- Hippocrates, On the Nature of Man, circa 5th century BC
Part 1 - A Balancing Act
21st Century schools of medicine teach their graduates human behavior – what I do in my own body in the next moment of my life – is understood by microscopically studying invented and invisible anatomical brain centers, each center equipped with miraculous behavioral functions. Students of psychiatry are instructed that undesirable behavior (psychiatry’s “symptoms”) is caused by a chemical imbalance effecting the brain centers. Treatment, then, is to prescribe laboratory chemicals to balance natural body chemicals that are, somehow, out of balance. Worth noting, the Psychiatric Medical Model Theory (PMMT) offers no definition, or explanation, of “balance.”
Practitioners of the PMMT believe you and I are victims of our excessive or insufficient chemicals – usually serotonin or dopamine – as well as our faulty “connectors” that negatively impact the brain centers where all behavior is neatly stored. Thus, psychiatric patients learn undesirable and life altering behaviors are caused by a deficiency, or derangement, or disease, or disorder, or disability, or disturbance, or dysfunction (the 7 D’s of the PMMT). Patients inadvertently suffer the consequences of these brain flaws. “It’s not you,” the doctor confidently instructs the patient, “it’s your disorder that’s causing you to experience the undesirable behavior.” Hence the title: The Zombie Theory.
Humankind has witnessed miraculous progress in medical science during the past 100 years. Thanks to new discoveries, medicines and procedures, we have benefitted greatly when it comes to our physical well-being. Especially true in modern countries, we live longer, our quality of life is better, our physical maladies better treated. Our flesh, blood and bones have never been in better hands. However, when it comes to human conduct, medicine has failed miserably throughout human history, up to and including today, without exception.
Medicine as Art1
Twenty-five hundred years ago, the Hippocratic School of Medicine began to understand medicine as an art form, and healers as practicing artists. Disease was no longer divine wrath, nor was healing a gift from God. Over time, heavenly punishments and gifts were replaced with cause and effect, providing the underpinnings for the burgeoning artform to become a rational science in the physical world. Along the way, medical ethics and standards of care were crafted, both keystones of the ancient Greeks that continue to guide modern day medicine. Most important, three primary conditions were identified and interconnected: the disease, the patient and the healer.
Healers were trained in the Seven Natural Factors in this holistic system of medicine: The Four Elements, The Four Humors, The Four Temperaments, The Four Faculties,The Vital Principles, The Organs and Parts and The Forces. The underlying theory was simple. When there is balance and harmony within the Seven Natural Factors, there is health. When they are not in balance, there is dysfunction and disease. When any one of the Seven Natural Factors ceases to function, there is death. Balance then, as it is now, was the pursuit.
For the first time detailed experiments were conceived and conducted, data was collected, results were assessed and treatments were formalized. Six healing pathways emerged, from mild to severely invasive. The first treatment of choice? Diet, considered the most gentle and safest path to restore balance. Second in this formal progression of treatment paths focused on altering the patient’s lifestyle and hygiene habits that were causing the imbalance of body humors (fluids). Only when the first two treatments were found to be ineffective did the healer select the third treatment path: medicine. Chemical concoctions with inherent healing powers were dispensed in the form of supplements, potions, tonics and herbs. These first three paths were self-administered, under the guidance of a healer.
Paths four, five and six were administered by the healer. The first of these, physiotherapy, included heat treatments to induce sweating, massages with medicated oils, and a variety of muscle, bone and other body manipulations designed to release trapped toxins. Physiotherapy was often a preparative stage for detoxification, the fifth path of treatment. Common purification methods included emetics (to induce vomiting), enemas, diuretics and, frequently, bloodletting. Only when the first five paths fail does the healer turn to surgery, the last treatment path. Surgery was seen as the most invasive and, except for immediate trauma and other emergencies, the last resort for the trained healer.
Also historic, diseases were systematically classified according to similarities and differences as the disciplines of etiology and pathology began to emerge. The goal was to ensure the healers diagnosis and choice of treatment was based on fact-based information. As momentous, individualized treatment was a core value. “It's more important,” professed Hippocrates in one of his famous aphorisms,“to know what kind of person has a disease than what kind of disease a person has.” Healers were trained to understand individual patients as living in a dynamic relationship with their environment. This new art form treated the patient, not just the disease.
What About Madness?
For epochs before this new medicine ancient civilizations viewed madness as punishment from an angry God for divine trespasses. The healers of 10,000 years ago treated their patients with music, prayer, charms, spells and other incantations. This new school of medicine professed madness to be the result of natural occurrences in the brain, centered around the four essential humors. To treat madness, patients would routinely be bled from the forehead, or from a large vein in the arm or leg or rectum to draw corrupted humors away from the brain in order to bring the body back to balance.
Thus, Greek medicine began with two interrelated principles. The first is to provide the body its natural beneficial cravings: a wholesome diet, healthy habits, adequate exercise, and sufficient rest and sleep. The second is to cleanse the body of wastes and pathogenic matter inside and out, creating a healthy body balance. Though form and fashion may be different, modern medicine embraces these same principles. Unfortunately, as you will see, so does modern psychiatry.
Primum Non Nocere – “First, do no harm"2
The Hippocratic Oath is the first expression of medical ethics in human history and it remains a rite of passage for medical graduates around the globe. This oath reminds the healer to be aware of the possible harm that can occur from any kind of intervention. “Practice two things in your dealings with disease,” reiterated Thomas Inman, a 19thcentury Liverpool surgeon, “either help or do not harm the patient.” Nonetheless, history has many examples of this oath being violated, and much harm done.
Here’s the longest lasting.
For more than two millennia the treatment of choice for healers around the world was bloodletting, mainly because of its versatility. In addition to madness, this medical technique was prescribed for acne, asthma, cancer, cholera, coma, convulsions, diabetes, epilepsy, gangrene, gout, herpes, indigestion, jaundice, leprosy, ophthalmia, plague, pneumonia, scurvy, smallpox, stroke, tetanus, tuberculosis and a hundred more – including heartsickness, and heartbreak.
The Talmud was cited by healers to proclaim the most beneficial days and times of the month to use this procedure. Christian healers gave guidance to their followers by declaring the specific Saints' Days favorable for this medical technique. Islamic healers too heralded bloodletting, particularly for fevers. During medieval times bleeding charts were common, designating specific bleeding sites on the body. The vein in the right hand, for example, was bled for liver problems, the vein in the left hand for spleen problems. “Do-it-yourself" instructions were created and distributed worldwide.
Bloodletting was in its heyday during the Middle Ages, prescribed by healers as both a curative and preventative medical procedure. The actual procedure was often done by a trained barber-surgeon, the red and white barber pole symbols of blood and bandages. There were a variety of techniques too. A phlebotomy occurred when blood was drawn from the larger external veins, an arteriotomy from arteries usually from the temple. Some healers used a scarificator, a specially crafted tool cast in a brass case that enclosed a spring-loaded mechanism with blades of steel. Leeches were commonly used too.
Bloodletting theory – the science of how it “works” – was based on two ideas; (1) blood did not circulate and would "stagnate" in the extremities; (2) removal was done to attain humoral balance to fight off illness and to restore health. The more severe the disease, the more blood that needed to be drained, fevers requiring the largest amount of drainage. Importantly, six hundred years later Galen, a philosopher-physician from the Roman Empire, revitalized, reinvented and “rebooted” Hippocratic humoralism as a meticulously detailed, rational, technique-focused medical theory that retained its popularity in cultures around the world for another seventeen centuries.
The End of Bloodletting
The 19thcentury was revolutionary for medical science. During the first half a British chemist discovered the anesthetic properties of nitrous oxide, a French doctor invented the stethoscope, and a British obstetrician performed the first successful blood transfusion. In the fourth decade an American surgeon used ether for the first time, and a Hungarian doctor discovered disinfecting the hands of medics, midwives and nurses drastically reduced the incidence of death from childbed fever that was killing nearly a third of infected mothers.
The second half of the century was equally impressive. A British surgeon introduced phenol to clean wounds and to sterilize surgical instruments. Louis Pasteur published the Germ Theory of Disease in 1970 and within 12 years his labs produced vaccines for chicken cholera, anthrax and rabies. The first Nobel Prize in Medicine was awarded to Emil von Behring, a German physiologist, for creating vaccines for diphtheria and tetanus. X-rays were discovered by German physicist Wilhelm Conrad earning him the Nobel Prize in Physics. Finally, in 1897, a German pharmaceutical company, Bayer AG, created a new wonder-drug: aspirin. Within two years aspirin was a global phenomenon.
The successes of this maturing art of medicine spelled the end to the ancient and barbarous practice of bloodletting. Centuries old theories as well as healer and patient testimonials could not stand up to the new and emerging regimen found in science. By the end of the 19thcentury Bloodletting was nearly extinguished worldwide (though not completely!).
In its place a new awakening was unfolding: modern medical science.
NEXT TIME: Part 2: The Era of Medical “Experimentalism”
Life is short; and the art long.
1History of Greek Medicine: http://www.greekmedicine.net/b_p/Standards_of_Health.html
2Interestingly, the Hippocratic Oath does not include the words “First, do no harm.” The oath is nearly 400 words and certainly includes the sentiment. The actual quote is attributed to a Parisian pathologist and clinician Auguste François Chomel (1788–1858). Please see the entire oath here: https://en.wikipedia.org/wiki/Hippocratic_Oath