Medical diagnoses define the possible modes of being ill from the medical point of view. Medical diagnoses are theoretical concepts that gain their meaning as a part of\ud the prevailing medical theory. As medical theories change over time, also medical concepts change, as can be seen in the long history of medical thinking.\ud The purpose of this essay is to illustrate medical thinking through examining the formation and use of one example of a particular medical concept “psychosomatic” in medical theory and practice.\ud The approach taken in this essay reflects the writings of Lev Vygotsky, who argued that scientific concepts are tools for scientific thinking. Since all conceptual tools\ud have their own developmental history, to understand the content of any scientific concept to the full we need to understand the processes leading to adoption of that\ud particular concept for scientific inquiry at that particular moment in history.\ud Vygotsky’s approach for analysing the development of science through analysing its concepts is reflected to the writings of Kuhn and Fleck on the development of science.\ud It is argued, that Kuhn’s theory does not apply to the development of medicine. While Fleck’s approach seems to fit better to analysing the theoretical development in\ud medicine, it remains somewhat superficial in analysing the nature and role of concepts in medical thinking.\ud The use of medical concepts in medical practice is discussed in the light of Mikael Leiman’s ideas on the therapeutic encounter as a dialogical process. While Leiman\ud also draws from Vygotsky he takes the issue further toward semiotic understanding of clinical dialogue by using Bakhtin’s and Voloshinov’s ideas of the semiotic nature of\ud human communication
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