Therapeutic Knowledge

How is therapeutic knowledge generated and justified in medicine? Modern medical knowledge in terms of both diagnostic and therapeutic procedures is certainly more dependent on technical innovation than fifty years ago, as detailed in Chapter 5. But that dependency is more than simply a need for technical devices in order to practice medicine; rather, it has a definite epistemological component. “The episteme of technology,” according to Ian McWhinney, “has become the episteme of medicine” (1978, p. 299). In other words, modern biomedical knowledge is driven by technical and research innovation, whether in terms of mechanical or cognitive devices. In this chapter, the epistemological issues concerning the cognitive or research devices are examined in the first section, followed by technical devices in the next section. The chapter ends with an examination of the epistemological issues associated with narrative therapy, often championed by humanistic or humane practitioners to address quality-of-care issues.