Medicine, Health and Being Human

Lesa Scholl

• Publisher: Routledge
• Year: 2018
• ISBN:
  9781351402132
• Edition: 1
• Topic: Social Sciences
• Subtopic: Global Development Studies
• Index: Social Sciences

Medicine, Health and Being Human begins a conversation to explore how the medical has defined us: that is, the ways in which perspectives of medicine and health have affected cultural understandings of what it means to be human.

With chapters that span from the early modern period through to the contemporary world, and are drawn from a range of disciplines, this volume holds that incremental historical and cultural influences have brought about an understanding of humanity in which the medical is ingrained, consciously or unconsciously, usually as a mode of legitimisation. Divided into three parts, the book follows a narrative path from the integrity of the human soul, through to the integrity of the material human body, then finally brought together through engaging with end-of-life responses. Part 1 examines the move from spirituality to psychiatry in terms of the way medical science has influenced cultural understandings of the mind. Part 2 interrogates the role that medicine has played in the nineteenth and twentieth centuries in constructing and deconstructing the self and other, including the fusion of visual objectivity and the scientific gaze in constructing perceptions of humanity. Part 3 looks at the limits of medicine when the integrity of one body breaks down. It contends with the ultimate question of the extent to which humanity is confined within the integrity of the human body, and how medicine and the humanities work together toward responding to the finality of death.

This is a valuable contribution for all those interested in the medical humanities, history of medicine, history of ideas and the social approaches to health and illness.

Part I

Situating the soul, self and mind

1 Physicians and the soul

Medicine and spirituality in seventeenth-century England

Michelle Pfeffer

There has been of late a vigorous interest in combining medical practice and spirituality to facilitate the provision of holistic patient treatment. According to this vision, it is only by considering the whole person – body, mind, soul and spirit – that optimal health can be obtained. What is at stake in these discussions is not only the connection between the “spiritual” and “biological” aspects of a person, but the very existence of a human soul and/or spirit. That is, a certain conception of “humanness” is a basic assumption of all claims for or against a combination of medicine and spirituality. This is important because the conceptual frameworks upon which medicine is practiced guide the ways that people see and define themselves. As Marilyn Schlitz has argued, if medicine plays a role in defining the human, then an “integrated” medical perspective “requires a deep examination of our core assumptions about reality and our place in it” (2011, 151).

The second half of the seventeenth century in England was a time when – like today – the relationship between the body, soul and spirit and the relations between medicine, spirituality and health were under negotiation. A key figure in these discussions was the Anglican and university-trained physician and anatomist Thomas Willis (1621–1675). Like today’s supporters of spiritually inclusive medicine, Willis’s views about humanity were the basis of his medical theory and practice. In this chapter, I will first examine common seventeenth-century ideas about the nature of the human and the study of the soul, showing how Willis reinforced and subverted different aspects of the mainstream position. From this point, I examine the ways Willis applied his philosophical ideas to his medical practice. His notion that the physician could and should play a role in healing the soul was built upon a complex blend of personal, theological, clinical and anatomical knowledge and experience. Crucially, Willis’s work in turn served both to subvert and reaffirm different theological approaches to human nature in the seventeenth century, and the final section of the chapter will explore three religious responses to his widely read work. The fact that we can discern contrasting levels of acceptance of Willis’s various findings suggests that medicine does not merely dictate what it means to be human, but instead provides a set of resources with which people can grapple, and accept, reject, or modify according to their pre-existing values and beliefs.

Despite originally intending a career in the church, Willis shifted his sights to medicine while studying at Oxford University and was awarded a Bachelor of Medicine in 1646. While his career began rather slowly in rural Oxfordshire, his rising social status on account of his involvement with prominent natural philosophers and his post as Sedleian Professor of Natural Philosophy from 1660 onwards meant that by the mid-1660s his career had advanced to such an extent that he was earning the large sum of £300 a year (Hawkins 2011). While a keen interest in chemistry in many ways guided his research, Willis soon became fascinated with anatomy and directed his attention to the soul and its relationship with the body. His medico-anatomical texts, Cerebri anatome (1664), Pathologiae Cerebri et Nervosi Generis Specimen (1667) and De anima brutorum (1672) in particular, were immediately influential.¹ In his application of medical and anatomical experience to the question of the soul, Willis was highly apologetic, in the sense that he was seeking a conception of the human that would fit with his clinical practice and his anatomical work as well as his religious beliefs (Bynum 1972). Willis constructed an understanding of the human that would go on to organise his approach to disease and illness. In early modern England, the human soul was typically considered the spiritual and immortal aspect of a person, and while Willis agreed with this vision, he also ensured that the soul was a medical patient.

Body, soul and spirit

In his first letter to the Thessalonians, St Paul wrote: “the very God of peace sanctify you wholly; and I pray God your whole spirit and soul and body be preserved blameless unto the coming of our Lord Jesus Christ” (1 Thessalonians 5:23). For Willis and the prevailing tide of opinion in the seventeenth century, these words were an accurate representation of the composition of a person. Humans possessed a body, a spirit, and an immortal, rational soul. While brute animals also had a body and a sensitive spirit (or sensitive soul), the rational soul was possessed by humans alone. The Bible was the foundational text of early modern English culture and implicated every area of society, so the scriptural support offered to this three-fold framework made it particularly attractive. But, like any text, the Bible could often mean different things to different people, and the same passages could be used to support divergent ideas and agendas. Accordingly, 1 Thessalonians 5:23 was combined with various “biological” understandings of humanity and mobilised in support of competing visions of humanness. For the most part disagreement centred on the spirit/soul that humans had in common with animals. Some, like Henry More, claimed that the sensitive soul of both humans and brutes was immaterial. Others, like René Descartes, believed that the word “spirit” in 1 Thessalonians referred to the “animal spirits,” those extremely subtle particles in the nerves that controlled bodily functions like muscle movement, sense perception and the passions. Animal spirits were corporeal, but very “fine,” and were therefore considered able to mediate between the physical body and the immaterial soul. Willis, however, like many of his contemporaries, complained that Descartes’s distinction between the res cogitans and the res extensa did not adequately explain how two radically different substances could influence each other. Thus, Willis decided that a mediator was necessary, and his solution was the “corporeal soul,” a refined and subtle substance that communicated between the body and soul (Willis 1683, 40–1).

The corporeal soul was composed of two parts: the “vital” spirit in the blood and the “sensitive” spirit in the brain and nerves (Willis 1681a, 95). While for Descartes the animal spirits belonged to “a totally different genus” from the rational soul (Descartes 1649, 131–3), for Willis the boundaries between soul, spirit and body were much more fluid (Bynum 1973, 456–7). Yet, for Willis, the human remained composed of a corporeal sensitive soul, an immaterial rational soul and a physical body, just as St Paul had described.

Whether they held the sensitive part of humans to be an immaterial soul, a corporeal soul or simply part of the body, early moderns saw a divide between the rational and sensitive aspects of humanity. This division implied that while the latter was the proper province of the physician and physiologist, the former was out of the bounds of naturalistic enquiry, knowable instead through metaphysics, theology and spiritual practices. The rational soul not only facilitated a relationship with God, but was responsible for what many saw as the two key aspects of the imago dei: thought and will. As an immaterial substance, it was believed to be incorruptible and thus liable only to moral and spiritual decay. The sensitive, corporeal part, meanwhile, responsible for the bodily functions of growth, nutrition and sense, was susceptible to physical disease and decay. Yet because the rational soul, residing in the brain, relied upon the “Images and Impressions” of the corporeal soul in order to exercise reason, judgement and will, its “mental” functions were liable to deteriorate with the sensitive ones (Willis 1683, 32). The health of the rational soul relied on the health of the corporeal soul, and, as we will see, the opposite was also the case.

The sensitive/rational division had a long history spanning back to classical philosophy. According to the principles of Aristotle, whose oeuvre had largely directed Western philosophy from the eleventh and twelfth centuries onwards, the soul was the “form” of the body, and manifested at nutritive, sensitive and rational levels. In De partibus animalium Aristotle suggested that natural philosophers should study the nutritive and sensitive levels, but not the rational level. So which discipline should examine the soul’s intellective functions? While nearly all Latin commentators located psychology in natural philosophy, in the Renaissance some speculated that the soul was an ens medium – a middle thing – belonging to both, with its nutritive and sensitive parts in natural philosophy and the rational part in metaphysics (Bakker 2007, 151–78). In general, however, the soul qua soul was placed in metaphysics, and the soul qua animating principle was studied in natural philosophy (Wolfe and van Esveld 2014, 374).

The faculty structure of English universities long reflected this division. Oxford students like Willis would have learned about the nutritive and sensitive souls in natural philosophy and the rational soul in metaphysics (Vidal 2011, 3–4). Outside the pedagogical system, however, the continued collapse of Scholasticism in the seventeenth century altered this Aristotelian divide (Funkenstein 1986, 6). In practice, the soul crossed the borders between physics, metaphysics and theology. The prominent natural philosopher Robert Boyle (1627–1691), for example, argued that theology and natural philosophy should be used alongside each other: in regards to the soul, “much may be deduced from the light of reason … [but] divine revelation teaches it us with more clearness, and with greater authority” (Boyle [1674] 1999–2000, 22). Boyle advised that “the judicious estimates of reason, improved by philosophy, [should then be] enlightened by natural theology” ([1691] 1999–2000, 348). In Charles Wolfe and Michaela van Esveld’s phrase, the soul was a “go-between concept;” it was the subject of “shared territory” where various disciplinary perspectives were useful and legitimate (2014, 379). Seventeenth-century writers on the soul purported to use the best information gathered in dialogue with different disciplines. They wanted their practice to be informed by well-rounded, cross-disciplinary truths.

Within this context, the soul in the later seventeenth century tended to be discussed in texts that claimed to use natural philosophical and theological methods simultaneously. But could medicine provide any insights on the soul? Medical students at Oxford were exposed not only to the Aristotelian corpus, but also to Hippocratic practice and Galenic anatomy (Booth 2005, 50). Galen had described the soul as dependent upon bodily temperaments, and there was an influential tradition that emphasised the need to treat the body and soul together (Gowland 2006, 47; Lund 2010, 113). While the soul thus had a long history of being within the purview of medical practitioners, seventeenth-century physicians in particular built for themselves a persona that emphasised the spirituality of their practice. The physician’s long-held reputation for immorality and atheism – summed up in the medieval adage ubi tres medici, duo athei – was based on both their supposed tendency to treat disease “naturalistically” (Henry 1989, 88; Kocher 1956, 241; Wolfe, 2006) and the common perception that physicians were greedy, untrustworthy and morally suspect (Sumich 2013, 2, 22). In their defence, physicians increasingly emphasised the spiritual facets of their practice. While physicians were sure to “disentangle their intended services from those of the minister” (their priority was the body; the health of the soul was a “by-product”) (29), the close connection between soul and body meant that in practice, “the duties and functions of the two professions often overlapped” (Hawkins 1995, 107). This was the case for Willis.

Willis studies the soul

The seventeenth century is often heralded as the period in which the important move from speculative to experimental natural philosophy began to take place (Anstey 2005). In the preface to Anatomy of the Brain, Willis discussed how his university position required him to provide some comment on the soul, and while he had “thought of some rational Arguments for that purpose, and from the appearances raised some not unlikely Hypotheses,” he nevertheless “seemed to my self, like a Painter, that had delineated the Head of Man … at the will of a bold Fancy and Pencil, and had followed not that which was most true, but what was most convenient” (1681a, 53). This quotation discloses the generally unstable position of speculative reasoning in the seventeenth century, and Willis’s decision to apply himself instead “to the study of Anatomy … [, that] a firm and stable Basis might be laid” is demonstrative of a physician’s attempt to situate himself firmly within the zeitgeist (53). Accordingly, the first treatise of Two Discourses on the Souls of Brutes was “Physiological, shewing the Nature, Parts, Powers, and Affections” of the corporeal soul, and Willis’s claims in this section emerged from his clinical and anatomical work, but remained rooted in theological presuppositions.

Willis’s anatomy revealed that the brains of humans and quadrupeds were similar in form, but the fact that they were so different in function – animals, it was said, could not reason or will like humans – meant that “some immaterial principle in man must be postulated in order to account for the mental differences in men and animals” (Bynum 1973, 447). Willis’s anatomical findings, then, inferred the existence of an immaterial, immortal soul.

In an example of the communication between physician and theologian that existed during this period, Willis dedicated Cerebri Anatome to the Archbishop of Canterbury. For Willis, religious leaders reside “over all our Temples and Sacred Things,” and this includes the temple of the mind – “the living and breathing Chapel of the Deity” (1681a, 51). Willis did not deny the spiritual authority of religious institutions; however, he admitted he was fearful that church authorities would be upset because he was treating a theological subject in a scientific way: “[c]oncerning the Soul, I have enter’d upon a great and difficult thing, and full of hazard; where we may equally fear the Censures of the Church, as the Schools” (51). Willis knew he was touching a matter of great theological importance. Some believed that by declaring the sensitive soul corporeal, there would be no evidence for human immortality or even for God himself. However, Willis was confident that his propositions were in line with Biblical doctrine. He claimed that he was in “a place of Safety, in that the Arguments and Reasons fight on my Side, and that I have got the Suffrages of the ancient Philosophers, and the holy Fathers” (51).

Willis argued that his medical theories adhered to the Biblical doctrine of the spirit/flesh divide – that is, between the fallen, sinful flesh and the immortal, immaterial spirit: “the Corporeal Soul adhering to the Flesh, inclines Man to Sensual Pleasures, whilst in the mean time, the Rational Soul, being help’d by Ethical Rules, or Divine favour, invites it to good Manners, and the works of Piety” (1683, sig. A4^r). This highly theological interpretation of human physiology meant that, as Willis explained, his view was “altogether Orthodox, and appears agreeable to a good Life, and Pious Institution: from hence the Wars and Strivings between our two Appetites, or between Flesh and Spirit, both Morally and Theologically inculcated to us, are also Physically understood” (sig. A4^r). For Willis, medical and anatomical analysis of the corporeal soul meant that “the wonderful things of God are very much made known,” so much so that “not only the Face and Members, but also the inward Parts” of animals “shew them to be of a most Elegant and Artificial and plainly Divine Structure” (sig. A4^v). Medical knowledge, then, can help an individual to live piously. Medicine served apologetic and theological purposes, and the soul was thought to be connected to the body on moral, theological and physical grounds. And if the body and soul and medicine and spirituality were so closely connected, the soul could be...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright page
• Table of Contents
• List of figures
• Notes on contributors
• Foreword: medicine, health and being human
• Acknowledgements
• Introduction: medicine and modernity
• PART I Situating the soul, self and mind
• PART II Socio-medical narratives
• PART III Limits of medical intervention
• Index