Sullivan M D
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle 98195.
J Med Philos. 1990 Oct;15(5):493-514. doi: 10.1093/jmp/15.5.493.
Claude Bernard's concept of the internal environment (milieu intérieur) played a crucial role in the development of experimental physiology and the specific medical therapeutics derived from it. This concept allowed the experimentalist to approach the organism as fully determined yet relatively autonomous with respect to its external environment. However, Bernard's theory of knowledge required that he find organismic functioning as the result of an external necessity. He is therefore unable to explain adequately the origin or operation of organismic autonomy. A more complete conception of biological autonomy must include a theory of knowledge that can accommodate the organism as a source of discrimination and determination. Only in this way will it be possible to see organisms as active as well as reactive, as ordering as well as ordered. This shift in perspective is crucial if medicine is to be able to characterize, for example, susceptibility to disease. A cognitive sense of the organic interior is proposed as an alternative to Bernard's internal environment.
克洛德·贝尔纳的内环境概念在实验生理学以及由此衍生出的特定医学治疗方法的发展过程中发挥了关键作用。这一概念使实验者能够将生物体视为在很大程度上由外部环境决定，但又相对自主的存在。然而，贝尔纳的知识理论要求他将生物体的功能视为外部必然性的结果。因此，他无法充分解释生物体自主性的起源或运作方式。更完整的生物自主性概念必须包含一种知识理论，这种理论能够将生物体视为辨别和决定的源头。只有这样，才有可能将生物体视为既具有主动性又具有反应性，既进行有序安排又被有序安排的存在。如果医学想要能够描述例如对疾病的易感性，那么这种视角的转变至关重要。本文提出一种关于有机体内在的认知观念，作为对贝尔纳内环境概念的替代。
