[This article is now published by Taylor & Francis in The Linacre Quarterly under the same title and available online. It remains posted here with the publisher’s permission]
A few decades ago, the idea of medicine presented no difficulty. A patient who fell ill would go to the doctor to get treated. He might get better or he might not, but there was no need for him to consider at the outset what type of medical care he should choose for his ailment.
Today, someone who needs attention for a health matter can seek conventional “Western” medicine or opt to receive a “holistic” treatment from the realm of so-called alternative medicine. For most people, there is a clear distinction between the two. Sure, some licensed physicians claim to provide holistic care, but this usually means that they might add an alternative form of therapy to standard treatment, or perhaps that they strive to be exceptionally considerate. The holistic character of the care rarely, if ever, comes from Western medicine per se.
But holism shares with health the same etymological meaning: the Greek holos and the Old English hale both refer to the idea of wholeness. So why does conventional medicine seem so unable to attend to the complete welfare of the patient? Why, despite the manifest efficacy of scientific treatments, do growing numbers of patients consider their medical care altogether unhealthy?
The answer may have to do with what is meant by a whole person.
St. Thomas Aquinas, borrowing from Aristotle’s philosophy of nature, explained that a human being is a substantial unity of body and soul or, to be more technically precise, a composite of “prime matter” (the principle of potency) informed by a rational soul (the principle of act).
The bodily unity in matter and form—a holistic concept in the fullest sense—has been a foundational principle of Catholic anthropology ever since 1312, when the Council of Vienne declared this account of man to be doctrinal truth. And for Aristotle and Aquinas, this substantial unity is not unique to mankind. All natural things necessarily exist by virtue of the union of these two essential principles: each material body is brought into existence as such by a particular substantial form. In the case of living organisms, the substantial form is also the animating principle, or soul, of the body.¹
The hylomorphic conception of nature (from hyle, “matter” and morph, “form”) was not unique to the Latin West. In fact, Aristotelian philosophy came to Europe by way of Arabic translations accompanied by commentaries from Muslim scholars such as the physician Avicenna and the polymath Averroes, both of whom became references for later European philosophers. Maimonides, the 12th century Jewish physician, philosopher, and theologian, also espoused the doctrine of intimate joining of body and soul and was an important influence on Christian Scholasticism.
At the dawn of the modern era, however, thinkers such as Francis Bacon and René Descartes rejected Aristotle’s notions of substantial form and chose to emphasize instead the material aspect of things. In the Baconian paradigm, nothing matters that cannot be measured or quantified, and nothing should be accepted that cannot be verified empirically. In a similar vein, Descartes imagined the world to be made up entirely of tiny corpuscles in motion. He believed plants and animals to be nothing more than mechanical entities whose nature can be entirely understood once their material make-up is characterized.
The heightened attention given to the material aspects of the universe promoted the achievements of a bewildering revolution in the empirical sciences. And under the influence of the new sciences, diseases came to be conceptualized in similar terms: illnesses are accident of nature due to defective arrangements or to faulty motions of material stuff. Fix the defect and you fix the patient. This approach has yielded such astounding benefits to mankind that Descartes’ dream of conquering illness through the methodical application of empirical science seems to be well under way.²
But when medical science rests on a basis of material reductionism, the human mind—the intellectual and willful aspects of the soul—has a hard time finding its proper place. Descartes dealt with this difficulty by splitting apart the body and the soul of man: he viewed the former as strictly mechanical and responsive to the directives of a separate spiritual soul by way of the pineal gland, a tiny structure inside the brain. His “ghost in the machine” metaphor still pervades the popular imagination to this day.
Following Descartes’ conceptual sundering of body and soul, scientists sought for a time to identify and isolate the vital principle of living organisms—as if that were possible. Vitalism, mesmerism, romanticism, and idealism became influential currents in Western Medicine in the eighteenth and nineteenth century. But when these efforts at grasping the essence of life proved futile or problematic, the inconvenient soul fell into neglect and was finally abandoned altogether as a subject worthy of inquiry or acknowledgment in polite scientific company.
Thus deprived of spirit, the human body assumed for the scientist the status of a mere, albeit complex, machine. And as the material successes of biomedical science multiplied, the mechanistic metaphor was adopted by the practicing physician as well. Over the last 100 years, the medical profession, with the help of government, academia, and big business, has turned Western medicine into a “health care delivery system” where biological material is the input, and health the hoped-for output. Accordingly, the noble medical enterprise must now be pursued in the most efficacious, safe, efficient, and accessible manner. Standardization has become its prime mode of operation.
The only wrinkle, of course, is that the raw material under process is a person: individual, substantial, rational, and—as Karol Wojtyla emphasized—self-determining and “incommunicable.”³ Ill-suited for the assembly line, that person is now protesting. Increasingly, men and women seek the holistic practitioner to attend to the neglected half of their being. Meanwhile, the massive delivery system, wobbling on a foundation of faulty mechanistic assumptions, threatens to collapse at any time. Yet the remedy seems so simple. But will Western medicine ever bring the soul back to the patient’s body?
Notes:
1. Although not necessarily the best place to start, the Stanford Encyclopedia of Philosophy’s entry on Thomas Aquinas has the merit of being online and written by an outstanding Thomistic philosopher.
2. Despite some shortcomings, Gerrit Lindeboom’s Descartes and Medicine (Amsterdam:Rodopi, 1978) is worth reading for its focus on the medical applications of Descartes’ philosophy.
3. Peter Colosi clarifies Wojtyla’s meaning of incommunicable as follows:
The quickest way to get to the notion of incommunicability is to ask why it is you love the person whom you love. The answer is not a communicable trait…There is something utterly unique about each person, which is indeed expressed through traits common to all persons (‘communicable traits’), and intimately united with those traits, but which is not accounted for by listing those traits…Each person is incommunicable, yet that fact is communicable in the sense that it is proper to persons as such to be unique. (Colosi, P. “The intrinsic worth of persons: revisiting Peter Singer and his critics” Journal of Interdisciplinary Studies, September 2003)
I have thought for some time that western medicine has lost or is losing its soul even though I had not considered it before in the frame you develop .I had previously considered the issue mainly as the substituting as a goal some nebulous good of the group for the good of the individual manifest in part as statistical medicine and risk factor medicine and diminishing respect for individual moral agency. I am still processing your fascinating and deep analysis and trying to integrate that with my views on the fundamental clash between the individual and the group and the friction between classical liberalism and the progressive agenda as it has impacted the practice of medicine.
What do you think is the remedy?
The utilitarian tendency is certainly dominant in medicine today. My aim here was to address the underlying anthropological confusion that has allowed utilitarianism to flourish. And you are right, the system did begin in the progressive era with the Flexnerian reform and its emphasis on the scientific and the eugenic. The idea was to “fortify” the nation by rational and scientific means, and to a large extent that has not changed.
The remedy? I’m not optimistic about political reform in health care, and besides, similar errors pervade our social and economic lives outside of medicine. The solution has to be cultural, I suppose, not political.
Thank you, James.
Dr. Accad,
Thank you for quoting me and alerting me to your site – it is great what you are doing. I am going to share you site with the team who organized the medical school boot camp of the Catholic Medical Association, of which I am a member.
In the articles section on my website, http://peterjcolosi.com/category/articles/ , I have two that go into more depth on incommunicability (Personal Uniqueness in the thought of Karol Wojtyla, and my critique of ANT-OAR) and two that go into the meaning of suffering.
All the best,
Pete
I am the Pres Elect of the national Catholic Medical Assn; Are you a member? If not, and would like more info, go to cathmed.org
Thanks
Great article
Thank you, Lester. I am a member of CMA and have had a couple of articles published in the Linacre Quarterly. Best wishes for your upcoming term.
“But when medical science rests on a basis of material reductionism, the human mind—the intellectual and willful aspects of the soul—has a hard time finding its proper place. ”
In which chapter of Gray’s Anatomy can I study the soul?
There is a reason that medicine relies on science for its understanding of biology and disease. It offers a structure of unparalleled strength and detail for accurately understanding reality. Let’s let physicians work with the body and priests with the soul.
He who seeks to be all things to all people ends up being of no use to anyone.
Windriven,
Thank you for reading and engaging me on these points.
I am not arguing for a blurring or overstepping of professional boundaries. Physicians clearly “work with the body,” but there are various ways to understand the nature of that body. In and of itself, Gray’s Anatomy says nothing in favor of, or against, a particular understanding of the human body. The anatomy texts of the medieval scholastics are not fundamentally different from the modern ones.
Medical practice is necessarily influenced by the degree to which we embrace or reject material reductionism (and I’m talking here primarily about our underlying medical culture). Medicine deals with “animated” persons and not textbook cadavers, however beneficial these may be to medical science (and they clearly are, as I mention in the essay).
Excellent Viewpoints on your site, Mr. Accad. Thank You for writing.
After more than 35 years in the health care fields, in my mind, one of THE most damaging aspects is excessively strict “Scopes of Practice,” and too rigidly “defining” a discipline. Such as that “physical medicine” is perceived as significantly different than mental and/or emotional medicine. Confining one’s self to what’s in Gray’s Anatomy (even if the 39th Edition) puts severe blinders on one’s ability to see the Whole Picture of a Client or Patient.
Of course, a lot of people have issues that ARE one or the other, either physical or mental/emotional. Yet many have MUCH overlap. And the BIG issue is how do you know about the Client or Patient sitting in front of you? If you do not have significant knowledge & experience of the other realms of healing, how do you recognize and know if that person sitting in front of you should be sitting in another realm instead?
I believe that, if one is working with a wide range of problems and “types” of human beings (keeping in mind the over-riding “incommunicable” factor), it does not take long to recognize that one “Scope” quickly bumps up against another “Scope.”
For example, in dealing with severe back pain, there are very clearly times when simply relieving the excess tension in muscles of the Client’s body — often VERY distant from the locus of pain — will relieve the back pain, sometimes more-or-less permanently and completely.
Yet, WHAT causes those neuro-muscular tensions and resulting pains in the first place?
These tensions can often be relieved with sustained, manual pressure directly to the muscles, which access one general set of structures in the neuromuscular system. But in some cases, if you work ON the painful muscles of the back, the Client gets worse. Work on the hamstrings, gluteals or abdominal muscles, the Client gets better. You can’t know in advance without the experimentation, often VERY time consuming.
Gray’s Anatomy, nor any other book, will tell you in advance which muscle group to work on ahead of time. Gray’s only gives you tentative yet wide-ranging ideas.
Yet other Clients, reporting with what appear to be near identical symptoms, respond as well or better to conscious stretching (yoga), addressing a somewhat different though overlapping set of internal structures, including higher brain centers. But there is no one set of yoga postures for “back pain.” That there might be is a dangerous myth.
And yet, other people discover that doing strength training exercises — the opposite of relaxing & lengthening through yoga — relieve their symptoms, and slightly different set of neuromuscular structures. But yoga teachers and personal trainers are rarely present in the same person, in great part because of “scope of practice.” So the Client is usually deprived of a “well rounded” exercise & stretching approach.
Other people, reporting with what also appear to be near identical symptoms, eventually went to Dr. John Sarno (retired), incorporating NO physical elements at all, and got complete relief by confronting their emotional issues like anger and rage. And of course, these are another set of internal psycho-neuro-muscular structures, also similar and overlapping the above mentioned structures, but not identical.
Then, of course, there are those who find some nutritional supplement, or reduction of toxic metals, that improves their situation. Again, another scope of practice, another vast realm of knowledge to consider.
We can go on and on, as there are those who have found sitting in a hot tub on a regular basis helped their back pain a LOT, or others who got a hot camel dung treatment in Israel did the trick.
But here’s the problem: the massage therapist, and the yoga teacher, and the personal trainer, and the nutritionist, and the psychotherapist (and maybe even the camel dung guy), have all had success in treating various forms of back pain that were superficially indistinguishable from each other, when the medical profession (including physical and occupational therapy) had failed.
Yet most of the practitioners in non-medical and narrowly “defined” disciplines are quite concerned, even afraid, of going “outside their scope of practice.” So they never venture into the territory next door, never explore the possibilities of different yet related therapies, for fear of the state-imposed “scope of practice” and narrow “professional definition” of practice.
In my mind, it is FAR more efficient & effective for the health care providers to have AT LEAST a working understanding of and basic skills in how the mind and emotions, or nutrition, can operate in or affect the physical body, and vice versa. These more well-rounded individuals are FAR more able to help their Clients or Patients, if for no other reason the Client has a higher likelihood of eventually ending up with the RIGHT specialist.
One reason is that each discipline collects a slightly or vastly different set of experience with, and knowledge of, the individual Client. It is often that greater, more diverse body of knowledge taken as a whole, rather than the narrow knowledge of the specialist, providing the Big Picture opening the doors to true healing of the Client or Patient. And as Hayek said, the idea that all that unique, specific knowledge can be processed by one person, one committee, one computer, one bureaucracy, is nearly, if not totally, impossible.
Excessive Compartmentalization — known as “siloing” of knowledge in the corporate world — of the various aspects of Human Beingness is, I think, one of THE most inefficient, ineffective, and sometimes dangerous, aspects of the “modern” health care system and medicine. Yet it is what the Specialists, those residing in their narrow “scope of practice,” do and excel at. Yes, specialization is of course a good thing, in many, or at least certain, cases. In others, it’s a disaster, as that specialist is the guy with the hammer seeing only nails. If nothing else, there are MANY different kinds of nails, requiring different hammers. But there are many tools for many jobs having no resemblance to a need for nails at all.
At very least, we need a significant rise in the number and skill range of General Practitioners, whose job it is, in part, to make sure the Client or Patient is going to the right specialist. Yet they need to expand beyond the orthodox ideas of what “medicine” and “health care” is all about.
Any medical doctor who denies that hands-on therapy or yoga or nutrition can have profoundly positive effects on patients is just plain out of touch with reality.
But that expanded view of heath care reality, though there are positive developments here and there, is not happening all that much now-a-days, if you ask me. And I know that because of all the horror stories I hear from MANY people who abandoned, in part or in whole, orthodox medicine because they got tired of being shipped from specialist to specialist, none of whom knew much about what the other doctors were doing nor why or how.
They didn’t even know that much about the patient, either. …
When an “alternative practitioner” like me knows more about their Client than ANY of their doctors do, you know something is very wrong. Yes, we can blame it on the economics of The System as designed by the Bean Counters. But at some point, a TRUE Physician has to look themselves in the mirror and do an integrity check. Are they REALLY serving their patients as well as possible by interviewing them for 3 to 5 minutes (often less) when it would take an hour or two just to get the real and whole picture of the Client’s background?
Is it really true that “Oh, that’s JUST a tight muscle” and has nothing at all to do with their problems? Or that an incident 20, 30 or more years ago has nothing at all to do with what the patient is experiencing today? … REALLY?
And until more doctors start seeing the Very Big Elephant in the Very Small Room — that being many human beings are in need of therapists or physicians who see the physical / mental / emotional not as separate worlds, but as ONE, integral world, but needing a wide variety of “tools” and perspectives to operate well — then the orthodox medical professions will continue to see increasing number of patients go toward the alternative practitioners.
Thank you, David.
The compartmentalization of disciplines that you refer to has been put into effect in our country by licensing laws starting about 100 years ago. In my opinion, these laws have been very damaging for health care.
On the other hand, I see nothing wrong with some practitioners taking a specific approach or wishing to stick to a specific school of thought about health and healing, be it “scientific” medicine or other types of healing arts, as long as they remain humble about it, understand their limitations, and sincerely strive to help the patient.
Michel
Great synopsis of your article above: https://www.sciencebasedmedicine.org/trying-to-impose-religion-on-medicine/#more-37813
Thank you, Sean. I wouldn’t have thought a brief essay required a synopsis, but I’m glad people are finding it thought-provoking (and hopefully not just reflex-provoking…)
Dr Accad,
Reading through your article and being a lover of philosophy, science and medicine myself, I notice a possible flaw in your reasoning. You argue against reductionism and science’s tendency to ignore any notion of a soul or animating principle. But I feel that the metaphorical ball is in your court to find the evidence for such a soul or animating principle. In philosophy, analysing the underlying assumptions can be just as enlightening as analysing the argument itself and, correct me if I am wrong of course, it seems that you have assumed a soul with no evidence. I greatly appreciate the work of philosophers of the world like Socrates or Aquinas but I feel that they also worked under the same assumptions that I am, possibly wrongly, seeing you working under.
In short, I was wondering if you had any evidence for a soul or animating principle and, if so, any evidence that attending to it can help wellbeing.
Alec,
Thank you very much for your comment.
You are absolutely correct that ideas and concepts should not be taken for granted. The principal task of philosophy is precisely to put ideas under scrutiny.
I may differ with you on the point you seem to be making that the onus is primarily on those who accept the soul principle to defend that position. I think every plausible philosophical system deserves to be examined, critiqued, defended, etc. As you said, all philosophies begin with some basic assumptions, and that is no different for material reductionism. I would also caution you against equating empirical science with reductionism. One can carry out empirical science without espousing philosophical reductionism.
If you are asking for “evidence” of the soul on strictly empirical grounds, I cannot satisfy you. By definition, soul is not a “thing” or substance. Looking for it would repeat the error of vitalism. The soul is a postulate which Aristotle advanced to explain nature and to solve conundrums stemming from the reductionist philosophies of his predecessors (notably Parmenides and Democritus), but it is not, strictly speaking, an assumption. Some Aristotelian assumptions are that there is an objective reality outside the mind, that change is real and not illusory, that “nothing comes to the intellect that is not first in the senses,” etc. From these assumptions Aristotle reasoned his way to the principles of act and potency.
Thanks again for your interest.
Michel
Your comments evoked a lengthy reply by Steve Novella at Science-based Medicine which in part described your views as an attempt to” brazenly insert faith healing and spiritualism back into medicine “. Do you believe that his comments are a fair critique worthy of a rebuttal or a reflect a major misunderstanding that should be dismissed by neglect?
James,
I was unfamiliar with that website until the Twitter tiff regarding the Mayo Clinic’s offering of “alternative medicine” care (see my prior blog post on scientific medicine). I have not checked it out but judging by the comments on Twitter and here, I think the emotions there run a little high (and with that, a tendency to jump to conclusions). Did you ever read Hayek’s The Counter-Revolution of Science? It’s a great account of Auguste Comte and his modern day descendants.
Steven Novella at Science-Based Medicine felt the need for a lengthy rebuttal to your comments saying in part that it was a brazen attempt to “insert faith healing and spiritualism back into medicine”. Did he completely miss the point ?
Dr. Accad,
Before I accept that I have a soul and my soul needs treatment along with my body and my brain, can you please provide me with any evidence you have that souls actually exist? I would not want to do any treatments on my soul that might harm my real body including my real mind. If you have any evidence that souls exist then I might be inclined to trust you as my physician, otherwise I will keep going to my current doctors.
Thanks,
Patrick
Dear Patrick,
Unfortunately, both my soul-o-meter and my animascope are undergoing repairs! Meanwhile, perhaps you can read my answer to Alec’s question, which was similar to yours.
I would clarify, though, that souls don’t need medical treatment. Persons do. If your doctors treat you with the kindness and respect that everyone deserves, regardless of one’s philosophical conceptions, you would do very well to stay with them. (I’m under no illusion of being more qualified than other doctors in that regard).
With friendship,
Michel
Michel,
I think you identified a real issue but sadly drew the wrong conclusion. There are so many holes in your argument for me to address here but what most bothers me is that you – ostensibly a man of science – chose to resort to philosophy and “soul of the gaps” to address this real issue. I hope to be wrong but in the absence of evidence to the contrary I am driven to conclude that this is just intellectual laziness.
There is a ton of things we don’t know when it comes to treating people, but to introduce the concept of a soul as something relevant to the treatment is unnecessary, or worse, laughable. You say in one of your responses “soul is not a “thing” or substance”, so how is it relevant when whatever you do as a healer is definitely a “thing”.
you start your discussion with “Why, despite the manifest efficacy of scientific treatments, do growing numbers of patients consider their medical care altogether unhealthy?”. you have not offered any evidence for this statement, but even if it is true, I could easily think of several reasons which have nothing to do with a soul or philosophy. for example:
1. the rise in expectations outpaces the rise in capabilities
2. most doctors treat patients as a cash register
when you walk into your GP’s clinic for a 1pm appointment, end up waiting until 1:30pm, the process is rushed because patients are booked in 15min time slots and you are asked to pay an not insignificant amount of money, is it any surprise you feel the treatment and experience are not what you would expect?
these are all attributable to a system and they can fixed without ever having to resort to a soul. after all, why not suggest some spells from the Standard Book of Spells by Miranda Goshawk? there is as much evidence for their efficacy as there is for the existence of a soul.
Er no….. Thomas Aquinas didn’t explain that “a human being is a substantial unity of body and soul”. He simply made that up by imagining the soul.
The soul/body question, like the mind/brain question, or the existence/essence question, is a binary state question. There are two ways to resolve the ambiguity implicit in such a question.
One is a deterministic approach: to assume that the system can only exist in one state, where “resolution” means figuring out which. The second is the quantum approach, which holds that the system can exist in any of four states (A, B, A/B, not A / not B) where “resolution” can only mean that all four states are in play at all times.
Some binary state questions lend themselves well to a deterministic approach. “Am I pregnant” is a good example; it’s a simple case of formulating a theory in such a way that it can be tested, and looking at the evidence.
Other questions lend themselves well to the quantum approach. To give an example, consider the original quantum question: whether an electron is a particle or a wave. It’s both; an electron is always a particle, and always a wave. Any effort to resolve ambiguity using a deterministic approach is doomed to failure due to self-referential error. In other words, regardless of whether your theory is “wave” or “particle,” you will always prove yourself right, and never be closer to the truth. We look at the spectacle of two groups of scientists screaming at each other — “particle!” “wave!” “particle!” “wave!” — and realize they are both delusional.
As Descartes inadvertently discovered, the question of the Self as it pertains to existence does not lend itself well to the deterministic approach; looking for “evidence of the soul” is an example of running around in the same circle (albeit in the opposite direction).
Speaking of Descartes, the question is not “can I think.” The question is, “can I think about the Self,” and if so, the matter of the Self must be a state question. The question of life is a state question. The nature of time, and the nature of matter are state questions. None of these are questions that can be answered with a deterministic approach.
But I would submit that, for these questions, the quantum approach isn’t much better in terms of giving up a meaningful answer. When Popeye says, “I am what I am,” he says nothing. Remember; the quantum approach requires Popeye to consider all four possibilities, including the part that says he is neither an object in existence, nor an essence. Resolution of duality is over-rated; one shouldn’t be eager to go there.
I think for all practical purposes, duality is all we have to go on around here. Holistic medicine is about embracing duality, accepting that a human being is a bag of stardust, and something golden. Asking, “which is it, stardust or gold?” is missing the point completely. But by the same token, it doesn’t have to be about answering a question that we just weren’t built to answer.
Thoughtful comment, David, but I must disagree about embracing duality, for it is contrary to our experience as unified beings: my self does not inhabit my body. Beside, I have found in hylomorphism a cogent alternative to dualism and determinism (and so have others, e.g. David Oderberg’s Real Essentialism; Norris Clarke’s The One and the Many; Edward Feser’s Scholastic Metaphysics, as recent examples).