This morning we’re starting out with Bob Baker and the Hippocratic Oath. Again, on the oath, but from a different perspective this time, which should be interesting to hear. My education has largely conformed to what Bob Veatch taught the prior week, which I suppose makes sense when you consider who my teachers were. Stepping outside that lineage for a differing point of view is very CHID, and should be educational, at the very least, if not also entertaining.
Baker is talking about why we should still pay attention to the Hippocratic Oath, and why the history of medical ethics is important; which I’m not sure I understood Bob Veatch to say was not important, last week, but he gave us a lot of information, so I might have missed it. Or simply discounted it; as a history person (albeit a weird one), the idea of discounting the history of anything seems asinine and rather ludicrous; history provides both the narrative for our lives, as well as creates a Nietzschean genealogy that we construct ourselves from. (It’s times like these I wish my entire library was unpacked and sorted properly — wasn’t it Deleuze who gave us the more current reading of Nietzschean genealogy, illustrating the never-ending, never-beginning stories our lives are pieced from?)
Anyhow, Juanna’s book is coming up today, of course — this is the book Shapiro recommended I read, and I never got around to. It’s interesting that they’re going back to Eidelstein’s Oath, as I actually rejected using in my thesis, instead opting for Francis Adams’ version of the Oath. They are almost identical, but there are a couple of key differences, the sorts of differences that come up when you’re doing lit crit and interpreting individual words, as well as the words paired up and their meaning. This comes up with Larry having us read through the Oath, as well — something that quite tickles me, since Jon Moreno and I got into it last year, over how many people had read the Oath and how many versions. It was sort of sad that in a conference room full of people, he, Shapiro and I were the only ones who’d read it, let alone read several copies of it. For that reason alone, I’m glad that we’re covering it — even if it seems that we’re covering it in depth. I will prove Moreno wrong! (Even if it’s slowly and over a succession of years.)
So, Baker is saying that Bob Veatch wanted to discard the Hippocratic Oath and start over with something else, and that part of his tactic of doing so is to link Hippocrates to Aesclepeus, a religious cult pre-dating the Hippocratics. The supposed argument is that religion and religious cults should be written off, therefore so should the Hippocratic Oath. This doesn’t work for me, primarily because the first time I ever encountered the link between the Aesclepians and Hippocratics was in a comparative religions class, and something that stayed rather constant during all my time in the field. Quite obviously, the most evident link would be the caduceus, a twined snake around a staff. Snakes were the sacred symbol of Aesclepeus, able to heal and harm, depending on how they were used. Not only snakes, but twined snakes — the same twining snakes we see in our modern medical sigil.
Because I think genealogy is so important, that the narratives and history we encounter matters, I don’t think writing off the connection between these two groups as wishful thinking on the part of someone who’d like to go “bah, religion” (which I’m not terribly convinced of, either) is necessarily valid. It seems to me that it’s instructive to look at the origins of the Hippocratic Oath in conjunction and connection with Aesclepeus, and how the cult did what Karen Armstrong argues all successful religious offspring have done: co-opt some important pieces of the religion, but change it to your own needs. We can of course see the caduceus as co-opting, a way of taking legitimacy with them, while expanding broadly upon the Aesclepeans. For example, there was a general prohibition against touching patients, especially women, at that time. Yet now we know that touch in and of itself is incredibly therapeutic, and something that the Hippocratics did.
Philosophically and historically, I also have issue with the concept that Hippocratic medicine is successful because it endured. I don’t think endurance works well as an argument; it seems more like a conclusion constructed out of desire to support the Oath, rather than historically mandated. For, how long does something have to “endure” to be successful and working? Slavery existed until 100-odd years ago; it endured for longer than the Oath. Does this mean slavery worked? Galenic medicine was the norm for hundreds upon hundreds of years; it’s only been the last few centuries that we move away from it, and really took the advent of modern medicine (specifically concepts of cleanliness and antibiotics) to create a big change in how we practice medicine. Does this mean Galenic medicine was successful and should be kept around because it endured so long? I don’t think so — change, progress happens.
In this case, I think that’s exactly what happened — change happened. It’s not that medicine found itself screwed up and wrong in the 1970s, so much as medicine changed. Suddenly medicine, in a very, very short period of time (especially when you put it on the timeline of humans) changed rapidly and dramatically. We went, in a few short years, from being able to do nothing to being able to prescribe antibiotics to God Squading people and their lives. Medicine desperately needed help negotiating the new terrain of technology, because technology rapidly got ahead of medicine — and the Hippocratic Oath. It’s not a screw-up of medicine; it’s the confluence of medicine, technology and a culture that suddenly valued freedom and independence above all else. Things that medicine was not equipped to deal with; and like any doctor when faced with something s/he is not trained in, medicine did the only thing it could: it referred to outside help.
I do agree that it’s necessary to familiarize yourself with history, know your genealogy, and what is influencing the narrative you construct. I just don’t think that necessarily means holding on to the Oath; I think Bob Veatch still has it right, and while we should keep the baby, the bathwater has got to go.
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Larry McCullough is, in no uncertain terms, a Texas gentleman. That is, he’s charming, funny, and has very sharp teeth. I found myself taking copious notes about the Texas act that I’ve to present on later this week, but otherwise simply listening to him talk and crack jokes. It was a nice downtime, and a chance to simply have the words wash over and rest upon me. I did find his conversion about Gregory particularly interesting when he loops both Bacon and Hume into it. Gregory uses Bacon because that’s the closest there is to an underlying concept of medicine (which doesn’t exist at the time — George Ingel being a bit away yet). Gregory defends the dignity of medicine because it was under attack, being ridiculed. And he did this using Hume’s idea of engaged concern and sympathy; this notion of experiential pain might very well be one of the earliest examples of an actual, engaged action of affect. Unfortunately, I don’t have a net connection at the moment; I’d love to do a quick Google and confirm my memory of Hume, through the Scots, having light exposure to Spinoza. This could be an interesting direction to trace the Anglicized notions of affect through, a sort of sideways and decidedly not postmodern history. Which, you know, if I can step away from Deleuze for a while, I’m all for it. Well, for that matter, do we even need to go through Hume for the Scottish influence? Gregory himself was in Edinburgh during the Scottish Enlightenment, which is about when Spinoza was brought over. Interesting — although I suppose this space is not the appropriate one for chasing my preoccupation with Spinozan affect.
Anyhow, McCullough is simply talking about early evidence-based medicine, and the virtues of giving attention to the patient as well as providing care and candor. Doing this, and conforming your practice to standards of evidence — of being a professional, in a way Glenn would probably approve the use of (since he did ask us to think about what a professional is) — is good medicine.
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It’s towards the end of the day, now, for Liva’s lecture, which is a shame. I’m hurting, pretty badly, and having to ration out my medications. I can’t see anyone here until September, so I’ve to very carefully control my pain medication. Unfortunately, this means pain towards the end of the day, which significantly impacts my interest in anything at all. Add to that empiricism never being my forte, and it’s hard to concentrate. I prefer “pure” research, if you will — read and dream research. So far, this is reminding me of the last conference I presented at, on my thesis, where the psych students all asked me, after my presentation, what my research was. Where were my numbers? What was my p value? Where were my controls?
Sorry, can’t control Spinoza…
I’m finding it hard to keep up with the constant shifts, too, between whether or not we should or should not be considering law. I feel like, if we’re just looking at ethics, we get the law thrown at us (terrifically confusing for me, too, since I’m from states with radically different laws), and if we consider the law, we’re told to think in pure ethical terms. I feel like there’s got to be some signal, some switchsign, that I’m missing.
I’m tired and ready for today to be over.