Thure von Uexküll
Foreword
Martin Krampen
The role of scientific indexes
Wolfgang Wesiack
The overcoming of uncertainty in medicine: a semiotic problem
Frowine Leyh
The meaning of dermatological signs
Thure von Uexküll
Symptoms as a sign for conditions in living systems
Thomas A. Sebeok
Symptoms, systematic and historical
Thure von Uexküll
Historical questions about the problems of medical semiotics
From research
Claus-W. Wallesch
Pathology of the use of writing
Alexias and agraphias and their relation to other
neuropsychological disorders
Discussion
Heinz Behrwind, Dieter Flader and Hans-Joachim Griep
Critical theses about the requirements of "hermeneutic objectives"
Project
Klaus Boehnke and Peter Noack
The use of symbols by teenagers
Literary report
Svend Erik Larsen, Per Erik Ljung, Sven Storelv and Eero Tarasti
Semiotics in Scandinavia
Foreword
Semiotics and medicine
Thure von Uexküll, Freiburg i. Br.
Summary. Semiotics, which has gained influence in the 20th century as a
generalization of the language sciences, originated in antiquity as a doctrine
of signs for diseases. As such it played an essential role in medicine until
the 17th century, when the natural science approach began to dominate. Today
the limits of this approach are clearly seen, and sign-related metaphors are
becoming prominent again in the description of diseases - a development which
may indicate an upcoming change of descriptive paradigms in medicine.
Present-day semiotics provides a terminological framework in which these
metaphors can be explicated and the organismic and interpersonal medical
processes can be described in a unified way.
The role of scientific indexes
Martin Krampen, Ulm
Summary. Symptoms of diseases are indexical signs. This article analyzes the
status of indexical signs in Charles S. Peirce's classification of signs and
distinguishes four types of indexical signs which help the medical doctor
overcome uncertainty regarding appropriate therapy. A comparison is made
between this approach and the different ways in which the scientist overcomes
uncertainty in the nomothetic and hermeneutic disciplines.
The overcoming of uncertainty in medicine: a semiotic
problem
Wolfgang Wesiack, Aalen
Summary. Medicine is an essentially semiotic discipline: It observes natural
events, interprets them as signs of diseases, and concludes from this diagnosis
what therapy to apply. In the course of history medicine has gone through three
stages: 1. Early medicine used events occurring outside the body in question,
such as bird flight and constellation of stars as signs for its diseases
(magical exosemiotics). 2. Scientific medicine from the Greeks until the 18th
century restricted the significant events to manifest and behavioral properties
of the person in question (patient-centered semiotics). 3. Medicine in the wake
of the natural sciences further reduced the significant events to those
measurable in diagnostic experiments (instrumental semiotics). In this last
stage there is a tendency to overemphasize local measurement and to neglect
unmeasurable signs like mimics, gestures, and reports about dreams. The
development outlined has not only led to the reproach that medicine has become
"inhumane" but has also made the diagnoses less and less relevant to an
effective therapy. What is required to overcome the current crisis is the
reintegration of the less certain and less easily measurable signs into a
holistic diagnosis.
The meaning of dermatological signs
Frowine Leyh, Lübeck
Summary. This article presents a semiotic analysis of the dermatological
doctrine of efflorescences. Each dermatological symptom is classified according
to a primary category, a secondary category, and six auxiliary categories. On
this basis some hundred skin diseases can be diagnosed. Underlying this
procedure is the dermatological code that maps efflorescences into diseases.
Symptoms as a sign for conditions in living
systems
Thure von Uexküll, Freiburg i. Br.
Summary. Present-day medicine regards disease as a defect in a biochemical
mechanism. This defect is to be eliminated by removing its causes. Diagnosis is
seen as inference from the symptoms (signifiers) of the defect to its causes
(signifieds). The sign relation involved here appears to be a binary relation
between symptoms and causes - a conception which this article refutes by
analyzing the inference processes applied. The multifactoral genesis of
diseases cannot be accounted for in binary causal models, but has to be dealt
within the framework of systems theory. An organism is a system whose needs
determine a code that enables it to interpret environmental effects in a
specific way and to react appropriately. Effects, interpretation, and reaction
in the system-theoretic approach can be related to sign, interpretant and
object in Peircean semiotics. The synthesis of systems theory and semiotics
advocated in this article allows a unified description of the sign processes
occurring on the different levels of cells, organs, organ systems, organisms,
and societies. According to this model, a sign that cannot be reacted to
appropriately on its proper level is translated into a sign on the next higher
level. A disease occurs when this multiple translation does not yield the
required results within the organism as a whole. In this case the signs
involved become symptoms of the disease. The task of diagnosis consists of
translating symptoms that occur on the level of organisms into conventional
signs that imply appropriate reactions of society. The code necessary for this
translation is provided by our various concepts of diseases.
Symptoms, systematic and historical
Thomas A. Sebeok, Indiana University, Bloomington
Summary. Symptoms may be investigated both in relation to the lexical field the
term "symptom" belongs to in semiotic terminology and in relation to the
medical phenomena that have been called "symptoms" since antiquity. This
article uses both approaches. It begins by relating "symptom" to
"signal" and
"sign", to "cue", "clue", and "indicator", to
"icon", "index", and "symbol", to
"legi-sign" and "sin-sign", "type" and "token", to
"communication" and
"information", to "induction", "deduction", and
"abduction", to "pars pro toto"
and other types of "metonymy", to "natural" and "artificial"
signs, to
"tracks", "marks", and other "evidence", to
"subjective" and "objective",
"private" and "public" signs and "syndromes", to
"Innenwelt", "Außenwelt", and
"Umwelt", to "physical change" and "pain", to
"diagnosis" and "prognosis",
"etiology" and "therapy". Quoting relevant passages from the ancient
masters of
medical semiotics, the article then traces the history of symptomatology as a
medical discipline from Hippocrates and Alcmaeon of Croton, Galen and
Philodemus to Thomas Sydenham, John Locke, Friedrich J. K. Henle, and CADUCEUS.
Symptomatology turns out to be that branch of semiotics which teaches us the
ways in which medical doctors function within their cultural milieu.
Historical questions about the problems of medical
semiotics
Thure von Uexküll, Freiburg i. Br.
Summary. The medical disciplines of diagnostics and therapeutics use opposing
conceptions of the pathological process. Whereas the concept of a symptom is
central in diagnostics, therapeutics relies on the concept of causality. Thus
the question has to be answered whether the relation between a disease and its
symptoms is basically of a semiotic or a causal nature. The scientific medicine
of antiquity and the middle ages treated this relation as a semiotic one and
had their own empirical methodology which used symptoms to make statements
about the past and the future of an organism. From the 17th century to the 19th
century this semiotic paradigm had to compete with the causal paradigm of the
human body as a biochemical mechanism, which became the prominent model in the
19h century. If the position of semiotics in medicine is to be restored today,
three tasks must be fulfilled: (1) One must find out why medical semiotics in
antiquity and the middle ages was not able to devise a concept of causality
useful for an effective therapy. (2) One must demonstrate in which respects the
mechanical model of the body used in modern medicine is insufficient. (3) One
must prove that modern semiotics can provide a conceptual framework appropriate
for the formulation of the problems confronting the medical doctor in diagnosis
as well as in therapy. The article argues that these tasks can be fulfilled and
outlines preliminary answers.
From research
Pathology of the use of writing. Alexias and
agraphias and their relation to other
neuropsychological disorders
Claus W. Wallesch, University of Freiburg
Summary. Writing disorders resulting from lesions in the brain are classified
and discussed in relation to acquired disorders of oral language, of
object-oriented action, and of spatial perception. It is argued that writing
disorders can rarely be isolated from other disturbances. A subclassification
of writing disorders into alexias and agraphias is shown to be of little use,
since it does not take into account all essential aspects of such disorders. It
is more appropriate to describe writing disorders as effects of complex
neuropsychological disturbances. As a result, all therapy of writing disorders
has to begin with extensive neuropsychological diagnosis.
