Schott Magic of Nature

On the Mystery of Healing
1. Auflage 2018
ISBN: 978-3-7460-4273-2
Verlag: BoD - Books on Demand
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 152 Seiten

What does "magic of nature" mean? Starting with the placebo effect and its relevance for biomedical research and clinical practice of today, this treatise focusses on diverse historical concepts of the "healing power of nature". This topos was fundamental for natural medicine, life reform movement, suggestive therapy, hypnotism, romantic natural philosophy, and mesmerism. Such a retrospection leads to the crucial concept of "natural magic" (Latin: magia naturalis), which was essential for early modern medicine and natural science. At that time, Nature (Latin: natura) was revered as a divine creator of natural things in the service of God, as a mediator of His wisdom for the inquiring humans. So, Nature was personified in many ways as a wise woman or magician, mystically adored by alchemists. At the end, the study returns to the present age. It reflects critically modern sexology and sexual medicine confronting them with certain spritually guided practices of "sexual magic". The 68 supplementary image pages stand for themselves displaying an emblematic subtext. Each of them tells an own story and is more or less self-explaining.

Dr. med. Dr. phil. Heinz Schott ist Professor für Geschichte der Medizin. Von 1987 bis 2016 leitete er das Medizinhistorische Institut der Universität Bonn.

Autoren/Hrsg.

Schott, Heinz

Leseproben

Chapter One
PLACEBO – THE VEILED IMAGE OF THE TRUE MEDICINE
Paradoxical healing effect
The placebo effect is a logical challenge for the academic medicine: A placebo drug has an effect without containing an effective substance. How can this happen? Objectively ineffective, the placebo drug is nevertheless subjectively effective, which can be objectively assessed. The medical doctrine presupposes that regarding a real or true drug the subjective-psychical effect can be clearly separated from the objective-pharmacological effect. In this way, the placebo effect appears to be just a subjective reaction of the mind taking a fake drug for a real, true one. Insofar it is a sort of a psychological projection, imagination, or even delusion. The contemporary evidence-based medicine (EBM) has focused on the objectivation of the placebo effect. It developed together with the information technology in the 1990ies. But the so-called randomized controlled trial (RCT) is about 30 years older. The concept of the placebo effect was introduced in medical terminology in the 1950es signaling a novel methodology of clinical research, especially in the field of pharmacology. For the first time, meta-analyses were performed. They showed that roughly one third of the test subjects felt a remarkable recovery of their state of health because of the placebo effect, which was the stronger the more they suffered from anxiousness and stress (Beecher, 1955). The controlled randomized trial was from now on appreciated as the only scientifically valid form of evidence of the effectiveness of the specific drug therapy. By this procedure the pseudo effectiveness of a placebo should be determined. Why became the placebo problem so popular in medical research of the 1950s, the early after-war epoch? Two circumstances may have contributed to this situation: on the one hand, the growing interest in medico-psychological topics fostered by the intensive reception of the Freudian psychoanalysis in the United States, and, on the other hand, the expanding pharmaceutical industry developing novel drugs, which had to be tested by human experiments. The introduction of the so-called placebo effect as an explicit concept coincided with the introduction of psychotropic drugs. Naturally, also in former times human experiments were performed to investigate the substantial (real, true) effect of a therapeutic method or drug by statistical methods. But a scientific methodology developed not before the 20th century. Nocebo like an evil spell
The fact is well-known, that medicinal drugs and medical doctors can harm patients without being consciously aware of it. Then, they apply a special sort of an evil spell. The manner, how a diagnosis is communicated, a prognosis is declared, a drug is applied, or a treatment is performed, is essential and often decisive for the outcome of a medical intervention. So, not only healing processes can be disturbed, but also healthy people made ill. Since the outgoing 19th century the double-edged power of suggestion and auto-suggestion was theoretically described, experimentally investigated, and therapeutically applied. Hereby the "iatrogenic disease" was considered as an object of medical psychology, i.e. the disease introduced by the physician. Regarding the nocebo effect I am less interested in the so-called medical malpractice, but much more in the subtle influence, which destructive attitudes of physicians may exert on their patients making their health condition worse or even provoke it. For example: The palpation of the abdomen in the case of a supposed appendicitis eliciting the specific symptom of a rebound tenderness (Blumberg’s sign) may also be felt by persons with a healthy appendix all the more, as the doctor is convinced of a real appendicitis. Only in the 1990es, "nocebo" was introduced as the counter-term of "placebo". The research on the nocebo effect is still at the beginning. So far, just a fraction of the means for the placebo research was spent for it. But it is for our issue of great interest because one may understand the nocebo effect as an unconscious process of magic, a hidden act of "black magic". That does not mean the rather rare case of a doctor harming his patient deliberately, but the transfer of harmful suggestions mostly unnoticed by the persons involved producing pathogenic effects and sometimes even severe symptoms. This can happen in medical practice as well as in everyday life. Evidence-based medicine
The concept of evidence-based medicine (EBM) emerged in the 1990s. Originally developed in Canada, it was approved in biomedicine all over the world. But one should be aware that already about 20 years earlier the so-called practice guidelines for special therapies in several clinical disciplines were created by experts communicating systematically e. g. in consensus conferences. This approach is considered today as a forerunner of the EBM. But based purely on clinical observation, it could only generate less "evidence" than the EBM with its statistical research methodology. The EBM came into the picture, when the digitization spread in science and the economization of the health system escalated. It offered medical doctors ostensibly a solution of their economic problems, especially regarding their knowledge about the most cost-effective alternative. The concept of the quality management is closely linked with this economic dimension of the EBM targeting to avoid losses by the inappropriate saving of necessary actions respectively the ineffective or harmful application of remedies. Nevertheless, the advocates of EBM and quality management generally reassure that always the well-being of the patient has to be in the focus and not the cost reduction. The idea of optimizing, essential in mathematics and business economics, tries to use the resources as money-saving and as effective as possible. It belongs to the belief system of the proponents of the EBM that the interests of the patient are as well preserved as the interests of the community of solidarity, so that they would coincide in fact. Scientific progress
The history of medicine and science is commonly understood as a progressive revealing of the truth. This evolutionary view recognizes only one direction of movement: from an earlier to a later, from a more primitive to a higher, from a backward to a developed condition. Often there is the talk of "stages" of progression illustrating science ascending higher and higher. This reminds of Jacob’s ladder, a well-known metaphor of the early modern natural philosophy symbolizing the approach to divine truth. Insofar, the secular manner of speaking is oriented towards the former idea of a mental ascent to heavenly wisdom. At least since the 18th century, historiography favored a popular pattern of thinking, namely that the "development" or "progress" of science and technique would be automatically accompanied with a growing knowledge of the "truth" in regard to natural processes and their relevance for men. But which sense makes the scientific-technical progress in the face of death inevitable for the individual because of biological reasons and for mankind because of cosmological ones? The death problem contradicts the idea of progress and reveals it as an absurdity, a problem, science cannot really handle with. "Nature" as an object
The term "biomedicine" was only coined at the end of the 20th century. Until then the term "natural scientific medicine" was commonly used, besides "academic", "university", or "school medicine", often understood as synonyms, nevertheless indicating different meanings in a historical perspective. Particularly two traits of this medicine have to be differentiated: on the one hand. the natural scientific objectivation of the healthy and ill organism by the experimental approach, on the other hand, the sophisticated manipulation of the organism by specific technical means. Both approaches merge in medical practice and can hardly be separated. Obviously these traits of the natural scientific medicine fit to the situation in pre-modern times. We may just think of the vivisection of humans by anatomical researchers in Alexandria in the third century A.D. (Staden, 1996) or the discovery of the systemic circulation in the 17th century by animal experimentation (Mani, 1996). But the natural scientific medicine in our present understanding became only established in the second half of the 19th century, when physics, chemistry, and biology became the leading sciences of the academic medicine. "Disenchantment" of magic
According to Max Weber, an essential factor of the progress due to modern science was the "disenchantment of the world". The progressing "intellectualization and rationalization" would have led to the knowledge or belief, that there were no mysterious, unreckonable forces, that one could rather bring all things under control through calculation: "This means that the world is disenchanted. One need no longer to have recourse to magical means in order to master or implore the spirits, as did the savage, for whom such mysterious powers existed. Technical means and calculations perform the service. This above all is what intellectualization means." (Weber, 1922) Weber’s formula can also be employed on the academic medicine: Through disenchantment of the religious and magical healing arts it depends no longer on priests and sorcerers, but is able to provide calculable ("scientific") methods and techniques for rational diagnostics and therapeutics. In fact, such a general formula went along with the natural scientific revolution in medicine refuting resolutely the "occultism" as an...