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02-Mar-2001
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Arch Hellen Med, 17(5), September-October 2000, 446-449
SPECIAL ARTICLE
Medicine and humanities
S.G. MARKETOS
International Hippocratic Foundation of Kos (IHFK), Athens, Greece
Key words: Hippocratic medicine,
Humanistic culture, Medical technology, Natural sciences, Social sciences.
“If you had all the knowledge and held
all secrets in the world,
but did not have the mysterious and sacred passion for love,
you would be completely worthless”
Werner Forssmann (1956)
The humanities are an indispensable part of medical practice. The need to combine the concepts of the values of humanities with the technological “imperative” (power) is more necessary than ever before for the improvement of the future of medicine, because, at present, the patient is seen as a disordered mechanism rather than a suffering psychosomatic entity. Modern medicine is expected to solve and not to pose problems, such as de-humanization and de-personalization of suffering. Today, some of the modern hospitals have lost their compassion. The patient is a machine and medical care is a production line that can forever be speeded up! Furthermore, the enormous biomedical technology has so far contributed little to the traditionally humane fields of psychosomatic disturbances, while posing new dilemmas and threatening new problems. On the other hand, the quest for the maximally efficient utilization of new biological knowledge represents one of the most important tenets of evolutionary wisdom. For these reasons, we need both more humane biomedical science and better biotechnology for health and disease.
In medicine, more than in any other science, what is of primary importance is to establish its liaison with philosophy and religion. The link was quite strong in ancient Greek times, but as medicine started being enriched by new knowledge and scientific concepts it began moving away from philosophy, turning itself into a science with an independent structural (biotechnological) system. On the other hand, the significance of Hippocrates' philosophy and religion is evident in the magnificent development of the temples of the Greek god of healing art, Asklepios. The centers for followers of Hippocrates, the Asklepiad, the cults of Asklepios, continued to expand and flourish long after the school of Hippocrates, showing that rational medicine does not exclude a parallel body of religious medicine. There was neither competition nor enmity between the god Asklepios and the physicians.
Some valuable lessons from the lives of Hippocrates and Schweitzer life and their productive activities are of paramount importance for the modern world and they reveal the fundamental role and the perennial values of the humanities in medicine. This can be summarized in the Hippocratic message:
“For where there is love of man (philanthropia)
there is also love of medical art (philotechnia)”
Humane medicine teaches us that rationalism without the humanities renders science insufficient, and that a culture based firmly in the humanities is as important as scientific education in medical practice. It is also interesting to note that the ascendance of Christianity did not diminish the stature of Hippocratic medicine and that doctors could easily exchange the cult of Asklepios for the worship of Christ. In other words, the illustrative profiles of Hippocrates and Schweitzer demonstrate the close relationship between medicine, philosophy, cultural education and religion.
Through the history of medicine from Hippocrates to Albert Schweitzer it can be appreciated that to be a doctor (in the true sense of the term) is to be a whole personality who fulfils the task of the clinician with professional quality and integrity; as a human being with a kind behavior and high ideals; and as a member of society with honesty and efficiency and cultural education. The social sciences –and medical culture in particular– can lend a bit of reality to the flights of fancy that sometimes characterise the technological sciences. In ancient Greek culture esthetic education played an important part and music was used for the healing of psychological disturbances.
Humanistic culture is as important as scientific culture for the practice of medicine. Psychology, sociology, history, philosophy –including religious philosophy– were encompassed by the Greeks under the general term of philosophy. It is unfortunate that in English until some years ago the term science was limited mainly to physical sciences. The humanities also have a scientific status, although their object and their methodology are different. They are sciences because they comprise as much knowledge as the physical or natural sciences. The Germans, happier in their epistemological terminology, distinguish two groups of sciences, the “Naturwissennshaften”, or natural sciences, and the “Geisteswissenshaften”, or cultural sciences and humanities. It is obvious that there was a tendency for medicine to be considered by some as a natural (or physical) science and by others as a science relating to humanities. To say therefore that the physician needs humanistic, as well as scientific culture, does not mean that he needs science plus something else that is not science, but that he needs superior and complete knowledge of human subject. The frontiers of the past between physical and cultural education no longer exist.
The ancient Greeks integrated the physical sciences and the humanities under the term Episteme, inadequately translated as “Science” and meaning superior and complete knowledge. As the Greeks on the basis of their philosophical ideal were the first to study the cultural and spiritual aspects of man and the Latins later devoted their literature to the same object, the term humanities is often taken as synonymous with Greek and Latin Classics. In fact, throughout antiquity, the truly humanitarian physician rejected the myth of scientific nomenclature. However, ancient Greek medicine cannot be separated from Greek philosophy. For example, Plato teaches in his “Phedrus” that without philosophy medicine is no longer an art, but a low vulgar craft, because it is philosophy which promotes grandeur of conception and completeness in execution. It is the cultural and philosophical background and the deep insight into the problems of the world and of human life which give the physician dignity, social rank and authority. The humanities focus mainly on healing in its spiritual, psychological, social and ethical dimensions.
Psychology, sociology and history constitute the first group of human sciences. All three are intimately connected, and we cannot understand one of them without the others. The three are of great importance for medical practice. The real psychology is a cultural science and not susceptible to an analytical study according to the physical scientific methods. Sociology, intimately connected with psychology and history, is also greatly needed. Man by definition is a being “engaged” in a social environment and cannot be understood except in connection with that social and natural environment.
Life is not systematic and cannot be ordered into a scientific system. “Healing –according to Hippocrates– is a master of time, but it is sometimes also a matter of opportunity”. Humanistic education differs from physical scientific education in that is not systematic. In the physical sciences we build up a “system”, a “whole” of order and logic, this being a condition of our special –and up to a certain point, a priori– scientific methodology. Hippocratic education refers to knowing the nature of the body as a whole rather than the various lesions of the parts. Humane medicine, therefore, is concerned with the patients rather than the diseases, in contrast with physical medicine which is concerned more with the symptoms of the diseases than with the patients.
Hippocrates and Schweitzer expressed the enormous power of the physician who was also a philosopher, or as we say today, a true humanist, in the famous aphorism:
“The philosopher physician is equal to the gods”
These are some of the many thoughts that came to mind after an in-depth study of the life and the monumental work of the “Father of Western Medicine”, Hippocrates the Asklepiad (fig. 1) and of the Alsatian humanitarian and medical missionary Albert Schweitzer (fig. 2), who have many similarities and common concepts.
– Both were dedicated medical doctors and followed the same fundamental principle:
“Knowledge of medicine is not possible
without knowledge of man.
This is necessary for anyone wishing to treat man properly”
– Both devoted themselves to the direct service of the sick and to humanity, and were inspired by humanistic ideals and an undeviating dedication to the holistic approach to the problems of the patient.
– Both supported that the physician is the patient's “friend”, and were respected social philosophers and religious thinkers, in so far as philosophy and theology represent both science and ethics.
– Both had a culture of depth and devoted all their energy to helping mankind, one under the plane tree of the small Greek island of Kos, the other “at the edge of the primeval forest” at Lambarene, in what was the French Equatorial Africa (Gabon).
– Both were prophetic environmentalists and pioneer ecologists! “Human health cannot be treated separately from the natural environment” pointed out Hippocrates. “We are united with all life that is in nature. Man can no longer live for himself alone” stressed Albert Schweitzer, 25 centuries later.
– Both pointed out the collaboration of the brain with the spirit and the psyche, and emphasized that human health cannot be treated separately from the social and natural environment.
– Both argued that medicine is relevant to philosophy and theology and were concerned with the twin question “what is mind, and how is it related to the body?”
– Both proved that to be a good physician, one must be a good human being and that the parallels between creativity in fine arts and medicine are closer than medical historians usually realize.
The story of the two fascinating personalities is a pattern for a better understanding of medicine. It gives us a perfect knowledge of the human situation and a faithful mirror reflecting the features of humanity. It shows us, in broad outline, the ethical behavior, the reverence life, the preservation of fundamental dignity and the moral duty to produce good and avoid harm entirely. It inspires us in our medical actions by the example of those who have trodden before us in the same laborious path. It shows the cultural aspects of medical science and art and thus discourages young physicians from becoming mere medical technicians. The physicians’ education must contribute to making them ever more humane, and competent in the use they make of the best modern biotechnology at their disposal.
In conclusion, modern medicine is transforming itself rapidly into a biotechnological-business enterprise science. However it can still learn from a wider knowledge of the rich heritage of Hippocrates and Schweitzer. Humanistic culture is now more important and more necessary than ever. Because –as the Alsatian medical missionary wrote– “only the respect for the ethical values in life can prevent the dramatic destruction of the European civilization”.
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