Still Caught between Descartes and Spinoza
In the aftermath of the attacks on September 11, the fovernment in Washington is planning to spend billions of dollars to protect Americans from the threat of biological/chemical warfare. But this new campaign, which is being organized by public health officials and pharmaceutical companies, will not remedy international dangers to human health such as epidemic diseases, environmental pollution, and the overuse of antibiotics in agriculture and medicine.
Even if it doesn't tacked these planet-wide problems, however, the current organization of health care in the United States is not sustainable. Medical expenses are rising to intolerable levels, while forty-three million Americans currently have no health care coverage at all. And the aging baby boomer generation will soon place demands on the system that it cannot possibly meet.
What can be done? It is pretty clear that we cannot simply depend upon the corporations-the so-called "medical-- industrial complex"-to handle the nation's health care needs. Medicine today-like Judaism, as this magazine suggests-needs renewal. But in what direction? Legislation to establish patient rights and a single-payer plan that covers everyone are certainly worth fighting for. And Western scientific medicine should make room for the valuable insights and practices of alternative traditions. But these reforms do not address what is fundamentally wrong with health care in this country and may not even be winnable in the absence of more fundamental change. In place of the orthodox medical model that focuses narrowly on biological repair, we need a much broader, prevention-oriented, and ecologically aware approach-one that remains scientific while encompassing all the relationships that are essential to human health.
If we look at the history of medicine, we can see that it became what it is today because of a sweeping social transformation that modernized Europe centuries ago. Urbanization and commerce, along with Protestantism and the Catholic Counter-Reformation, encouraged new ways of conceiving and interacting with nature. It was within this context that "scientific medicine" was invented. The particular scientific model that became predominant in Europe in the seventeenth century accepted the mind-body dualism of Rene Descartes, for whom the human body is a self-contained, entirely material machine. His contemporary, Baruch Spinoza, on the other hand, elaborated a more relational view, stemming from a Jewish tradition that regards the body as essential to a complex and ultimately spiritual being, and all beings as mutually dependent.
Spinoza's perspective is no less compatible with scientific medicine than the Cartesian view. For science has two complementary ways of explaining: by taking apart-as atomic physics mainly does-and by bringing into relation-- as Einstein's relativity theory does. Spinoza was quite aware of the power of the first approach, as elaborated by Descartes and advanced by technologies such as the newly invented microscope. Spinoza acknowledges that the human body is composed of parts, and those parts of smaller parts still. But he recognizes also that bodies are encompassed by, and can be adequately understood only in relation to, unities larger than themselves, until we reach the widest system of all, which is "the whole of nature." Spinoza was an early exponent of what is known today as "systems theory."
Medicine in the sixteenth and seventeenth centuries could have taken a more integrative path, in keeping with Spinoza's insight that we are guardians not only of our bodies, taken individually, but of the entire domain of nature with which they are continuous. Instead-for reasons that this essay will explore-mainstream medicine adopted the Cartesian machine model. Today, nearly four centuries later, the contradictions between these two approaches to health care remain unresolved. …