Michael Schwartz, University of Hawaii and University of Louisville
18 February 2010
Regretfully, we have misspelled the name of the French philosopher and physician Georges Canguilhem (1904-1995) throughout this manuscript. Veuillez nous excuser!
Michael Schwartz and Osborne Wiggins
Competing interests
The authors have no conflicting interests to declare.
Duality, polarity in medicine
Michael H. Kottow, Universidad de Chile
1 March 2010
MA. Schwartz and O.P. Wiggins thoughtful article is an audacious attempt to deal with the mind-body problem, and the first question that comes to mind is whether Descartes’ dualism can ever be solved, or perhaps dissolved at least for medical purposes. Psychosomatic’s valiant effort finally backfired because it could not avoid thinking about the integration and mutual influence of two components –psyche and soma-. Hans Jonas taught us that subjectivity runs through most animal species, but only humans are aware of it and therefore bound to be ethical. Awareness recreates a duality, in that human beings are their own observers as they dislocate their conscious self from their body: our subjectivity is eccentric to our body, as H. Plessner remarked. Merleau Ponty saw the body as a “system open towards the world”, prompting Plügge to understand the physical body (Körper) in its phenomenological dimension as Leib (stretching scholarly grammar which often differentiates Leib (living body) from Körper (dead body). Referring to the body that we are and the body we have, the Anglophonic literature refers to the lived –phenomenological- body and the living –physical- body. In all three languages, the distinction has phenomenology in mind, trying to present the lived body as experiencing the world -and itself-, and the living body as a physical organism. This has enriched medical thinking by reaffirming the distinction between feeling ill and having a disease. A vast field of inquiry is thus opened, which will also lead to exploring the conceivable difference between, and the ethical consequences of, being genetically engineered and living the experience of being programmed. There is unanimous agreement that this distinction is in clear opposition to Cartesian dualism. Intertwinement is often mentioned, and in his German text, Plügge speaks of Ambiguïté (sic). It remains a major task to understand what it is that intertwines, and explore the nature of this interaction. This may well be the Gordian knot Schwartz and Wiggins are focusing on. It also remains to be seen whether the concept of polarities will be a unifying element. Nuclei may be understood as a unity, but poles present as a duality. This stimulating article confirms Toulmin’s belief that medical ethics may have saved the life of philosophy. Miguel Kottow Universidad de Chile
Competing interests
None declared
value and organic life
Thomas Huddle, UAB
13 March 2010
Michael Schwartz and Osborne Wiggins propose to offer an account of reality better than any presupposed by mind-body dualism. They claim that psychosomatic medicine demands such an account, but why this is so is unclear. Medicine has been successfully practiced by dualists, monists, and those who have never given the matter any thought at all. Must we indeed have any particular philosophy of life to practice medicine and practice it well? Let alone the correct one?
Schwartz and Wiggins go on to describe some aspects of organic life and conclude that “value is built into the reality of organic life”. From the propensity of living things (presumably including non-sentient living things) to seek their own continuation and reproduction, we must proceed to grant a normative character to life and health and, hence, to the goals of medicine. The implications of this inference will presumably be drawn in the future essays these authors intend to write; here I simply note that the inference is dubious. Normative conclusions for us do not follow from the physico-chemistry of organic life, including its propensity to continuation and reproduction. It would, of course, be convenient if we could solve the conundrum of authority in morals by appealing to the workings of organic life or any other aspect of the world as given by science. The most persuasive attempts to derive ought from is, however, appeal not to the denatured scientific world but to the fully human world, in which value undoubtedly resides. It is not our behavior qua organisms that underwrites that value.
Competing interests
none
Reply to M.H. Kottow's comment on our article, “Psychosomatic Medicine and the Philosophy of Life.”
Michael Schwartz, O. Wiggins (U. Louisville) and M. Schwartz (U. Hawaii)
16 March 2010
We are grateful to M.H. Kottow for his kind and very insightful comments on our article, “Psychosomatic Medicine and the Philosophy of Life.” He is correct to emphasize that one of the main aims of our essay is to try to re-unite, through re-conceiving, the realities of the “physical organism” (Korper) as explained by natural science and the “lived body” (Leib) as described primarily by phenomenologists. Phenomenologists recognize that the mind/body dualism is more adequately explicated as a physical organism/lived body dualism because in our everyday non-scientific lives we do not experience ourselves as pure minds but rather as thoroughly embodied minds. Hence philosophers like Merleau-Ponty focus on the experiencing, embodied subject engaged in the social world of everyday life, the “lifeworld.” Medicine customarily comprehends disease and injury, however, by conceiving of the human being in a quite different manner, namely, as the physical organism portrayed by biology and physiology. These two “bodies” are obviously the same living entity. The very word “psychosomatics” expresses this sameness, but the theoretical task lies in bringing to light the characteristics that demonstrate it.
In order to undertake this task we have adopted the approach of Hans Jonas for surmounting the dualism. Jonas proposes that since Darwin we must understand the human being as at least in principle explainable in the same terms in which we comprehend other living beings. If this is so, then we should be able to take the two aspects of human embodiment, namely, the lived body and the physical organism, as contributing to our overall picture of the psychosomatic whole, the living human being. We can thus reason from two directions at once, i.e., from the direction of phenomenological descriptions of embodied mind and from the direction of scientific explanations of the physical organism, and, incorporating what each has taught us, re-conceive them as constituents of a unified whole. This has been the “method” of our article.
The “polarities” which we discuss are, we contend, ones that can be found as central to both the lived body and the physical organism. Hence they express precisely the unity that we unearth when we seek what is common to or the same in the two ways of conceptualizing living beings. Far from introducing a new dualism, the polarities permeating and sustaining both lived body and physical organism demonstrate their fundamental sameness. Certainly the mere fact that the polarities we describe consist of poles does not betoken our erecting, either explicitly or implicitly, a new metaphysical dualism to replace the earlier Cartesian one. For the purposes of our essay we restricted ourselves to delineating common elements in terms of polarities, and these just happened to consist of two poles. If we had had space to continue, we could have shown “trilarities, “quadrilarities,” and so on. The ultimate account of the sameness of the lived body and the physical organism would exhibit multiple common properties. We contented ourselves with the polarities we chose although we now regret any appearance of a new dualism that this choice may have created.
Kottow’s understanding of what we are attempting is so insightful as to foresee precisely the areas into which we envision ourselves moving next, namely, toward H. Plessner’s “eccentric positionality” of human beings as well as toward H. Plugge’s incorporation of the lived body into a medical perspective. We obviously have much to learn from Kottow’s own ideas in this regard.
Osborne Wiggins, Ph.D. and Michael Schwartz, M.D.
Competing interests
We have no competing interests to declare.
Reply to Thomas Huddle’s comments on our article, “Psychosomatic Medicine and the Philosophy of Life”
Michael Schwartz, O Wiggins (U Louisville) and M Schwartz (U Hawaii)
19 March 2010
T. Huddle raises some important questions that must be more fully addressed than we for reasons of space were able to do in our article. Since these questions pertain to large areas, we shall here be able merely to indicate the direction in which we would approach them.
Huddle wonders why we think a psychosomatic medicine of the sort that we sketch is needed by medicine, and he points out that, “Medicine has been successfully practiced by dualists, monists, and those who have never given the matter any thought at all.” However, it is precisely this uncritical approach to patients and the doctor-patient relationship that we question. Lurking in that uncritical approach lie assumptions taken over from one’s culture and one’s profession that, despite their unquestioned nature, shape doctor-patient interactions. Some of these assumptions are ones that Huddle himself articulates and seems to fully accept. He writes, “Normative conclusions for us do not follow from the physico-chemistry of organic life.” Since in the search for ethical norms it makes no sense to seek them in what he calls “the denatured scientific world,” we must look for them only in “the fully human world.” The “physico-chemistry of organic life” is thus inherently valueless or value-free, and if value is to be found anywhere, it can only be in “the human world.” Accordingly, if nature is to acquire any value, it can only be because humans for some reason impute value to it. Herein lies Huddle’s own metaphysics. He assumes precisely the metaphysics of nature, i.e., of “the physico-chemistry of organic life,” and of “the human world” that we seek to surmount. This dualism between a nature devoid of inherent value and the human world in which alone value dwells is the dualism that arose in the 17th Century in order to secure a new conception of nature that would open itself to the new science of Copernicus and Galileo. Bacon had wanted to ban any consideration of teleology from this new science, and therefore he secluded it in the human mind, apart from nature. Descartes turns this separation into a metaphysics by propounding res cogitans and res extensa as two entirely different substances. In this way it was a basic mistake to attribute to the res extensa (physical nature) features peculiar to res cogitans (the human mind). Huddle asks, “Must we indeed have any particular philosophy of life to practice medicine and practice it well?” But he too possesses a “particular philosophy of life,” namely, the dualistic one separating the human from nature that pervades the last several centuries. We submit that Huddle’s own assumptions about organic life and the human world go to prove physician and philosopher Karl Jaspers’ point (specifically made about psychiatry but applicable to psychosomatics and to medicine), “If anyone thinks he can exclude philosophy and leave it aside as useless he will eventually be defeated by it in some obscure form or other…”(1). We grant that a metaphysics such as Huddle’s may appear “obvious” or “self-evident” to educated people today, but it is precisely this obviousness or self-evidentness of this wide-spread view of nature and value that we wish to critically examine.
Our proposal regarding living beings differs from the one that Huddle presupposes. We see his understanding of nature to be still operating under the abstraction that natural science chose to institute in the 16th and 17th centuries in order to break with the Aristotelian science of the Middle Ages. The new science of Copernicus, Galileo, and Bacon departed radically from Medieval science by at the outset banning teleology and value from all the “nature” that it undertook to explain in its novel mathematical terms. Since these beginnings, natural science has adhered strictly to its initial choice to seek explanations that disregard or abstract from purposes and values. It is precisely such an abstraction that we undertake to leave behind by proceeding not only from the present-day sciences of biology, physiology, and chemistry but also from a phenomenology of our own experience of ourselves as living beings where value and purpose are pervasive. We seek to theoretically integrate these two perspectives by explicating what is common to them both. Thus our reasoning describes and then extrapolates from our own direct experience of living and seeks for features which are evinced by all living beings that to some degree bear resemblances to our own. Granted, this is an analogical way of reasoning (namely, non-human organisms are viewed as analogous to human organisms but not precisely like them), and we claim that the evidence found in non-human organisms resembles features of human life sufficiently to warrant such extrapolations. These claims we cannot justify in these comments. The reader of our full article must judge for him- or herself. It is essential, however, for the reader to realize that our mode of approach to living beings is not simply based on reductionistic renderings of the contemporary sciences of biology, physiology, etc., (“the physico-chemistry of organic life”) but also seeks to incorporate as equally real the array of experiences that each of us has as living beings ourselves.
We do concede that Huddle is correct to think that what we claim in this essay is insufficient to provide a fully adequate account of the “normative” in ethics. Such an account can only be given by a more completely developed ethical theory. What we sought to suggest in our article was that “value” finds its roots in life even in its lowest forms. Our view, far from seeing value as peculiar to the human world, relocates it in nature itself. This is only a beginning, but it runs counter to many intellectual trends in the West in the past four or five centuries and remains contrary to widespread assumptions today.
We thank Huddle for his challenging comments; and although we have sought to respond to them here, we do not delude ourselves that our responses decide with any finality such weighty issues. Again we refer the reader to the writings of Han Jonas in order to find a more fully elaborated position.
1. Jaspers, K. General Psychopathology. Trans. by J. Hoenig and M.W. Hamilton. Chicago, The University of Chicago Press, 1963, p 770.
Competing interests
The authors have no competing interests to declare.
On the nature of the good
David Kelly, unaffiliated
19 March 2010
I do have a couple of questions. If the good for me is the continuation of my own life, doesn't that mean that it is moral for me to do anything to preserve it? What moral principle prohibits me from doing just anything to preserve it?
Then, again, if preservation of my own life is the good for me, why would the preservation of the lives of others be of concern to me? Is there a moral principle in this philosophy of life that obligates me in any way to work to preserve the lives of others?
Competing interests
none
Embodiment, Values, and Dis-ease
Ronald Pies, SUNY Upstate Medical U. and Tufts USM
25 March 2010
I very much enjoyed this paper from Drs. Schwartz and Oz. Their discussion of how "...living beings are both enclosed within themselves...[and also] ceaselessly reaching out to their environment..." reminds me of Merleau-Ponty's concept of "embodiment", as another reader already noted.
In their chapter on this topic, Gallagher & Zahavi write, "The phenomenological emphasis on the body obviously entails a rejection of Cartesian mind-body dualism. But it should be just as obvious that this does not entail an endorsement of some kind of Cartesian materialism." (p. 135, The Phenomenological Mind).
I also liked the discussion of Canguilhem's thesis that "...the positive value of health and negative value of illness" is "...posited by the organism itself and not simply through some external judgment conceived by medical practitioners."
This, in my view, is analogous to the position that several of us have taken, in relation to the construct of "disease"; i.e., that it originated not as an external judgment by "experts", but as an expression of the ordinary person's felt experience of "dis-ease" (suffering and incapacity)when affected by some pathogen, infection, etc.
As Dr. Schwartz and I have discussed (and debated!) many times, the term "disease" has taken on a more technical, "pathology-based" meaning, in the past few centuries; however, I believe that the primordial meaning of the term--which is essentially phenomenological--is the appropriate point of orientation when we consider, for example, whether psychiatric diagnoses are instantiations of disease ("dis-ease").
Furthermore, the late Dr. R.E. Kendell's insistence that "disease" ought to be predicated of persons--not "minds" or "brains"--is consistent with the unified, "psychosomatic" approach taken in the paper by Drs. Schwartz and Oz. In essence, "personhood" is the bridge that over-arches "mind" and "body" duality.
Similarly, when we hear (as psychiatrists) the charge that psychiatric diagnoses are merely "value judgments", we should be reminded by the Schwartz-Oz paper that all judgments about illness and health entail "value judgments"--judgments, for example, that it is better to be able to digest food than not; or that it is better to be able to think clearly than to have one's thoughts interrupted by accusatory "voices" (auditory hallucinations).
In short, I believe the discussion of Canguilhem lays the foundation for acknowledging that in all of medicine, including psychiatry, very basic--indeed primordial--"values" underlie our judgments about health and illness.
--Best regards, Ronald Pies MD
Dr. Pies declares no conflicts of interest. He is Professor of Psychiatry and Lecturer on Bioethics & Humanities, SUNY Upstate Medical University, Syracuse, NY; and Clinical Professor of Psychiatry, Tufts University School of Medicine, Boston.
Competing interests
None declared
Reply to David Kelly’s comment, “On the nature of the good.”
Michael Schwartz, O. Wiggins (U. Louisville) and M. Schwartz (U. Hawaii)
5 April 2010
In his comment on our article, “Pscyhosomatic Medicine and the Philosophy of Life,” David Kelly poses questions about our all-too-brief discussion of some basic values as inherent in life itself. His questions offer us an opportunity to articulate more clearly the point of our remarks and to circumscribe their implications. Our point about value was a metaphysical one. We certainly did not intend there to propound an ethical theory, i.e., a philosophical ethics that would adequately delineate moral duties and obligations. The sort of egoistic ethics to which Kelly suspects we may be committed is far from our purpose. The metaphysical point about values and life that we rather sought to make was related to our opening sketch of the mind/body dualism that historically issued from Descartes’ metaphysics. Cartesian metaphysics, if taken to its logical conclusion, postulates a value-free or value-neutral nature. Later philosophers, convinced that natural science must regard nature as devoid of inherent value in order to consistently apply the scientific method to it, tend to view all value that is attributed to nature as issuing solely from the human subjects that experience it. It was this view of a nature whose value comes exclusively from human subjectivity, whether collective or individual, that we were concerned to oppose. We wanted to make the metaphysical point that value was present in nature itself if living beings are understood as parts of nature. Thus in the section of our essay to which we assume Kelly must be referring we write:
Value is thus built into the reality of organic life: it is organic life itself that places value there. It is not human beings and certainly not human agency that introduces value into an otherwise value-free universe. Living beings themselves, by striving to preserve themselves, already signal that, at least for the being involved, its own life is a good (Schwartz et al, PDF 3).
We certainly believe that there are other goods for livings beings, depending upon which kind of living being one is considering. But the full range of goods or values for organic beings is something that in this article we did not have space to survey. For some remarkable examples illustrative of this range, we direct interested readers to John Tyler Bonner’s recent “The Social Amoebae” Princeton University Press, 2009.
Competing interests
We have no competing interests to declare.
Surmounting dualism
Fernando Ruiz, None
1 November 2010
Surmounting dualism
The theory of polarities presented by Schwartz and Wiggins seems to be basically a description of the totality of living organisms according basic biological characteristics that unify them. Naturally, this totality includes human beings, in consonance with the theory of evolution. This theory is an ‘external’ vision of the organisms; therefore the mind in human beings is only an inference of subjectivity. The conscience and its intentionality is an internal phenomenon, a phenomenon that appears in the private interiority; in the subjective space of man. Science is not able to gain direct access to human subjectivity. The third person world of science can only infer it However, the authors claim: “The “polarities” which we discuss are, we contend, ones that can be found as central to both the lived body and the physical organism. Hence they express precisely the unity that we unearth when we seek what is common to or the same in the two ways of conceptualizing living beings. Far from introducing a new dualism, the polarities permeating and sustaining both lived body and physical organism demonstrate their fundamental sameness.” With the acceptance of the ‘lived body’, the authors bring up the ‘mental’ side of the traditional dualism, and contend that this ‘lived body’ shares the same basic characteristic of polarities extracted from scientific observation and analysis. Moreover, they claim we have here a fundamental sameness of these bodies. This seems to me a quite strong and overenthusiastic statement considering ‘lived body’ referrers primarily to subjective corporeal experiences including feelings, and sense of communication and usefulness. Any further conceptual elaboration on this ‘lived body’ (‘personal body image’) will utilize ideas from the surrounding culture, and physical body concepts begging the purpose of the theory. The important point to underscore and keep in mind is that ‘lived body’ is fundamentally a state of conscience occurring in the privacy of the person, not in the objective, external and interpersonal world of science; they are two worlds apart. Only when man starts reflecting on his basic living experiences do the concepts of “body” and “mind” arise. These concepts, and epistemological perspectives, emerge from the living experiences and are developed in order to gain access to the diverse aspects of the primary living experience. They are an effort to understand human existence in the “circumstances” or “world” in which life itself is immerse. In basic spontaneous living –the radical reality—the indissoluble unity of living man appears. Only after reflecting and studding this primary experience do mind and matter emerge as spaces of exploration to understand and to explain the original experience of ‘existing-in-the-world’. The philosophy of life and polarities might be pragmatically useful to remind us the wholeness of spontaneous living of organisms, and most importantly of the living man. This is particularly relevant to physicians so they do not forget to inquire about the inner world of patients --the world of feelings and existential meanings. However, it seems the theory of philosophy of life gets around the philosophical problem of mind/body. It is my impression that the theory, as far it is developed, fails to unify coherently the ‘outside’ with the ‘inside’ of the human experience. The theory seems to mix up two perspectives of the human being, --the scientific and the phenomenological--, and does not reach an intelligible surmounting of dualism, neither at the metaphysical, nor epistemological level. Thanks for this thoughts provoking paper.
Georges Canguilhem
18 February 2010
Regretfully, we have misspelled the name of the French philosopher and physician Georges Canguilhem (1904-1995) throughout this manuscript. Veuillez nous excuser!
Michael Schwartz and Osborne Wiggins
Competing interests
The authors have no conflicting interests to declare.
Duality, polarity in medicine
1 March 2010
MA. Schwartz and O.P. Wiggins thoughtful article is an audacious attempt to deal with the mind-body problem, and the first question that comes to mind is whether Descartes’ dualism can ever be solved, or perhaps dissolved at least for medical purposes. Psychosomatic’s valiant effort finally backfired because it could not avoid thinking about the integration and mutual influence of two components –psyche and soma-. Hans Jonas taught us that subjectivity runs through most animal species, but only humans are aware of it and therefore bound to be ethical. Awareness recreates a duality, in that human beings are their own observers as they dislocate their conscious self from their body: our subjectivity is eccentric to our body, as H. Plessner remarked.
Merleau Ponty saw the body as a “system open towards the world”, prompting Plügge to understand the physical body (Körper) in its phenomenological dimension as Leib (stretching scholarly grammar which often differentiates Leib (living body) from Körper (dead body). Referring to the body that we are and the body we have, the Anglophonic literature refers to the lived –phenomenological- body and the living –physical- body. In all three languages, the distinction has phenomenology in mind, trying to present the lived body as experiencing the world -and itself-, and the living body as a physical organism. This has enriched medical thinking by reaffirming the distinction between feeling ill and having a disease. A vast field of inquiry is thus opened, which will also lead to exploring the conceivable difference between, and the ethical consequences of, being genetically engineered and living the experience of being programmed.
There is unanimous agreement that this distinction is in clear opposition to Cartesian dualism. Intertwinement is often mentioned, and in his German text, Plügge speaks of Ambiguïté (sic). It remains a major task to understand what it is that intertwines, and explore the nature of this interaction. This may well be the Gordian knot Schwartz and Wiggins are focusing on. It also remains to be seen whether the concept of polarities will be a unifying element. Nuclei may be understood as a unity, but poles present as a duality.
This stimulating article confirms Toulmin’s belief that medical ethics may have saved the life of philosophy.
Miguel Kottow
Universidad de Chile
Competing interests
None declared
value and organic life
13 March 2010
Michael Schwartz and Osborne Wiggins propose to offer an account of reality better than any presupposed by mind-body dualism. They claim that psychosomatic medicine demands such an account, but why this is so is unclear. Medicine has been successfully practiced by dualists, monists, and those who have never given the matter any thought at all. Must we indeed have any particular philosophy of life to practice medicine and practice it well? Let alone the correct one?
Schwartz and Wiggins go on to describe some aspects of organic life and conclude that “value is built into the reality of organic life”. From the propensity of living things (presumably including non-sentient living things) to seek their own continuation and reproduction, we must proceed to grant a normative character to life and health and, hence, to the goals of medicine. The implications of this inference will presumably be drawn in the future essays these authors intend to write; here I simply note that the inference is dubious. Normative conclusions for us do not follow from the physico-chemistry of organic life, including its propensity to continuation and reproduction. It would, of course, be convenient if we could solve the conundrum of authority in morals by appealing to the workings of organic life or any other aspect of the world as given by science. The most persuasive attempts to derive ought from is, however, appeal not to the denatured scientific world but to the fully human world, in which value undoubtedly resides. It is not our behavior qua organisms that underwrites that value.
Competing interests
none
Reply to M.H. Kottow's comment on our article, “Psychosomatic Medicine and the Philosophy of Life.”
16 March 2010
We are grateful to M.H. Kottow for his kind and very insightful comments on our article, “Psychosomatic Medicine and the Philosophy of Life.” He is correct to emphasize that one of the main aims of our essay is to try to re-unite, through re-conceiving, the realities of the “physical organism” (Korper) as explained by natural science and the “lived body” (Leib) as described primarily by phenomenologists. Phenomenologists recognize that the mind/body dualism is more adequately explicated as a physical organism/lived body dualism because in our everyday non-scientific lives we do not experience ourselves as pure minds but rather as thoroughly embodied minds. Hence philosophers like Merleau-Ponty focus on the experiencing, embodied subject engaged in the social world of everyday life, the “lifeworld.” Medicine customarily comprehends disease and injury, however, by conceiving of the human being in a quite different manner, namely, as the physical organism portrayed by biology and physiology. These two “bodies” are obviously the same living entity. The very word “psychosomatics” expresses this sameness, but the theoretical task lies in bringing to light the characteristics that demonstrate it.
In order to undertake this task we have adopted the approach of Hans Jonas for surmounting the dualism. Jonas proposes that since Darwin we must understand the human being as at least in principle explainable in the same terms in which we comprehend other living beings. If this is so, then we should be able to take the two aspects of human embodiment, namely, the lived body and the physical organism, as contributing to our overall picture of the psychosomatic whole, the living human being. We can thus reason from two directions at once, i.e., from the direction of phenomenological descriptions of embodied mind and from the direction of scientific explanations of the physical organism, and, incorporating what each has taught us, re-conceive them as constituents of a unified whole. This has been the “method” of our article.
The “polarities” which we discuss are, we contend, ones that can be found as central to both the lived body and the physical organism. Hence they express precisely the unity that we unearth when we seek what is common to or the same in the two ways of conceptualizing living beings. Far from introducing a new dualism, the polarities permeating and sustaining both lived body and physical organism demonstrate their fundamental sameness. Certainly the mere fact that the polarities we describe consist of poles does not betoken our erecting, either explicitly or implicitly, a new metaphysical dualism to replace the earlier Cartesian one. For the purposes of our essay we restricted ourselves to delineating common elements in terms of polarities, and these just happened to consist of two poles. If we had had space to continue, we could have shown “trilarities, “quadrilarities,” and so on. The ultimate account of the sameness of the lived body and the physical organism would exhibit multiple common properties. We contented ourselves with the polarities we chose although we now regret any appearance of a new dualism that this choice may have created.
Kottow’s understanding of what we are attempting is so insightful as to foresee precisely the areas into which we envision ourselves moving next, namely, toward H. Plessner’s “eccentric positionality” of human beings as well as toward H. Plugge’s incorporation of the lived body into a medical perspective. We obviously have much to learn from Kottow’s own ideas in this regard.
Osborne Wiggins, Ph.D. and Michael Schwartz, M.D.
Competing interests
We have no competing interests to declare.
Reply to Thomas Huddle’s comments on our article, “Psychosomatic Medicine and the Philosophy of Life”
19 March 2010
T. Huddle raises some important questions that must be more fully addressed than we for reasons of space were able to do in our article. Since these questions pertain to large areas, we shall here be able merely to indicate the direction in which we would approach them.
Huddle wonders why we think a psychosomatic medicine of the sort that we sketch is needed by medicine, and he points out that, “Medicine has been successfully practiced by dualists, monists, and those who have never given the matter any thought at all.” However, it is precisely this uncritical approach to patients and the doctor-patient relationship that we question. Lurking in that uncritical approach lie assumptions taken over from one’s culture and one’s profession that, despite their unquestioned nature, shape doctor-patient interactions. Some of these assumptions are ones that Huddle himself articulates and seems to fully accept. He writes, “Normative conclusions for us do not follow from the physico-chemistry of organic life.” Since in the search for ethical norms it makes no sense to seek them in what he calls “the denatured scientific world,” we must look for them only in “the fully human world.” The “physico-chemistry of organic life” is thus inherently valueless or value-free, and if value is to be found anywhere, it can only be in “the human world.” Accordingly, if nature is to acquire any value, it can only be because humans for some reason impute value to it. Herein lies Huddle’s own metaphysics. He assumes precisely the metaphysics of nature, i.e., of “the physico-chemistry of organic life,” and of “the human world” that we seek to surmount. This dualism between a nature devoid of inherent value and the human world in which alone value dwells is the dualism that arose in the 17th Century in order to secure a new conception of nature that would open itself to the new science of Copernicus and Galileo. Bacon had wanted to ban any consideration of teleology from this new science, and therefore he secluded it in the human mind, apart from nature. Descartes turns this separation into a metaphysics by propounding res cogitans and res extensa as two entirely different substances. In this way it was a basic mistake to attribute to the res extensa (physical nature) features peculiar to res cogitans (the human mind). Huddle asks, “Must we indeed have any particular philosophy of life to practice medicine and practice it well?” But he too possesses a “particular philosophy of life,” namely, the dualistic one separating the human from nature that pervades the last several centuries. We submit that Huddle’s own assumptions about organic life and the human world go to prove physician and philosopher Karl Jaspers’ point (specifically made about psychiatry but applicable to psychosomatics and to medicine), “If anyone thinks he can exclude philosophy and leave it aside as useless he will eventually be defeated by it in some obscure form or other…”(1). We grant that a metaphysics such as Huddle’s may appear “obvious” or “self-evident” to educated people today, but it is precisely this obviousness or self-evidentness of this wide-spread view of nature and value that we wish to critically examine.
Our proposal regarding living beings differs from the one that Huddle presupposes. We see his understanding of nature to be still operating under the abstraction that natural science chose to institute in the 16th and 17th centuries in order to break with the Aristotelian science of the Middle Ages. The new science of Copernicus, Galileo, and Bacon departed radically from Medieval science by at the outset banning teleology and value from all the “nature” that it undertook to explain in its novel mathematical terms. Since these beginnings, natural science has adhered strictly to its initial choice to seek explanations that disregard or abstract from purposes and values. It is precisely such an abstraction that we undertake to leave behind by proceeding not only from the present-day sciences of biology, physiology, and chemistry but also from a phenomenology of our own experience of ourselves as living beings where value and purpose are pervasive. We seek to theoretically integrate these two perspectives by explicating what is common to them both. Thus our reasoning describes and then extrapolates from our own direct experience of living and seeks for features which are evinced by all living beings that to some degree bear resemblances to our own. Granted, this is an analogical way of reasoning (namely, non-human organisms are viewed as analogous to human organisms but not precisely like them), and we claim that the evidence found in non-human organisms resembles features of human life sufficiently to warrant such extrapolations. These claims we cannot justify in these comments. The reader of our full article must judge for him- or herself. It is essential, however, for the reader to realize that our mode of approach to living beings is not simply based on reductionistic renderings of the contemporary sciences of biology, physiology, etc., (“the physico-chemistry of organic life”) but also seeks to incorporate as equally real the array of experiences that each of us has as living beings ourselves.
We do concede that Huddle is correct to think that what we claim in this essay is insufficient to provide a fully adequate account of the “normative” in ethics. Such an account can only be given by a more completely developed ethical theory. What we sought to suggest in our article was that “value” finds its roots in life even in its lowest forms. Our view, far from seeing value as peculiar to the human world, relocates it in nature itself. This is only a beginning, but it runs counter to many intellectual trends in the West in the past four or five centuries and remains contrary to widespread assumptions today.
We thank Huddle for his challenging comments; and although we have sought to respond to them here, we do not delude ourselves that our responses decide with any finality such weighty issues. Again we refer the reader to the writings of Han Jonas in order to find a more fully elaborated position.
1. Jaspers, K. General Psychopathology. Trans. by J. Hoenig and M.W. Hamilton. Chicago, The University of Chicago Press, 1963, p 770.
Competing interests
The authors have no competing interests to declare.
On the nature of the good
19 March 2010
I do have a couple of questions. If the good for me is the continuation of my own life, doesn't that mean that it is moral for me to do anything to preserve it? What moral principle prohibits me from doing just anything to preserve it?
Then, again, if preservation of my own life is the good for me, why would the preservation of the lives of others be of concern to me? Is there a moral principle in this philosophy of life that obligates me in any way to work to preserve the lives of others?
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Embodiment, Values, and Dis-ease
25 March 2010
I very much enjoyed this paper from Drs. Schwartz and Oz. Their discussion of how "...living beings are both enclosed within themselves...[and also] ceaselessly reaching out to their environment..." reminds me of Merleau-Ponty's concept of "embodiment", as another reader already noted.
In their chapter on this topic, Gallagher & Zahavi write, "The phenomenological emphasis on the body obviously entails a rejection of Cartesian mind-body dualism. But it should be just as obvious that this does not entail an endorsement of some kind of Cartesian materialism." (p. 135, The Phenomenological Mind).
I also liked the discussion of Canguilhem's thesis that "...the positive value of health and negative value of illness" is "...posited by the organism itself and not simply through some external judgment conceived by medical practitioners."
This, in my view, is analogous to the position that several of us have taken, in relation to the construct of "disease"; i.e., that it originated not as an external judgment by "experts", but as an expression of the ordinary person's felt experience of "dis-ease" (suffering and incapacity)when affected by some pathogen, infection, etc.
As Dr. Schwartz and I have discussed (and debated!) many times, the term "disease" has taken on a more technical, "pathology-based" meaning, in the past few centuries; however, I believe that the primordial meaning of the term--which is essentially phenomenological--is the appropriate point of orientation when we consider, for example, whether psychiatric diagnoses are instantiations of disease ("dis-ease").
Furthermore, the late Dr. R.E. Kendell's insistence that "disease" ought to be predicated of persons--not "minds" or "brains"--is consistent with the unified, "psychosomatic" approach taken in the paper by Drs. Schwartz and Oz. In essence, "personhood" is the bridge that over-arches "mind" and "body" duality.
Similarly, when we hear (as psychiatrists) the charge that psychiatric diagnoses are merely "value judgments", we should be reminded by the Schwartz-Oz paper that all judgments about illness and health entail "value judgments"--judgments, for example, that it is better to be able to digest food than not; or that it is better to be able to think clearly than to have one's thoughts interrupted by accusatory "voices" (auditory hallucinations).
In short, I believe the discussion of Canguilhem lays the foundation for acknowledging that in all of medicine, including psychiatry, very basic--indeed primordial--"values" underlie our judgments about health and illness.
--Best regards, Ronald Pies MD
Dr. Pies declares no conflicts of interest.
He is Professor of Psychiatry and Lecturer on Bioethics & Humanities, SUNY Upstate Medical University, Syracuse, NY; and Clinical Professor of Psychiatry, Tufts University School of Medicine, Boston.
Competing interests
None declared
Reply to David Kelly’s comment, “On the nature of the good.”
5 April 2010
In his comment on our article, “Pscyhosomatic Medicine and the Philosophy of Life,” David Kelly poses questions about our all-too-brief discussion of some basic values as inherent in life itself. His questions offer us an opportunity to articulate more clearly the point of our remarks and to circumscribe their implications. Our point about value was a metaphysical one. We certainly did not intend there to propound an ethical theory, i.e., a philosophical ethics that would adequately delineate moral duties and obligations. The sort of egoistic ethics to which Kelly suspects we may be committed is far from our purpose. The metaphysical point about values and life that we rather sought to make was related to our opening sketch of the mind/body dualism that historically issued from Descartes’ metaphysics. Cartesian metaphysics, if taken to its logical conclusion, postulates a value-free or value-neutral nature. Later philosophers, convinced that natural science must regard nature as devoid of inherent value in order to consistently apply the scientific method to it, tend to view all value that is attributed to nature as issuing solely from the human subjects that experience it. It was this view of a nature whose value comes exclusively from human subjectivity, whether collective or individual, that we were concerned to oppose. We wanted to make the metaphysical point that value was present in nature itself if living beings are understood as parts of nature. Thus in the section of our essay to which we assume Kelly must be referring we write:
Value is thus built into the reality of organic life: it is organic life itself that places value there. It is not human beings and certainly not human agency that introduces value into an otherwise value-free universe. Living beings themselves, by striving to preserve themselves, already signal that, at least for the being involved, its own life is a good (Schwartz et al, PDF 3).
We certainly believe that there are other goods for livings beings, depending upon which kind of living being one is considering. But the full range of goods or values for organic beings is something that in this article we did not have space to survey. For some remarkable examples illustrative of this range, we direct interested readers to John Tyler Bonner’s recent “The Social Amoebae” Princeton University Press, 2009.
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We have no competing interests to declare.
Surmounting dualism
1 November 2010
Surmounting dualism
The theory of polarities presented by Schwartz and Wiggins seems to be basically a description of the totality of living organisms according basic biological characteristics that unify them. Naturally, this totality includes human beings, in consonance with the theory of evolution. This theory is an ‘external’ vision of the organisms; therefore the mind in human beings is only an inference of subjectivity. The conscience and its intentionality is an internal phenomenon, a phenomenon that appears in the private interiority; in the subjective space of man. Science is not able to gain direct access to human subjectivity. The third person world of science can only infer it
However, the authors claim: “The “polarities” which we discuss are, we contend, ones that can be found as central to both the lived body and the physical organism. Hence they express precisely the unity that we unearth when we seek what is common to or the same in the two ways of conceptualizing living beings. Far from introducing a new dualism, the polarities permeating and sustaining both lived body and physical organism demonstrate their fundamental sameness.” With the acceptance of the ‘lived body’, the authors bring up the ‘mental’ side of the traditional dualism, and contend that this ‘lived body’ shares the same basic characteristic of polarities extracted from scientific observation and analysis. Moreover, they claim we have here a fundamental sameness of these bodies. This seems to me a quite strong and overenthusiastic statement considering ‘lived body’ referrers primarily to subjective corporeal experiences including feelings, and sense of communication and usefulness. Any further conceptual elaboration on this ‘lived body’ (‘personal body image’) will utilize ideas from the surrounding culture, and physical body concepts begging the purpose of the theory. The important point to underscore and keep in mind is that ‘lived body’ is fundamentally a state of conscience occurring in the privacy of the person, not in the objective, external and interpersonal world of science; they are two worlds apart.
Only when man starts reflecting on his basic living experiences do the concepts of “body” and “mind” arise. These concepts, and epistemological perspectives, emerge from the living experiences and are developed in order to gain access to the diverse aspects of the primary living experience. They are an effort to understand human existence in the “circumstances” or “world” in which life itself is immerse. In basic spontaneous living –the radical reality—the indissoluble unity of living man appears. Only after reflecting and studding this primary experience do mind and matter emerge as spaces of exploration to understand and to explain the original experience of ‘existing-in-the-world’.
The philosophy of life and polarities might be pragmatically useful to remind us the wholeness of spontaneous living of organisms, and most importantly of the living man. This is particularly relevant to physicians so they do not forget to inquire about the inner world of patients --the world of feelings and existential meanings. However, it seems the theory of philosophy of life gets around the philosophical problem of mind/body. It is my impression that the theory, as far it is developed, fails to unify coherently the ‘outside’ with the ‘inside’ of the human experience. The theory seems to mix up two perspectives of the human being, --the scientific and the phenomenological--, and does not reach an intelligible surmounting of dualism, neither at the metaphysical, nor epistemological level.
Thanks for this thoughts provoking paper.
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