The Soul of Medicine: Spiritual Perspectives and Clinical Practice

1. Spirituality and Biomedicine: A History of Harmony and Discord

CHAPTER ONE Spirituality and Biomedicine A History of Harmony and Discord Michael J. Balboni, M.Div., Th.M., Ph.D., and Tracy A. Balboni, M.D., M.P.H. Inthe1642treatiseReligioMedici (TheReligionofaDoctor),theEnglishphysician Sir Thomas Browne remarked on the public acceptance of the medieval proverb “Tres medici, duo athei” (Where there are three physicians, there are two atheists). He reflected on the belief that study of the natural world and secondary causes turned “the devotion of many unto atheism” (Greenhill 1898, p. 34). Browne suggested that both faith and reason have their own “sovereignty and prerogative in a due time and place,” coming under God, who is “the Cause of all.” Browne is one of many physicians who has thoughtfully synthesized belief in God with the study and practice of medicine. But does Browne’s argument undermine the medieval proverb or prove its validity? Is the practice of medicine congruent with a spiritual worldview, or does it lead to irreligion? The relationship between medicine and spirituality, like that between science and religion, is not subject to a simple account (Wilson 2002). Its history has been marked by harmony but also punctuated by seasons of suspicion and discord. In this chapter we offer a general historical overview and then consider current questions facing the soul of medicine, particularly in relation to research and clinical practice in the United States. 4 Historical and Clinical Context Our goal is to recount the history of the relationship between spirituality and biomedicine, and also the implications of this history for the practice of medicine today. Our historical review has limitations worth noting at the outset . First, its focus is on the relationship of Western scientific medicine, or biomedicine, to North American and European culture and traditions, primarily Judaism and Christianity (Porter 1994). Other healing traditions, such as Shamanism, Islamic folk medicines, traditional Chinese medicine, and Ayurvedic or Indian medicine, also represent centuries of reflection on the relationship between spiritual practice, psychology, and religion but they will be only peripherally addressed here. A second limitation is that this will be an overview, not a comprehensive academic account. Harmony: Spirituality as the Healing Narrative Healing and spirituality have a long-standing interrelationship both conceptually and institutionally. On the conceptual level, the ability to address and heal a person’s physical pain and suffering serves as a sign of that spiritual worldview ’s authenticity and power. Spiritual worldviews also provide a conceptual framework for understanding why a particular person may be physically suffering and how that suffering relates to the spiritual world. Most major religions have viewed the spiritual and the material as inseparable, organically related entities. On an institutional level, most spiritual worldviews generate practices that attempt to ameliorate physical suffering. Nearly every traditional society has combined the role of healer and priest. One renowned medical historian called this “a strange belief which has persisted through the centuries and millennia with incredible tenacity” (Sigerist 1951, p. 134). This interconnection has also frequently resulted in the use of buildings and other forms of physical space (e.g., monasteries) for the combined aims of spiritual and physical healing. The spiritual worldview has provided not only a larger explanatory model in which illness and healing could be understood but also the context and expertise in which physical healing could occur. The prevalent and persisting phenomenon of shamanism illustrates the supernatural framework that traditional societies have adopted in understanding disease and healing. The shaman functions as a medium between individuals and a sometimes hostile spiritual world that can be pacified through an array of medical and ritualistic practices to “avoid conflict and sickness as well Spirituality and Biomedicine 5 as ensure fertility” (Risse 1997, p. 49). Though shamans embrace a largely spiritual understanding of illness, they also practice materially focused procedures (e.g., bone setting) and pharmacologic interventions based on empirical experience . This led historian Roy Porter to suggest that there may be unrecognized similarities between contemporary Western medicine and traditional concepts of sickness. Cultural anthropologists also compare the shamanistic use of powerful medicinal remedies with the rituals, beliefs, and structures of biomedicine (Porter 2001). The connection of the Hippocratic tradition with spiritual devotion to the Asclepian cult is another example of the historic alliance between spirituality and medicine. As distinct from shamanistic folk medicine, Hippocratic medicine is grounded in a natural theory of health and disease. The Hippocratic tradition conceptualizes the physical and emotional qualities of the human being...