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Medical Materialism, Health, and the Pursuit of Happiness

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"Medical Materialism, Health, and the Pursuit of Happiness - reflections on healing and happiness" - a talk to the Student National Medical Association, Middle Tennessee State University December 3, 2013

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Medical Materialism, Health, and the Pursuit of Happiness

  1. 1. Medical Materialism, Health, and the Pursuit of Happiness Reflections on healing and livingSNMA/MTSU, Dec. 3, 2013 Phil.Oliver@mtsu.edu
  2. 2. My original working title for this talk was ―Happiness, Experience, and Medical Materialism‖ - not as catchy, maybe, but ―experience‖ drops out only in name. The title is now bent towards the Spring 2014 Honors Lecture Series on Health and Happiness at the University Honors College. On Monday Feb.3 I’ll present a more evolved version of this talk (3 pm, Honors Room 106). Thanks for your assistance today, in helping me evolve!
  3. 3. PHIL 3345, BioethicsSpg 2014, TTh 1 pm http://bioethjpo.blogspot.com
  4. 4. PHILOSOPHY 3345, Bioethics Description. This course explores ethical issues arising from the practice of medical therapeutics (conventional and “alternative”), from the development of new biomedical technologies, and more largely from reflections on life’s meaning and prospects. The course aims at clarifying relevant bioethical and medical issues and debates, representing various perspectives in application to present and future human possibilities and concerns (for example: genetic engineering and biochemical “enhancement,” longevity and life extension, end-of-life decisions, health care access, nanotechnology, cloning, stem cell research, mood and performance-enhancing pharmaceutical use, animal research, and reproductive technologies).
  5. 5. “Bio” means simply life, but questions about life’s goals, about appropriate means for attaining them, and about the professions devoted to sustaining life, give rise to the most complex and enduring ethical problems.
  6. 6. The course compares many approaches to the urgent human preoccupation with life and its many challenges (biological, environmental, social, technological) , in order to articulate the appropriate uses of emerging technologies, therapies, pharmacological interventions etc., in ameliorating and possibly altering the human condition. Other objectives include exploring the future of life (human, nonhuman, and possibly post-human) and reflecting constructively on what it can mean to be human in an age of rapidly advancing technologies and bioengineering. The course’s ultimate objective is to provide students with critical resources and tools they can apply in making pivotal professional decisions and crucial life-choices.
  7. 7. Bioethics: The Basics by Campbell, Alastair V. (May 29, 2013) $13.77 Kindle Edition Auto-delivered wirelessly $21.95 $19.00 Paperback Humanity Enhanced: Genetic Choice and the Challenge for Liberal Democracies (Basic Bioethics) Hardcover by Russell Blackford (Author) Hardcover $27.00 Life at the Speed of Light: From the Double Helix to the Dawn of Digital Life by Venter, J. Craig (Oct 17, 2013) $10.99 Kindle Edition $26.95 $18.84 Hardcover The Case against Perfection: Ethics in the Age of Genetic Engineering by Sandel, Michael J. (May 1, 2007) $9.99 Kindle Edition Auto-delivered wirelessly $15.00 $13.96 Paperback Enhancing Evolution: The Ethical Case for Making Better People Paperback $14.68 by John Harris Kindle$10.49 Limits to Medicine: Medical Nemesis, the Expropriation of Health Paperback $14 by Ivan Illich The Immortal Life of Henrietta Lacks by Skloot, Rebecca (Jun 4, 2010) $8.99 Kindle Edition Whispersync for Voice-ready $16.00 $9.78 Paperback
  8. 8. “In 2010, scientists led by J. Craig Venter became the first to successfully create “synthetic life”—putting humankind at the threshold of the most important and exciting phase of biological research, one that will enable us to actually write the genetic code for designing new species to help us adapt and evolve for longterm survival. The science of synthetic genomics will have a profound impact on human existence, including chemical and energy generation, health, clean water and food production, environmental control, and possibly even our evolution.” “In Life at the Speed of Light, Venter presents a fascinating and authoritative study of this emerging field from the inside— detailing its origins, current challenges and controversies, and projected effects on our lives. This scientific frontier provides an opportunity to ponder anew the age-old question “What is life?” and examine what we really mean by “playing God.” Life at the Speed of Light is a landmark work, written by a visionary at the dawn of a new era of biological engineering.”
  9. 9. The Venter-like character in Generosity declares, in response to critics who complain that his gene-patents are driven by a selfish personal profit motive and cynical disregard for the wellbeing and future happiness of individuals: ―I agree; no patent should be allowed to prevent progress. The only thing profit is good for is reinvesting in research. I want a world where the one real source of wealth-- genetic possibility- is common knowledge and accessible to everyone.‖
  10. 10. All writing is re-rewriting, Stone & Powers & Kurton keep saying. In the past that’s always slowed us down and made us think. But if we’re re-writing not just words but genetic code, it may speed us up and change us faster than we can think about. That's the promise and peril of genomics. Stopping the world may not be an option, nor thinking before we change.
  11. 11. As a pragmatist I feel somewhat dissed by Powers’ characterization of the ‖witty pragmatism‖ of the positive psychologist who tells ―Oona’s‖ audience– much like Oprah’s– about happiness. He might be right, though, to advise keeping your options open (―stay loose and keep revising the plan‖). Is Powers right to predict that pop media culture will be the largest stage upon which our collective future is to be written? Another scary thought.
  12. 12. But ―all the world’s a stage‖ is scary, too, and there's nothing new about that. Yesterday's pop is today's classic rock. We're an adaptive species, we're easily sold on the new and sentimentally forgetful of the old. What's new from the genomicists and synthetic biologists? "So medicine keeps getting more complicated. I see the revenue potential there, down the line. But you can't run a business without products. What exactly are you selling?‖
  13. 13. Is he telling us he's found the happiness gene? No. Yes. Maybe... maybe you could market it that way… Up@dawn
  14. 14. A lot of people wonder what happened to J. Craig Venter, the maverick biologist who a few years ago raced the US government to sequence the human genetic code… ...he's in the midst of a scientific enterprise as ambitious as anything he's ever done. Leaving colleagues and rivals to comb through the finished human code in search of individual genes, he has decided to sequence the genome of Mother Earth…” Wired 12.08: Craig Venter's Epic Voyage to Redefine the Origin of the Species
  15. 15. PHIL 3345, BioethicsSpg 2014, TTh 1 pm http://bioethjpo.blogspot.com Phil.Oliver@mtsu.edu
  16. 16. ―You are a mammal with extraordinary potential, but we have to take care of you if you are going to fulfill that potential.‖ -Jennifer Michael Hecht, ―The Triumph of Experience,‖ in The Happiness Myth Hecht's last words in Happiness Myth, in the chapter she calls “The Triumph of Experience”: "there are other ways to see things." Isn’t that precisely what good physicians and diagnosticians do? Look for other ways to see things? And try to see things whole?
  17. 17. Experience triumphs over preconception, ideology, rigidity, misdiagnosis... when we take it seriously, and don't attempt to reduce it to something smaller and more conveniently compact. In a medical context, doesn’t this means healers who treat entire persons, not just bundled symptoms and physio-mental malfunctions?
  18. 18. There are plenty of high-profile humane and caring exemplars of this model of physician to emulate and appreciate. Some of them have popped up at TED (Technology, Entertainment, Design). Abraham Verghese-Modern medicine is in danger of losing a powerful, old-fashioned tool: human touch. In the strange new world where patients are merely data points, we should return to the traditional one-on-one physical exam. Atul Gawande-Doctors are capable of extraordinary (and expensive) treatments, but they are losing their core focus: actually treating people. We should take a step back and look at new ways to do medicine -- with fewer cowboys and more pit crews. Mark Hyman-functional medicine is the way of the future, and we can only improve medicine if we understand the body's system, not just symptoms.
  19. 19. ―We have to take care of you…” Hecht, a poet and historian as well as a philosopher, whose latest book is about suicide (another issue in bioethics, whether ―assisted‖ or self-executed), was not speaking as a physician. But it is a physician’s credo, and one which implies a physician’s vital interest in the whole person who is his/her patient - an interest in that person’s health, happiness, experience, and future. I know you all intend to be humane, holistic, whole-person physicians and healthcare professionals. You may already have identified some role-models, in that regard…
  20. 20. Why do some people mistake wives for hats? Must have something to do with personhood. Oliver Sacks has an "abiding preference for the organic, the human, the humane." Robin Williams may have been a good casting call, then, since humanity is nothing if not crazy and sometimes manic. Like the notorious metaphysical pessimist Arthur Schopenhauer, he's a musicophiliac and a fount of epigrammatic wisdom. Unlike Schopenhauer, he's a nice man. He'd never push an old lady down the stairs, or inform a patient that the world is without point or purpose.
  21. 21. Music can lift us out of depression or move us to tears - it is a remedy, a tonic, orange juice for the ear. But for many of my neurological patients, music is even more - it can provide access, even when no medication can, to movement, to speech, to life. For them, music is not a luxury, but a necessity. If a man has lost a leg or an eye, he knows he has lost a leg or an eye; but if he has lost a self—himself—he cannot know it, because he is no longer there to know it. Language, that most human invention, can enable what, in principle, should not be possible. It can allow all of us, even the congenitally blind, to see with another person’s eyes.
  22. 22. “In examining disease, we gain wisdom about anatomy and physiology and biology. In examining the person with disease, we gain wisdom about life.” Sacks the person, as revealed in a charming “desktop diary” interview in which he declared “my theme is survival,” is “grounded” by his stuff.
  23. 23. What Hallucination Reveals About Our Minds Neurologist and author Oliver Sacks brings our attention to Charles Bonnett syndrome — when visually or aurally impaired people experience lucid hallucinations. He describes the experiences of his patients in heartwarming detail and walks us through the biology of this under-reported phenomenon. (Recorded at TED2009, in Long Beach, California. Duration: 18:48)
  24. 24. On Thanksgiving Day my wife’s elderly Aunt posed a philosophical-neurological question some might be tempted to dismiss. She’d been hearing voices, in chorus. Who or what were they? Oliver Sacks would not be dismissive. He’d take Aunt Tom’s reported experience seriously. He’d wonder if it wasn’t possibly an instance of Bonnet Syndrome. He’d be a great role model in this respect, for physicians and neurologists. And for philosophers?
  25. 25. “Good bye + God bless you! Keep your health, your splendid health! It's better than all the 'truths' under the firmament. Ever thy W. J." William James to F. C. S. Schiller, 8 August 1910 shortly before his death.
  26. 26. Though the ULTIMATE state of the universe may be its extinction, there is nothing in physics to interfere with the hypothesis that the PENULTIMATE state might be a happy and virtuous consciousness...
  27. 27. In short, the last expiring pulsation of the universe's life might be... "I am so happy and perfect that I can stand it no longer.” WJ to Henry Adams, 1910
  28. 28. William James (1842-1910) was America’s greatest psychologist and philosopher, one of our greatest writers, founding “Pragmatist,” an ardent advocate of everyone’s right to pursue happiness, and - by the way - a Harvard M.D.
  29. 29. Medical materialism seems indeed a good appellation for the too simple-minded system of thought which we are considering. Medical materialism finishes up Saint Paul by calling his vision on the road to Damascus a discharging lesion of the occipital cortex, he being an epileptic. It snuffs out Saint Teresa as an hysteric, Saint Francis of Assisi as an hereditary degenerate. George Fox's discontent with the shams of his age, and his pining for spiritual veracity, it treats as a symptom of a disordered colon. Carlyle's organtones of misery it accounts for by a gastro-duodenal catarrh. All such mental over-tensions, it says, are, when you come to the bottom of the matter, mere affairs of diathesis (auto-intoxications most probably), due to the perverted action of various glands which physiology will yet discover. And medical materialism then thinks that the spiritual authority of all such personages is successfully undermined. [Lecture I]
  30. 30. Taking experience seriously in every context involves humility, compassion, receptivity, and openness. It doesn't claim to know more than can be known in advance,of one's own or another's experience of life. It doesn't automatically "discredit states of mind for which we have antipathy." Unlike Medical materialism, it's multiply-perceptive and non-reductive. It's like Emerson's self-reliant "thousand-eyed present" and Thoreau's miracle of vision through another's eyes.
  31. 31. "It seems to be a rule of wisdom never to rely on your memory alone, but to bring the past for your judgment into the thousand-eyed present, and live ever in a new day." -An Essay on Self-reliance
  32. 32. ―Could a greater miracle ever take place than to look for an hour through another’s eyes… ?‖ -HDT
  33. 33. When someone identifies one of his own experiences as transcendent, he is making a much stronger statement about its vivacity and impressiveness for him than if he were simply to say that he had had a vision, an intuition, or a powerful feeling that might for all he now knows have been just a bit of synthetically or chemically induced mental weather signifying nothing. "I had a transcendent experience but . . . I might have just been hallucinating" or "my norepinephrine and serotonin levels were spiking" or "my medication was kicking in" would be very strange things to say in reflective response to one's own transcendent experience, even if accurate at an isolated level of neurophysiology. The personal quality of our specific experiences is rarely so isolated from our "real" world that we are prepared to dismiss them out of hand.
  34. 34. It makes even less sense to cash out a transcendent attitude or habitually high default level of happiness in terms of causal factors sharply removed from the form of a person's actual experience of life. Such a translation of personl experience into the generalized form of an explanation might not be literally false, yet it might be inappropriate, harmful to someone's ends, or incompatible with our happiness. Pragmatists and their foes argue incessantly about the relevance of such considerations, the former insisting that nothing could be more relevant. For a Jamesian, taking experience seriously involves the rejection of single-level description in favor of a multiplicity of selfreckoning. (Continues in Springs)
  35. 35. Beyond Therapy: Biotechnology and the Pursuit of Happiness ...perhaps the most promising route to real happiness is to live a fully engaged life, as teachers and parents, soldiers and statesmen, doctors and volunteers-in short, to follow the vocations of life that involve not the self alone, but the ties that bind and that ultimately give the individual's identity its true shape. To be sure, there are many people whose deep psychic distress precludes meeting obligations and forming close relationships, and for whom the proper use of mood-brighteners is the blessed gift that can restore to them the chance for a full and flourishing life. But there is also a danger that such drugs, suitably improved and refined, may one day offer us peace of mind not only without side effects but also without exertion or interest in human attachments-a peace of mind that might rival friends, family, and country for our deepest devotion...
  36. 36. What will you have done to your newborn when you have installed into the nucleus of every one of her billions of cells a purchased code that will pump out proteins designed to change her? You will have robbed her of the last possible chance for creating context— meaning—for her life. Say she finds herself, at the age of sixteen, unaccountably happy. Is it her being happy— finding, perhaps, the boy she will first love—or is it the corporate product inserted within her when she was a small nest of cells, an artificial chromosome now causing her body to produce more serotonin? Don't think she won't wonder: at sixteen a sensitive soul questions everything. But perhaps you've "increased her intelligence"—and perhaps that's why she is questioning so hard. She won't be sure if even the questions are hers. Bill McKibben
  37. 37. "Ever not quite!"—this seems to wring the very last panting word out of rationalistic philosophy's mouth. It is fit to be pluralism's heraldic device. There is no complete generalization, no total point of view, no all-pervasive unity, but everywhere some residual resistance to verbalization, formulation, discursification, some genius of reality that escapes from the pressure of the logical finger, that says "hands off," and claims its privacy, and means to be left to its own life.
  38. 38. In every moment of immediate experience is somewhat absolutely original and novel... Let my last word, then, speaking in the name of intellectual philosophy, be [this]: "There is no conclusion. What has concluded, that we might conclude in regard to it? There are no fortunes to be told, and there is no advice to be given—Farewell!" -A Pluralist Mystic
  39. 39. There is no conclusion, no final word on how to be happy and healthy. On how to be. Experience triumphs not when it gets the last and final word, but when we open ourselves to the practical and personal wisdom of its next instructive deliverance. Tomorrow and tomorrow and tomorrow, the mind must walk its path. Life is a highway. This is no less true of the humane physician than of any of us. An experienced medical practitioner has not yet seen it all. So… nothing has concluded, but I conclude my modest remarks with a hearty Thank you! for inviting me today, and a humble request that you beware medical materialism and remember to take your patients’ experience seriously.

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