Physicians cure the bodies of the sick, and neglect the health of their souls. Lawyers diligent in observing the Laws of Men, however transgress the Commands of God: whence it is grown to be a Proverb, Neither Physicians live well, nor Lawyers die well; Physicians being the most disorderly sort of men, and Lawyers the most dishonest (Heinrich Cornelius Agrippa von Nettesheim (1526). De incertitudine et vanitate scientiarum atque artium declamatio invectiva (Declamation Attacking the Uncertainty and Vanity of the Sciences and the Arts).
The (modern) medical profession wasn’t always a prestigious or lucrative one. Most European languages apparently hold proverbial sayings of the above kind, indicating a more modest social rank and reputation of the forerunners of today’s doctors.
To be sure, the history of Western medicine is a very complex and interesting one, with various strands of folk medicine and scholastic enterprises being woven together throughout the medieval and early modern periods, so we’re not going to be able to make many far-reaching, non-trivial, general observations here.
But it’s safe to say that the institution and profession of medicine was not anything like a key ideological state apparatus back in Paracelsus’ day and age.
This changed surprisingly late. While the systematic study of medicine was practiced at the oldest medieval universities way back in the 1100s, who formally trained physicians at least by the early 1200s, the practice of healing was never considered this central social endeavour of paramount importance until much later.
Academic medicine in the high medieval period was more or less a subcategory of the broad field of “natural philosophy”, i.e. the systematic philosophical study of the cosmos. By no means unimportant, its purpose was nonetheless subsumed under the general quest for truth, and the overarching Catholic (or Islamic) worldview’s ultimate goal of redemption and salvation.
This, the highest aim of the pursuit of medicine as an art receives a dual reward: the subtle intangible but far-reaching influence upon the patients, benefiting them unknowingly; the influence upon the physician by the spirit of divine love whereby is imparted the gift of insight into the realms of absolute realities - into that which underlies deeply the appearances of this kaleidoscopic world; the gift of ability to counsel the patients along the road of their own life, whereby those for whom this counsel is intended shall proceed towards the common goal of Man (ibn Sina. (1025). Canon of Medicine).
Even so, out of this formalization of theoretical medicine grew an institution of medical practice, likely with the university-trained physicians at the top, which especially in the cities branched out into sub-disciplines populated by the likes of midwives, surgeons, dentists, oculists &c.
In connection to this institution, as well as to the monasteries and cathedral schools, also emerged the hospital system. Advanced precursors were seen throughout the Islamic world from the early middle ages and onwards. Monasteries in the West established hospitiae for pilgrims, a form of inn for the traveller which also functioned as poor houses, clinics for injured folk, and asylums for the mentally troubled.
But it wasn’t until the modern era that medicine began to emerge as the central ideological enterprise we’ve come to know and love. Foucault has outlined the early phases of this development in his Madness and Civilization (1961), and pinpoints its appearance to sometime during the 16th century, in connection to the invention of madness as a social category of exclusion and isolation which is also foreshadowed by the leper colony’s institutional excision of the sick member from the body politic.
During the Renaissance, the prestige of medicine indeed began to grow significantly in relation to the expansion of early capitalism and Enlightenment thought. The slow displacement of traditional folk healing methods now began in earnest (yet which was hardly complete even by the early 20th century) as the authority inherent to healing and medicine was being appropriated by the new experts of the bourgeoisie and the universities’ powerful production of ideology.
This latter point really cuts to the heart of the issue. Healing and everything related is in many ways a fount of massive power, which now had to be diverted in service of reproducing the new social and ideological order. Medicine regards the delineation between sickness and health, between that which is desirable and that which is to be discarded. Sacred and profane. This immediately branches into the fundamentals of ethics as well as the exercise of governance. It also connects with human flourishing and fulfilment in terms of defining and satisfying needs and desires.
Healing, at quite a profound level, thereby inevitably expresses what the human being is, in terms of what relationships she needs to be whole, and how these relationships are conceptualized.
In this sense, medicine both expresses and reproduces a culture’s ontology of the human nature, its philosophical anthropology. To ibn Sina, healing connected the human being to the realm of absolute divine realities and made manifest a relational purpose of redemption. To the reductionist order of industrial capitalism, medicine is (at best) for repairing components of the megamachine, as well as to postpone death against a reductive backdrop of human health as merely physical-mechanical flourishing.
The violation of the once-sacred human body perpetrated by the Renaissance dissection theatres fully epitomizes this particular contrast and the radical transition from the former to the latter.
The so-called Medical Renaissance, the structured application of natural philosophy within a framework of Renaissance humanism, is even to a great extent predicated upon the very proliferation of dissection. This wonderful and enlightened procedure is in the dominant historical narratives advertised as something like the key demarcation between the backward and authoritarian attitudes of religion, ushering in the early methodological foundations of modern science.
Indeed. Cutting up a nameless, naked corpse to expose its defenseless innards to a gaggle of detached observers is a far cry from the relational holism of both traditional folk medicine and monasterial healing. It truly marks an entirely new way to conceptualize the human person, and in a profound sense serves to reify, to make tangible in the very physicality of our bodies, the incipient reductionist philosophy common to the capitalist economic order and its supporting Enlightenment ideologies.
The body is now utterly objectified, i.e. made into a thing, and disconnected from its rich network of lived relations in which the human person normally has its being, reduced to an isolated abstraction that can be approached “objectively”. Or is it rather more obscurely?
I started looking for other kinds of healers and I found there are lots of them. Herbalists. Faith healers. Acupuncturists. Masseurs. Hypnotists. All quacks, according to the established medical opinion. The first thing that caught my attention was their method of diagnosis. No painful interference with the organism.
Many of these people had developed efficient methods of diagnosing from pulse, colour of eye, of tongue, from gait, and so on. (Later on, when reading the Nei Ching which develops the philosophy behind acupuncture, I found that in China this was intentional: the human body must be treated with respect which means one has to find methods of diagnosis that do not violate its dignity) (Paul Feyerabend. (1978). Science in a Free Society. NLB: London. 137).
One of the most important aspects of this historical development that’s rarely mentioned at all, is the loss of the established distributed agency in relation to health.
The formerly local and contextual agency in terms of defining health and flourishing, and of treating the accordingly delineated infirmities, is now being pushed aside by the centralized authority of an expert class and its ideological institutions. While entities like the Catholic Church and the Islamic social order affirmed absolute precepts of ethics and spirituality that took precedence over any incompatible local beliefs and traditions, neither ever appropriated healing in the authoritative manner that already incipient secular modernity did.
Indeed, there is no evidence that the new science had a liberating effect. The mechanistic view of Nature that came into existence with the rise of modern science "disenchanted the world.” But there is no evidence that those who promoted it ever spoke in defense of the women accused as witches. Descartes declared himself an agnostic on this matter; other mechanical philosophers (like Joseph Glanvil and Thomas Hobbes) strongly supported the witch-hunt. What ended the witch-hunt (as Brian Easlea has convincingly shown) was the annihilation of the world of the witches and the imposition of the social discipline that the victorious capitalist system required. In other words, the witch-hunt came to an end, by the late 17th century, because the ruling class by this time enjoyed a growing sense of security concerning its power, not because a more enlightened view of the world had emerged.
The question that remains is whether the rise of the modem scientific method can be considered the cause of the witch-hunt. This view has been argued most forcefully by Carolyn Merchant in The Death of Nature (1980) which roots the persecution of the witches in the paradigm shift the scientific revolution, and particularly the rise of Cartesian mechanistic philosophy, provoked. According to Merchant, this shift replaced an organic worldview that had looked at nature, women, and the earth as nurturing mothers, with a mechanical one that degraded them to the rank of "standing resources,” removing any ethical constraints to their exploitation. The woman-as-witch, Merchant argues, was persecuted as the embodiment of the "wild side" of nature, of all that in nature seemed disorderly, uncontrollable, and thus antagonistic to the project undertaken by the new science. Merchant finds a proof of the connection between the persecution of the witches and the rise of modern science in the work of Francis Bacon, one of the reputed fathers of the new scientific method, showing that his concept of the scientific investigation of nature was modeled on the interrogation of the witches under torture, portraying nature as a woman to be conquered, unveiled, and raped.
Merchant’s account has the great merit of challenging the assumption that scientific rationalism was a vehicle of progress, and focuses our attention on the profound alienation that modern science has instituted between human beings and nature. It also links the witch-hunt to the destruction of the environment, and connects the capitalist exploitation of the natural world with the exploitation of women (S. Federici (2014). Caliban and the Witch. Autonomedia. 261).
Incidentally, to some extent, a symbiosis between traditional folk medicine and the Catholic religion had previously been institutionalized.
This is not least exemplified in the prominence of Hildegard af Bingen within the framework of medieval medicine. Hildegard was a 12th century mystic, polymath, composer and medical practitioner, and was named Doctor of the Church in 2012. She involved quite a bit of traditional folk healing in her medical writings, which among much else related to the application of herbal medicine, tinctures, and even what today would be categorized “crystal healing”.
All within a framework of theologically anchored spiritual holism.
She’s also, apparently, the first person to record the use of hops as a preservative in the context of brewing beer. And advised the consumption of a good measure of undiluted wine, the blood of the earth, after a healthy round of bloodletting.
What Renaissance Medicine and the new economic order now brought about, was a radical centralization of the previously popular authority inherent in healing. “Healthcare” and medicine now began to take form as institutionalized commodities within the framework of capitalism, produced and distributed in accordance with the centralized authority of an expert class.
Medicine now becomes “scientific”, increasingly separated from both particular local traditions and religious influence, which in other words eradicates local agency in defining health in connection to the deep situatedness of distinct cultures.
… Not being used to such ceremonies, he was very awkward at first. There was wood laid out by the fire in the middle of the tipi and he accidentally kicked it and sparks flew everywhere. When he sat down, he didn’t sit cross-legged or on his knees to show respect like we do; he just sat with his legs straight out in front of him. As part of that prayer circle in the tipi, the participants usually pray while smoking tobacco rolled in corn shucks—that smoke carries our prayers up to the Creator.
It took him a long time to roll his and he spilled his tobacco and had to ask for more, causing quite a distraction. But after a while he got his tobacco rolled up and then he asked to pray out loud for this woman. “She knows the kind of person I am, yet she’s never pointed a finger of scorn at me. She always talks good to me. God, You have need for this kind of person to be in this world. If we had more people like her, maybe those of us who are looked down upon by others would not have reason to feel so bad about ourselves. She’s the one who makes me feel good. I don’t qualify like these other people who talk to You. But I came here because I love her, and I ask that You look down upon her. You don’t have to bless me. But I ask, if it’s at all possible, that You bless her. Take away her illness, whatever it might be. You’re the One who can do it. That’s all I have to say.”
The woman had been lying down but soon after that prayer she sat up and wanted to speak. “I appreciate all the efforts everyone has put forth on my behalf. I feel well now, I have no pain, none whatsoever, and what got me well is how my son here prayed for me. What that prayer meant to me most was the fact that there was sincerity and love there. It was like taking good medicine and I’m very grateful.” (Bear Heart, Molly Larkin. (1996). The Wind Is My Mother).
This loss of agency manifests in myriad ways. Not only in terms of the obscuring of traditional knowledge and ways of approaching ailment and injury, but also in the erosion of our ability to care for ourselves and each other, spiritually as well as physically. We become dependent upon authority to know whether or not we’re actually healthy and sane. Expertise becomes a proxy between ourselves and reality.
And the medical-industrial complex providing us with healthcare commodities within the capitalist order is not going to be the must trustworthy intermediary.
I have friends in their mid-30s who think their poor health (derived from chronically inadequate diets, lack of exercise, prescription medications and… Well, alienation) is actually nothing but the inevitable ravages of old age. Yes. Really. They’re just unlucky in the genetic lottery (since human beings apparently evolved to randomly self-destruct).
But one day, they say, Science might be able to augment, heal and revitalize their decaying bodies.
In summary, it’s crucial that the commodification of health which developed within the modern social order is considered in relation to its role and function within capitalism. It goes much deeper than the mere extraction of value and the implicit taxation inherent to the artificially generated demand for the medical commodity. From the very beginning, the development of “modern medicine” (and the positive discursive charge of that concept which most of us immediately perceive) is an ideological battle over the definition of the human being as such, and the radical usurpation of the authority to discern her end and manners of fulfilment.
Having proved his fitness by passing a very stiff competitive examination, Heiser spent several years combating the flood of diseased and otherwise Undesirable immigrants. He was then lent to the Philippines as Chief Quarantine Officer under the Medical Board. Shortly afterward he became head of the department of health in the civil government under Taft. Taft and his successors surrounded themselves with a remarkable group of young men who brought civilization and organized government to the people of the Islands in the space of a decade. Without Heiser it is doubtful if the other departments could have functioned. How he conquered one scourge after another to make the Islands the healthiest tropical land on earth is exciting reading.
When, in 1912, President Wilson turned the administration of the Islands over to the native politicians, Heiser went to work for the new International Health Board.
This foundation, endowed by John D. Rockefeller, Sr., has spread its measure of good health through all the medically backward parts of the world, including the United States. The wise policy of the Board was to prepare a test demonstrating each new project to a small unit of the population. Once this had succeeded in convincing the people and the bureaucrats, financial and administrative aid was maintained until the project had extended throughout the health service. Then the wrork was turned over to the service and the subsidy stopped. Heiser’s great contribution lay in finding out the need for each innovation and in carrying out the exceedingly difficult diplomatic negotiations that paved the way to eventual success.
…
This autobiography should be of great interest to anybody who enjoys adventure and the achievements of medical science. It will be read with distress by all antivaccinationists and many Christian Scientists. It should be very stimulating to anyone working in the field of public health. It should be required reading for all politicians and administrators who have any doubts as to the wisdom of generous appropriations for good public-health departments and as to the supreme importance of keeping these departments free from the contaminating influence of political spoilsmen (Charles B. Lund Jr. (Oct. 1936).“An American Doctor’s Odyssey” (review of Victor Heiser’s book of the same name). The Atlantic).
Modern medicine’s function of actual healing - of servicing the workforce, the human machinery - is almost incidental to its role in anchoring ideological reproduction and the maintenance of the class structure and expert authority.
Modern medicine is, essentially, a ritual system engaged in the monocultural commodification of health against the backdrop of the fundamental myths of modern industrial society. It singularly embodies modernity’s narrative of progress and infinite technological power, and allows us to immediately partake in and internalize this narrative through the consumption of medical products.
Its early history is deeply intertwined with the emergence of the capitalist social order and the ideological reproduction of its class structure and bourgeois expertocracy. Modern medicine is clearly auxiliary to the ideology of secular scientism that permeates contemporary industrial societies, and its later developments are intimately connected to the spread of colonialism, imperialism as well as the formation and legitimation of 20th century totalitarian ideology.
The glaringly obvious malfeasance of the last couple of years indicates that the time is ripe for a broad interrogation of industrial medicine under capitalism, not only in terms of its immediate destructive effects (widespread medical and clinical iatrogenesis through unnecessary or wrongful treatment or the obscuring of a wide range of effective practices for maintaining health), but also in relation to its role in the reproduction of ideology, its symbolic function, and its overall impact on popular agency and spiritual health.
But the fundamental reason why these costly bureaucracies are health-denying lies not in their instrumental but in their symbolic function: they all stress delivery of repair and maintenance services for the human component of the megamachine, and criticism that proposes better and more equitable delivery only reinforces the social commitment to keep people at work in sickening jobs. The war between the proponents of unlimited national health insurance and those who stand up for national health maintenance, as well as the war between those defending and those attacking all private practice, shifts public attention from the damage done by doctors who protect a destructive social order to the fact that doctors do less than expected in defense of a consumer society (Ivan Illich (1976). Medical Nemesis. Pantheon).
Most excellent essay, here are a few ideas that leapt off the page (for me).
The body is now utterly objectified, i.e. made into a thing, and disconnected from its rich network of lived relations in which the human person normally has its being,
is now being pushed aside by the centralized authority of an expert class and its ideological institutions.
because the ruling class by this time enjoyed a growing sense of security concerning its power, not because a more enlightened view of the world had emerged
because the ruling class by this time enjoyed a growing sense of security concerning its power, not because a more enlightened view of the world had emerged
We become dependent upon authority to know whether or not we’re actually healthy and sane. Expertise becomes a proxy between ourselves and reality.
the workforce, the human machinery
What's missing are bit comments concerning the machine's food we are eating (I propose purposely making us sick) and the nature of hierarchy. Otherwise don't be dissing the generalists as they are the source of ideas for you who dig well into ideas.
I've gotten over this we thing a few years ago and respond by typing don't include me in we!
Have you read Spengler Johan? He has a great take on this period of the west and the changes wrought. He argues that what happened during that early modern period is not unique to the west, it's merely what happens as a culture begins to urbanise to a greater degree as it goes though its life cycle. Obviously the west also has unique qualities that made this particularly damaging. to the outside world.
The catholic religion of the early middle ages is a religion of the countryside, fantastical, beautiful and crazy, with many different deities (saints, Mary, Satan and his Demons). Protestantism and the Puritanism that followed are that of the City, cold, calculating, intellectual, demanding much while offering little in regards to priestly contrition, festivals or just fun. Nature is the Devil, human brilliance is God (God becomes a master of machine universe). Medicine becomes completely caught up in this and everything else is shoved to the side (it is interesting that dissection is carried out on the dead, not the living).
It is but a short step from there to atheism and 'scientific rationality'. Nothing is scared and everything is up for grabs.