Reactions to Suffering in the History of Biomedicine

an introduction to soteriology and biomedicine

Soteriology is the study of systems of salvation. Every significant religion is occupied with the pursuit of salvation or deliverance.  That begs the question, “From what are we pursuing salvation?” Modern America’s soteriological crisis increasingly affects the world of Biomedicine.

Biomedicine is the system of medicine which relies on the application of physiologic and biochemical principles to attempt to heal suffering (in other words – modern Western Medicine).  This term is helpful as a contrast with other medical traditions which rely on spiritual or natural principles to heal suffering.

Over the last several hundred years, Western culture has had several changes in its soteriological orientation.   Prior to the industrial revolution, salvation was solely the realm of the church.   All sufferings: physical, social, psychological, spiritual were in the Church’s domain.

Christ after the flagellation and the christian soul, by Diego Velázquez

The Church provided actions and direction to people in an attempt to ameliorate suffering.  Prayer, supplication before God, and confession were central tenets and ways to address suffering.

Christianity largely places the attainment of the salvation on the other side of death.  As such, the Church had little to offer in terms of preventing, curing, and ameliorating worldly suffering.  Comfort – yes.  Solutions – not so much.

The rise of the enlightenment, the industrial revolution, and advances in all forms of study, including Biomedicine planted the seeds for Modernism to arise in the late 19th century.

the rise of modernism and medicine

Over the course of the 19th century, and into the early 20th, Western societies increasingly placed faith in science, technology, and “progress” to deliver societies from many of the woes of life.

However, Biomedicine was rather late to the party.  Rapid advances in Biomedicine did not really begin until the turn of the 20th century.  The Germ Theory of Disease was still only postulations until the late 19th century.

Thus, by the time medicine began delivering great advances (such as antibiotics), Western society was in the throes of Modernism and the worship of technology, science, and progress.  At the same time, psychology was providing competing ideas for explanations of human behavior beyond sin and virtue.

These allowed for the sidelining or religion in our soteriology.

World War II was a wake up call for many in the West. Wholesale destruction through intensely technological war caused a great many to doubt the cult of technology.  Suddenly, technology was not only a means of deliverance but a means of suffering as well.

Again, medicine seems to operate on a delayed timeline.  The Modernist phase of medicine seems to have continued well into the 1990s. During that time, Western society moved Biomedicine to a central role in its soteriological framework as religion was increasingly sidelined.

The emphasis on science, technology, progress and objectivity also often led to objectification in medicine.  The Tuskegee Experiments are an example, and on more mundane levels House of God is a critique of the worship of progress at all costs.

By the 1990s we had gone from worldly suffering as something to be endured for eternal salvation to a belief in technology’s ability to eliminate worldly suffering to the destruction of Modernity’s golden idol.

[M]edicine is deeply implicated in our contemporary image of what constitutes the suffering from which we and others hope to be delivered and our culture’s vision of the means of redemption. In a civilization deeply committed to biological individualism, one in which the spirit is an ever more residual category, the maintenance of human life and reduction of physical suffering have become paramount.  Health replaces salvation. – Medicine, Rationality, and Experience: An anthropological perspective.  Byron J. Good.

postmodern medicine

In response to Modernism’s technological hubris and blind spots, Postmodernism arose.  Postmodernism is primarily a reaction to Modernism’s inability to deliver on its promises and a critique of its excesses.  Most centrally, it rejects the idea of objective truth.

Moreover, Postmodernism offers no hope of salvation, no road for progress.  Many criticize the cynicism of post-modernism.

Postmodernism’s affect on Biomedicine is multifaceted and interesting.  The challenge to physician autonomy and authority can be seen as one of the first entrances of postmodernism into Biomedicine.

The patient-physician relationship’s hierarchical nature and the many times this led to ethical violations (again: Tuskegee Experiment, or HeLa Cells) made it a prime target for postmodern critique.

The culture-bound nature of  Biomedicine also leaves it open to the critique of objective truth on the part of postmodernism.  Think about your own practices.  How many different ways of practicing medicine have you seen?

Just like any other healing tradition, Biomedicine is subject to its own mores, traditions, and taboos.  Some of what we do is based in science, but much it is not.

Sure, some of the variation can be attributed to local differences in populations and disease, but most of it is purely cultural.

I.E: We do it this way because it is how we have always done it this way.

the postmodern patient

This has led to the rise of the post-modern patient.  As individual physicians are no longer arbiters of reality, patients feel empowered to have opinions on their care.  In the hands of reasonable individuals, I think this improves care.

People’s values and beliefs are important in their care.  I used to tell medical students, the most effective treatment plan is the one the patient will actually follow.

However,  many people have values and beliefs which are destructive to their health and well-being.  Physicians no longer have the cultural authority to offer corrections, as all beliefs are equally valid in the Postmodern office visit.

The main problem with postmodern’s influence in medicine, to my view, is it offers no hope or structure.  Postmodern Biomedicine has no soteriological framework.  It is simply a reaction, not a scaffold.

Additionally, many people are now so distant from their previous soteriological traditions (religion or other philosophies), they are drowning in meaninglessness. As the quote above states, health has replaced salvation for many in our culture.

Here’s the rub:  Everyone’s body will eventually let them down, everyone suffers, everyone dies.

In a world where health is a manifestation of your righteousness, illness threatens not just your body, but your soul.

How can you make sense of your suffering if it itself is evidence of your failure to attain redemption?  You can’t.

What’s the next best option: numbness.

existential crisis

“Today, our view of genuine reality is increasingly clouded by professionals whose technical expertise often introduces a superficial and soulless model of the person that denies moral significance. Perhaps the most devastating example for human values is the process of medicalization through which ordinary unhappiness and normal bereavement have been transformed into clinical depression, existential angst turned into anxiety disorders, and the moral consequences of political violence recast as post-traumatic stress disorder. That is, suffering is redefined as mental illness and treated by professional experts, typically with medication. I believe that this diminishes the person,”
― Arthur Kleinman, What Really Matters: Living a Moral Life amidst Uncertainty and Danger

In a worldview devoid of possible redemption in exchange for struggle, the struggle becomes meaningless.  Our existential crisis in the face of meaninglessness has been medicalized and medicated.

I increasingly view benzodiazepines, stimulants, narcotics for chronic non-cancer pain as a society wide attempt to anesthetize our collective existential crisis.

Our postmodern malaise is just too painful and we have no path to redemption no hope at deliverance. So, increasingly we seek a near constant anesthesia.

“We are healed of a suffering only by experiencing it to the full.”
― Marcel Proust.

is oscillation the answer?

Increasingly, Metamodernism in the wider world of art and culture is emerging as answer to the Postmodern malaise.  Metamodernism’s basic tenet is oscillation.  The world moves back and forth between diametrically opposed poles so quickly as to be effectively in both places at once.

Can we be naive and cynical at the same time?  Metamodernism posits yes.  This is inherently unwestern as an idea.  Also, it is inherently against America’s puritan roots.  The pursuit of purity is central to the birth of the American identity.

American’s don’t know how to do something 75% – we have to shoot for 100%.   Metamodernism challenges us to accept the world as made of dualities and imperfections.

At a very basic level, physics supports the idea in the natural world.  Is light a particle or a wave?  The answer: Both.

Christianity is very comfortable with oscillation as well.  Are God, Jesus, and the Holy Spirit one or three?  Again: Both.

Can we apply the same ideas to medical practice?

Can we accept Biomedicine is both a culture-bound system of healing and a science?  That no 100% objective truth exists, but yet some truths serve us better than others in a given circumstance? That suffering should be ameliorated, but it is also a necessary and important part of the human condition?

In an amusing twist, accepting oscillation as a necessary aspect of the universe means there can be no one answer to our postmodern malaise.  In order to thrive, survive, and heal we must oscillate as well.





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