Locating Medical History: The Stories and Their Meanings

18 Transcending the Two Cultures in Biomedicine: The History of Medicine and History in Medicine

C H A P T E R E I G H T E E N Transcending the Two Cultures in Biomedicine The History of Medicine and History in Medicine Alfons Labisch Scientific knowledge always aims at generalized conclusions labeled as ‘‘laws of nature.’’ What matters in medicine is to meet the requirements of an individual human being who is particularly in need in the case of illness. The dilemma of science-oriented medicine can be characterized as follows: in the immediate encounter with patients, doctors have to put their generalized scientific knowledge into action to address the individual conditions and needs of the patient. Thus, in the doctor-patient encounter the scientific object-orientation of medical science turns into the subject-orientation of medical practice. At the beginning of the twenty-first century, the more advanced variants of the life sciences do not strive for a more or less ultimate truth: ‘‘laws of nature,’’ valid acrosstimeandcontext.Accordingly,thedistinctionbetweennaturalsciencesand the humanities begins to blur, as the categories of time and of individuality are introduced as objects of science. Time and individuality are essential categories of historical analysis as well. The physicist and biologist Max Delbrück (1906–1981), Nobel laureate in 1969, commented on these fundamental developments. ‘‘The complex accomplishment of any one living cell is part and parcel of the firstmentioned feature, that any one cell represents more a historical than a physical event,’’ Delbrück insisted in 1966. ‘‘These complex things do not rise every day Transcending the Two Cultures in Biomedicine 411 by spontaneous generation from the nonliving matter—if they did, they would really be reproducible and timeless phenomena, comparable to the crystalization of a solution, and would belong to the subject matter of physics proper. No, any living cell carries with it the experiences of a billion years of experimentation by its ancestors. You cannot expect to explain so wise an old bird in a few simple words.’’1 As a consequence, the changing scientific and technological appropriation of the world and the interrelated appropriations of the general social world and the different inner worlds of individuals are more and more being viewed not as opposites but as part of a comprehensive cultural process. Neuroscience, to give just one example, is a modern field in which not only physical, chemical, and biological issues are addressed in a transdisciplinary context but questions relating to the social sciences and humanities are routinely raised as well. In the interaction of neuroanatomy, neurophysiology, neurology, modern visualizing procedures, behavioral research, philosophy of cognition, anthropology, and theology and religion, the neurosciences have grown into a conglomerate of questions , methods, and results. This compound mixture renders a strictly defined classification of ‘‘natural sciences vs. the arts and humanities’’ absurd. Such a disintegration of traditional scientific entities, traditional subjects, and traditional disciplines should not be considered as a problem but as an opportunity; like economics, the sciences have to rearrange themselves in a globalizing world. An integrated way of looking at these new developments is already well advanced in the Anglo-American concept of the humanities. In a pragmatic manner , it is oriented partly toward technical, partly toward economical, and partly toward social and political phenomena and decisions. Such a culturally specific pragmatism can hardly suffice in the traditions of continental Europe. What matters is to arrive at a complex and integrated view of a globally industrialized form of culture. In the first place, it has to accommodate the more and more differentiating forms of knowledge, techniques, and action. The starting point for sorting out how this matters for rethinking medicine must be to develop new orientations , perhaps new interpretations, but at the very least to raise the proper questions . In such a scheme, the humanities do not merely offer a complementary function to science and technique, by simply commenting on developments that already happened. Rather, they can be indispensable ingredients in a common approach to those compound phenomena of today that demand explanation. The main purpose of this paper is to outline the specific character of medicine as a science and as an acting discipline (Handlungswissenschaft) in the special perspective of its historicity. Before going into detail, the editors of this volume urged me to put the story into perspective by giving a few autobiographical thoughts on 412 After the Cultural Turn acting as a doctor among historians and as a...