Toward an Adventist Theology of Health (Part 4) — On Therapy
And this healing process is internal – it comes from within our body. A mysterious and endogenous force is the precondition for whatever external therapeutic strategy is pursued. A mechanical perception of the body and its twin sister, a technical understanding of medicine, tend to overlook this. They converge toward reducing the body to be a failing machine, unable to generate and trigger its own healing process. In contrast, a more holistic way to healing requires discernment, listening, wisdom and love – not just mechanistic medical capabilities.
But a healing process isn't only affirmative toward life. It's also unavoidably paradoxical – for two reasons:
– First, it inevitably presupposes its counterpart: disease. Disease always contests healing by preceding, resisting and sometimes surviving it. Healing doesn't always overcome disease. Thus healing is a vulnerable process which is unable to completely eliminate surprises.
– Second, healing itself sometimes creates more disease. Diseases that follow healing are not always residuals of previous dysfunctions. Sometimes they are simply by-products of the healing process. Iatrogenic episodes (i.e. induced inadvertently by medical treatment) are unfortunately not exceptions but a constant reality even in today's progressive medicine.
This double characteristic of healing as affirmative yet paradoxical exists in every medicine and in all cultures, ours included. The affirmative characteristic of healing in Western medicine results from the enormous pragmatism and efficiency reached at almost every level of the therapeutic intervention. But the other indicator, that of the intrinsic paradoxical character of today's medicine, results from numberless diseases that have increased and radicalized through medico-technical progress itself. Today's medicine is efficient but unfortunately not always resolutive. Let's consider now this paradoxical profile by examining three typical trends of today's medical strategies.
1. Medicalization of healing
Technical medicine is having an increasingly powerful impact people's lives through a dual mechanism. First is a measure of de-humanization within the clinical process. Our humanness, with its asymmetries, paradoxes, discontinuities, exceptionality and opacity certainly slows management of the strictly clinical process. In order to streamline and make it more manageable the clinic has been coupled with the laboratory. And the laboratory mentality, with its important quantitative but also unilateral data, has impacted the clinics, hospitals and the understanding of patients themselves. This method has imposed a new metaphysics, that of the immanent cause. Bodies are viewed as machines and the technical instruments which support a body's life functions are also machines. Both work based on the same principle: absolute supremacy of the mechanical model. Success is assessed in terms of mechanical metrics. Contemporary medicine is thus based on technological innovation where the body is supported by other machines such as cardiac defibrillators, ventilators, artificial hearts, or artificial organs. Even modern pharmacology operates according to the same mechanical principles. The archetype of this kind of medicine is the ICU (Intensive Care Unit) – spearhead of today's medicine.
Additionally, medicalization can end up treating as diseases a variety of negative but formerly-considered normal experiences of human existence. For example, various types of sadness, dissatisfaction or sub-clinical depression. Modern medicine is asked to provide absolute satisfaction of requests that are not strictly necessary in order to adequately fulfill life's common experience. Today's medicine doesn't aim merely to relieve suffering, but also to optimize people's endeavors. The border between normal and pathological, for a medicine constantly unsatisfied with its conquests, moves constantly in search of ever higher standards. And the perceived promise of optimizing the quality and duration of life are goals that will push medicine to transform our desires into needs and produce unattainable, utopian targets.
2. De-socialization of healing
Healing has always been a relational experience. The therapeutic alliance included a long chain of actors. Beyond physician and/or priest the healing mechanism typically included family and friends who intervened as therapeutic agents. Today all these actors are considered peripheral and are just present as accessories or anonymous, interchangeable witnesses of a process from which they have been divested. And even when they are involved in the healing process they tend to do it in mechanical terms or on a contractual basis – for short, and physician-directed interventions. All the social support, lauded as essential for the healing process, is nevertheless understood and implemented without correcting the mechanical-contractual model. The therapeutic social bond has almost disappeared from the healing process and all the compensating mechanisms and substitutive strategies hardly hide its absence.
3. De-personalization of healing
The mechanization of the healing process has also unavoidably touched the patients directly. A model aimed at absolute efficiency as the end result could not do otherwise. They are the irregularity – the “wild card”. The patients, of course, have not disappeared. They are an important component of the medical process. But with what status? Patient present unique, objective, failing bodies, and thus are quantitatively included. But the qualitative aspect has simply disappeared. And the evident sign is the dictatorship of numbers. Quant covers over qual. All the initiatives and strategies invented to personalize patients hardly hide structural failures. The therapeutic setting more and more moves toward depersonalization.
The reintroduction of human centricity in today's technical and impersonal medicine will never succeed if it is done peripherally. It will not succeed if the mechanical and analytical model is not reduced and essentially revisited. Certainly the true inclusion of the human dimension will necessarily impact the mechanistic model, but what the resulting fusion loses in quantitative precision it will gain in qualitative meaning.
We rightfully recognize that Adventism considers the person holistically. But there is a strange symmetry between the mechanical and depersonalizing trend of Western medicine and the schematic, linear and pragmatic Adventist anthropology. This probably derives from inadequately taking into account the various complex levels of existence (body, spiritual, behavioral, etc.) and an oversimplified way of understanding them. Until we seriously consider humanness, with all of its asymmetries, paradoxes, exceptionality, opacity and alternatives, our person-centered medicine and anthropology will remain superficial.
Hanz Gutierrez is a Peruvian theologian, philosopher and physician. Currently he is Chair of the Systematic Theology Department at the Italian Adventist Theological Faculty of “Villa Aurora” and director of the CECSUR (Cultural Center for Human and Religious Sciences) in Florence, Italy.
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