In his Conversation Starter essay, Kimbell Kornu makes what he admits is an outrageous claim: Modern medicine is nihilistic; it believes in nothing. “Death lies at the heart of modern medicine.” What can he mean? Surely, everyone who practices medicine seeks to extend and enhance life. How can they be engaged in promoting death? Has Josef Mengele been appointed Surgeon General?
Kimbell isn’t saying all medical practitioners or theorists are nihilists or Nazis. He’s not doubting the sincerity and goodwill of physicians, nurses, and others. He’s not saying the practice of medicine is meaningless. He’s not saying he longs for the days of leech therapies and amputations without anesthesia. Rather, he’s saying modern medicine is a development within modernity, and as such it participates in the nihilism or “primacy of death” at the heart of modernity. I think he’s correct, though I suggest below he obscures the counterforces at work within medicine.
My response to Kimbell’s essay moves through several stages. To start, I offer a parallel account of modernity, drawing on Hans Jonas (to whom Kimbell alludes) and Robert Spaemann. This parallel account is complementary, not corrective. I offer a somewhat more concrete and accessible version of the argument, which shifts the discussion to what is (for me) more familiar terrain. I hope my account will yield a portrait of medicine more recognizable to its practitioners, and, in the end, open up the possibility that modern medicine is now, and might increasingly be, a site of resistance to nihilism.
In his second paragraph, Kimbell briefly summarizes Hans Jonas’s essay, “Life, Death, and the Body in the Theory of Being.”[1] The earliest interpretations of nature, Jonas says, were vitalist and animist: The world is alive. We never encounter “mere” matter, but always matter animated by soul. In such a world, death is the great intellectual challenge, the paradox at the heart of the cosmos. In a world of vibrant life, how is it that things cease to live? One option is denial. Death isn’t real. The biblical option is to say death is an interloper. It “enters” the world on the heels of sin, as Paul puts it (Romans 5:12).
In modernity, death and life switch places. Death is natural. The most basic stuff of the universe is inert matter. Chemistry and physics become the fundamental sciences, and biological systems are explained by reference to dead matter in motion. Modern thought about the natural world is thus “under the ontological dominion of death.”[2] Life becomes the great intellectual puzzle (as, for instance, in Darwinian evolution), for “how . . . is life reducible to nonlife?”[3]
There wasn’t an abrupt transition from a monism of life to a monism of death one spring morning in the fourteenth or fifteenth century. Dualism provides the bridge between vitalism and thanatism. Dualism erects a wall of separation between matter and spirit. Life is on the side of spirit. Dualism thus drains life from the body, the soul from physical. The body is “nothing but corpse,” which is alive only because “life dwells like a stranger” in it.[4] In our living experience, of course, matter and spirit are mingled. But that only means living things obscure the truth. Truth is revealed in death, as the body dissolves into the inorganic stuff that it truly is, and the soul flits away to a blissful realm of spirit. Modern materialism – the dominion of death – could not exist without the prior dualistic act of division.
Jonas links this genealogy with modern science’s rejection of final ends. Aristotle claimed four factors are responsible for, e.g., a statue: The material cause (bronze or stone), the formal cause (the shape), the efficient cause (the sculptor who shapes the bronze into the form), and the final cause (the purpose of the sculpture, say, to adorn a temple). From an Aristotelian perspective, modern science is reductive. It doesn’t care what a thing is for, what its ultimate purpose is. Purpose is the province of theology or philosophy, not science. Science examines, experiments on, and theorizes about mechanisms or, in Aristotle’s terms, “efficient causes.” A billiard ball hits another billiard ball, and the second ball moves. It doesn’t move because billiard balls seek their final end in a state of rest. The second ball moves because of a more or less mechanical transfer of energy, which can be mathematically expressed.
The erasure of final causes isn’t the result of observation, experiment, or even argument. It’s not that scientists assiduously sought final causes but were, alas, unable to find them. It’s not even that final causes are odd or unnatural. Quite the contrary. We start asking “Why? Why? Why?” almost as soon as we can talk, and we don’t stop until we die. For Francis Bacon, this is what makes final causes suspect. Asking “why?” is a prejudice, an “idol of the tribe,” and science exists to prosecute an iconoclastic war against prejudice. For science, the elimination of final causes is “a methodological principle guiding inquiry.” “Quite suddenly” the search for final causes was “held to be at various with the scientific attitude.”[5] By fiat, science stops the asking of “Whys?” when we arrive at the efficient cause. This is, of course, a natural stopping place for a science operating under the ontological dominion of death. Material, formal, and efficient causation can exist in a world of dead matter, but final causes have no place. A dead world is a world devoid of purpose. In a dead world, there is no chief end for anything.
It’s common to see the elimination of final causes as part modern science’s war with Aristotle.[6] Jonas sees it also as an episode in modernity’s war with anthropomorphism, the attribution of human intentions and passions to nature. Final causes, Bacon admits, “have relation clearly to the nature of man” but not “to the nature of the universe.” We must cease and desist from drawing inferences from human nature to the universe, a practice that has, Bacon warns, “strangely defiled philosophy.”[7]
Over the centuries since Bacon, thinkers have recognized that many of our most basic concepts rest on anthropomorphisms. Force and cause “spring from a type of experience,” human experience. Hume is right: Once we rigorously exclude “projections” from human experience to nature, we cannot find “cause” in nature. Jonas concludes that even our descriptions of the mechanisms of efficient causality are anthropomorphic.
Further, as Robert Spaemann points out, the concept of “motion” assumes purpose. We can say a body is in motion in the present only if the body’s arrival at some other location in the future is anticipated. Who is doing the anticipating? We observers only? Or the body itself? Spaemann says the latter: The brakes have slipped and the car is heading toward the tree. Without ascribing “anticipation” to a body in motion, we can’t distinguish moving bodies from stationary ones. Infinitesimal calculus eliminates anthropomorphism by dividing “movement into an infinite number of closely juxtaposed states of rest.” But a series of states of rest, no matter how close the states are to each other, isn’t motion. When we eliminate “purpose” from our idea of “motion,” we lose the idea of motion itself. Spaemann concludes, “we can understand actual movement only if we posit a ‘conatus,’ a striving, at its basis.” The ground for our understanding of motion is our own, anthropic, experience.[8]
Modern ontology says we live in a dead world of matter moved by the clanging machinery of efficient causality. Consistent with this, modern science censors anthropomorphism. Then we find we can’t even speak about motion or causality without sounding like vitalists and Aristotelians.
If only our intellectual confusion were the worst of it! You can see where this is headed: If it’s illegitimate to attribute anthropomorphic purpose, motion, freedom, and unity to nature, and if we are material beings, then the razor of anti-anthropomorphism shaves us to the bone too. Human purpose, freedom, and motion is as much an idolatrous illusion as seeing purpose in a tumbling rock, a germinating seed, or a bird building a nest. We arrive, as Kimbell says, at the view that human beings are inert sites of standing-reserve, capable of being manipulated by the will to power. We arrive at the nihilism of modern medicine.
Spaemann offers euthanasia as a medical example of the war against anthropomorphism. For advocates of assisted suicide,
The only thing that exists are states, which are either desirable or undesirable. Those that are not desirable, i.e., the states of suffering, are to be eliminated, and if there is no other way, then this rejection is to be achieved by eliminating the one who suffers. For the sufferer does not in reality have an actuality, a being, that would be something more than the sum of the conditions in which it happens to be. It is not in fact someone who suffers, but it is suffering that demands to be eliminated from reality.[9]
In this, and in other limit cases (e.g., abortion, which pushes constantly toward infanticide), the mask of modern medicine slips and its inherent necrophilia is exposed.
Most of modern medical care, however, doesn’t occur at the limits. What do things look like when we move closer to the center? We certainly see some of the same forces at work. Pressured by the medical association of which he is a part, a physician has quotas to meet, and so he spends only a few minutes with each patient. He has no time to consider his patients as full persons, whose health is affected by diet, living conditions, family, work, and neighborhood. Patients are collections of systems and sites of suffering, and the physician concentrates on eliminating the suffering.
At the same time, our physician longs to practice medicine like his grandfather, whose days included leisurely appointments that gave him a chance to befriend his patients, or like my father, a general practice doctor who often told me an hour’s conversation was often more therapeutic than medication or tests. Our physician resists the pressure to treat his patients as bags of dead chemicals that need an occasional re-balancing, or as standing-reserve to enrich his medical company, the pharmaceutical industry, or insurance corporations. Within the constraints he’s given, he does what he can to treat patients as persons, with freedom and purpose, living out a unified life story in which he’s privileged to play a role.
I suspect many, many physicians, both in primary care and in more specialized sectors, resist the ontological dominion of death. And the practice of medicine is, in a sense, an “easy” place to mount this resistance. Chemists, physicists, and mathematicians murder to dissect. Given the focus of their disciples, materialism appears to make sense of things. The biological sciences, though, deal with living bodies. True, they come to knowledge of living bodies by studying corpses and cadavers. True, surgical procedures take various steps to depersonalized diseased or broken parts of the body. Yet most physicians practice their craft on living bodies. They know their patients are free, purposeful beings. Many practice on the assumption that the living bodies they care for are ensouled bodies.
Perhaps because his argument unfolds at a high level of abstraction, Kimbell gives too little attention to the actual practice of medicine. Even if the “truth” of modern medicine is nihilism, many practice, perhaps all unwittingly, as if life is prior to, and indeed has triumphed over, death.
Kimbell is right that many of the structures, incentives, and instincts of medicine science are nihilistic. It’s not enough to personalize medical care here and there. It needs an overhaul of its training practices, its standards of care, its relation to insurance, its use of medications, its treatment of the frail and dying.[10] But an institutional, utilitarian reform isn’t enough either. Not only in medicine, but in the sciences and the realm of human knowing in general, there needs to be an “ontological” revolution, which must be a theological revolution founded on a resurgent anthropomorphism. We must strive for a healthcare system rooted in the conviction that “people are people too.”
Peter Leithart is President of Theopolis Institute.
[1] This is the “First Essay” in Jonas, The Phenomenon of Life: Toward a Philosophical Biology (Evanston, IL: Northwestern University Press, [1966] 2001) 7-37.
[2] Jonas, Phenomenon, 12.
[3] Jonas, Phenomenon, 11.
[4] Jonas, Phenomenon, 13. Levitically expressed, this is a moment in the cultural history of purity, or of pollution-avoidance. On one side of the divide is “pure spirit” unmixed with flesh, while “pure matter” lies on the other.
[5] Jonas, Phenomenon, 34-35.
[6] Aristotle is making a comeback of late, however, as is the concept of “purpose” in nature (which, in truth, was never really eliminated). See Benjamin Leibeskind, “Einstein in Athens,” New Atlantis 59 (Summer 2019), available at https://www.thenewatlantis.com/publications/einstein-in-athens, accessed May 11, 2020; Stephen L. Talbott, “Evolution and the Purposes of Life,” New Atlantis 51 (Winter 2017), available at https://www.thenewatlantis.com/publications/evolution-and-the-purposes-of-life, accessed May 11, 2020.
[7] As quoted by Jonas, Phenomenon, 35.
[8] D.C. and Jeanne Heffernan Schindler, eds., A Robert Spaemann Reader: Philosophical Essays on Nature, God, & the Human Person (Oxford: Oxford University Press, 2015) 87-88. The chapter is entitled, “In Defense of Anthropomorphism.”
[9] Spaemann, Reader, 88-89.
[10] See the searing indictment in Anne Case and Angus Deaton, Deaths of Despair and the Future of Capitalism (Princeton: Princeton University Press, 2020), ch. 13. Case and Deaton charge that America’s “healthcare system is a uniquely American calamity that is undermining American lives” (pp. 9-10).
In his Conversation Starter essay, Kimbell Kornu makes what he admits is an outrageous claim: Modern medicine is nihilistic; it believes in nothing. “Death lies at the heart of modern medicine.” What can he mean? Surely, everyone who practices medicine seeks to extend and enhance life. How can they be engaged in promoting death? Has Josef Mengele been appointed Surgeon General?
Kimbell isn’t saying all medical practitioners or theorists are nihilists or Nazis. He’s not doubting the sincerity and goodwill of physicians, nurses, and others. He’s not saying the practice of medicine is meaningless. He’s not saying he longs for the days of leech therapies and amputations without anesthesia. Rather, he’s saying modern medicine is a development within modernity, and as such it participates in the nihilism or “primacy of death” at the heart of modernity. I think he’s correct, though I suggest below he obscures the counterforces at work within medicine.
My response to Kimbell’s essay moves through several stages. To start, I offer a parallel account of modernity, drawing on Hans Jonas (to whom Kimbell alludes) and Robert Spaemann. This parallel account is complementary, not corrective. I offer a somewhat more concrete and accessible version of the argument, which shifts the discussion to what is (for me) more familiar terrain. I hope my account will yield a portrait of medicine more recognizable to its practitioners, and, in the end, open up the possibility that modern medicine is now, and might increasingly be, a site of resistance to nihilism.
In his second paragraph, Kimbell briefly summarizes Hans Jonas’s essay, “Life, Death, and the Body in the Theory of Being.”[1] The earliest interpretations of nature, Jonas says, were vitalist and animist: The world is alive. We never encounter “mere” matter, but always matter animated by soul. In such a world, death is the great intellectual challenge, the paradox at the heart of the cosmos. In a world of vibrant life, how is it that things cease to live? One option is denial. Death isn’t real. The biblical option is to say death is an interloper. It “enters” the world on the heels of sin, as Paul puts it (Romans 5:12).
In modernity, death and life switch places. Death is natural. The most basic stuff of the universe is inert matter. Chemistry and physics become the fundamental sciences, and biological systems are explained by reference to dead matter in motion. Modern thought about the natural world is thus “under the ontological dominion of death.”[2] Life becomes the great intellectual puzzle (as, for instance, in Darwinian evolution), for “how . . . is life reducible to nonlife?”[3]
There wasn’t an abrupt transition from a monism of life to a monism of death one spring morning in the fourteenth or fifteenth century. Dualism provides the bridge between vitalism and thanatism. Dualism erects a wall of separation between matter and spirit. Life is on the side of spirit. Dualism thus drains life from the body, the soul from physical. The body is “nothing but corpse,” which is alive only because “life dwells like a stranger” in it.[4] In our living experience, of course, matter and spirit are mingled. But that only means living things obscure the truth. Truth is revealed in death, as the body dissolves into the inorganic stuff that it truly is, and the soul flits away to a blissful realm of spirit. Modern materialism – the dominion of death – could not exist without the prior dualistic act of division.
Jonas links this genealogy with modern science’s rejection of final ends. Aristotle claimed four factors are responsible for, e.g., a statue: The material cause (bronze or stone), the formal cause (the shape), the efficient cause (the sculptor who shapes the bronze into the form), and the final cause (the purpose of the sculpture, say, to adorn a temple). From an Aristotelian perspective, modern science is reductive. It doesn’t care what a thing is for, what its ultimate purpose is. Purpose is the province of theology or philosophy, not science. Science examines, experiments on, and theorizes about mechanisms or, in Aristotle’s terms, “efficient causes.” A billiard ball hits another billiard ball, and the second ball moves. It doesn’t move because billiard balls seek their final end in a state of rest. The second ball moves because of a more or less mechanical transfer of energy, which can be mathematically expressed.
The erasure of final causes isn’t the result of observation, experiment, or even argument. It’s not that scientists assiduously sought final causes but were, alas, unable to find them. It’s not even that final causes are odd or unnatural. Quite the contrary. We start asking “Why? Why? Why?” almost as soon as we can talk, and we don’t stop until we die. For Francis Bacon, this is what makes final causes suspect. Asking “why?” is a prejudice, an “idol of the tribe,” and science exists to prosecute an iconoclastic war against prejudice. For science, the elimination of final causes is “a methodological principle guiding inquiry.” “Quite suddenly” the search for final causes was “held to be at various with the scientific attitude.”[5] By fiat, science stops the asking of “Whys?” when we arrive at the efficient cause. This is, of course, a natural stopping place for a science operating under the ontological dominion of death. Material, formal, and efficient causation can exist in a world of dead matter, but final causes have no place. A dead world is a world devoid of purpose. In a dead world, there is no chief end for anything.
It’s common to see the elimination of final causes as part modern science’s war with Aristotle.[6] Jonas sees it also as an episode in modernity’s war with anthropomorphism, the attribution of human intentions and passions to nature. Final causes, Bacon admits, “have relation clearly to the nature of man” but not “to the nature of the universe.” We must cease and desist from drawing inferences from human nature to the universe, a practice that has, Bacon warns, “strangely defiled philosophy.”[7]
Over the centuries since Bacon, thinkers have recognized that many of our most basic concepts rest on anthropomorphisms. Force and cause “spring from a type of experience,” human experience. Hume is right: Once we rigorously exclude “projections” from human experience to nature, we cannot find “cause” in nature. Jonas concludes that even our descriptions of the mechanisms of efficient causality are anthropomorphic.
Further, as Robert Spaemann points out, the concept of “motion” assumes purpose. We can say a body is in motion in the present only if the body’s arrival at some other location in the future is anticipated. Who is doing the anticipating? We observers only? Or the body itself? Spaemann says the latter: The brakes have slipped and the car is heading toward the tree. Without ascribing “anticipation” to a body in motion, we can’t distinguish moving bodies from stationary ones. Infinitesimal calculus eliminates anthropomorphism by dividing “movement into an infinite number of closely juxtaposed states of rest.” But a series of states of rest, no matter how close the states are to each other, isn’t motion. When we eliminate “purpose” from our idea of “motion,” we lose the idea of motion itself. Spaemann concludes, “we can understand actual movement only if we posit a ‘conatus,’ a striving, at its basis.” The ground for our understanding of motion is our own, anthropic, experience.[8]
Modern ontology says we live in a dead world of matter moved by the clanging machinery of efficient causality. Consistent with this, modern science censors anthropomorphism. Then we find we can’t even speak about motion or causality without sounding like vitalists and Aristotelians.
If only our intellectual confusion were the worst of it! You can see where this is headed: If it’s illegitimate to attribute anthropomorphic purpose, motion, freedom, and unity to nature, and if we are material beings, then the razor of anti-anthropomorphism shaves us to the bone too. Human purpose, freedom, and motion is as much an idolatrous illusion as seeing purpose in a tumbling rock, a germinating seed, or a bird building a nest. We arrive, as Kimbell says, at the view that human beings are inert sites of standing-reserve, capable of being manipulated by the will to power. We arrive at the nihilism of modern medicine.
Spaemann offers euthanasia as a medical example of the war against anthropomorphism. For advocates of assisted suicide,
The only thing that exists are states, which are either desirable or undesirable. Those that are not desirable, i.e., the states of suffering, are to be eliminated, and if there is no other way, then this rejection is to be achieved by eliminating the one who suffers. For the sufferer does not in reality have an actuality, a being, that would be something more than the sum of the conditions in which it happens to be. It is not in fact someone who suffers, but it is suffering that demands to be eliminated from reality.[9]
In this, and in other limit cases (e.g., abortion, which pushes constantly toward infanticide), the mask of modern medicine slips and its inherent necrophilia is exposed.
Most of modern medical care, however, doesn’t occur at the limits. What do things look like when we move closer to the center? We certainly see some of the same forces at work. Pressured by the medical association of which he is a part, a physician has quotas to meet, and so he spends only a few minutes with each patient. He has no time to consider his patients as full persons, whose health is affected by diet, living conditions, family, work, and neighborhood. Patients are collections of systems and sites of suffering, and the physician concentrates on eliminating the suffering.
At the same time, our physician longs to practice medicine like his grandfather, whose days included leisurely appointments that gave him a chance to befriend his patients, or like my father, a general practice doctor who often told me an hour’s conversation was often more therapeutic than medication or tests. Our physician resists the pressure to treat his patients as bags of dead chemicals that need an occasional re-balancing, or as standing-reserve to enrich his medical company, the pharmaceutical industry, or insurance corporations. Within the constraints he’s given, he does what he can to treat patients as persons, with freedom and purpose, living out a unified life story in which he’s privileged to play a role.
I suspect many, many physicians, both in primary care and in more specialized sectors, resist the ontological dominion of death. And the practice of medicine is, in a sense, an “easy” place to mount this resistance. Chemists, physicists, and mathematicians murder to dissect. Given the focus of their disciples, materialism appears to make sense of things. The biological sciences, though, deal with living bodies. True, they come to knowledge of living bodies by studying corpses and cadavers. True, surgical procedures take various steps to depersonalized diseased or broken parts of the body. Yet most physicians practice their craft on living bodies. They know their patients are free, purposeful beings. Many practice on the assumption that the living bodies they care for are ensouled bodies.
Perhaps because his argument unfolds at a high level of abstraction, Kimbell gives too little attention to the actual practice of medicine. Even if the “truth” of modern medicine is nihilism, many practice, perhaps all unwittingly, as if life is prior to, and indeed has triumphed over, death.
Kimbell is right that many of the structures, incentives, and instincts of medicine science are nihilistic. It’s not enough to personalize medical care here and there. It needs an overhaul of its training practices, its standards of care, its relation to insurance, its use of medications, its treatment of the frail and dying.[10] But an institutional, utilitarian reform isn’t enough either. Not only in medicine, but in the sciences and the realm of human knowing in general, there needs to be an “ontological” revolution, which must be a theological revolution founded on a resurgent anthropomorphism. We must strive for a healthcare system rooted in the conviction that “people are people too.”
Peter Leithart is President of Theopolis Institute.
[1] This is the “First Essay” in Jonas, The Phenomenon of Life: Toward a Philosophical Biology (Evanston, IL: Northwestern University Press, [1966] 2001) 7-37.
[2] Jonas, Phenomenon, 12.
[3] Jonas, Phenomenon, 11.
[4] Jonas, Phenomenon, 13. Levitically expressed, this is a moment in the cultural history of purity, or of pollution-avoidance. On one side of the divide is “pure spirit” unmixed with flesh, while “pure matter” lies on the other.
[5] Jonas, Phenomenon, 34-35.
[6] Aristotle is making a comeback of late, however, as is the concept of “purpose” in nature (which, in truth, was never really eliminated). See Benjamin Leibeskind, “Einstein in Athens,” New Atlantis 59 (Summer 2019), available at https://www.thenewatlantis.com/publications/einstein-in-athens, accessed May 11, 2020; Stephen L. Talbott, “Evolution and the Purposes of Life,” New Atlantis 51 (Winter 2017), available at https://www.thenewatlantis.com/publications/evolution-and-the-purposes-of-life, accessed May 11, 2020.
[7] As quoted by Jonas, Phenomenon, 35.
[8] D.C. and Jeanne Heffernan Schindler, eds., A Robert Spaemann Reader: Philosophical Essays on Nature, God, & the Human Person (Oxford: Oxford University Press, 2015) 87-88. The chapter is entitled, “In Defense of Anthropomorphism.”
[9] Spaemann, Reader, 88-89.
[10] See the searing indictment in Anne Case and Angus Deaton, Deaths of Despair and the Future of Capitalism (Princeton: Princeton University Press, 2020), ch. 13. Case and Deaton charge that America’s “healthcare system is a uniquely American calamity that is undermining American lives” (pp. 9-10).
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