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The Madness of the Market
On the Medical-Psychiatric
Capitalism, Individualism and Health
Marxism and Medicine
Health Fascism vs Spiritual Socialism
Healing and Hearing
The Metaphoric Body
The Metamorphic Process
Medicine beyond Medicine
The New Medicine
This essay seeks to describe in Marxist and Heideggerian terms the essential madness of the market economy and its culture, with an emphasis on its medical-psychiatric consequences and the role that medicine and psychiatry play in protecting the capitalist system from these consequences, whilst at the same time exploiting them for profit. It also seeks to bring to attention the new and insidious forms of health fascism promoted by drug and biotech companies, arguing that so-called ‘breakthroughs’ in genetic medicine and drug-based psychiatry serve not only as new and lucrative sources of corporate profit but (a) as a means of protecting capitalism from the economic costs of stress, depression and disease, and (b) as a front-line weapon in preventing an internal psychological breakdown of the capitalist ethos in the minds and bodies of individuals - one that could lead to a genuine spiritual breakthrough in human social relationships. I suggest that the roots of contemporary biological medicine lie, firstly, in a fundamentally false concept of scientific ‘truth’ and secondly, in the insane theories and murderous practices of Nazi psychiatry.
For all the supposed miracles of medical science, the fact is that medically-triggered conditions are probably the third major cause of death in the world today - after cancer and heart disease. This does not of course affect the profits made from drugs and medical technology, as long as those individuals and countries who most need them can afford to pay the drug companies’ premium prices. Not included amongst the latter, of course are the 22 million Aids sufferers in Africa. But as Daniel Berman, head of Medicine Without Frontiers noted, as far as the drug companies are concerned “The responsibility is to the shareholders and no one else. If you were to try and raise the question of Aids in Africa, they’d look at you like you were from another planet.”
My purpose here, is more than just to attack corporate profit-seeking. It is to diagnose both the essential sickness of the capitalist social body, and question the false, asocial and entirely mechanistic concept of health that capitalism promotes to hide the face of this sickness. To do so I apply Marx’s analysis of economic value to understanding the effect of capitalism on the individual’s sense of self-worth, and their capacity to achieve mental and physical well-being through value-fulfilment. The concept of a Multidimensional Marxism, embracing the medical and psychiatric, psychological and spiritual, ethical and ecological dimensions of contemporary society is introduced, together with a new social and meta-medical philosophy of health and healing.
Multi-dimensional Marxism has its historic roots in the abortive attempt, within pre-war Germany, to articulate a new spiritual understanding of socialism in opposition to both Stalinism, Hitlerism and Western capitalism. The key figure in mounting this challenge was Martin Heidegger, whose pioneering work with doctors and psychiatrists sought to lay the foundation of a New Medicine – a medicine beyond medicine which challenges the reduction of the human being to the human body and mind. It was Heidegger who also anticipated the total devaluation of being that continues to characterise our era - the reduction of the earth and its living beings to a mere stock of economic resources, the reduction of the human being to a mere source of shareholder value, the medical-scientific reduction of the patient to a mere ‘case’ of some generic disease, and the bio-technical reduction of the human body to a biological machine - an object of genetic reengineering.
Capitalism, Individualism and Health
Marx did not define communism as a totalitarian or collectivistic society, but an individualistic one in which “the free development of each is the condition for the free development of all”. Far from being ‘individualistic’ in nature, the culture of global capitalism, on the other hand, works to consistently and corrosively erode the self-worth, self-esteem and free self-expression of each individual. Self-worth has to do with value fulfilment - with valuing our own individual qualities, being valued for them, and fully expressing them in our lives. But capitalism values individual human qualities and creativity only in so far as they contribute to corporate profits or according to the price they fetch on the labour market. Just as Van Gogh remained a pauper in his time, so today a Beethoven, Freud or Einstein would only be valued and employed if their creativity could be instantly transformed into marketable products or services. Ideas and human qualities which have as yet no readily identifiable ‘market’ to transform them into a source of corporate profit are deemed essentially valueless. Employment is equated with “having a job” - irrespective of how little the individual’s creative human qualities and potentials are genuinely employed - valued and rewarded rather than devalued or exploited.
In ‘Das Kapital’ Marx showed how the material use-value of commodities is transformed by the market into a mere symbol or cipher of their monetary exchange value. Thus a painting by Van Gogh, monetarily worthless in his own lifetime, becomes a material symbol of its own inflated market value. Its intrinsic qualities as a product of creative labour are not valued but essentially devalued in this process. Each individual, whether a great artist or not, embodies unique qualities which are materialised through their creative labour. In a market economy, these qualities and this labour have no intrinsic value. Individuals are not valued according to the individual human qualities they bring to their labour, or the creative quality of the time they devote to it. Instead it is the abstract quantity of their working hours, and the purely quantitative market value of their labour that determines what they earn.
A poor quality manager working overtime earns many times more per hour than a part-time but high quality receptionist whose personal qualities improve the morale and well-being of everyone she works with - or a social worker for abused children whose every hour of work has a creative quality incomparably deeper than that of the manager. The corporate jargon of ‘values’ and ‘quality’ is a symbolic compensation for the actual devaluation of the qualities individuals bring to their work and the quality of the time they devote to it. The egalitarian principle of socialist economics is not equal pay for equal hours - whatever type of work people do. It is equal pay for equal quality of work - irrespective of the type of work people do and its current market value.
The source of corporate profit is what Marx called ‘surplus value’. This has its source in surplus labour time - for it is the difference between the value of the labour time provided by the employee and the value of the labour time needed to recreate the employee’s ‘labour power’ - the labour time materialised in the food, clothing energy etc. necessary to keep them functioning economically. But the source of profit is not just this quantitative surplus value. It is also qualitative surplus value. This is the difference between the quality of the time invested by an employee in their work and the quality time necessary to sustain the quality of their labour. Without this quality time, as we know, people experience what we now call ‘stress’. This is of course a negative, non-value generating cost. But at the same time it is no mere accidental by-product of today’s high-pressure working conditions. For it is the qualitative exploitation of labour that is the hidden precondition for the creation of quantitative surplus value in capitalist economies - ‘added value’ as managers like to talk of it.
Capitalism defines health as the capacity for normal economic ‘functioning’, irrespective of the individual’s inner sense of spiritual value fulfilment. By ‘spiritual values’ I do not mean anything purely bodiless or immaterial but that which truly bodies and matters - the individual qualities that people embody in their relationships to one another and materialise in their work. The less able people feel to fully embody who they are in their work - to express their innermost qualities and be materially valued for these qualities - the less spiritual value fulfilment they experience. Their lacking sense of inner well-being or spiritual health then expresses itself in mental and physical symptoms. The health fads promoted by the market economy are themselves a symptom of a basic lack of spiritual health ie. individual value fulfilment in economic activity.
The market economy constantly devalues the individual employee’s real human qualities by rewarding them only according to the purely symbolic value of the work they do - its market value - and the quantity rather than quality of their labour time. As a result, most employees feel inwardly devalued and demoralised. Either they are not afforded the quality time necessary to recreate and cultivate their own individual qualities, or the pressures of their working environment hinders them from fully embodying and materialising these qualities and achieving a sense of value fulfilment. Instead, the culture of the market offers the individual a symbolic substitute for true, individual value fulfilment - value consumerism. Far from valuing the genuine human qualities embodied in human relationships, it turns all such qualities, whether fatherhood or femininity, partnership or trust, even spirituality itself, into purely symbolic values - ‘virtual’ values attached to commodities by brand advertising. The hard-working employee may not have any time for his family. But buying the right brand of washing powder can give him or her a sense of ‘buying into’ the family values he or she is unable to embody and fulfil in real life - purchasing their spirit. If such an employee would go to a psychiatrist and claim that a particular washing powder or pair of trainers had a soul that spoke to them and was the materialisation of a good spirit, he or she would be diagnosed as insane. Yet the architects of modern advertising write blatantly of the ‘soul’ of branded products, aiming to manipulate the consumer into identifying their own soul with it - seeing the shoes or washing powder as a materialisation of their own spiritual values. The psychological process they rely on and encourage is known in psychoanalysis as ‘projective identification’ and regarded as psychotic. But the marketing culture that promotes it is regarded as sane. The amusement and entertainment value of brand advertising is used to justify its ‘harmlessness’ - ignoring the role it plays in the spiritual value economy - replacing real values with purely virtual ones, and true value fulfilment with value consumerism.
What I call ‘Multidimensional Marxism’ is the direct application of Marx’s analysis of economic value to analyse the exploitation of human ethical values in the culture of the market - their spiritual ‘transubstantiation’ into material commodities. Only in this way can we begin to understand the true madness of the market in all its dimensions - not only its dire economic and ecological consequences for mankind as a whole but its basic ethical depravity.
The medical, psychological and spiritual consequences of market ethics and economics are enormous. We see them in both the ‘epidemics’ of stress-related disease and depression and in the very medicalisation of these conditions - their use to promote new forms of corporate health profiteering and health fascism. These include the promotion of mind-altering psychiatric drugs such as Prozac or the anti-psychotics, behavioural health ‘management’ programmes (Employee Assistance Schemes) and neo-Darwinist eugenics (the creation of an illness-free biological super-race) - all aimed at promoting the average employee’s ‘normal’ economic functioning in capitalist society rather than their fulfilment as individual human beings.
The human body and its DNA is not a machine in need of repair, redesign or reengineering. It is the living biological language of the individual human being. But Darwinist science is set to become the medical religion of the new millennium, with the gene as its god and the biotech laboratories its corporate-funded temples. When human beings are treated as mere lumps of flesh, as they are by practitioners of genocide and ethnic cleansing, then the body itself is dehumanised, and we are horrified. But the core assumptions of biological medicine also work to dehumanise the patient - reducing the human being to the human body and mind, reducing the human mind to the human brain, and the human body to a mere stock of genes. The individual patient is reduced to a mere “case” of some particular generic disease or genetic imperfection.
When we are ill, our bodies and minds feel foreign to us. Orthodox medicine treats illness as something basically unnatural, the work of malignant foreign bodies such as viruses or cancer cells that need to be defended against or annihilated. The fact that Hitler spoke of the Jews in medical terms - as a cancer or tumour of the social body, is no accident. The fetish made of the body’s immunological ‘defences’ in medical discourse is a military metaphor for the ego’s xenophobic fear of new and hitherto foreign dimensions of experience - for these might reveal new and foreign aspects of the self. This is the same fear that is expressed politically in nationalist and racist xenophobia. It is through the scientific dehumanisation of the body that biological medicine opens the way to new forms of health fascism - in particular the ideal of a genetically engineered “superman”, biologically cleansed of all troublesome genetic diversity, and perfectly immune from life itself, with all its challenges and frustrations. Can the human gene pool continue to produce what we regard as geniuses if we deny it the potential to produce what we think of as idiots or handicapped people. Or do the latter - for example, individual’s with Down’s syndrome with their wonderful emotional qualities - provide a necessary balance to the cold, calculative and competitive intellect prized by the culture of the market. Who knows at what cost we eliminate human biodiversity or turn it into the private property of biotech corporations.
The biomedical view of health defines it as an unchanging state of well-being rather than as an ongoing process in which illness may have a natural part to play - reminding us of a lack of value fulfilment, and encouraging us to embody more potentials of our inner being. Ill health is always associated not just with poverty but with a basic lack of value fulfilment. Man cannot indeed live by bread alone, and does not live even with bread, not to mention medical treatment, if he cannot find meaning in living. The capitalist ideal of mental and physical health is the employee who continues to function under all conditions, immune from any processes of inner change or reflection that might threaten this efficiency. Biological psychiatry treats mental distress by the use of psychoactive drugs which either make sure that people can go on functioning as they did before they got anxious or depressed, irrespective of the personal meaning of this anxiety or depression. And if the individual psyche gets psychotically out of hand, then the use of so-called neuroleptics can effectively disable their brains - placing them in what amounts to a chemical concentration camp, with all its ‘side-effects’.
Sickness and depression are essentially threats to a well-functioning
global capitalism machine, revealing the spiritual as well as material
poverty it generates amidst wealth. But they are also a source of
corporate profit for the drug companies, private health insurers and
hospitals etc. No wonder then, that genetic medicine, promising as it
does not only a new and lucrative source of profit but a Final Solution
to all health problems, is vaunted by capitalism as the technological
salvation of mankind - the solution to its profound medical-psychiatric
crisis. At the same time, the nasty word 'eugenics' has been
conveniently erased from the language of medical genetics, along with
any mention of some of its founding fathers - the Nazi psychiatrists who
first promulgated the idea of 'schizophrenia' being a genetic disorder.
One of these key figures, Ernst Rubin, is described by Peter Breggin,
author of Toxic Psychiatry, as follows:
It was Rudin who influenced Hitler, not Hitler who influenced Rudin. The psychiatrist became the architect and official interpreter of the first legislation establishing the Nazi eugenics programme that led to the castration and sterilisation of tens of thousands of individuals accused of being schizophrenic, retarded, epileptic, or in some way physically or mentally 'defective'....He was awarded the Iron Cross by Hitler; but at the end of the war he had to flee for his life from the outraged families of mental patients. Rudin's mountainous publications on genetics, pivotal in justifying the mass murder of ‘genetically defective' mental patients under German rule during World War 2, stimulated acceptance of the eventual slaughter of the Jews as well.
He goes on to note that similar policies of medically sanctioned murder of 'incurable' mental patients were advocated by the American Journal of Psychiatry in 1942. But modern health fascism is untainted by any such scandalous associations, and instead shrouds itself with an aura of institutional medical and scientific respectability. Through constant promotion, the myth that mental illness is ‘all in the brain’ has become an accepted or acceptable proposition, justifying, paradoxically, the use of drugs whose disastrous effects do indeed come from wreaking havoc with brain chemistry. In his book Breggin also describes the unprecedented epidemic of drug-induced addiction, dementia and dysphoria created by the prescription or forced use of legal, psycho-pharmaceutical agents: neuroleptic ‘anti-psychotics’ which depress, dull and damage the brain and nervous system - replicating in their effects the very symptoms of madness they are designed to cure. These include addictive tranquillisers which can cause more acute symptoms of agitation and anxiety than that for which they were prescribed; anti-depressants which, if they do not precipitate panic or violent psychoses, keep the patient on an unnatural ‘high’ and support an unhealthy, hypermanic lifestyle. Millions suffer the equivalent of a chemical lobotomy, or worse, incarceration in a chemical concentration camp - anaesthetised from their own feelings and those of others. Side-effects are routinely unreported.
That is not to say that psychiatrists are ‘evil’. All too often, however, their good intent to do something to ease their patients’ suffering conceals an incapacity to be with them in a patient way - to relate to them as individual human beings and understand their symptoms as the attempt to express and communicate a fundamental spiritual dis-ease. And how many are prepared to take the vaunted drugs they routinely prescribe, experience their effects and risk their side-effects first hand? More importantly, how many fully acknowledge the socio-political dimensions of their work?
What greater hypocrisy can we imagine than a society whose politicians engage in a self-righteous ‘war’ against illegal drugs whilst legalising the drugging of tens of thousands of its own children with Ritalin (an amphetamine-type stimulant drug prescribed for hyper-activity and so-called Attention Deficit Disorder). This is justified because the drug ‘works’. But as Peter Breggin notes:
In none of the many standard and even specialised textbooks I consulted could I find any interest in how children feel when taking stimulants. It is as if we are putting coins (instead of pills) into one end of a black box (instead of a child) and getting output at the other end. What happens inside the box is of no concern….Whilst psychostimulants can blunt a child sufficiently to make him more amenable to control in a classroom or at home, at least for a few weeks, there is no evidence of any beneficial long-term effect on academic or social life. Listed side-effects such as social withdrawal, flattened emotions and loss of energy “are not side effects but the primary ‘therapeutic effect’, rendering the child less troublesome and easier to control.
Many marriages are torn by conflicts that frighten and confuse the children. When our children finally go off to school, it is often to a more unsatisfactory situation than the one at home within the family. Typically children are forced to endure long, boring hours in regimented classrooms that give almost no attention to their personal needs or unique attributes…The schools virtually have given up on educational reform. Children who cannot or will not fit the mould are sent off to mental health professionals, frequently for stupefying or addictive medications.
‘Psychology’ today has sold its soul. It has no interest in the speech (logos) of the individual soul (psyche) but only in cost-effective chemical inputs and behavioural outputs. Biological psychiatry and cognitive-behavioural psychology both tend to ignore the social and spiritual dimensions of the individual psyche - reducing health to the capacity to function at work under ever greater conditions of stress and insecurity, and mental health ‘care’ to behavioural ‘management’ through drugs or counselling. But the essentially subversive work of R.D. Laing, Breggin and other radical psychiatrists and psychologists is a model for what I call psycho-spiritual socialism. This is not a traditional Marxist platform for collective socio-political change so much as a work of ideological subversion and relational transformation - starting with our beliefs and relationships to others. Its aim is to undermine the psycho-political foundations of modern capitalism by overcoming the madness of the market within ourselves and helping others to do so.
To begin with, this means challenging the vast edifice of medical-scientific theories and technologies whose apparently ‘neutral’ and apolitical character conceals a huge and dangerous socio-political agenda. Secondly, it means challenging not only biological medicine and psychiatry but the increasing institutionalisation of purely psychological counselling and therapy - their conversion into a covert, second line of defence against the medical-psychiatric crisis of modern capitalism. Thirdly it means recognising that social health is rooted in the spiritual health of individuals; not in the way this term is understood by New Age philosophies and practitioners of Alternative Medicine, but in the ways it was understood by Karl Marx and Willhelm Reich, Medard Boss and Martin Buber, Laing and Levinas - as relational health and value fulfilment. But if Marx was the most subversive, anti-capitalist thinker of the nineteenth century, then his counterpart in the twentieth century was most certainly Martin Heidegger - not least because the object of Heidegger’s subversion was the still prevailing concept of scientific truth itself and its parody in the racial biology of National Socialism.
The aim of socialism is the transformation of human social relationships. Paradoxically, however, this transformation requires a fundamental distinction between social relationships as such, whether economic or institutional, professional or inter-personal, and what Martin Buber called the realm of the ‘interhuman’. The interhuman is the realm of genuine dialogue between human beings that takes place ‘through the word’. Within this realm, language is not merely a tool for mentally representing relationships between things or between ourselves and others, but a medium through which we communicate in an embodied way a direct human relationship to them. As long as we listen and respond to another human being as this or as that, as a man or as a woman, as a parent or as a child, partner or colleague, as our boss or employee, patient or counselee - or even as a person we think we know - we remain outside the realm of the interhuman. It is capitalism that reduces the realm of the interhuman to the world of social, political and economic relationships - reducing the direct relationships of human beings as beings to the outward face of their professional and/or personal relationship, their relationship to one another as this or that. It requires moral courage not to submit to this reduction, to relate to another human being as more than just the person we know, in whatever role, and instead acknowledge the person themselves as one expression or face of their selfhood - the individual human being. Paradoxically, however, we cannot relate to another human being as a self without the capacity to relate to our own self as to another being - a being fundamentally distinct from the personal, human self we know and the faces it shows to others. The realm of the interhuman is the realm of the spiritual, for we access it only by relating to others from the spiritual, trans-human and trans-personal core of our being. It was Heidegger who first argued that a revolution in our relationship to other human beings was conditional on a renewed relationship to Being. It was Martin Buber who recognised that a renewed relationship to Being needed to be embodied in a renewed capacity to relate to other beings as beings and not as intellectual, emotional or clinical-scientific objects.
‘Having’ relationships, personal and professional, sexual and social, is not the same as being able to truly relate. The more emphasis that is placed on the legally sanctified relationships of marriage and parenthood, employment and education, the more we forget that ethics is grounded in this capacity to relate - that responsibility is rooted in our ability to fully respond to others as individual human beings and not in the obligations, ‘rights and duties’ of relationships. Education in relating begins with learning what it means to respond to the other as something more than just a contractual partner or an abstract object of our social responsibility.
Healing and Hearing
Capitalist culture is one which prides itself on democracy and ‘free speech’. Yet what use is free speech in a society in which no-one feels called on to listen, and in which education in the art of listening plays virtually no role in the professional training of health professionals. Where it does, listening is reduced to a mere prelude to some form of outer response to others, whether in the form of intellectual agreement or disagreement, expressions of sympathy or antipathy, psychological analysis or medical diagnosis and treatment. “Not knowing how to listen, neither can they speak.” (Heraclitus). Healing begins with being heard. Where the human being is not heard they may well end up in need of medical help, physical or psychiatric. But the question is then whether the helper in turn genuinely hears the human being or merely attempts to heal their body or mind.
The idea that genetic engineering - manipulations of the body’s biological alphabet and vocabulary - can provide a Final Solution to the annihilation of illness makes no more sense than the idea that certain communicable meanings, in particular those connected with human pain and distress, can be eliminated by censoring the use of certain words or letters of the alphabet, or replacing them with others. This ‘1984’-style approach will always fail to produce health, as it has done so far. Instead it only serves the creation of new and more profitable health products for the drug corporations. Meanings whose expression in certain symbols or symptoms is blocked will find other symbols and symptoms. And as pharmaceutical researchers will readily admit - there is always a price to pay for manipulating the body’s physiology with drugs, however sophisticated.
The common belief that modern medicine has worked miracles is far from the truth. Taking full account of the impact of reductions in child mortality due to improved social conditions, medicine has not succeeded in increasing average life expectancy one bit - let alone extending it by decades as the promoters of the new eugenics dream of doing. As long as we perceive healing metaphorically as a ‘war’ against disease, one whose ultimate purpose is its elimination, we will not help others to find alternative forms of expression for their dis-ease. Medical tests and examinations can provide information about the human body, but meaning is something communicated only by human beings and something that can only be received by human beings. A computer display or cardiogram can provide information but it does not mean anything with that information and nor does it mean anyone with that information - it does not intend to convey a message to the human being to whom it provides the information. Whilst it provides information to a human being it does not mean that being. It is in this sense that it lacks soul. For what is called the ‘soul’ is not what we now call the ‘mind’ and liken to a neurological computer. Quite simply, it is a being capable of meaning another being. Just as questions about the source of human consciousness can only be asked by already conscious beings, so the question of what the word soul actually ‘means’ is a question that can only be asked by a being capable of meaning. From a medical point of view, the word ‘soul’ is not a scientific concept at all - a programmable brain is. That does not imply it is meaningless, however. The fact that scientific analysis of the chemistry of ink and paper can reveal no evidence of meaning in a text surely does not imply it is not there. Similarly, the fact that scientific analysis does not reveal evidence of organic disease does not, as in Zigmond’s case study cited on page 14, imply the absence of a genuine dis-ease, which, if unrecognised may translate itself into the body’s biological language.
“We hear, not the ear” (Martin Heidegger). The fact that a doctor lends an ear to your description of some symptoms does not mean that they hear you as a being or hear the message that communicates from your being. Similarly, the fact that an ophthalmologist sees your eyes in minute detail using certain instruments does not imply that they see you as a human being. To see or hear you, it is not enough for me to have eyes and ears. It must be me, the human being and not simply the eyes and ears of the professional practitioner, that sees and hears. Heidegger was right: we do not hear another human being because we have ears that can hear sounds and tones. We have ears that hear sounds because we are beings capable of hearing other beings. This understanding of hearing applies equally to other senses and organs of the body, including the organ of thought itself. The fact that books can be published today with titles like “How the brain thinks” is a sad sign of our times and indicative of a serious lack of critical thinking. We think, not the brain. We do not think because we have brains. We have brains because we are thinking beings.
The Metaphoric Body
Speech is itself a bodily medium of communication between human beings. So too is bodyhood a communicative language of our being. The very organs of the body have an intrinsically relational and communicative dimension. With our eyes we both look at others, and communicate feelings through our look. With our respiratory organs we not only breathe but speak. The skeleto-muscular system allows us to move towards and away from each other, to stand upright and face each other. Hands are what we touch each other with. The chest and heart are where we allow feelings of love to expand within us. The abdomen is the domain of our ‘gut feelings’. The individual ways we each walk and talk, move and rest, stand and sit, look and listen, reflect our innermost, individual way of being. We do not so much ‘have’ a body as body our being, translating its idiomatic language into the different languages of bodyhood. Bodyhood is a way of being. Languages are ways of speaking. Each of us does not only ‘have’ or ‘speak’ a language. Each of us is a language - an embodied ‘language of being’.
A purely biological approach to illness implicitly reduces the patient to a ‘case’ - a hapless victim of a generic disease - rather than understanding the disease itself as the embodied expression of a highly individual dis-ease. The understanding of DNA as a biological code or language is relevant here, for biologists study this code as if it were a language without speakers - conveying biological information perhaps but not meanings intended by beings. And medical practitioners search only for well-defined organic abnormalities in the body’s biological language - like looking for grammatical mistakes in people’s words rather than listening to what they might be saying through the word (dia-logos).
A patient’s actual words, no less than the embodied ‘word’ or ‘speech’ of their flesh, is regarded as meaningful only in so far as it gives today’s doctor clues to the body’s own disordered physiological language - to organic diseases of body or brain. The language with which the patient describes their bodily experience is only regarded as meaningful in so far as it can be subsumed and incorporated into the doctor’s own body of medical terminology and diagnostic categories. It is with this purely mental body that the doctor listens - hearing the patient not as a speaking human being but only as a speaking body and brain - and one with language problems too.
Dr David Zigmond writes about the “engulfment” of the patient’s experience in the doctor’s medical language, the aim of which is to turn the patient’s subjective experience of dis-ease or distress into an objective disease or disorder. He uses the example of an elderly widow - a Mrs G - who complained to her doctor of chest pains at night. Concerned about her heart, she was referred to a consultant, who, despite inconclusive tests, diagnosed mild angina and prescribed tablets. The latter proved to have little effect. What did have an effect however, was going to her GP a second time and this time being heard. The GP recalled this time that her husband Harry had died not long ago from a heart attack, sensed her depression and realised that she may be suffering from a double broken heart - “the one that killed Harry, and the one that you’re left alive with, that hurts when you’re most alone in the middle of the night…the broken heart that gave up and the one that has to carry on painfully.” This heartfelt hearing of Mrs G’s basic dis-ease, and the heart-to-heart talk that ensued, gave her and not just her physical heart acknowledgement. This in turn gave her heart to recognise what she had been feeling - and her symptoms disappeared.
Zigmond’s ‘case study’ goes to the heart of the contrast between biological medicine and meta-medical approaches to health and healing, showing the difference between listening to and doing tests on the patient’s heart and listening in a heartfelt way to the patient as a human being. The paradox is that without this type of listening from her GP the patient might well have gone on to develop real angina, thus turning her still unacknowledged dis-ease into a fully verifiable disease - ‘speaking’ this subjective dis-ease in a biological language that would finally bring it medical-scientific recognition. Crucial to the doctor’s listening was his capacity in this second consultation for a metaphorical understanding of the patient’s pained heart. For without this metaphorical understanding the patient would have continued to rely on her symptoms to speak for her symbolically - providing a living biological symbol of her emotional pain.
The idea of “illness as metaphor” has been scorned by Susan Sontag as unscientific and indeed dangerous to those suffering from serious or life-threatening medical conditions such as cancer, and therefore in dire need of orthodox medical treatment rather than some form of psychoanalysis. Yet ‘scientific’ medicine is itself based on metaphor - the metaphor of the foreign, ‘non-self’ cancer cell which seeks to ‘colonise’ the body. Such metaphors can work in an unhealthy way, psychically abetting a process by which the patient’s inner dis-ease is transformed through a metaphoric process into somatic disease. Metaphors are not mere products of the mind. On the contrary, as Lakoff and Johnson point out, verbal metaphors are rooted in bodily experience - for example actions such as ‘pointing out’. Understanding the human body as a living biological language of the human being goes together with acknowledging the body’s own organic metaphoric process.
The Metamorphic Process
We tend to think of health and illness as states rather than processes. This leads to a common idea of healing as a mere return to a former state of health, rather than as a process of change. The basic principle of what I call The New Medicine is that processes of change in the human body and mind, including pathological processes, are the temporary expression of a healthy process of change in the human being. This metamorphic process has two sides, which I call the metabolic process and the metaphoric process respectively. The metabolic process is the process by which we inwardly digest our everyday experience and draw nourishment and meaning from it, not just mentally but in a wordless, bodily way. The metaphoric process is the process of generating new mental metaphors that express the meanings we extract from experience. Healing, from this point of view, is less to do with changing our mental or physical condition than with letting ourselves be changed by it, and finding metaphors to express this change. If treatments facilitate changes in the patient’s condition but not in the patient themselves, the metamorphic process is aborted. The aim of a meta-medical approach to healing is not to ‘immunise’ human beings to the stirrings of change felt in their minds and bodies, nor to manipulatively alter their minds and bodies but to help them to fully metabolise these changes - to be changed by their mental and physical condition. Only when individuals allow processes of inner change and metamorphosis to take place can society as a whole change.
The often nameless dis-ease that people experience in a society based on value exploitation and value consumerism is caused by a lack of relational value fulfilment - an embodied sense of inner contact and communication with other human beings. This lack of an embodied relation to other beings is replaced by a disembodied, purely clinical relation to one’s body. Mental anxieties and somatic symptoms become a temporary language through which the individual seeks to communicate their inner dis-ease. Medical practice itself encourages the patient to identify this dis-ease with its somatic or psychological expression, to name it as a disease and treat it accordingly. The patient is encouraged to adopt an ‘objective’ clinical relation to their own body, medicalising their own symptoms. The medical practitioner’s own clinical relation to the patient’s body and mind replaces an embodied relation to the patient as an individual human being. The urge to identify an organic disease replaces a capacity to identify with their inner dis-ease and understand its manifold existential dimensions - social and spiritual, economic and ethical.
The ‘empirical science’ on which modern medicine is based reduces truth to the truth of verbal propositions. From this standpoint, a child who says "an elephant stamped on my ear" (cited by Fiumara in The Other Side of Language) is using words to assert a proposition about reality - one which may be proved to be ‘empirically’ false. But what if the child is experiencing ear-ache and just doesn’t know the word ‘earache’ - or whatever technical term medical science employs. In that case he or she is not so much seeking to represent a truth in words as communicating a truth through the word - ‘dia-logos’. Dialogical truth is communicated through a metaphorical rather than literal use of language. Would we regard a mother who took her child’s statement literally, or asked the child to “prove” it, as a model of a thinking human being? And do we have any grounds for thinking that the more literally-stated and clinical proposition "I have an ear-ache" is an intrinsically superior way of communicating the truth behind the child’s statement than the elephant metaphor. (Are ear-aches or tummy-aches, for example, things that we ‘have’, in the same way that a child may be said to “have” a toy?).
In medical terms, the core assumptions underlying the modern scientific world outlook are the expression of a type of psychopathology - specifically a type of autism which prevents people from hearing what others are saying and which reduces their understanding of communication to the literal meaning of other people’s words. On the other hand, the language of ‘empirical’ science itself, not least medical science, is replete with metaphor - for example the military metaphor of ‘fighting’ disease and ‘strengthening’ the body’s immunological ‘defences’. From a psychiatric point of view however, these metaphors are regarded as scientifically legitimate and ‘sane’, whereas the metaphors employed by the so-called ‘paranoid’ or ‘schizophrenic’ patient are not. The literalism of modern science and medicine creates a psychiatric deafness to what the mad seek to communicate through their words. More than that, it encourages the ‘paranoid-schizophrenic’ to take their own words literally, believing, as science itself does, that what they communicate lacks any validity unless it takes the form of propositions which assert a literal ‘empirical’ truth.
Marx’s dialectical theory of economic value showed how the process of exchange converts the material use value of commodities into a mere outward expression of their monetary exchange value. This model applies not only to the process of commodity exchange in capitalism but to the very nature of communicative exchange. Here the dia-logical meaning of people’s words - what they say to one another through them - is reduced to their literal meaning. In other words the truth value of their words is reduced to their linguistic exchange value - their conventional meanings as words. Meanings that are difficult to express or defy literal expression in words, and utterances that cannot be reduced to empirically verifiable statements about reality, are both regarded as lacking any intrinsic truth value whatsoever.
Words are the money of the mind, and languages their currencies. In the process of commercial exchange the material qualities and use-values of commodities become merely the outward expression of a purely symbolic or virtual value - their exchange-value symbolised in monetary terms. In capitalist culture human communication suffers a similar fate. The process of ‘normal’ communicative exchange subordinates the wordless, embodied meaning of an individual’s utterances to their conventional verbal meaning. Alternatively it reduces the former to the latter - interpreting messages conveyed through ‘body language’ for example, as if they were merely physical equivalents or substitutes for words and verbal meanings. In interpreting a patient’s body language as ‘depressed’ for example, the richness of meanings that communicate through the individual’s physical demeanour are reduced to a clinical-diagnostic label. The doctor’s own body of clinical terminology thus reduces their openness to the embodied communication of the patient.
The word 'depression' actually means 'a deepening'. When the surface structure of human relationships in capitalist culture breaks down and individuals begin to confront their own lack of value fulfilment, they get ill or depressed. The use of 'breakthrough' medications to fight depression and other illnesses, mental and physical, has become a major front in a covert medical-psychiatric war aimed at preventing the internal psychological breakdown of the global capitalist order, with its consequent economic costs. The pharmaceutical fight against depression, which psychiatry reduces to an illness of the brain, reveals no regard for its wider social meaning as a counterpart to the essentially manic culture of corporate competition. Nor does it acknowledge the positive value of depressive moods and the depressive process as a natural part of a metamorphic healing process - helping individuals to metabolise their experience on a wordless, bodily level. ‘Feeling down’ is the first stage in the depressive process, a deepening process which allows us to feel our way down into ourselves and re-contact the inner ground of our being. A ‘negative’ depressive response to events and experiences can be understood as a perfectly natural response to negative realities, to a felt lack of value fulfilment. This natural depressive response can be thought of as a third instinctual response that takes us beyond fight and flight and allows us instead to face negative facts or feelings - thus facilitating a deeper process of reflection on them. Chronic depressive symptoms and states are not the result of a depressive process or ‘caused’ by a disease of the brain called ‘depression’. Rather they arise from the very attempt to flee from or fight the depressive process a fight-flight response that medicine itself encourages with its use of mood-lifting “medicine” and its talk of “beating” depression.
"The sicknesses of the soul are sicknesses of relationship."(Martin Buber). There is a world of difference between understanding mental symptoms as something caused by internal bodily states, neuro-chemical or hormonal, and understanding them as the body's own natural response to a sickness of relationship - an unhealthy relationship to our own being and other human beings. When each individual is forced to treat themselves as a commodity, selling themselves on the labour market and valuing their own embodied human qualities and potentials only in terms of their economic marketability, it is not surprising that failure to 'succeed' and join the small pool of capitalism's winners is experienced as a depressive loss of self-worth and self-esteem. At the root of the market economy and its culture lies a total devaluation of the individual human being as a being, and not merely as a functioning, more or less successful cog in the capitalist economic machine. Just as the market reduces the rain-forest to a giant timber factory, the sea to a giant fish-farm, herding animals in factory-farm concentration camps and reducing the entire earth to a giant stock of exploitable material resources, so too does it also reduce human beings to 'human resources' - raw material for educational and economic processing and exploitation.
‘Medicine beyond Medicine’
Without a New Medicine – a ‘medicine beyond medicine’ or ‘meta-medicine’ - we cannot understand the nature of illness in a genuinely alternative and holistic way, one that not only acknowledges the whole person but the inner human being. One that does not see the human being as the embodiment of the illness but the illness as one expression of the human being. One that does not merely look for alternative explanations of the causes and cures of illness, or alternative treatments for them, but which understands illness itself as the expression of a holistic healing process - a process of change or metamorphosis through which we can become whole. A model for this metamorphic process is provided by the processes of pregnancy and birth, a process of change in the human body that allows a new being to find embodiment in the flesh. Pregnancy is not an illness, but illness can be understood as a form of pregnancy, through which we can eventually give birth to previously unborn qualities and potentials of our being. These unborn potentials are the core values - the spiritual genes we bear with us into physical life, and which seek embodiment in that life. But just as genes are activated by messages exchanged with their cellular environment, so are these spiritual genes - our core values - activated by messages exchanged with the social environment. If the individual’s core values find no echo in this social environment, and in the beliefs and behaviours they acquire from it they will be ignored or experienced as foreign values, alien to the self. As a result they cannot find embodiment and fulfilment. To activate and fulfil a new value is to allow our interactions with our social environment to change us in such a way that we begin to embody this new value in our everyday life and relationships. Illness can be understood as a process in which change is embodied in a different way, finding expression in the human body before the human being themselves has changed.
Being ill, like being pregnant, does of course change an individual’s life. But the physical changes and discomforts that accompany pregnancy are also preparatory to the real changes that come after birth, with the demands of parenthood. Similarly, with illness, except that what we give birth to and “bring up” is not another being but a new aspect of our own being. The medical approach to illness can be compared to a response to pregnancy that throws the baby out with the bath water, seeing it as a cancerous foreign body that ‘causes’ the mother’s symptoms and threatens her life. Illnesses that are successfully treated are like pregnancies that have been successfully terminated, offering no guarantee that the individual will not become pregnant again, and no guidance in bringing this pregnancy to its proper conclusion. Medical treatment seeks to reverse whatever bodily changes accompany illness, rather than helping the human being to change.
Helping the human being to change means helping them to patiently bear the changes that are pregnant within them and learn to embody these changes without need of bodily symptoms. But we live in an age which has forgotten the difference between bearing and suffering. Bearing is not suffering, nor is it simply a way of putting up with or coping with suffering. It has the double meaning of “carrying” and “giving birth”. To bear a change is to allow it to ripen and bear fruit within us, giving birth to a new inner “bearing” on life. We can bear change with patience or impatience, ease or dis-ease, anxiety or confidence, giving birth painfully and arduously or smoothly and with pleasure. “Patience is the truly human mode of being.” (Martin Heidegger). However much time doctors give or do not give their patients, both tend to treat illness itself with fundamental impatience, seeing it not as an expression of processes of change in the human being but as the expression of something wrong with the body, something that needs to be diagnosed and fixed as soon as possible. What helps us most to bear change is other people’s capacity to listen - to bear with us like midwives, even when we are not able to describe or label our dis-ease or dis-stress in words.
Such deep hearing can only come from a fundamentally different type of listening to the one cultivated in conventional medical and psychotherapy training. I call this listening “maieutic”, from the Greek maieuesthai - “to act as a midwife”. This is not a listening based on medical or psychiatric knowledge but on a capacity to bear with another human being in pregnant silence, helping them become aware of the changes pregnant within them and bring them to maturation. Helping them to do so requires a type of hearing attuned to the source of change - the inner being of the patient and not just to their body or mind. Maieutic listening is one of a number of ‘meta-medical’ therapies that are not treatments or forms of psychotherapy in the conventional sense. Their aim is not the elimination of physical or mental disease and suffering but the transformation of the individual’s underlying dis-ease and suffering into a new and fruitful inner bearing towards life, the successful embodiment of which frees them of the necessity to symbolise processes of change in somatic symptoms.
Genetics provides us with a scientific metaphor of the human being and its spiritual potentials. These spiritual potentials are indeed embodied in the flesh, coded in our genes. The body itself is a living biological metaphor of the human being. But if only one-thousandth of the money invested in genetic research into the human body were invested to research the nature of medicine as a human practice - the art-science of hearing and healing the human being - the results, though unprofitable to global corporations, would be quite different. Then we might begin to understand more of meta-physiology - the complex and subtle relation between the human body and the human being, in sickness as in health. To develop, in other words, a “medicine beyond medicine” which was a genuine complement to current medical training and treatment - albeit one which transcends many of the core assumptions of both orthodox and alternative medicine - and might one day allow us to shed them entirely.
The New Medicine
What I call The New Medicine is a meta-medical approach to health and healing, one that I believe can fulfil Heidegger’s desire that his work would “escape the confines of the philosopher’s study and become of benefit to wider circles, in particular to a large number of suffering human beings”. It integrates the thinking of Martin Heidegger with that of the Jewish ethical philosopher Martin Buber, the revolutionary psycho-politics of Wilhelm Reich, and the ‘Aspect Psychology’ of Jane Roberts. Based as it is on a fundamental bio-ethical distinction between the human body and mind, on the one hand, and the human being on the other - it constitutes a radical challenge to the biological reductionism of modern medicine and psychiatry, with its roots in racist and Nazi eugenics. Instead of reducing the human being to the human body, it understands the human body and its genes ‘onto-biologically’ - as a living biological language of the inner human being. What I call “Aspects” are the basic ‘alphabet’ of this inner language - inner potentials of the individual human being comparable to spiritual genes. These manifest themselves as different ways of experiencing ourselves and others, each of which alters our inner sense of self and our perception of external reality. Aspects are not ephemeral by-products of our biology. They are coded in our genes and reflected in our dreams in the same way that meanings are coded in language and reflected in our imagination.
Both orthodox and alternative medicine focus on the causes and cures of disease. The New Medicine focuses on the individual’s personal experience of dis-ease, and the inner meaning it holds for them. From a meta-medical standpoint, health is not an unchanging state of well-being, but a continuous process of change or metamorphosis through which we learn to express and embody new Aspects of our inner being. Illness is not an unnatural disruption of health but a natural part of this metamorphic process. When we are ill we do not ‘feel ourselves’, and our bodies and minds feel foreign to us. That is because we are pregnant with new and hitherto foreign Aspects of our being, ones which we have not found ways to express and embody in our everyday life and personality. Healing means becoming midwives to ourselves and giving birth to these new and unborn Aspects.
Paradoxically, genetic biology undermines the basic structure of the capitalist psyche, modelled as it is on the belief that identity is the private ‘property’ of the individual or group. Just as people can share common genes, even though they do not belong to the same family or ethnic group, so they can share common Aspects. Genes are shared biological potentials. Values are shared Aspects or potentials of being. Like genetic traits, they find expression not as similarities or differences between individuals but as ‘simferences’ - similarities-in-difference. ‘Simferences’, like family resemblances are irreducible to similarities or differences. If any two human beings were absolutely different in any respect, then in that respect there would be no meeting point, no relationship between them. Conversely, if any two human beings were identical in any one respect, there would also be no relationship between them - for an absolute identity would imply that in that respect they were one being, not two. Thus it makes no sense to regard relationships as a product of people’s similarities and/or differences - for if people were simply similar in certain respects and different in others in neither respect would there be any relationship between them.
Simference is a fundamental cause of dis-ease for the capitalist psyche because it challenges the idea of a singular, ‘atomic’ self which remains forever the same, connected in its basic identity to others only through superficial similarities or differences which can be labeled or categorised in words or scientific terminology. But, conversely, understanding the principle of simference helps us to transcend the concept of identity as private property and acknowledge in a healthy way our co-identity with others - the Aspects we share with them. What I call (following Jane Roberts) Aspect Psychology is based on a dialectical and relational concept of human being. Expressed formally, any external relationship between two human beings, A and B, is understood as an expression of an internal relationship between A and his or her own B-aspect, as also between B and his or her own A-aspect. The A-aspect of A and the A-aspect of B are neither the same nor different but simferent. Likewise the B-aspect of B and the B-aspect of A. That is why it is through our relationships with others that we can both discover new Aspects of ourselves or find new ways to express those Aspects. The principle of simference also applies to human communication. Verbal communication does not depend on the same words meaning the same thing to different people. On the contrary, it is only because each person’s understanding of the same words is neither absolutely the same nor absolutely different that communication with each other is able to make a difference - to communicate something over and above the socially agreed, conventional meaning of words.
The dialectic of Aspects is the basis for a dia-logical understanding of human communication and relating - for what communicates ‘through the word’ are precisely the irreducible simferences between human beings and the meanings they convey. What people mean to one another is essentially what they are for one another - the Aspects of each other’s being that they embody and express, each in their own way. The New Medicine is based on this understanding of the human being as an in-dividual, in-divisible unity of different Aspects, each of which is also a shared ‘value’ or potential of being linking them to other beings. Values as ‘simferent’ Aspects or potentials of being, are also the basis of individual value fulfilment - the relational foundation of both social and spiritual health. The individual psyche can be likened to an internal society of Aspects with the ego as head of state - a society whose politics is not only influenced and distorted by external social relationships and the ‘madness of the market’ but can also play a decisive role in subverting and transforming them. The key to this transformation is the acknowledgement of the intrinsically relational dimension of health and healing, the communicative and metaphoric nature of bodily processes, and the natural function of illness itself in helping each individual to grow and change - incorporating new dimensions of their self-experience and thus embodying new and hitherto foreign Aspects of their inner being.
© Peter Wilberg, 2004