medical knowledge and as the doctrine about causal conditionality of the phenomena, processes and states not only do not match, but acts as different levels of knowledge of patterns of health and diseases of the person. Studying of an etiology of diseases of the person means identification, the analysis and the description of specific pathogenic factors and conditions in emergence and the course of diseases, definition of their nosological specificity. In turn, the concept «causality», reflecting during each specific historical period a categorial system of medical knowledge, the level of development of outlook in general, determines logic of identification of the objective general reasons of diseases and their communication with a specific disease of the certain person.

Modern views on P. in medicine — result of long historical development and generalization of knowledge in the field of philosophy, medicine and natural sciences in general.

Rudiments of scientific it is spontaneous - materialistic understanding of P. in medicine are clearly traced in works of Ancient Greek doctors-naturalistic philosophy representatives, and first of all Hippocrates considering harmony of four liquids making a human body as the reason of health (blood, slime, yellow and black bile) and respectively as a cause of illness — disturbance of this harmony. Despite the speculative nature of antique physiophilosophical understanding of P., it armed doctors with the materialistic principles of studying of diseases of the person, orienting them to knowledge of the real processes proceeding in an organism. The great influence on formation of the concept of P. in medicine was exerted by views of Aristotle trying to combine materiality of the reason, its active and reasonable character in activity of live organisms. P.'s concept developed by Aristotle played an essential role not only in development of antique medicine (e.g., in K. Galen's creativity), but also medicine of the Middle Ages. However, teleologic character of the Aristotelean concept of P. in the conditions of domination of religious outlook during an era of feudalism turned back in medicine idea of the demonic nature of pathogenic factors, of influence of stars and planets on health of the person.

Rapid development of natural sciences during Modern times, requirements of mechanical production, distribution of mechanistic views of the nature and society exerted the revolutionizing impact on formation of the concept of P. in medicine of 16 — 18 centuries, and especially to physiology. Dominating there is an idea of a human body as the mechanism, in Krom all processes are interconnected and caused by laws of classical mechanics. The clockwork appears an ideal of an era, and various manifestations of a live organism as are normal, and in pathology are considered from positions of mechanics (see. Yatromekhanika ). It was R. Descartes, Zh. Lametri's time, G. Burkhava — the philosophers and physicians who entered into medicine and biology of the concept «person car», «plant car», the principle reflek even activity of an organism (see. Reflex theory ) etc. As the reason biol, the phenomena external forces which should be put to bodies were considered to set them in motion.

Mechanistic interpretation of P. in medicine, being considerable simplification of real causal relationships in an organism, promoted, however, development of pilot studying of processes of life activity, origins and spread of diseases and, therefore, had significant effect on development of empirical medicobiological knowledge. So, e.g., use of the principles of classical mechanics allowed U. Garvey to describe the blood circulatory system truly.

At the same time the deepening of knowledge of the phenomena of the organic world showing them a considerable originality in comparison with inanimate nature and also an obvious reasonable structure, functioning and development, showed insolvency of mechanistic outlook in biology and medicine.

As opposed to it acted vitalism (see), explaining specifics of organic life with existence of special non-material factors or forces. The doctrine which is going back to yatrokhimichesky ideas of Paratseljs and Y. Van-Gelmonta's Archean about vital force gained new development in Shtal's works (G. E. Stahl) and S. F. Ch. Hahnemann. Having acted with resolute criticism of mechanistic views of P. in medicine, vitalists claimed that in wildlife allegedly there are special forms of causal relationships which are not reduced to those which are observed in the inorganic world (see. Teleology ).

Bases of a modern scientific determinism and prichinnostny approach to the analysis of interrelation of various medicobiological phenomena began to develop with the middle of 19 century. Widespread introduction in medicine, the general pathology and physiology of experimental methods put forward as the most important purpose of scientific knowledge search of objective patterns in system of interrelations of the phenomena of life activity of an organism. The cellular theory created by T. Shvann theory of evolution of Ch. Darvin, cellular pathology of R. Virkhov, experimental embryology of W. Roux created natural-science base of studying of cause and effect interrelations in medical science.

In consolidation and distribution of the natural-science concept of P. in medicine scientific views of founders of modern had great value physiology (see). I. M. Sechenova and I. P. Pavlov. Being guided by the principles of a scientific determinism, Y. M. Sechenov proved the fundamental concept about a role of reflexes in activity of a brain, having laid thereby the theoretical foundation of all subsequent neurophysiology (see), neurology (see) and psychology (see). In turn, I. P. Pavlov repeatedly noted that the determinism (see)’, always addressing the reason, looking for the reason, allowed it to establish the mechanism of formation of a conditioned reflex (see) that served as the scientific base in development of theory of higher nervous activity (see).

Orientation to studying of steadily reproduced patterns, the analysis of causal relationships of all variety of the phenomena, processes and conditions of life activity of an organism become the defining tendency of development of medicobiological sciences since the end of 19 century. However emergence and distribution of deterministic concepts in medicine and biology substantially proceeded in line with the metaphysical and mechanistic style of the thinking which was identifying P. and a determinism and reducing definiteness of causal action directly to any invariable internal or external factor dominating in consciousness of scientists. Especially brightly this metaphysical nature was shown in the doctrine about origins of infectious diseases in the form of historical confrontation of a monokauzalizm (see) and a konditsionalizm (see). Supporters of a monokauzalizm claimed that there is enough impact on an organism of any one causative factor for developing of the corresponding disease. From this point of view, the infectious agent, getting to an organism, inevitably causes a disease. In turn, a konditsionalizm, trying to overcome limitation of ideas of the unambiguous reason — need, replaced it with multiple-valued need where the reason is dissolved in total the conditions which are for each case of a disease of unique set. Therefore supporters of a konditsionalizm came to the actual denial of P. in objective reality.

The materialistic dialectics rejects as absolutization and P.'s data to one of etiol, factors and not accounting of their universal interrelation and interaction, and denial of objectivity of a causal relationship and its data to the sum of equivalent conditions. These unilateral approaches are not able to disclose entities of origins and development of diseases. Only as the scientific basis for a solution of the problem of P. in medicine the dialektiko-materialistic doctrine about relationships of cause and effect developed by K. Marx, F. Engels and V. I. Lenin acts.

For right understanding of P. in medicine it is impossible to lose sight that, studying the cause and effect relations during specific experimental studying, the researcher is forced «to pull out» the separate phenomena from them «general communication». Thus, scientific research deals not with all phenomenon in general, and with its certain fragment (see. Reductionism ). The phenomenon, the bigger number of sciences is more difficult than it studies. Various parties of the cause and effect relations between the phenomena in the course of life activity of the person are investigated by biophysics, biochemistry, molecular biology, histology, physiology, psychology, pedagogics, sociology, etc. Also the number of the medical sciences revealing new aspects of emergence and development of diseases grows. Therefore the number of etiological factors constantly increases, and their communication is represented harder and harder. Analytical approach to a research of such supercomplex system as the person, not only isolates separate medical sciences from each other, creating their special object of research — the level of studying of relationships of cause and effect, but also and in each science, accenting separate approaches to studying of difficult integrative phenomena of existence of the person.

Depending on the organization of pilot study the same factors can be considered in quality both the reasons, and conditions and the investigations. The last is especially often observed at detailed studying patol, processes in which process the so-called vicious circle forms. E.g., local disturbances of a hemodynamics in bodies and fabrics can act as the reason of changes of cordial activity which, in turn, will cause still big deviations in blood supply of bodies and fabrics. Cause and effect at various approaches to a research of these processes are as if interchanged the position. The similar situation is observed at a research of infectious process when at various approaches a «external» factor (infekt) and a «internal» factor (an organism, its reactivity and hereditary and constitutional features) act as the reason of a course of a disease, as its condition.

Dependence of certain characteristics of the relationships of cause and effect revealed in objective reality on methodical approach to their studying does not mean their subjectivity and randomness as konditsionalist consider. Practice of the person, including profession of a physician, in a cut are used achievements of special sciences for knowledge of origins and development of diseases, proves P.'s objectivity as categories of scientific knowledge. V. I. Lenin emphasized: «The causality usually understood by us is only a small part of the world communication, but... part not of subjective, but objectively real communication» (V. I. Lenin. Pauly. SOBR. soch., t. 29, page 144). Therefore the dialektiko-materialistic concept of P. aims physicians at complex studying of patterns of functioning of a human body normal and pathologies, disclosure as which are rigidly determined and the statistical cause and effect relations (see. Causality probabilistic ).

At the same time a comprehensive approach to studying of relationships of cause and effect in emergence and development of diseases shall not come down to vicious concepts of a polyaetiology and konditsionalizm. Dialectic materialism, insisting on multidimensional studying of objective reality, at the same time orients to identification of a fundamental unit and knowledge of system unity of diverse forms of the cause and effect relations. In any, most special research it is impossible to lose sight of aspect of integrity. So, organizing an experiment, the scientist constantly faces need to choose from variety of real-life properties and signs in a live organism their nek-swarm the acceptable quantity representing not accidental properties, but essence of the studied phenomenon.

The dialectic understanding of P. is inseparably linked with ability to isolate from variety of bonds in this specific case the main genetic interaction in total with its necessary and sufficient conditions. Therefore, previously formulated dialectic concept of causality in general interpreting essence and integrity of an object of research shall precede any special research, predetermining its strategy and tactics. In all cases as K. Marx emphasized, an image whole «... shall soar constantly before our representation as premises» (K. Marx and F. Engels. Compositions, t. 46, p.1, page 38). Only in aspect of integrity the real sense and value of the cause and effect relations revealed during special studying of the diverse parties of life activity of an organism is revealed also pathologies are normal. In the modern teoretiko-medical literature devoted to a problem of the cause and effect analysis, complete approach to P.'s understanding contacts idea of nosological unity of diseases (see. Nosology ).

The problem of a medical research is, therefore, not in finding the unique reason or set of a set of separate conditions, and in that, to connect variety of the special researches of the cause and effect relations between various processes and the phenomena found in the course in uniform natural communication. And this communication should be understood not only as the ready created system, but also as the system which passed certain stages of evolutionary development. Therefore as I. V. Davydovsky fairly considered, the understanding of patterns of health and a disease requires not only the nobility why there was a disease at this person, but also as there was this disease in the history of mankind. Theoretically synthesizing «why» and «as», the medicine armed with the dialektiko-materialistic doctrine about causal relationships develops new effective measures according to the prevention of developing of diseases (see. Prevention , Prevention primary ) and to their treatment.

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V. I. Tyshchenko.