Mystery, Mechanism, Meaning and the Re-Enchantment of Medicine
It is well-documented that an epidemic of disillusionment exists among modern health care practitioners. Stressed, stretched, and burnt-out doctors are more prone to errors, substance abuse, and depression . In the U.S., nine out of ten doctors now dissuade others from joining the profession, and there are about 300 physician suicides per year, far higher than in any other profession . What is the cause of this disillusionment, and what can be done about it?
In the spring of 2017, the annual Medicine and Religion conference will be held in Houston under the theme “Re-Enchanting Medicine.” The conference sets the tone this way:
2017 marks the centennial of Max Weber’s lecture, “Science as Vocation,” in which he claimed that the modern world had lost its enchantment. Modern people, Weber argued, are socialized to see the world as merely material, without intrinsic meaning. This disenchantment leads modern cultures to treat nature, including human nature, as substance to be manipulated and controlled, using the latest scientific knowledge and technique, organized by bureaucracy and market forces .
The theme of the conference is to discuss how the disillusionment in medicine can be tied to the disenchantment of medicine. Disenchantment is often thought to be a condition of the modern mind, which sees the world as “merely material, without intrinsic meaning,” and has big impacts on the way medicine is practiced . This disenchantment is thought to arise from a naturalistic worldview. Naturalism is the philosophical view that the natural world in which we live is all there is, although, much depends on what one means by “natural.” Naturalism holds that the world is physical stuff subject to the causal laws of nature, and since we too are in the world, then we are no fundamentally different than any other physical thing. Naturalism creates what Ian Thompson has called a “monopoly on the real,” which delegitimates all non-quantifiable understandings of reality as “irrelevant, ridiculous, nonserious, irrational” . It is the inability of the modern mind to remain open to other ways of seeing the world that these thinkers believe is depressing, dehumanizing, and ultimately a major source of disillusionment in medicine.
Disenchantment critiques often begin by citing the prescient remarks of thinkers like Max Weber or Martin Heidegger, who warned of the dangers in seeing the world in purely naturalistic terms. A “totalizing naturalism,” or gestell, as Heidegger called it, is the view that all of reality is the natural, physical world, and our only way of knowing this world is through the application of science. For Heidegger, the gestell caused humanity to see everything as bestand, mere resource on standby for use and abuse if necessary . All we need to do is understand how a thing works, and then proceed to use it, without reservation, however we see fit. Through the lens of the gestell, we no longer see a river as a river, or a field as a field, but as potential reserves of power. We do not behold a field in its natural, beautiful state, instead we wonder how we can use it for some gain, as a place to grow crops, build a hotel, or potentially harvest some precious mineral. This is what Heidegger meant when, in his famous 1966 Der Spiegel interview he stated, “All our relationships have become mere technical ones. It is no longer upon an earth that man lives” . Heidegger’s view is echoed by Max Weber when he writes, “The fate of our times is characterized by rationalization and intellectualization and, above all, by the disenchantment of the world” .
Humanity too eventually comes to be consumed by the gestell—people can be reduced, studied, modified, and ultimately exploited—no different from fields, rivers, or machines . It is this application of gestell to humanity that has implications for the practice of medicine. This disenchantment of medicine is blamed for the feeling had by so many healthcare practitioners of being cogs in a machine. The era of evidence-based medicine has sought, as much as possible, to remove the judgment of the individual physician in making treatment decisions and rely solely on studies and statistics instead. Seemingly endless documentation in the electronic medical record has practitioners spending more time staring at the screen of a computer than actually spending time with their patients. Only quantifiable metrics are used to evaluate hospital practices, features of experience resistant to being captured by a number are considered less real, less important. Physicians are trained to intellectually dissect their patients, to see them through what Michel Foucault termed the “medical gaze,” a dehumanizing separation of the patient’s body from the patient’s identity.
Tying the modern disillusionment with medical practice to the disenchantment derived from a totalizing naturalism sets up the “solution” to modern disillusionment to be the rejection of naturalism. Is this the best way forward? There is an assumption motivating the move to re-enchant medicine that needs to be made explicit. This assumption is that we need mystery to have meaning in life—that, conversely, we come to devalue what we come to fully understand. It is bad enough when humans come to understand being as, in principle, mechanistic, and even worse when it is proven to us. A general belief that all being is, in principle, mechanistic, can lead to a kind of malaise towards being. However, once science “opens” an entity up and proves its mechanism by showing precisely how it works, the understanding of that entity becomes complete and devaluation looms. Courtney Campbell recognizes this malaise with respect to research on human embryos. The moment we start subjecting human embryos to scientific research and begin revealing their secrets, awe is diminished, reverence reduced and abuse threatens. He writes, “To begin to make sense of the mystery of life itself is surely at the core of scientific inquiry…Yet, will it be possible to pursue both the scientific…quest, and to retain the awe that animates it, or will familiarity transform the miraculous into the mundane?” .
The assumption that mystery is required for meaning seems to be psychologically persuasive to us, but is it conceptually coherent? Why, exactly, do we devalue what we come to understand on mechanistic terms? Is the best way to fight the epidemic of disillusionment in modern medicine through a “re-enchantment” of medicine, a rejection of the totalizing naturalistic view, a re-emphasis on mystery? Why is mystery even valuable to us in the first place? Isn’t confusion the appropriate response to mystery? What about all the attendant dangers of mystical thinking?
The naturalism born out of the scientific revolution was, in part, a response to the Thirty Years War that saw bloody slaughter all throughout Europe on account of disagreements among religious authorities who grounded their knowledge claims in revelation and mystery. It is not clear what the re-enchantment of medicine would look like, but such obscurity is likely the result of any solution predicated upon the affirmation of mystery. Instead of accepting such mysticism, it may be more interesting to wonder why we care so much about mystery in the first place. What do we really lose in such a world where, in the words of AI researcher Eliezer Yudkosky, “Since the beginning, not one unusual thing, has ever happened” ?
Shanafelt, T.D., et al., Burnout and medical errors among American surgeons. Annals Of Surgery, 2010. 251(6): p. 995-1000.
Drake, D., How Being a Doctor Became the Most Miserable Profession, in The Daily Beast. 2014.
Weber, M., Science as a Vocation. 1958, American Academy of Arts and Sciences. p. 111.
Thomson, I.D., Heidegger on ontotheology : technology and the politics of education. 2005: Cambridge ; New York : Cambridge University Press, 2005.
Heidegger, M., The question concerning technology, and other essays. Harper colophon books ; CN 419. 1977: New York : Harper & Row, 1977. 1st ed.
Sheehan, T., Heidegger, the man and the thinker. 1981: Chicago : Precedent, c1981.
Campbell, C.S., Awe Diminished. Hastings Center Report, 1995. 25(1): p. 44-46.
Yudkowsky, E. A Technical Explanation of Technical Explanation. 2005; Available from: http://yudkowsky.net/rational/technical/.