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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 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 twelfth-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 accidents 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's dream of conquering illness through the methodical application of empirical science seems to be well under way (Lindenboom 1978).
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's 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 centuries. 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 one hundred years, the medical profession, with the help of government, academia, and big business, has turned Western medicine into a “healthcare delivery system” in which 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.”2 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?
Michel Accad, M.D., practices cardiology and internal medicine in San Francisco. He writes about medical philosophy, medical ethics, and healthcare economics in his blog “Alert and Oriented” (http://AlertandOriented.com).” His Twitter handle is @michelaccad, and his email address is moc.daccard@daccard.
1.Readers unfamiliar with hylomorphism may wish to read Fr. Michael Dodds's introductory texts which explain Aristotelian-Thomistic natural philosophy from a vantage point of familiarity with modern empirical science (Dodds 2010, 2013).
2.Colosi (2003) clarifies what Wojtyla means by “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.”