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Introducing Whole Person Medicine The World of Natural Therapy A Guide to Holistic Medicine An Appreciation of Chinese Medicine Links
Foundations of Medical Humanities
Definition of Ethical Freedom and its Infringement by Scientific Theories
Sigmund Freud Jung's Psychology
A Psychotherapy, based on the acknowledgement of Ethical Freedom
A Clinical Illustration
Who is in need of True-Self Psychotherapy?
Counselling Infringement of Ethical Freedom by Genetic Determinism
A Refutation of Darwinian Psychiatry
An irrelevant outcome of an important research subject
A case invalidating genetic deterministic monopoly
Conclusion References

Medical Humanities will be understood in ethical terms. An ethical approach will be chosen that provides the grounds for considering the human being as a bearer of body, mind and spirit. The spiritual dimension will be taken as fundamental. Our bodily and mental health depend on our spiritual affirmation. Whereas bodily and mental phenomena are understood scientifically which implies an acceptance of necessity or determinism, spiritual phenomena involve an acceptance of freedom which affirms our responsibilities and values. These aspects will be clarified with reference to writers whose views are fundamental for Medical Humanities.

Definition of Ethical Freedom and its Infringement by Scientific Theories

A citation from Karl Jasper’s book The Perennial Scope of Philosophy provides the basis for our definition of Ethical Freedom. It stipulates how man can ‘maintain his inner integrity ‘, of how he must be ‘given to himself over and over again, if he is not to lose himself.’ He needs help to gain his freedom when facing fate and even death. According to Jaspers, this help comes from the realm that lies beyond empirical knowledge, from the ‘Transcendent’. These are Jaspers' words:

Man as object of (scientific) investigation and man as freedom are known to us from radically different sources. The former is a content of (scientific) knowledge, the latter a fundamental trait of our faith. Freedom must not itself become an object of investigation, it must not be drawn into the sphere of scientific knowledge. …Through freedom I attain independence from the world, but precisely through the consciousness of my radical attachment to transcendence. For it is not through myself that I am.
The value of each individual can be regarded as unassailable only when men cease to be regarded as expendable material, to be stamped by a universal (for instance statistical material in the evaluation of the treatment for some disease).

Jaspers makes it clear that man as an ethical being is entitled to respect ‘which forbids that any man should be treated only as means and not at the same time as an end in himself.’

If such faith is not achieved, man lives in ‘unfaith’, when ‘the human condition becomes a biological fact among other biological facts’. The result is ’man surrenders to what his finite knowledge determines as necessities and inevitabilities, he gives in to a sense of futility, the energy of his mind declines. He stifles in his supposed factuality; he no more breathes his freedom. ‘ (1)

Jaspers calls this faith ‘philosophical faith’. It is not the faith which I as a doctor have in medical science in which I was trained and which I apply to my patients. But it is the faith they have in me as their doctor who has to support them when they have to cope with their illness and their death. The doctor practices Medical Humanities by entering into a free ethical personal relation with the patient.

Such a positive account of Medical Humanities will now be compared with the view of another thinker whose views are incompatible with Medical Humanities. By presenting these views, the reader can gain a deeper understanding of Medical Humanities, by realising what rules out the realm of Ethical Freedom.

Sigmund Freud

By calling religious faith an illusion, Freud denied the transcendent justification of those who find meaning for their lives in God.

Freud revealed a total inability to grasp the manifestation of Medical Humanities when he made the following statement about love which constitutes a supreme element in Medical Humanities, in the freedom of ethical human personal relations: ‘The nucleus of what we mean by love naturally consists (and this is what is commonly called love, and what the poets sing of) in sexual love with sexual union as its aim. But we do not separate from this - what in any case has a share in the “love” - on the one hand, self-love, and on the other love for parents and children, friendship and love for humanity in general, and also devotion to concrete objects and to abstract ideas, all these tendencies are an expression of the same instinctive activities ‘(2)

From the rejection of an instinctual monopoly we pass to a rejection of gaining pleasure as man's supreme aim in life. The "pleasure-principle" follows from the supreme position of instinctuality which is pleasurable.

There are two objections to this hedonistic psychology: firstly it is not true: soldiers who brave the enemy and parents who express their love by a nursing a sick child are not seeking pleasure.
Secondly, anybody whose aim is to seek pleasure will not find it and will end up with disappointment and pain . Hedonistic psychology is a fallacy. The ethical mistake follows from the psychological mistake: people ’ought’ to strive for pleasure as their ultimate aim.

This does not mean that life must be devoid of pleasure. It comes as a bonus, not as the fulfillment of a supreme aim. It occurs when we see a beautiful sight, listen to a lovely tune or taste a favourite dish.

Medical Humanities raise further powerful objections to psychoanalysis. The adult patient is regressed in the analysis to childhood. He is deprived of his moral adult strength by his therapist. He is now dragged through inevitabilities of the Freudian infantile dependency, dependency on his therapist. In accordance with scientific principles, the analyst deprives the patient and himself of personal human relations and only allows impersonal object relations. Some analysts develop complicated and terrifying accounts of such inner infantile worlds which the adult patient is led to accept as his true world. Psychic realities are revealed, full of persecutions and depression, causing severe guilt as the object is the mother or the father.

For Freud, the parents constitute the ‘super-ego’, a patient's conscience. This conscience is utterly different from the conscience which is a freely chosen authority of moral right and moral wrong. Its fundamental role will be developed in later stages of this essay. The Freudian conscience is authoritative, it is imposed on the child, threatens withdrawal of love in case of rejection. In the same way , a ‘cultural superego’ is as sadistic as the personal variety.

To understand the significance of such dynamics, we must pay attention to Freud's insistence that a second instinct is postulated: apart from being dominated by the sexual libido man is ’aggressive’, which constitutes ‘an innate, independent instinctual disposition in man.’ (3) In his Civilisation And Its Discontents, Freud elaborates details of this aggressive instinct in relation to a stranger meeting me:
‘ Not merely is this stranger on the whole not worthy of love, he has more claim to my hostility, even to my hatred. He does not seem to have the least trace of love for me, does not show the slightest consideration. He has no hesitation in injuring me, never even asking himself whether the amount of advantage he gains by it bears any proportion to the amount of wrong done to me. What is more, he does not even need to get an advantage from it, he thinks nothing of jeering at me, insulting me, slandering me, showing his power over me; and the more secure he feels himself, or the more helpless I am, with so much more certainty can I expect this behaviour from him towards me.’(4)

In their treatment, analysts never fail to bring this unconscious aggression into their patients' ( their victims ) consciousness.

It is not surprising that the psychiatrist Gavin Andrews has come to the following conclusion about the results of Freudian treatment : ‘Ten per cent of mental health professionals who underwent the obligatory training analysis considered that the experience had been harmful. Therefore the number of patients harmed but who do not complain might be considerable.‘( 5) Of course the real harm results from the innumerable sources from which people in general have received and still receive knowledge of Freud's views. It would be impossible to imagine that Freudian views could be subtracted from current thinking in Western society. Medical Humanities must assess Freud's influence.

Jung's Psychology

Jung started his own school and his followers train therapists and publish papers in their Journal. My task is to assess this psychology for Humanistic Medicine. Here is one exposition of his views:
‘The Jungian system claims, in spite of its intimate reference to the fundamental problems of our being, to be neither religion nor philosophy. It is the scientific summary and representation of all that the experienceable totality of the psyche includes ; and as biology is the science of the living physical organism , so is it the science of the living organism of the psyche . It alone gives the possibility of forming a ’Weltanschauung “that is not merely taken over traditionally and uncritically but that can be worked out and personally shaped by the individual with the help of these materials and tools.’

The question for Medical Humanities is : does Jungian treatment involve the exercise of personal freedom, of responsibility?

Jungian patients see in their dreams mandalas, magic circles, religious symbols which are accompanied by ‘strong feeling of harmony or of peace.’ (7) Such experiences suggest that the treatment helps such patients to enter into the freedom of Medical Humanism. Jung studied myths, the ‘spirit’ of the myths is a creative urge, arising from the collective unconscious. These, Jung holds, explain what is happening in the sea, the sky, on earth: primordial images which also appear in dreams and psychotic phantasies, possessing power and energy. The medical humanist is concerned when he learns that they inspire ‘both creation and destruction.' (8) He wonders how patients can cope with such ‘ buried treasures.' (9) They are archetypes, awe-inspiring products of the psyche.(10)

The Medical Humanist is forced to the conclusion that archetypes do not challenge a person to act as a free person but are excuses for the way in which his life runs. In his autobiography Jung states: ‘My life is a story of the self-realization of the unconscious.’ (11) This clearly means that he was not responsible, the unconscious took away his responsibility for his life, a clear rejection of Medical Humanities.

His patients are also absolved from responsibilities. ‘When, for instance, a highly-honoured scholar in his seventies deserts his family and marries a 20-year-old red-haired actress, then, we know, the gods (archetypes) have claimed another victim, showing their demonic supremacy.’ (12)

The archetype, the shadow, completes a picture which denies the case of ethical striving for Jung's followers: The shadow which must not be suppressed: ‘trying to live as better and nobler people than we are involves us in endless hypocrisy and deceit, and imposes such a strain on us that we often collapse and become worse than we need have been.’ (13)

Medical Humanities cannot exist in the world of this shadow. My task is to construct a treatment that allows Medical Humanities to express its tenets.

A Psychotherapy, based on the acknowledgement of Ethical Freedom

As has been hinted when criticising Freud's definition of conscience, it is conceived by medical humanists rather as a freely accepted authority of moral right and moral wrong and it offers a basis for a therapy.

For the religious person, conscience is regarded to be a divine call, but for the non-religious person it stands for duty which people owe to themselves and to others.

It is of course the patient's and not the therapist’s conscience. His or her duty is to find a way of confronting the patients with their own conscience. But the therapists must be aware that their patients’ conscience may be unreliable and must not be confronted. A severely depressed patient may feel guilt which is a symptom of his illness and has no moral justification. By confronting such a psychotic person with an assumed guilt would be a serious medical neglect, it may lead to a suicide. Such patients have to be treated as objects of medical science, for instance with an anti-depressant or with electro-convulsive therapy.

Conscience may lose its validity: The obsessional person considers it to be his duty to touch some object dozens of time or to make sure that the gas has been turned off. He returns to the oven again and again. Such people are aware of the senselessness of their actions.

Conscience may be misapplied. There are cases when possessive parents ruin their children's lives by insisting that they must be entirely at their disposal. In such a case, the therapist has to make the son or daughter aware of his or her duty to himself or herself. Such patients need an appropriate psychotherapy.

In my book Medicine for the Whole Person (14) I called this psychotherapy ‘A True-Self Psychotherapy.' I gave details of its methods. They can be adapted to individuals or to groups.

Patients are encouraged to tell their life stories and to face conflicts that have occurred, whether in their professional or personal relations. How honestly were these conflicts met? is a constant question. If patients are in a group, members of the group are encouraged to voice their opinion, relating a fellow patient's problem to their own.

In order to stir their conscience, patients are confronted with works of art that provide deeper realisation of life. Sir Jacob Epstein's ‘The Madonna and Child ‘ is a sculpture that expresses suffering, pain, love and compassion. Patients who consult me in Harley Street are advised to gain a moving experience by walking to nearby Cavendish Square to see the work. I also show patients reproductions of this sculpture.

In appreciating this and other works of art. I am guided by Ernst Cassirer's observation that ‘in the creativeness of art we must seek the evidence for and the fundamental manifestation of the creativeness of life.’ (15)

Patients are also provided with sheets of paper and crayons to picture some emotional conflict. These products are not works of art, but can provide valuable insight into people’s lives.

Mental Health films are shown, portraying conflicts of childhood, adolescence and adulthood, providing opportunities to confront emotional conflicts.

Dreams are interpreted as challenges, they may be the means of raising the unconscious conscience into consciousness when calling upon a dreamer to face a situation which he or she has avoided in their wakeful state.

Finally reveries: patients, sitting or lying down, are told to close their eyes, relax their bodies and imagine that they are in a theatre. They are then told to report what is going on on the stage. They are given a chance to play out the drama of their lives, their conflicts and possible solutions. The therapist acts as the producer of this drama, suggesting some deeper understanding. The reverie is terminated when the therapist counts from 5 to 1 and tells the patients to open their eyes. Some patients conduct their reveries at home and report results when they meet the therapist next time.

There is no need for such elaborate methods in every case. A single interview provides an illustration

A Clinical Illustration

A single lonely woman, aged 62, consulted me in a state of severe anxiety. A lump in one breast had been diagnosed as cancer and after the removal of the breast the disease was shown to have had infiltrated lymphatic tissues. She was told by the oncologist that the chemotherapy which she will receive cannot cure the cancer and that she will probably die within one or two years.

She asked the cancer specialist whether a healthy diet, as advocated in one of my books, would help her. She was told that food would make no difference to her disease, his advice was: ‘You left the treatment until it was too late for a cure, now enjoy any food.’

This hedonistic oncological treatment was not successful, and the patient was left feeling even more frightened. My task was to try to enable her to summon her freedom to face her death.

I did not mention food, as this was not relevant. I asked: "Are you religious?” I expected that this faith would provide necessary strength. She told me that she had been brought up as a Catholic, she prays regularly, but does not attend church.

I immediately telephoned Farm Street Church, a Jesuit church in London which has helped my patients in severe emotional crises. This patient was given an interview with one of the priests, and she told me later that he had helped her to face her death.

But some more personal help was required at the interview with me, as her religious faith was not very strong. She asked me: "Do you believe in God, Doctor? " I told her how I was trying to cope with death without religious faith. I quoted Goethe who in one of his poems relates the ethical principle to a person’s immortality: "What a good man can achieve, cannot be achieved within the narrow confines of his life. His influence on those who accept moral goodness continues after his death, his good word, his good deed, they strive for ever as he strove while alive. ". My patient thought for a while and then said:" I have done good to people and the thought of my influence continuing after my death is a comfort for me."

The third thing which I did for her was to order homeopathic remedies, to help her with her fear of death and with the serious side-effects that cancer patients experience from the chemotherapy. The homeopathic remedy is not for certain bodily or mental diseases. The remedy is for a type of person, including bodily, emotional and spiritual aspects of the personality.

I received one telephone message: I had helped her when contacting the priest, also when opening her mind to the persistent good influence we have on others and thirdly when ordering the remedy that helps all aspects of the human personality.

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