From Philosophical, Scientific and Applied Points of View In this study, medical activity and its evolution has been considered and re evaluated in the light of a new perspective. This re-evaluation, with the concept of Esthetics as its departure point, has been realized thanks to what we have termed `Esthetics in Medicine`. Esthetics is a discipline whereby we inquire the whatness of our likings and tastes, evaluate comparatively the judgements of `beautiful` and `ugly` (and the like) in connection with the object, and form the set of the related values. However, esthetics is a comprehensive concept with its relation to other areas such as the philosophy of art and the science of the beautiful, or rather the latter's consideration in sciences. Conceptually speaking, esthetics is certainly not a branch of medicine as is ordinarily understood. As a branch of philosophy, `esthetics` has been termed in the beginning of the 18th century and has then begun to evolve as a discipline in its own right. Man tries to perceive and understand the objects and the world through his different senses such as seeing, hearing, touching, or smelling. Although different senses are involved in his perceiving the world, seeing and hearing have a priority in man's esthetic attitude. In the present study, and as is clearly seen in its title, only the visual sense has been taken as the core concept, whereby those aspects of objects (and relations) which can be evaluated by this sense have been clarified and discussed from an esthetic point of view. Although the present work is, in a general sense, a dissertation in history, the topics constituting its content have been considered by an approach which has already been termed `medical evolution`. Thus, esthetic topics in medicine have been discussed in their continuity and entirity, and to the exclusion of irrelevant historical detail. The idea of evolution makes it possible for us to consider topics in their temporal entirity and at the level of phenomena rather than singly. It then becomes possible to reach certain generalizations and more scientific conclusions in the study of a process.218 Esthetics in medicine is a differentiated extension of the idea of esthetics into the medical domain and the evaluation of medical activity from an esthetic standpoint. It can be seen as the realm of esthetics in medicine as a whole. Accordingly, the topic of esthetics in medicine and its evolutionary dimension have been grouped and discussed under three headings in this context: 1) The esthetics of those spaces where medical activity takes place in general; 2) The esthetic dimension the physician-patient relationship; and 3) The esthetic changes in the patient as a result of clinical applications. Although the basic concern of medicine is the preservation of health, the third set has been considered more comprehensively in this study. Medical activity is, above all, a pragmatic discipline with man's health problems as its subject matter. We observe this basic pragmatic priority in medicine, inevitably it seems, when we discuss and apply the idea of esthetics in the medical context. It may be said that the exploitation of esthetics for a pragmatic purpose is not reconcilable with its philosophical status. In general, too, however, esthetics does have such an applied aspect, if one excludes the (purely) esthetic evaluation of the works of art. One should not forget that a pure esthetic concern may be fruitless in applied esthetics. In the medical context, the word `space` is associated with the hospital, health center, the patient's room, or part of the hospital. In this dissertation, the term `esthetics of the space` also denotes the fixed material of the inner space such as doors and windows, and the portable elements such as beds, sheets curtains and the like. The esthetic concern in this area is apparently formed by different (sets of) factors or parameters - climatic, environmental, cultural, economic, historical. In addition to all these, as a metter of fact, what we might call a more or less pure esthetic concern has gained importance in our time, which is taken into account in the construction of new spaces. This development can possibly be regarded as a positive development in medical evolution. The esthetics of or the esthetic aspect in the physician- patient relationship has been considered here under two subheadings - that of the appearance of the physician, and the esthetic dimension in the Salter's behavior towards the patient. The first one is apparently closely related to the doctor's outward look and dress. They have changed in the course of time under the impact of factors with then- possible effects on the patient - the medical (or, rather, health) institution and the219 physician's attitude. But the change in physicians' attitude and dress is, in addition to the effect of external, social factors, patient- and physician-centered. Within the context of behavior or action, the physician-patient relationship is ordinarily questioned from the viewpoint of ethics. Whereas in this dissertation the esthetics of the physician's behavior has been stressed in the context of this relationship. The relation between esthetics and ethics, in general as well as in medical activity, has also been considered within the conceptual scope of the dissertation. If one of the most basic aims of medical activity is the treatment of the patient and the attainment of his/her well-being from a biopsychosocial viewpoint; certainly the other one is the prevention of disease. In addition to its being a pathological phenomenon, the latter leads, perhaps most of the time, to a morphological disorder in the individual concerned. Called `deformity`, this situation is caused, besides diseases, by accidents, injuries, and congenital malformations. The physician in our time is expected to treat all these deformities and to secure the patient an appearance which is as `normal` as possible. Deformity is most of the time associated with such feelings as pain and suffering; with an unwanted appearance or `ugliness` brought about by the structural and functional deficiency of a tissue and/or organ; and with a situation which is pathological. The person in such a situation is affected on the part of his/her biological, individual/psychological, and social identity. The social norms in esthetics is really important for the individual who tries to get rid of deformity and to assume a more esthetic appearance. Effected by the value judgements of the society, the individual would like to have a healthier and more beautiful physique. To be healthy and beautiful, or without a deformity, is among the necessary conditions to become a popular person. To be beautiful and without a deformity gives the individual a security. From a biological perspective, too, man is inclined to be without deformity, and makes use of the morphological aspect of his/her body in vital biological activities such as being alive, choice of the mate or reproduction; having no deformity at whatever level provides gains in these respects as well. In the present work, topics related to the biological, psychological and social aspects of medical esthetics have been discussed in a separate chapter and in an intrerrelated manner.220 While the physician tries to prevent and treat deformity in principle, his interventions, too, may from time to time lead to a temporary or permanent deformity. In such situations, and as is the case in general, the physician is involved in making use of scientific-technical and social possibilities such as prosthesis and rehabilitation, with the aim of securing the patient a more esthetic physique. The individual may demand the service of the physician not only for the correction of morphological deformities, but also for cosmetic interventions which are apparently becoming more and more widespread. In these situations, where there is no pathological sign or functional loss, the individual perceives himself/herself as `ugly` due to personal and/or social concern, and wishes to change. The fact that the therapeutic intervention involves not only the scientific and technical but also an esthetic concern has come to stress, from the viewpoint of medical evolution, the principle that the patient should be evaluated as a whole and not at the level of individual organs. In this dissertation, the biopsychosocial unity of the human being has been considered within the context of esthetics in medicine and its evolution, conceptually as well as from a scientific-technical aspect, and also from the viewpoint of ethics. Key Terms: Medical Evolution and Medical History, Visual Esthetics in Medicine, Medical Ethics and Esthetics in Medicine, Esthetics, Visual Esthetics from a Biological Viewpoint, Visual Esthetics in Psychology.
