The medical model that informs the training of doctors and the care of patients, considers people to be machines made up of organs, limbs and chemical processes. A widely accepted definition of health says that health is “the level of functional and metabolic efficiency of a living organism.” In plain language, health is the extent to which our limbs and organs work well, and the degree to which we are able to properly digest our food. Medical examinations are surveys of the chemical and mechanical systems of our bodies. We are mechanical patients.

This view was advanced by philosopher scientists like René Descartes and  Robert Boyle around 400 years ago. They believed that once we understood the human body as a machine, we could develop a medical discipline that could use standardized methods to identify disorders and repair them. For Descartes we are intensely isolated. We are minds inside physical mechanical bodies. He must even prove the existence of the external world. Descartes view of the body as mechanical has achieved widespread success and this has supported the conclusion that we are best treated as mechanical patients.


But what was left out of this conception was the very critical fact that human beings are social animals, not isolated entities like machines. Our birth, our nurturing, our development and much of our health and well-being depend not only on our mechanical functioning, but on our interactions with other people. This omission was recently recognized in the rather startling creation of the Ministry of Loneliness in the UK.

The task of the Ministry of Loneliness was described in the Guardian of 23 January 2018. The article declares that loneliness is not

“an end-of-life condition. Rather it is an indiscriminate disease that has become an epidemic. There are some obvious pathogens: the deconstruction of community, the conversion of citizen into consumer, the politics of envy. …. The latest strain is a digital virus, detectable only to the analogue eye of our pre-electronic generation. It is demolishing real sociability and replacing it with virtual reality. A techie elite has hijacked the narrative, causing a quantum shift in human interaction. This threatens the human genius of community which has been the primary driver in the species’ journey from family to gang to clan to tribe to nation to federation.”

This short excerpt describes loneliness as an epidemic and uses metaphors of earlier communicable diseases caused by external pathogens. In the metaphor loneliness remains a disease of the mechanical patient It is a new disease caused by improved material conditions, more secure housing, increased convenience of food delivery, all of which serve to isolate us,. There is even a “digital virus” that delivers individual entertainment through the internet and forces us to “enjoy” amusements alone.

There is no doubt that loneliness is a problem in our societies, but I do not think that it is a new problem. Rather it is one that is just being recognized. It seems that social and relational deficits have always been there for parts of the population. We do not have a measure of what it was a long time ago and our memories are skewed by sentimental pictures of the past. But a closer look suggests that loneliness is not a new problem. Nor that it only affected a small proportion of the population in the past. We just do not have measures of it in earlier times. The century old novels of Thomas Hardy and Charles Dickens suggest that loneliness was a problem even then and for substantial numbers of people.

We can immediately see that the problem of loneliness does not fit the model of the mechanical patient, much as the Guardian article tries to suggest it. Loneliness is not caused by technological germs. It is not a communicable disease. It is a lack of social and community connections which are vital to us as essentially social beings and not mechanical patients.

Moreover it is especially inappropriate to characterize the Internet as a viral agent of loneliness. The Internet does not only isolate people; it also connects them. Through social media and search engines we can maintain contact with old far-away friends better than ever. We can find and regain connections that appear to have been lost. We can create online communities for special interests and dispel loneliness that comes from having no one to talk to about our obsession with 13th century music, or rare stamps.

What is different is that we now recognize that a social condition can have serious consequences to health. Many articles recognize the impact that social isolation has on the health of lonely people. One declares that being lonely has the same impact as smoking 15 cigarettes day. But loneliness is not a poison like tobacco. It is not a chemical, mechanical or even a biological pathogen. We are not chemical/mechanical patients. We are social beings. We need to enter into a conversation about changing the medical model from being so focused on the chemical and mechanical aspects of health and recognize the extent to which our social context and the nature of our relationships affect us.

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7 Replies to “We are mechanical patients”

  1. I agree. The medical school training snd how our health systems respond to health continue to treat health as a mechanical/chemical input and outcome. Even though the WHO definition of health itself repudiates this approach and its enlightened definition is 70years old, the WHO itself has propogated a mechanical/chemical approach. The mental health dimension, the lonliness element etc of what makes us unique have been unrecognized at best and ignored at worst. Time to change this disposition

    1. Thanks for this. My new book is coming out in June. It is called The Mechanical Patient and describes how we got into this fix and how we are slowly moving out of it.

  2. Dear Shalom… how good to see, read, have, you back with a Blog! You are right on about the real issue with medicine/treatments, technology. Our health system as it currently exists has left the human, social dimension of care by the wayside.

    Time to remember we are all on our life’s journey together, just walking each other home!

  3. Is it possible to subscribe by email to your posts?

    I’m very keen to follow your thoughts on this matter. I’m an RN and member of RNAO and see you are on a committee with other advisors.

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