Commentary on Schwartz and Wiggins: Science, Humanism, and the Nature of Medical Practice

COMMENTARY ON SCHWARTZ AND WIGGINS: SCIENCE, HUMANISM, AND THE NATURE OF MEDICAL PRACTICE GEORGE L. ENGEL* Surely there exists no wider gulf, nor more stubborn resistance to bridging it, than that which for centuries has separated science and humanism in medicine. That this should be so in medicine is a remarkable paradox, for medicine, after all, is by its very nature a human science, historically perhaps the very first human science. Its earliest scientific origin began at whatever point in historical time Samaritans comforting the sick became curious about the nature and origins of their wards' suffering and began to make more systematic efforts to try to understand what they were encountering and how to bring relief. In a word, medicine as science evolved as man's cognitive approach came to include the elements of scientific reasoning—namely, to search for evidence and proof to buttress the generalizations that were being made about illness. From the beginning, even in ancient times, the application of a protoscientific approach to such problems had to take into account that the object of inquiry was perforce another person, if not indeed oneself, who mysteriously sickened and died. Evidence required not merely observation of, but testimony from, the sufferer; that is, it depended on human behavior and a human dialogue. How else other than by behavior and dialogue could, for example, the Egyptians have established in the sixteenth century b.c. the efficacy of the poppy seed for the relief of pain? So it was from the beginning, and so it remains today. Sir William Gull, in his 1870 Harveian Oration, had no doubt of this fact when he urged his colleagues to recognize that "the science of medicine, being the science of man (in health and disease), must occupy the central place in human knowledge." Gull was all too aware of the resistance to such a view, for he went on to say, "It must be asked if our minds are [yet] made *Departments of Psychiatry and Medicine, University of Rochester Medical Center, Rochester, New York 14642.© 1985 by The University of Chicago. All rights reserved. 003 1-5982/85/2803-0444$0 1 .00 362 I George L. Engel ¦ Nature ofMedical Practice up as to whether man is altogether an object of scientific study or not, whether the mystery of his organization are fairly subjects admitting of investigation" [I]. That was more than a century ago, yet resistance to acknowledging the essential humanness of medicine is no less, maybe even more, today than it was in Gull's time. Indeed, the perception of a fundamental incompatibility between science and humanism has today acquired the power of a cultural imperative and accounts for a good deal of the public's (which means patients') ambivalence toward physicians. Thus, while the physician 's mastery of up-to-date scientific tools and knowledge is generally equated with competence, it is a mark of opprobrium to be called "too scientific," for that damns the physician as cold, impersonal, and insensitive to human needs. It would appear that the detachment and objectivity associated in the public mind with being scientific is deemed incompatible with the warmth, understanding, and sensitivity desired and needed when one is ill. How thoroughly entrenched such viewpoints are, even among the intelligentsia, is well illustrated in the recent muchpublicized critique of medical education by the president of Harvard University, who, while decrying the neglect of the personal, the psychological , and the social in the education of the physician, nevertheless refers to all of these as "the nonscientific side of medicine" [2]. By adopting such a terminology, Bok would appear once and for all to place the "art" and the "humanism" of medicine beyond the reach of scientific inquiry. Clearly, the cultural resistance to bridging science and humanism remains as intense as ever. It is precisely in addressing this anachronism that the essay by Schwartz and Wiggins is so valuable. Their basic thesis is that the roots of both humanism and science draw their nourishment from the same human sources, that is, from what the phenomenologists have designated the lifeworld and the lived body, and from the practical understanding that derives therefrom. Nowhere is this confluence...