Some of Plato's Views on the Art of Medicine

In Plato's Laws (Book 4, 720a-720e), he describes the differences between two types of doctors: the free-born doctor and the slave doctor. He says that both types of doctors acquire their art under the direction of their teachers or masters, by observation and practice, rather than by the study of nature. However, a free-born doctor is mostly engaged in visiting and treating the ailments of free people, and he does so by listening to their complaints, not prescribing any treatment without their consent. A slave doctor, on the other hand, is engaged in treating slaves and doesn't listen to any account of their ailments. He simply prescribes treatment based on his own experience and on what he thinks is best. He does so with the confidence and assurance of a tyrant or autocrat, then rushing off to see some other sick slaves so that his master won't be bothered by having to attend to them.

      In the same way, the Athenian lawgiver has a choice of two kinds of methods, persuasion or compulsion. The lawgiver has it in his power to use both methods, but he may mistakenly think that his legislation can be enacted by force alone. To ensure that those who are governed by his laws will actually obey them, the lawgiver must offer those whom he governs some kind of persuasion, just as a free-born doctor must offer his free-born patient a persuasive rather than despotic prescription.

      Plato's medical analogy has several implications for our current views of biomedical ethics. It indicates the need for doctors to listen to their patients, and to fully inform them about their conditions, as well as about possible diagnostic modalities, therapeutic options, and possible side-effects of treatment. It also indicates the need for doctors to obtain informed consent from their patients for treatment, and to fully engage and coordinate with their patients in order to ensure their compliance with treatment. It also indicates that the efficacy of treatment may depend on clear and effective communication between patients and providers, as well as on coordination of care, timeliness and appropriateness of care, compassionate care, respect for patient privacy and autonomy, respect for patient dignity, collaboration between patients and providers, and other components of the patient-provider relationship.

      In Plato's Republic, Socrates says that the physician studies only the patient's interest, and not his own (I. 342). Socrates also says that Asclepius treated patients by means of drugs or the knife in order to enable them to go on living as usual, but would not try to prolong the lives of those with advanced disease whose existence was miserable (III. 407). Socrates agrees with Glaucon that the best physicians may be those with the widest experience in treating healthy and sick patients, but he adds that physicians who have themselves suffered from various illnesses may be even more capable of treating those illnesses (III. 408).

Galen, on the Physician as Philosopher

Claudius Galenus (Kλάυδιος Γαληνός, 129-216 CE) was a Greek physician and philosopher who was born in Pergamum (now Bergama, Turkey). He traveled widely, to Smyrna, Corinth, Crete, Cyprus, and Alexandria, before becoming physician and surgeon to the gladiators in Pergamum (from 158-161 CE) and settling in Rome (in 161-162 CE), where he eventually became court physician to the Roman emperors Marcus Aurelius (161-180 CE), Commodus (180-192 CE), and Septimius Severus (193-211 CE). He died in Sicily in 216 CE.

      Galen combined the practice of medicine and philosophy, and he wrote an essay entitled Ὅτι Ἄριστος Ἰατρός καὶ Φιλόσοφος  ("That the best physician is also a philosopher"). In this essay, he argues that a physician must be practiced in logic in order to discover the nature of the body, as well as to know the differences between diseases and the indications for treatment. A physician must also be practiced in ethics in order to best serve his patient's best interests, rather than his own personal interests or financial gain. A physician must therefore know all the parts of philosophy: the logical, the scientific, and the ethical. If a physician doesn't put his own wealth before his moral virtue, then he won't put his own financial gain before his patient's benefit. If a physician despises money and practices temperance, then he will possess all the other moral virtues as well, since they all go together. Galen therefore asks: What grounds are left for any doctor not to be a philosopher?

      While Galen rightly explains that the pursuit of financial gain may be a corrupting influence on a physician and on the practice of medicine, some of the obvious defects in his argument that the best physician is also a philosopher include: (1) logic doesn't necessarily yield understanding of the physical nature of the body (although it may serve to promote consistency in thinking about the physical nature of the body), (2) he doesn't recognize ignorance as a cause of wrong actions on the part of a physician, (3) greed and intemperance aren't the only possible sources of wrong actions. Other vices, such as arrogance, carelessness, indifference, and bigotry may also act as sources of wrong actions, (4) possession of one moral virtue (at one moment or in one situation) doesn't necessarily guarantee possession of all the other moral virtues (at some other time or in some other situation), and (5) philosophy includes not only "the logical, the scientific, and the ethical," but also the metaphysical, the epistemological, the aesthetic, and the political, as well as other fields or domains. 

Is God at Work in All Things?

The following is a reflection I shared at the "Faith at Eight" service at church on Sunday, July 30, 2023.

Last Friday, July 21st, I was playing basketball, and I tripped and fell on my right hip. I had a hard fall on a concrete surface, and I broke my right hip. The next day, Saturday, July 22nd, I had right total hip replacement surgery, and I'm now walking slowly eight days post-op.

      I'd been running eight miles a day, but I'm now just getting to the point where I can walk without a cane. So my ability to do various physical activities is suddenly much more limited. I need help getting my socks and shoes on. I have to use a walker to support myself when I get out of bed in the morning. I have to be very careful not to get pressure sores on my lower back and heels during the night, since I have to lay flat on my back. I have to use ice packs on my right thigh to bring down the swelling. I still have numbness below the surgical site on my right leg.

      This experience has been life-changing for me. My physical expectations of myself have been dramatically altered. I can now better recognize how fragile in some respects my body may be, and I can better understand and appreciate the importance and preciousness of having an overall sense of physical health and well-being.

      At the same time, it's also been an opportunity to interrogate my need to feel physically independent and self-sufficient. It's been an opportunity to discard my feelings of shame and embarrassment when I have to get undressed in front of others in order to bathe or to have medical care. It's also been an opportunity to develop an even greater love and understanding and intimacy with my wife, who's been so loving, caring, patient, reassuring, and wonderful in taking care of me during my recovery.

      My feelings of being physically limited, and my uncertainty regarding the timeline and extent of my future recovery have led me to review some of the reading I did a few years ago about the concept of self-limiting beliefs, which has been a subject of research in behavioral medicine and cognitive behavioral therapy.

      I think some of my own present self-limiting beliefs include "I won't ever be able to be fully physically fit again," "I'll only be able to do low level physical training," and "I won't ever be able to do strenuous exercise again." Some of my more long-standing self-limiting beliefs include "I don't have the social skills," "I don't have the technical skills," "I don't have the professional connections," "I won't be accepted," and "I'm not qualified."

      Why do people so often feel they're defective or broken in one way or another? Why do people so often feel they're not strong enough or not good enough? This feeling can be reflected in many kinds of emotional, cognitive, and behavioral disorders.

      Self-limiting beliefs or core limiting beliefs may be basic beliefs about ourselves that modify other beliefs. They may be foundational, in the sense that they may seem self-evident to us and may be a foundation for other beliefs. They may be longstanding and difficult to change. They may begin in childhood and continue through adulthood. They may be conscious or unconscious. They may also be ways in which we label ourselves, such as by saying "I'm not good at math" or "I'm not good at public speaking" or "I'm not good at getting to know people."

      Self-limiting beliefs are beliefs that restrict our social functioning, and that prevent us from living life as freely, actively, joyfully, creatively, and lovingly as we can.¹ Examples include the beliefs, "I'm not good enough," "I'm worthless," "I'm not valued," "I'm unworthy," "I'm a mistake," "I'm weird," "I'm a failure," "I have no future," "I'm unlovable," "Nobody cares about me," "Something's wrong with me," "Something's wrong with my body," "Something's wrong with the way I look," "I'm weak," "I'm defective," "I'm broken," "I have no control," "I'm not smart enough," and "I don't belong."

      One way of modifying self-limiting beliefs is by looking at the evidence for them and seeing whether there are facts that don't fully support them or that serve as counter-evidence against them. Another way of modifying self-limiting beliefs is by looking at whether they help us in our social functioning, whether they really represent who we are, and whether they truly reflect who we want to be.

      I think that for us as Christians, another way of modifying negative or self-limiting beliefs may also be to remember that even when we're undergoing misfortune, hardship, or suffering, God is with us. God hasn't forgotten us. God won't abandon us. God will be our strength and salvation. God loves us. God sees us as worthy of being loved. God will encourage us. God will comfort us. God will take care of us. God has a plan for us, and God has a purpose for us.

      That's a reason why Romans 8:28, which is included in the epistle reading for today (Romans 8:26-39), is perhaps my favorite verse of scripture. While I'm not a Greek scholar, I've been trying to better understand the meaning of the verse as it appears in Greek: 

Οἴδαμεν δὲ ὅτι τοῖς ἀγαπῶσιν τὸν Θεὸν πάντα συνεργεῖ εἰς ἀγαθόν, τοῖς κατὰ πρόθεσιν κλητοῖς οὖσιν. 

Oidamen (we know) de hoti tois agaposin ton Theon (that to those loving God) panta sunergei eis agathon (all things work together for good), tois kata prothesin kletois ousin (to those according to [His] purpose being called). In the King James Version, this verse is translated as, "We know that all things work together for good for those who love God, who are called according to his purpose." In the Revised Standard Version, it's translated as, "We know that in all things God works for good with those who love him, who are called according to his purpose." And in the New International Version, it's translated as," We know that in all things God works for the good of those who love him, who have been called according to his purpose." 

      I think it's important to note that while the Greek verb συνεργεῑν (sunergein) means "to work together," God not only works for good with those who love him, God also works for good in and through those who love him. We each have a purpose for which we are called. And God has given us everything we need in order for us to fulfill his purpose for us. Let me repeat that: God has given us everything we need in order for us to fulfill his purpose for us. Even though we may not be aware of it, God has given us everything we need to fulfill our destiny. God has given us everything we need for victory.

      I think it's also important to note that it's for those who love God and who are called according to his purpose that all things work together for good. For all things to work together for good, we must love God and be called according to his purpose. If we love God and are called according to his purpose, then God will always be working for good for us in all things.

      Another reason Romans 8:28 is meaningful to me is that we all endure hardship and suffering at one time or another, and we want to know what God's response is to that suffering. During the course of each liturgical year, we have many lectionary readings from Paul about the theme of suffering. Romans 8:28 tells us that even though God may not have caused our brokenness or suffering, God is at work in a broken and suffering world. God is always working for good for us, and God is always working for good in and through us. And if we love God, then we'll fulfill God's purpose for us.

FOOTNOTES 

¹John J. Prendergast, "Recognizing Core Limiting Beliefs," in Utne Reader, Dec. 10, 2019, online at https://www.utne.com/mind-and-body/core-limiting-beliefs-ze0z1912zhoe/

The Story of Abraham and Isaac

In the Book of Genesis (22:1-14), God tests Abraham by telling him to take his son Isaac to the land of Moriah, and to sacrifice him there as a burnt offering. So Abraham saddles his donkey and takes Isaac, along with two young men, to Moriah. On the third day, when he sees the place in the distance that God has shown him, he leaves the two young men behind with the donkey. He lays the wood that he has cut for the offering on Isaac, and as they are walking along, Isaac asks him where the lamb is that they will sacrifice for the offering. Abraham tells him, "God himself will provide the lamb for a burnt offering, my son."

      When they come to the place that God has shown him, Abraham builds an altar, and then places the wood on it. He binds his son Isaac, and then lays him on top of the wood. He takes out a knife to kill him, but the angel of the Lord calls to him from heaven and tells him not to lay his hand on Isaac or do anything to him. Abraham's faith in God has been proven, and he suddenly sees a ram caught in a thicket by its horns, which he takes and offers as a burnt offering instead of his son.

       Søren Kierkegaard, in his book Fear and Trembling (1843), describes four ways in which the story of Abraham and Isaac could have have been told differently.

      (1) Abraham could have seized Isaac and thrown him to the ground, and he could have told him that it wasn't actually God's command, but only his own idolatrous desire, that he be sacrificed, so that Isaac wouldn't lose faith in God.

      (2) Abraham could have been ready to sacrifice Isaac, but after God instead provided a ram to be sacrificed, he could have remembered what God had commanded him to do, and thus he could have lost his faith.

      (3) He could have asked God to forgive him for his failure to protect his son, and he could have been troubled by the question of whether it had been a sin to be willing to sacrifice Isaac.

      (4) He could have been ready to sacrifice Isaac, but at the last moment he could have revealed his own anguish and despair to his son, and thereafter his son, though having been spared, could have lost his faith.

      However, some other ways in which the story could have been told differently include:

      (1) Instead of beginning with "God tested Abraham," the story could have begun, "Abraham heard a voice, and he thought it was the voice of God, but the voice told him to take his son to the land of Moriah, and to offer him there as a burnt offering. Abraham truly believed he was hearing the voice of God, but he couldn't understand why God would command him to do such a thing."

      (2) Instead of binding Isaac and laying him on the altar, Abraham could have asked God to forgive him for not being able to sacrifice his son, because he could have so truly believed in God's mercy that he was certain that God would forgive him.

      (3) Instead of binding Isaac and laying him on the altar, Abraham could have offered his own life as a sacrifice, so that Isaac's life would be spared.

      Since it's difficult to understand why a loving and merciful God would order Abraham to sacrifice his son, the story might be interpreted as signifying that we live in an absurd and meaningless world, and that the only way we can find meaning is through faith. Or the absurdity might consist in Abraham's believing that God actually wanted him to sacrifice Isaac, and in Abraham's being ready to carry this out.

      If God actually ordered Abraham to kill Isaac in order to test his faith, but God already  planned to spare Isaac before Abraham could put him to death, then the story would seem to make God rather capricious, and we wouldn't really have a plausible explanation for why God acted as he did. But if we believe that a loving and merciful God wouldn't tell Abraham to kill his son, then we might not have any plausible explanation either for why the story says this is what God did.

      Perhaps God's command for Abraham to sacrifice "his only son" ("only" in the sense that Isaac was Abraham's sole heir, and that Abraham, in accordance with his wife Sarah's wishes, had cast out his first-born son, Ishmael, along with Ishmael's mother, Hagar) can only be understood if we remember that in the gospels of the New Testament, God sacrifices his only Son, so that the world might be saved through him. The story of Abraham and Isaac foretells the story of Jesus, who is sacrificed to redeem the world from its sins, and who rises on the third day.

      Kierkegaard explores three problems: (1) Is there a teleological suspension of the ethical? (2) Is there an absolute duty toward God? and (3) Was it ethically defensible for Abraham not to have told Sarah (his wife), Eliezer (his servant), and Isaac (his son) about his undertaking?

      Regarding the first problem, Kierkegaard argues that the story of Abraham is an example of a teleological suspension of the ethical. As an act of faith, Abraham suspends his ethical obligation to his son. He is not a tragic hero, because a tragic hero is admirable for his ethical virtue and his capacity to remain within the ethical, allowing an expression of the ethical to have its telos in an even higher expression of the ethical. Abraham himself has a higher telos than the ethical, which he temporarily suspends.

      Regarding the second problem, Kierkegaard argues that ethical duty is a relative duty, while duty to God is an absolute duty. The ethical is the universal, and it has nothing outside of itself that is its telos (goal, end, or purpose). But the paradox of faith is that faith is found in the individual, rather than the universal. The paradox of faith is also that the individual is higher than the universal. Thus, in the religious stage of existence, there is a teleological suspension of the ethical. The religious stage is higher than the ethical stage, and the ethical stage is higher than the aesthetic stage.

      Regarding the third problem, Kierkegaard argues that Abraham was justified in concealing his intentions from Sarah, Eliezer, and Isaac, insofar as faith is an inwardness, while ethics is an outwardness. The paradox of faith is that inwardness is higher than outwardness. An individual determines his relation to the universal by his relation to the absolute, not his relation to the absolute by his relation to the universal.¹ While the tragic hero renounces himself for the universal, the knight of faith renounces the universal for the individual.²

      

FOOTNOTES

¹Søren Kierkegaard, Fear and Trembling, translated by Bruce H. Kirmmse (New York: W.W. Norton, 2022), p. 84.

²Ibid., p. 91.

Erasmus's The Praise of Folly

Desiderius Erasmus of Rotterdam (1466-1536) was a Dutch humanist scholar and theologian who was born in Rotterdam and died in Basel. He was the second illegitimate son of Roger Gerard, a priest, and Margaretha Rogerius, a physician's daughter. Because his father was a Catholic priest, his parents could not be legally married. They died from the plague in 1483, and Erasmus was educated in monastic schools. He took monastic vows in 1486, and was ordained to the Catholic priesthood in 1492. Shortly after his ordination, he was granted a temporary dispensation (later made permanent) from his monastic vows in order for him to be able to accept a post as Latin secretary to the Bishop of Cambrai, in northern France. He studied theology at the University of Paris in 1495, and he traveled widely in France, England, Italy, Germany, and Switzerland. 

      While in England in 1499, he taught at the University of Oxford, and he met John Colet, an English Catholic priest, scholar, and educator, and Thomas More, an English lawyer, diplomat, and statesman, both of whom became close personal friends. (Thomas More later became Lord Chancellor of England, and was executed in 1535 for refusing to acknowledge King Henry VIII as supreme head of the Church of England). Erasmus earned a Doctor of Divinity degree from the University of Turin in 1506, and he was a professor of divinity at Queen's College, Cambridge from 1511-1514. 

      From 1521-1529, he lived in Basel, but due to religious unrest in the city in 1529, he moved to Freiburg. While in Freiburg, he received an invitation from Queen Mary of Hungary, Regent of the Netherlands, to move to Brabant, and after having decided to accept the invitation, he preliminarily moved back to Basel in 1535. But in 1536, he died of an attack of dysentery, and was buried in Basel Münster (the city's former cathedral).

      His writings included his annotated text of the Greek New Testament, with his Latin translation (Novum Instrumentum omne, 1516), his Adages (Adagiorum collectanea, 1500), Handbook of the Christian Soldier (Enchiridion militis Christiani, 1503), The Praise of Folly (Stultitiae Laus, 1511), The Education of a Christian Prince (Institutio principis Christiani, 1516), On the Immense Mercy of God (De immensa misericordia dei, 1524), and On Free Will (De libero arbitrio diatribe sive collatio, 1524). 

       Erasmus is regarded as one of the founders of Renaissance humanism, which emphasized the study of ancient Greek and Latin grammar, rhetoric, literature, history, and philosophy as a route to better understanding of the human capacity for virtue. He criticized the pedantry of scholastic theologians, and he condemned clerical abuses and corruption within the church. He was initially sympathetic to the Reformation, but later opposed it, and he rejected religious violence and dogmatism.

      The Praise of Folly was written in 1509 while he was in England, and it was published in Paris in 1511. It was written in Latin, and its title, Stultitiae Laus or Moriae Encomium, was a play on the name of Thomas More (Moria is the Greek word for folly), to whom it was dedicated. 

      Erasmus writes in a prefatory letter to Thomas More that the name "More" is as close to the Greek word for folly (Moria) as More himself is far from it. He describes the work as a declamation that he hopes More will accept as a memento of their friendship.

      In the text, Folly wears the costume of a jester as she delivers an oration in praise of herself. (Erasmus considers Folly to be a woman, since he considers women to be more foolish than men. Indeed, Folly says that a woman who considers herself wise is twice as foolish. But she also says that it's through folly that women strive to be attractive to men, and that this capacity for folly is precisely what attracts men to women. Thus, folly defines both men and women.¹ However, the personification of folly as a female jester is of course based on the sexist assumption that women don't have the same capacity for wisdom as men, and that women are less rational beings than men. Erasmus intentionally promotes the sexist and patriarchal conception that women have less capacity for rational judgment than men, and that it is in women's natures to be governed solely by their emotions and not by their powers of reason.)

      The oration is full of well-worn proverbs and is characterized by inflated, empty rhetoric. It's mocking and satirical, without any real attempt at disguise or subtlety. It's quite amusing, however.

      Folly is a goddess whose father was Plutus (the god of riches), and whose mother was Nethe (Youth). She was nursed by Methe (Drunkenness) and Apaedia (Stupidity). Among her attendants are Philautia (Self-love), Kolakia (Flattery), Lethe (Forgetfulness), and Misoponia (Laziness).

      Some of what we learn from the oration is that it's foolish to be impulsive and to unthinkingly blurt out whatever comes to mind. Folly is obvious and easily recognized. It's never disguised, and it can always be seen for what it is. It can't be concealed, even by those who call themselves wise. Those who call themselves philosophers and try to conceal foolishness are actually "foolosophers."²

      Those who overestimate their knowledge or understanding of things may also commit acts of folly. So may those who seek to be admired for their knowledge and understanding.

      We may be careless or imprudent and yet think ourselves wise. We may take pleasure in our acts of folly, because through folly, we are relieved of, or freed from, the cares and concerns that might preoccupy us if we were wise.

      Just as wisdom may be based on reason, prudence, and self-control, folly may be based on the swings of passion, impulses of desire, and vicissitudes of emotion. Folly is present everywhere throughout human society.

      Engagement in foolish amusements and pastimes may bring us pleasure. Indeed, the more trivial and foolish they are, the more lighthearted we may become.

      Even love and friendship may cause us to be foolish, since they may cause us to be blind to our own, and one another's, faults and shortcomings. Indeed, folly may cause us to overlook things we would otherwise be unable to ignore. Through folly, we may also be unjustifiably pleased with ourselves.

      It's human nature to be foolish and not wise, says Folly. Socrates wasn't actually stupid, since he refused to be called a wise man, reserving wisdom for divinity alone. But Socrates, for being wise, was sentenced to drink hemlock.³ And Plato, who said the state will be happy when philosophers become kings and kings become philosophers, failed to see that no state was ever more unhappy than when power fell into the hands of a pseudo-philosopher.⁴ Even Marcus Aurelius, if we grant that he was a relatively better emperor than others, did more damage to the state by leaving such a son as Commodus behind him than he ever prevented by his own rule.⁵ 

      And anyone who believes that anything as vague and empty as fame or glory is worth as much sweat and as many sleepless nights as it takes to be careful and persistent must be the greatest fool of all! What is wise is to profit from the folly of others.⁶

      Fools provide us with jokes, fun, and laughter. They alone speak the plain, unvarnished truth.⁷ They don't know any better than to tell the truth, even when their audience won't profit from hearing it. They can't conceal anything. They're swayed by flattery and easily deceived by liars. They deceive themselves, and they're easily deceived by others.

      Fools include those liars and frauds who think that if they throw into the collection basket one small coin from their plunder, then all their sins will be expunged, and all their acts of perjury, deception, dishonesty, and betrayal will be paid off like a mortgage.⁸

      Fools also include those philosophers who know nothing at all but claim to know everything.⁹

      Fools also include those theologians who brand anyone who disagrees with them a heretic. They claim to be able to explain sacred mysteries, such as by what channels original sin is transmitted to Adam's descendants, and for how long Christ was fully formed in the Virgin's womb.¹⁰ They claim to know whether God could have taken on the nature of a cucumber, and whether that cucumber could have preached, performed miracles, and been nailed to the cross.¹¹ Among all the competing schools of theology, including the Realists, Nominalists, Thomists, Albertists, Occamists, and Scotists, there's so much academic subtlety and dialectical precision regarding such matters as the difference between Christ's body as it is in heaven, as it was on the cross, and as it is in the eucharist that the apostles themselves would have been hard pressed to match wits with such theologians.¹²

      Fools also include those hypocrites who make a great show of their devotion and piety, and those scholars who, when preaching, make a great show of their learning by bringing forth their syllogisms, premises, conclusions, corollaries, hypotheses, and utterly pedantic concerns about matters that are trivial and irrelevant.¹³

      Fools also include those in the hierarchy of the church who, rather than teaching holy scripture, make frequent use of interdicts, suspensions, formal warnings, and excommunications. They interpret the patrimony of St. Peter as if it were merely fields, towns, taxes, and dominions to be defended by fire and sword.¹⁴

      Indeed, says Folly, Christianity has more of an affinity with folly than with wisdom. Who else but fools would give away all their belongings, ignore injuries received from others, allow themselves to be deceived, make no distinction between friend and enemy, find satisfaction in fasts and vigils, and desire self-sacrifice above anything else?

FOOTNOTES

¹Desiderius Erasmus, The Praise of Folly, translated by Clarence H. Miller (New Haven: Yale University Press, 1979), pp. 29-30.

²Ibid., p. 13.

³Ibid., pp. 36-37.

⁴Ibid., p. 38.

⁵Ibid., p. 38.

⁶Ibid., pp. 41-42.

⁷Ibid., p. 55.

⁸Ibid., p. 65.

⁹Ibid., p. 86.

¹⁰Ibid., p. 88.

¹¹Ibid., p. 89.

¹²Ibid., pp. 90-91.

¹³Ibid., p. 105.

¹⁴Ibid., pp. 112-113.