Another interesting review in the Sunday New York Times of a book by medical historian Anne Harrington on the mind-body problem. The reviewer, Jerome Groopman, is a physician and trained as a skeptic — as such his reaction is suitably non-plussed. He concludes by writing that “whatever science reveals about the cause and course of disease, we will continue to tell ourselves stories, and try to use our own metaphors to find meaning in randomness.”
Maybe. But once we’ve found meaning in it all, it’s no longer random, is it? That, of course, is the dilemma here. The title of Harrington’s book — The Cure Within: A History of Mind-Body Medicine (New York: W.W. Norton, 2008) — suggests how important it is to realize how medicine has historically been concerned with life’s meaning and the spirited internal struggle to survive and triumph in the face of the ever-looming entropic forces of disease and decay.
In essence, Harrington addresses the history of the mind-body problem, and the way it has deeply shaped the history of Western medicine. Many see this as beginning with Aristotle, who proposes the idea that humans have an anima rationalis — a “rational soul”. The idea of animas and the breath (pneuma) were central to Galenic medical models developed in the classical era, and continued to have relevance all the way into the early modern world.
But medicine took a sharp turn in the 17th century, becoming enamored of more mechanistic models. As a philosophical background, Descartes was important in this development, and his classic Discourse on Method (1637) takes a page from the famed physician William Harvey, who in Du Motu Cordis (1628) first described the function of the heart as a pump, using mechanical metaphors liberally.
Still, there were those who resisted mechanism, and emphasized the healing power of mind and a gentler approach to therapeutics. As many historians have argued, in an age still unequipped with anesthetics and antibiotics this aggressive reductionism rooted in heroic and often unwise surgical interventions probably did more harm than good. And yet progress in understanding the basic mechanics of the body continued.
Harrington, who has also edited a cross-disciplinary text on the placebo effect, focuses in contrast on the medical interest in the effect of mind, what she calls the “power of suggestion”, within a historical context. She thus discusses the sometime radical approaches of men like Franz Anton Mesmer, Jean-Martin Charcot and Sigmund Freud. And the real emergence of a more psychologically inclusive vision of health and healing.
This leads her arguments naturally into the 20th century, where thinkers like the physiologist Walter B. Cannon figure prominently. His book The Wisdom of the Body (1932) is a classic in this realm, and explores the intriguing concept of homeostasis. Perhaps even more interesting is the thought of Czech physician Hans Selye, who worked here in Montreal, and introduced the idea of “stress” into the medical lexicon. Selye’s vision is deeply critical of the traditional reductionism so prominent in modern biomedicine.
Which brings us, lurching, into the present day. As Groopman is justified in pointing out, there is a lot of personal experience involved in sickness and being a patient these days. For him, the ever-present quest for alternative remedies is, in general, a waste of time. But perhaps more important than this is the way the whole engagement with medicine is becoming a very particular, even existential, experience. The technology of the internet has facilitated this process in virtually unchartable ways. There is no map for this new territory. It is a whole new world. Whether a critical view of all these processes — and of the pat assumptions of mechanistic medicine — will emerge, is unclear. But things are changing, and this review and books like Harrington’s are evidence of this fact.
Modern biomedicine has made great leaps. The use of drugs and a more complex understanding of the bacteriological sources of disease has led to major increases in lifespan and quality of life. Yet, sadly, there are as many untold stories about the alienation, fear and even death generated by the modern process of healing. It is structured around norms that never exist in the particular, and this tension continues unabated…
And, in the background, hidden away behind the tongue depressors and morphine, is the healing power of mind. It can no longer be ignored as a central issue in health and general welfare, and yet its immaterial quality makes it ever elusive.
In any case, there are deep schisms forming in our understanding of mind-body, psyche-soma relationships, and placebo effects seem to multiply like so many drug company ads. As a concept, it continues to persist. There is so much at stake here, and so much to discuss. Perhaps the intractability of this issue means there’s still space to speak about alternatives, even at the philosophical level. Alternatives like vitalism.
So, this is all I will say on the issue here — with any luck, somebody will be reviewing my take on the subject in a couple of years. Harrington, and others, like Harvard colleague Ted J. Kaptchuk, are using the history of medicine to shape radical critiques of the modern medical enterprise.
I should like to join their cause. It’s a worthy one.