The Cancer Journal - Volume 9, Number 6 (November-December 1996)
editorial
What is life? - This important question is usually
asked by philosophers, but should also concern medicine, which still lacks a good
definition of life. What are the medically relevant aspects of life that could
be harnessed for the patient's benefit? After all, we interfere with life at all
levels, aiming at prolonging it, and improving its quality. Our practice is not
without danger to the patient. The organism is extremely complex and we have to
treat despite uncertainty. However, complexity may not be the sole obstacle to
correct treatment. We cherish also a philosophy that may be harmful to the patient.
In other words, the philosophy of modern medicine might be iatrogenic.
An alternative approach, currently in limbo, seems less iatrogenic, and deserves
to be brought back into the medical limelight; this is the philosophy of Henri
Bergson (1).
Henri Bergson - Born in Paris, October 18, 1859, Bergson was a brilliant
mathematician, and a great philosopher. Interested in medical aspects of life,
and in biology, he realized that the prevailing philosophy was inadequate for
understanding life. It was dominated by the mechanistic view of Newton, and Kant's
philosophy according to which the human mind conceives nature as Newtonian. Spencer
reasoned that since the world is Newtonian, and since the evolving human adapted
to this kind of physical environment, he thinks "Newtonian". Yet life started
long before Kant and Newton; how did it think then (2)?
Bergson distinguishes between intelligence and instinct. Instinct
accompanies life from its beginning and reveals the real world to us. Intelligence
evolved only recently, and serves mainly for making machines: "Intelligence, considered
in what seems to be its original feature, is the faculty of manufacturing artificial
objects, especially tools to make tools, and of indefinitely varying the manufacture.
". . . " we should say not Homo Sapiens, but Homo Faber." (1, p.139).
The animal knows the real world instinctively, but is unaware of its knowledge.
The human, on the other hand, is endowed with intuition that makes him aware of
instinctive knowledge. Instinct and intelligence evolved side by side, and " represent
two divergent solutions, equally fitting, of one and the same problem." (1) (
p.143).
Kant maintained that we shall never know the real world, or the thing in itself.
To which Bergson responded that life could not have evolved without the knowledge
of the real world (1). True, our intelligence is insufficient for comprehending
the thing in itself. Yet it is grasped by our instinct, and intuition makes us
aware of this knowledge. In other words the philosophy of Homo Faber does not
suffice for grasping the real world and we should therefore turn to our instinct.
"Life is creative!" is Bergson's central theme. He opposed
Darwin's evolution theory, which regards life as a passive process adapting to
a random environment. Darwinian evolution is a mechanical process based on Newton's
premises. Our genes are deaf to the music of nature, and mutate randomly, creating
the variability of live forms; yet only those who adapt to nature's idiosyncrasy
survive. Bergson believed that life is more than that. By its vital impetus, or
elan vital, life acts on its environment, and evolves with
it.
Medicine of Homo Faber - Homo Faber applies the
tools and concepts of his trade to study life. Our organism may be more than a
machine, yet we study it in the same way as machines. Diseases are reduced to
genes, and physiology to physico-chemical processes. The organism cannot be more
than the sum of its parts, since this cannot be treated mathematically. The effect
of the mind on disease and life is reduced to psycho-chemistry, or psycho-somatics,
which follow the rules of machines. Everything else is non-science, or at best
medical art. Yet, what if disease were an instinctive process that cannot be reduced
to the laws of machines? What if disease is a new life, as declared by Canguilhem?
(3) (4). Shouldn't we also
study it with our intuition?
This is the idea behind the concept of the "Wisdom of the Body" (5),
an attribute of living organisms that directs diseases in their course. It has
its own language that can be interrogated (6) or understood
instinctively, since "Instinct is sympathy. If this sympathy could extent its
object and also reflect upon itself, it would give us the key to vital operations
- just as intelligence, developed and disciplined, guides us into matter" . .
. " But it is to the very inwardness of life that intuition leads us" (1) (p.176).
Patient-centered medicine - This may be the first step towards patient-oriented
medicine, which is directed to the patient's norm and health, and interrogates
the wisdom of his body. Despite their intricacy and depth, these concepts can
be expressed rigorously with mathematics. Recently the exact sciences turned their
attention to complex phenomena and dynamic processes, for which they are developing
new mathematical tools, e.g., chaos theory (7). In
the mathematical context, the individual's norm is a strange attractor, and the
wisdom of his body a topological space. Hopefully, mathematics and medicine will
soon meet and merge into a science whose first task ought to be the definition
of a measure of health.
Gershom Zajicek
1. Henri Bergson. Creative Evolution. (Inc. Lanham
MD ed, translated by A Mitchell); University Press of America, 1983.
2. Zajicek G. Cancer and metaphysics. Cancer J 5, 2,1992.
3. Canguilhem G. Le Normal et le Pathologique. (Cohen
RS ed, translated into English by Fawcett CR); Zone Books, New York, 1991.
4. Zajicek G. The Normal and the Pathological. Cancer
J 7, 48-49, 1994.
5. Zajicek G. Wisdom of the Body. Cancer J 7, 212-213,
1994.
6. Zajicek G. The language of the wisdom of the body.
Cancer J 8, 291-292, 1995.
7. Zajicek G. Chaos and Biology. Meth Inform Med 30,
1-3, 1991.
