HEALING

Health and Wholeness

Healing is an action whose goal is the restoration of health. The English word health literally means wholeness and to heal means to make whole. Ancient Greek had two words generally translated as "health": hygieia, meaning "a well way of living," and euexia, meaning "good habit of body." Leon Kass (1985) notes that the English and both Greek words for health are totally unrelated to all the words for disease, illness, and sickness. This is also true for German, Latin, and Hebrew. In addition, the Greek terms for health, unlike the English, are unrelated to all the verbs for healing. Health for the ancient Greeks was a state or condition unrelated to, and prior to, both illness and healers. The English emphasis on wholeness, Kass also notes, is comparatively static and structural, implying a whole distinct from all else and complete in itself and connoting self-sufficiency and independence. The Greek terms, in contrast, stress the functioning of the whole, and not only its working but its working well. Kass sums up this Greek understanding of health by defining it as a natural as opposed to a moral norm that reveals itself in activity as a standard of bodily excellence or fitness. It is the well-working of the organism as a whole, an activity of the living body in accordance with its specific excellences.

The work of healing in Western culture is the proper activity of the profession of medicine. Howard Brody (1987) calls medicine a craft in which scientific knowledge is applied to particular patients for the purpose of "a right and good healing action," employing the now-classic phrase of Edmund Pellegrino (1982). Unlike the Greek, the English language sets up a relationship between medicine, whose business is healing, and health that is problematic. Kass states the problem this way: Health and only health is the doctor's proper business; but health, understood as well-working wholeness, is not the business only of doctors.

HEALTH AS EQUILIBRIUM. A less formal starting point than Kass's from which to examine the relationship between health and medicine is Pellegrino's definition of health as a state of accommodation, defined in different terms by each person. We feel healthy, he says, when we have found an equilibrium between our already-experienced shortcomings and our aspirations and have adjusted our goals to the gap between them. This means that health cannot be understood apart from a person's life history, or to use José Ortega y Gasset's phrase, one's "personal project" (p. 45). Healing, according to this definition of health, occurs when a new equilibrium is found between one's hopes and one's failures that can be incorporated into one's personal project. As such, healing must be based on an authentic perception of the experience of illness in the particular person.

THE CONTEXT OF HEALING. It follows that for an action of someone who professes to heal to be a right and good healing action, it must be situated in the context of a personal history so as to restore the direction of a personal project. This requires that a dialogue be established between healer and patient whose goal is the creation of a common ground of meaning shared by the healer and the patient. How extensive that common ground must be to constitute a right and good healing action is open to question. In taking a medical history, physicians have traditionally tended to restrict the province of illness to the facts of diseases, leaving unexplored the fact of illness—that is, the physical, psychological, and moral vulnerability the patient suffers in the attack on his or her very being that Pellegrino calls "the ontological assault of illness" (1982). However, this concentration on facts and diseases does not result from simple, unreflective traditionalism. Rather, it has enabled the profession of medicine to set very definite limits to the boundaries of healing and thereby to maintain control over the responsibilities that physicians take upon themselves as healers.

THE BOUNDARIES OF HEALING. The attempt by physicians such as Pellegrino to enlarge the boundaries of what counts as healing has often produced frustration and anger. For example, Franz J. Ingelfinger, in a classic editorial in the New England Journal of Medicine, rebukes those who would expand medical treatment to include families, not just individuals: "The curious idea is abroad that the doctor should be a factotum of health. By some singularity of reasoning, his role as healer is disparaged, and the words 'care, not cure' are becoming as tiresome as 'death with dignity'" (p. 565). He continues by lamenting that if the doctor is insensitive to the "multiple environmental conditions that threaten our mental and physical selves, he is regarded as failing the holistic image that many—both lay and medical—wish to impose on the physician" (p.565). Ingelfinger concludes by asserting that the physician's primary concern, in spite of utopian claims to the contrary, should be sickness, not overall health; medicine should concentrate on "scientifically accurate diagnosis and treatment."

THE NATURE OF HEALING. The resistance of physicians such as Ingelfinger to what they regard as an unwarranted expansion of their role in society signals a fundamental disagreement within Western society about the nature of healing. Holistic approaches to medicine challenge traditional assumptions about who can be called a healer, what the goal of healing should be, and, most important, who can say what constitutes a right and good healing action: the healer or the one to be healed. Those who take positions like Ingelfinger's insist that only those who engage in "scientifically accurate diagnosis and treatment" deserve to be called healers, that healing aims at the cure of disease, and that the healer's profession alone can determine what constitutes a right and good healing action.

Those who disagree with these assumptions often attack their opponents as simply uncaring. Victor Kestenbaum, however, argues that the point of departure and method, not the lack of feeling, is the real issue. By distinguishing between caring and curing and limiting medicine to the latter, Ingelfinger and his colleagues take as normative the physician's perception of illness, shaped by the method of science, and then seek to derive global professional obligations from it. Thus they cut the phenomenon of illness to fit a prior conception of role and discourse. Pellegrino, Kestenbaum notes by way of contrast, starts with illness as experienced by the patient and derives professional obligations from the distinctly human dimensions of being ill and in distress. The responsibilities of the healer follow from the complexity and scope of the phenomenon of illness, not from the self-declared duties of the profession.

The Healing Profession

In the 1950s Pedro Laín Entralgo observed that "the curative activity of the physician is always determined by the reality of the human being towards which it is directed, that is, by the 'personal' conditions of the disease and of the patient" (p. xv). Pellegrino believes that this accommodation to the reality of the patient follows from the promise that the medical profession, in the person of the physician, makes to the patient: "The promise of help that shapes the nature of every healing act and defines the requirements for successful healing—even when cure is not possible" (p. 160). But, Pellegrino notes, considerable confusion exists between doctor and patient about what healing means. Physicians, he says, often fail to comprehend what the patient understands by the promise of healing; patients often fail to understand what the physician thinks he or she is promising. Physicians, in response, are moving toward a restricted sense of promise, emphasizing technical competence, whereas patients expect not only competence but compassionate help as well. The wider the gap between professional promises and lay expectations, the more difficult becomes the collaboration between physician and patient to discover the equilibrium that constitutes genuine healing. As the gap increases, Pellegrino also notes, patients will be more tempted to seek alternatives to the "medical model" and lose the benefits of scientific competence.

COMPETENCE AND COMPASSION. Healing requires, Pellegrino insists, both competence (in scientifically accurate diagnosis and treatment) and compassion (the capacity to enter into the experience of illness with the patient). Competence is a necessary but not sufficient condition of healing. Healing "must be shaped at every step by the purposes of the healing acts—by the good of the person who is ill—his bodily good, of course, but also his concept of health, his value system, and his sense of the kind and quality of life he thinks is worthwhile" (p. 161). Pellegrino sums this up by declaring that the physician therefore has the obligation to protect the moral agency of the patient, to enhance it even in the face of the special vulnerabilities of being ill.

This protection of the moral agency of the patient lies at the heart of compassion; it is essential to the performance of a right and good healing action. Healing thus requires that the conversation between physician and patient encompass more than what can be accommodated by scientifically accurate medical language. As Jay Katz has observed, despite the quantity of words overflowing patients' medical charts, the world shared by doctor and patient is often one of profound silence, offering not the humaneness of shared understanding but the humaneness of services silently rendered (Katz).

The Silent World of Medicine

Yet modern scientific medicine owes its success to silence of a sort, a disbelief in words that Laín Entralgo traces to two tenets of the Hippocratic school of medicine. First, the latter rejected the use of words as a therapeutic tool; medicinal remedies were preferred to exorcism, which relied on the curative power of "fine words used in the manner of charms" (Laín Entralgo, p. 47). In addition, Hippocratic physicians trusted the patient's symptoms to reveal the causes of disease and dismissed the patient's own words about the source of his or her condition as unreliable opinion.

THE CLINICAL GAZE. Michel Foucault (1973), in his discussion of the antecedents of modern medicine, discovers a similar kind of silence in the "clinical gaze," a reorganization of medical perception that took place in the eighteenth century. Disease ceased to be perceived as an alien force inserted into the body and subject to the words of exorcism; instead, disease was the body itself, become diseased. Healing became the task of deciphering corporal space, a work of seeing instead of speaking. The model physician is Hippocrates, who applied himself only to observation, despising all preconceived systems that might bias the observer. This clinical gaze flourishes only in the relative silence of theories, imaginings, and whatever serves as an obstacle to the sensible immediate. In addition, when physicians question the patient, they question only what they can see—the body become diseased—and only in the language proposed by the body. All other languages, including that spoken by the patient, must fall silent before the absolute silence of observation. Within this double silence, Foucault says, things seen can be heard at last, and heard solely by the virtue of the fact that they are seen. It is in this sense that "the clinical gaze has the paradoxical ability to hear a language as soon as it perceives a spectacle" (p. 108).

The conversation that emerges from this double silence is an interior dialogue that the observer has with him-or herself, not a dialogue with the object of gaze. In the context of the physician-patient encounter, the language describing what the physician has seen gives structure to the encounter, not any language the patient might speak. The profundity of this silence derives from its absoluteness: Not only must the patient keep quiet about theories and imaginings that might relate to his or her illness, absolutely nothing the patient says can have any significance for the physician because no language can exist that has priority over the language of observation. This muting of the patient's own voice gives rise to what Foucault calls "the great myth of a pure Gaze that would be pure Language: a speaking eye" (p. 114). What it sees, it gathers and organizes; and as it sees, and sees more clearly, it speaks and teaches. The speaking eye becomes "the servant of things and the master of truth"(p. 115).

THE LANGUAGE OF CURING. Secretiveness, or what Foucault terms "esotericism," arises from this model for the physician-patient relationship because, as Foucault observes, one sees the visible (the true) only because one knows the language. Unlike Molière's physicians, who spoke Latin merely in order not to be understood, Foucault's clinicians speak openly about that which anyone can see but only they can understand, because through the language of clinical description they have the means to see and hear at the same time, having access to a language that masters the visible. At this point, the earlier epistemological silence (Foucault's "double silence") that results from a constriction of perception changes into the silence of which Jay Katz speaks, a silence made even more baffling and profound by having as its vehicle a multitude of words that make every pretense of being understandable.

In effect, this model of medical perception insists that healing cannot be spoken or even thought of apart from the language of curing, that is, scientifically accurate diagnosis and treatment. This clinical perception and its promise of truth tend to overshadow all other claims to truth, reducing the promise to help those who suffer illness to the promise to be scientifically competent. Attempting to expand that visual horizon—particularly in the direction of the perspective of the patient—risks introducing an unacceptable noise into the silence of the medical clinic, an unwelcome and meaningless distraction from the work of curing.

Healing and Cultural Reality

Healing, of course, is a much broader cultural phenomenon than that encompassed by Western scientific medicine. Admittedly, the success of Western medicine at curing has helped justify its claim to be the model for healing in the world today. Yet, as Eric Cassell notes, "the success of medicine has created a strain: the doctor sees his role as the curer of disease and 'forgets' his role as healer of the sick, and patients wander disabled but without a culturally acceptable mantle of disease with which to clothe the nakedness of their pain" (Cassell, 1976, p. 51). This strain also appears in the way patients perceive their physicians. Western culture has conferred upon doctors the role of the care of the sick; but although doctors' role as the curers of disease is clear, their role as healers remains obscure. The latter role, Cassell adds, depends less on their ability to provide a scientifically accurate explanation of their patient's illness than to provide an explanation consistent with the culture of the patient. The reality that counts is cultural reality, and the system used by the healer or doctor need be accurate only in terms of the culture in which it is being used, for it serves to explain illness. The importance of the healer's explanation, Cassell insists, cannot be overemphasized.

THE HEALING RELATIONSHIP. As Cassell sees it, the healer's knowledge, imparted to the patient, helps move the world of illness from the unknown to the rational world. This knowledge allows the patient to "work on" the illness and to make an essential link between conscious process and body process that, Cassell says, marks the "educated" patient. Such healing is not cognitive alone. In addition to educating the patient, healers also play an active physical part in providing a link between symbolic reason and the body: They use their hands. Cassell calls this the "tenderness phenomenon," as important as education in the process of healing. He associates this phenomenon with parenting, and, in this sense, healers serve as parents. In addition to other aspects of the parental role, we transfer to them the right to lay hands on us, to be tender to us, and to pass through our territorial defenses.

The connectedness that underlies the tenderness phenomenon works in both directions. Healer and sufferer become exquisitely sensitive to one another; each can sense the feelings of the other. If healers can accept that the feelings they have can come from the patient, they can use their own feelings in the presence of the patient to provide a vital link with the patient's interior emotional state that is otherwise closed to the clinical observer. Cassell emphasizes that the ability of healers to establish this connectedness with the patient is not an exception to the role of healer but is rather an integral part of the healing function. It shatters the silence of which Katz writes, and substitutes for clinical detachment the "constant will of one trying to recognize" (Brody, 1992, p. 263).

Establishing this connectedness does not make of the healer a great person but does place both healer and patient in the presence of a deep human mystery that is greater than both of them. It is to be present at a creation that Elaine Scarry likens to the rediscovery of language: "Physical pain is not only itself resistant to language but also actively destroys language, deconstructing it into the pre-language of cries and groans. To hear those cries is to witness the shattering of language. Conversely, to be present when the person in pain rediscovers speech and so regains his powers of self-objectification is almost to be present at the birth, or rebirth, of language" (p. 172).

Explanation, education, and connectedness form the core of Cassell's understanding of the healing relationship. The problem with the scientific explanation of illness is not that it is incorrect, since, as Cassell notes, "we know that it need not be correct, since for most of the history of medicine it has not been correct" (1976, p. 128). Put differently, the virtue of scientifically accurate diagnosis and treatment does not lie in its correctness. The fact that it seems correct does not entitle it to stand as the only and sufficient explanation of illness. Although science has been empowered by Western culture to dictate diagnosis and disease categories, Cassell notes that it has little or nothing to say about sick persons, their behavior, patient-healer communication, and so on. "If the whole point of the clinical encounter is to decide what is the right and the good thing to do for a specific patient, then traditional medical theory is sorely lacking" (1991, p. 6).

The Power of the Healer

Although he recognizes the limitations of traditional medical theory, Cassell does not intend to belittle or dismiss the role that the scientific explanation of disease has in Western culture or the promise it holds for the world. He wishes, in fact, to acknowledge its power: "The therapeutic power of the doctor-patient relationship grows in importance as the technology of cure becomes more powerful" (1991, p. 69). Yet, unfortunately, even as the importance of the relationship between doctor and patient grows under the stimulus of technology, so does the isolation of the patient, who becomes lost in a maze of tests, procedures, and treatment teams. To disregard this relationship only adds insult to the injury inflicted by isolation. "It has been one of the most basic errors of the modern era in medicine to believe that patients cured of their diseases—cancer removed, coronary arteries opened, infection resolved, walking again, talking again, or back home again—are also healed; are whole again" (1991, p. 69). What has been forgotten, he says, is that technology itself has no power—humans acquire power by employing the technology.

The importance of power in the therapeutic relationship has been explored at length by Howard Brody (1992). He analyzes the healer's power in three components: Aesculapian, charismatic, and social. The healer acquires Aesculapian power by virtue of training in the craft of healing. The power is impersonal, transferable to any other healer of comparable skill and experience. Charismatic power is founded on the healer's personal qualities and character and cannot be readily transferred. It is independent of the disciplinary knowledge and skill belonging to Aesculapian power. Social power arises from the social status of the healer within a particular society. It derives its authority in part from the implied contract between the healing profession and society that empowers the profession to determine truth in regard to illness.

The power to heal involves a complex interplay among all three kinds of power; it is a mistake, Brody notes, to limit the power of healing to Aesculapian power alone. Any discussion of what constitutes a right and good healing action must entail an exploration of the proper use of the other forms of power that the healer possesses. These forms of power risk what Brody calls "the dark side of the force." This is "a lust, half childish, half sadistic, to use whatever power we might have to victimize others less powerful, and to enjoy it—to glory in the fact that they and not we are the victims, and to escape for a moment into the fantasy that since we can avoid their victimhood through our power, we are invulnerable and need never again feel fear" (Brody, 1992, p. 21).

THE VIRTUE OF COMPASSION. Healers can find the anti-dote to the dark side of the force by acknowledging the feelings of vulnerability and weakness that arise in them as they face the patient. They can do this only if they are open to the experience of being ill and in distress. To do this effectively, Brody says, healers need more than to be told they have an obligation to be open; they need to develop the virtue of compassion, an internalized habit of character that becomes an instinctive attitude of openness and vulnerability.

A major irony in the healer-patient relationship emerges here. To be compassionate in response to the suffering of the patient is itself a powerful act of healing. In showing compassion, the healer empowers the patient in a way that merely curing disease cannot. Curing disease eliminates a threat to bodily function and integrity; alleviating suffering, without which healing is a mere charade, restores the sufferer's connections with humanity and the ability to make sense of his or her own life. Yet, Brody says, this act of empowerment is possible only to the extent that the healer is willing to adopt a position of relative powerlessness, to acknowledge that the patient's suffering has incredible power over her or him and that it is impossible to remain unchanged in the face of it.

SHARED POWER. Western medical training urges compassion as a duty of the profession but at the same time warns, "Don't get too involved." Brody interprets this warning as a form of false reassurance that the power to heal does not entail the felt powerlessness of compassion. This denial of the power that the patient's suffering has over the physician is a rejection of the concept of shared power, which Brody states is the essential element in the ethical use of power. This denial also betrays a fundamental misperception of power as a zero sum game, that is, the belief that anything that increases the power of the patient within the healing relationship must necessarily decrease the healing power of the physician.

This competitive notion of power conforms to the type of moral reasoning that Carol Gilligan discovered among non-minority males in North American culture. The dominant male culture emphasizes the importance of finding the rules that govern a relationship and then selecting courses of action in keeping with the rules, even if such devotion to rules means sacrificing someone's interests to the considerations of abstract justice (Gilligan). She counters with a type of moral reasoning common to the women she studied: They tend to focus on the nuances of personal relationships and seek solutions that protect the interests of all affected parties and that avoid bringing harm to anyone.

RESTRUCTURING THE POWER OF HEALING. Following the lead of Gilligan, other voices have appealed to an understanding of moral relationships from the perspective of women, such as Nel Noddings (1984), whose work on caring has influenced nursing ethics (Bishop and Scudder); and Virginia Warren (1989), who applies a feminist point of view to the conduct of medical ethics itself. Although these critics represent a wide range of opinion on the means to be used and even on the foundational reasons for doing so, most of them would agree with Susan Sherwin that there is a need to develop conceptual models for restructuring the power associated with healing and to clarify how "excessive dependence can be reduced, how caring can be offered without paternalism, and how health services can be obtained within a context worthy of trust" (p. 93). Sherwin notes with approval that, for many mainstream medical ethicists, compassion is frequently claimed to be more compelling than justice, a tendency she finds especially common in the contribution of physicians to medical ethics.

If this need for compassion is admitted, the significant question then becomes, What can allow a physician to experience the powerful suffering of a patient in a way that encourages the physician to share power and therefore to become not only a curer but also a healer? What is needed is a way for healers, and physicians in particular, to experience the felt reality of shared power without seeing it as a betrayal of their Aesculapian power, no matter how evident in this process its limitations may appear to become.

THE LIMITS OF AESCULAPIAN POWER. The strategy employed by many patient advocacy groups of leaving physicians' Aesculapian power undisturbed while severely restricting their social and charismatic power avoids the issue by ceding to physicians their chosen territory. Such an approach abandons the project of power sharing and attempts to render the healer-patient relationship "doctor-proof" by segregating Aesculapian power from the other forms of power. This strategy errs because it assumes that "we can wring morally acceptable actions out of any physician no matter how good or bad his motives if only we have the right rules for him to follow" (Brody, 1992, p. 55). As feminist critics have noted, this strategy endorses the masculine assumption that solving moral problems means discovering the right rules while leaving intact the existing power relationships. It cannot succeed because, as Brody points out, it mistakenly presumes that the healer's power comes in two neatly differentiated categories: power that helps fight illness, and power that can be used to violate patient's rights. But no such easy distinction is possible because the same powers can be easily redirected for good or ill.

The realization of shared power can take place only if those who profess to heal acknowledge responsibility for all the forms of power they possess. They must be reassured that owning up to their charismatic and social power does not imply that their Aesculapian power is fraudulent, although it may require them to admit that something like the placebo effect is present in almost every healing encounter (1992). For physicians to profess to heal requires the realization that their Aesculapian power, despite the warrant of its scientific accomplishments, is limited in both its scope and effectiveness. Curing does not ensure healing, and healing is possible even if there cannot be cure; nor is every human ill subject to cure. Such an admission, however, does not exempt those who profess to heal from attending to the needs of the poor, the oppressed, or those victimized by war, prejudice, and despotism. It only reminds them that their social and charismatic powers alone have authority in these difficult areas.

AESTHETIC DISTANCE. Compassion, lest it degenerate into codependency, does need to maintain a certain strength and thus a certain distance from the plight of the sufferer. Brody characterizes this distance as aesthetic rather than emotional; it resembles the reader's approach to a work of fiction (1992). To regard the suffering patient as a text, attended to at an aesthetic distance, still permits and even encourages intense emotional involvement. In reading the text presented by the sufferer, the healer must maintain in his or her imagination that separate vantage point from which the experience of the sufferer can be reinterpreted and reconnected to the broader context of culture and society.

Healing and Community

Healing reconnects the sufferer both to the self and to the world. The final and perhaps least appreciated aspect of healing is the need for this reconnection to take place in the context of a community, a need as real for the healer as it is for the sufferer. Healing requires from the healer a commitment over time to become a person capable of compassion and therefore of healing, who has the deep knowledge of how to fuse power and powerlessness, strength and vulnerability. This openness to vulnerability required of healers is more than a simple disposition to the notion of vulnerability. As Brody notes, there is a difference between being "disposed" to something and striving over time to become something. It is the latter that is the mark of virtue.

In cultivating compassion as a professional virtue, healers must be willing to be formed by a compassionate community, "confident that they will receive empathic compassion and support from each other as they attend to the sufferings of their patients" (Brody, 1992, p. 267). In this arena, Brody ruefully notes, implicit issues of power have most stood in the way of the profession's reform. The self-imposed image of the physician as a powerful, scientific, objective individual, he says, works against the development of any effective peer support system. But it also cripples the physician's ability to be present to those in pain, which, as Stanley Hauerwas notes (1985), should be the goal of medical training.

For Hauerwas, "the physician's basic pledge is not to cure, but to share through being present to the one in pain"(p. 220). This pledge is difficult to carry out on a day-to-day basis. No individual has the resources to see so much pain without that pain hardening him or her. Pain, as Scarry notes, is destructive of human community; hence the prime directive of the healer to be present to those in pain carries with it an embodied threat to the ability to continue to be a healer. She or he must not only be formed as a healer by a compassionate community, but must also be continually sustained and nurtured by such a community—the kind of community, Hauerwas notes, that the Christian church claims to be.

There is a rich and varied tradition of healing not only within the Christian church but also in virtually every religious tradition. In fact, the role of healer in early societies encompassed not only the people's health but their entire welfare, including their spiritual welfare. The specialization that has accompanied modern civilization, however, makes discussion of the relationship between healing and religious belief problematic in that it is no longer clear who is priest, who is healer, and whose authority should predominate. The relation of medicine to particular religious traditions (Numbers and Amundsen) and the relevance of theological ideas, particularly that of covenant, to medical ethics (May) have opened up areas of fruitful exploration for both medicine and religion. But it may be well to concentrate, as Hauerwas does, not on these theoretical relationships but on the practical relation between communities, between those who practice religion and those who practice healing.

It is in this sense, Hauerwas says, that those who profess to heal need religion—not to provide miracles when there is a failure to cure, not even to supply a foundation for their moral commitments, but rather as a source of the habits and practices necessary to sustain them over the long haul as they care for those in pain. There needs to be a body of people who have learned the skills of presence to keep the world of the ill from becoming a separate world, both for the sake of the ill and for those who care for them. "Only a community that is pledged not to fear the stranger (and illness always makes us a stranger to ourselves and others) can welcome the continued presence of the ill in our midst" (Hauerwas, p. 223).

In the final analysis, healing is a communal action whose goal is the restoration not only of physical and mental wholeness to those who suffer illness but also of their integrity as persons, that is, as beings-in-relation to themselves and to other persons. It is a communal action in two senses: It reaches out to those isolated by illness to reconnect them to the human family; and it is sustainable only within a community that practices compassion as a virtue. The future of the healing professions everywhere depends as much on this nurture as on technical competence and the wise use of material resources. Those who profess to heal must know that no one is fully healed until all are healed.

j. pat browder

richard vance (1995)

bibliography revised

SEE ALSO: African Religions; Alternative Therapies; Body: Cultural and Religious Perspectives; Care; Christianity, Bioethics in; Compassionate Love; Daoism, Bioethics in; Disability; Grief and Bereavement; Health and Disease; Hinduism, Bioethics in; Human Dignity; Life, Quality of; Medicine, Art of; Narrative; Native American Religions, Bioethics in; Professional-Patient Relationship; Teams, Healthcare; Trust; Virtue and Character

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Warren, Virginia L. 1989. "Feminist Directions in Medical Ethics." Hypatia 4(2): 73–89.

HEALING

It is a hazardous task to attempt to offer a summary of Islamic medicine and healing and to map the contribution of the Islamic empire to human civilization. The Islamic empire covered a wide territory stretching from the western shores of Europe to the Indian subcontinent to the former Soviet states in Asia. The Islamic empire maintained unchallenged authority in medicine for over six centuries. This entry offers brief synopses of this history.

Islamic scholars have referred to the medicine that existed within the bounds of the Islamic empire as "Islamic." The term refers to a heritage consisting of two distinctive categories of medicine. First, there was what might be termed Islamic folk medicine, which existed among the populace throughout the Muslim world. Folk medicine did not enjoy the blessings of the ruling elite and is still very often dismissed as sheer quackery. Second, there was what might be termed Islamic state-sanctioned medicine. This category was the pride of the Islamic empire and enjoyed lucrative support from the Muslim ruling elite, particularly during the golden age of the Islamic empire (seventh to thirteenth centuries).

Islamic Folk Medicine

Islamic folk medicine derives its legitimacy from its claim to have been based on the teachings of Islam. This claim is corroborated by frequent use of Qur˒anic verses, prophetic prescriptions, and the wisdom of saints and imams. It should be noted here that exceptionally few passages in the Qur˒an can be related directly to healing and medication. Prophet Muhammad made no claim to be an authority in medicine and most of his relevant speeches correspond with what was practiced within his culture. The hadith collection of Sahih al-Bukhari, one of the most authoritative works on prophetic narratives, stands as testimony to this, that is, to this continuity with pre-Islamic practices. Al-Bukhari's voluminous work contains less than one hundred entries that are of relevance to medicine. Most of these entries are no more than different versions of the same narratives. Other less authoritative collections exist, such as al-Tibb al-Nabawi (Prophetic medicine). There is a consensus among scholars that collections under the term prophetic medicine—a genre of medical writings intended as alternatives to the exclusively Greek-based system derived from Galen—do not stand up to any scholarly or theological scrutiny. The Arab philosopher Ibn Khaldun described this class of medicine as essentially a Bedouin craft that has no divine revelation and thus cannot be obligatory under religious laws.

Barely literate practitioners dominate Islamic folk medicine, serving primarily illiterate masses. Far from being a weakness, this made it more flexible and hence accommodating to the diverse cultures of the Islamic empire. The result is a craft that varies with cultures while retaining some degree of harmony within each. Many of these diverse cultures did no more than adapt their new medical creed to their original etiology and treatment of disease.

Four categories are identified in Islamic folk medicine as major causes of disease: sorcery, the evil eye, jinn, and adverse routine conditions (e.g., adverse weather, food problems, accidents, etc.). Holy power represents a primary source of medicine for all categories of disease except the last. Holy power is often manifested in combinations of Qur˒anic verses and magical formulas in various forms: Qur˒anic verses that are worn on the body or drunk; direct recitation from a holy person; an object from a holy site and saintly tombs; and so on.

Islamic Medicine

In general, the contribution of the Islamic empire to modern medicine is often underrated in the West. More often than not, Western scholars have overlooked Islam's true contribution to human civilization. A Eurocentric outlook affects even the most authoritative scholars in the field. However, more recent scholarship shows that medieval Muslim physicians made many contributions to the medical knowledge from Greece, Persia, and India that passed through their hands. In reviewing medieval Islamic medicine, one should be wary of creating false impressions. The Islamic empire was more welcoming for non-Muslims than is popularly imagined in the West. In fact, many of its famous doctors were Jews (Musa ibn Maimun Maimonides, 1135–1204 c.e.), Christians (Hunayn ibn Ishaq, 809–873 c.e.), and non-Arabs, mostly Persians (al-Razi / Rhazes, 841–925 c.e.; ibn Sina/Avicenna, 980–1037 c.e.). Moreover, the term "Islamic medicine" disguises a fundamental aspect of this class of medicine. Namely, that it was not based on Islamic teachings. Instead, it simply existed, and prospered within that cultural space that the empire afforded.

In its technological advancement, and to its credit, the Islamic empire did not attempt to reinvent the wheel. Starting from where others stopped is now a central tenet of modern science. The empire was fortunate that the wealth of Greek philosophy was already at its doorstep. Up to the sixth century, Alexandria and Athens stood as rival centers of medical learning. Persia was the new flourishing abode for scientists following the expulsion of the "heathen philosophers" from Athens and Alexandria (527–565 c.e.). Khalid ibn Yazid (655–704 c.e.) was unquestionably the first emir who laid the foundation for the translation of Greek works into Arabic. Following its fall under Muslim rule in 641, Alexandria proved to be a rich repository of Greek manuscripts. A century later, caliph al-Mansur reinvigorated Baghdad as a center of knowledge enshrined in the famous Institute of Wisdom (Bayt al-Hikma). Scholars were enticed to convert foreign manuscripts appropriated from the city of Junde-Shappur (in Persia) into Arabic. This city provided a vast wealth of Latin manuscripts in addition to equal numbers of other documents of Indian and Chinese origin. The Christian medical scholar Abu Zakariya ibn Masawayh (died 857 c.e.), who was a personal physician for four caliphs, was in charge of this establishment. Other no less famous centers of knowledge and translation followed and were abundant across the Islamic empire from the Persian Gulf to the European Atlantic borders.

Early scholarship tended to portray the contribution of the Islamic empire to world medicine as no more than that of a diligent storekeeper. In other words, that no original contribution was made during the vibrant era of the Islamic empire (seventh to thirteenth century) when the Christian world was dormant. Nothing could be further from the truth—and it would be futile to even attempt to map out this vast contribution.

Almost every field of modern medicine has a founding figure in the early Muslim world. Avicenna, often called the "prince of physicians," left behind more than a million words in medical documents. His contribution to science in general, but medicine in particular, can also be found in his methodology, which insisted on the use of reason alone to solve all medical problems.

Ibn Haytham (965–1039 c.e.) made great strides in optics, earning the nickname "father of optics." He also made a broad paradigmatic shift in the pursuit of science, which he centered around the use of inductive reasoning in the search for knowledge. Experimentation—the backbone of modern science—is what he preached in his approach to medicine.

Sinan ibn Thabit (died 946 c.e.) earned a good reputation in both the Arab world and later in the West. He contributed significantly to the art of presenting medical teaching books. Moreover, he was instrumental in establishing a regulatory system of medical control, examination, and registration of doctors and formulating ethical rules to govern medical practice.

Another figure who made an immense contribution to the art of medical writing is ˓Ali ibn al-˓Abbas al-Majusi (died between 982 and 995 c.e.). He was distinguished by his influential style of presenting medical facts with clarity, lucidity, and freedom from both magical and astrological ideas of the past. Al-Majusi had a a wealth of knowledge that spanned several branches of medicine, but is legendary for his illustrated thesis on the movement of the blood in the human body.

The Islamic empire inherited a medical system in which surgery was regarded as an inferior branch of medicine, if it was ever a part of it at all. Abu 'l-Qasim al-Zahrawi (936–1013 c.e.) elevated surgery to a primary position in medicine. Ample literature attests to his successful clinical treatment of bone fractures, bladder lithotomies, hemorrhoids, hernia, wounds to the abdomen, tonsillectomies, and many other ailments that required surgery.

The contribution of Islamic medicine was also impressive in chemistry and preparation of medicinal drugs, distillation, and sublimation. Many drugs now in use in modern medicine are of Muslim origin.

It has often been argued that Islamic medicine was crippled by Islam's attitudes toward dissection. These attitudes are said to have been derived from the Islamic prohibition of human body mutilation. It is true that Prophet Muhammad instructed his followers to respect the dead, foes and friends alike, and to avoid mutilation. He also instructed his followers to hasten the burial of their dead, a practice that is favored to this day in the Muslim world. It is conceivable that following such commands would have made dissection or indeed autopsy a compromising practice. One must realize that such prohibition was issued in tandem with other prescriptions accompanying jihad wars and was designed to oppose excessive revenge and humiliation of slain enemies. While few theologians might have opted to extend this prohibition to the practice of medicine, the ban has never been a central issue in debating the advancement of medicine. The Muslim philosopher and theologian al-Ghazali (d. 1111 c.e.) did exactly the opposite when he hailed anatomy as an important branch of medicine, stating "whoever does not know astronomy and anatomy is deficient in the knowledge of God." Indeed many of the prime pillars of Islamic medicine have left writings and narratives as evidence of their practice in the field of tashrih (dissection or anatomy). To name but a few, the list includes Rhazes, Masawayh, al-Zahrawi, and Avicenna. It is important to note that not every religious prohibition was zealously observed, particularly by the powerful. After all, the prohibition against alcohol was flouted even in the palaces of the emirs. The biggest obstacle against dissection was possibly the Arabian weather. In the absence of modern methods of refrigeration, it would take much more determination to handle a cadaver hours if not days after death. It has often been argued that Islamic medicine was no more than a theoretical exercise that was not translated into practice. Nothing could be further from the truth as most major Islamic cities had their medical establishments, which were similar to modern teaching hospitals that combine healing with training. D. L. Wright narrates that hospitals were established in the Arab world as early as the seventh century; that in the thirteenth century, al-Mansuri's hospital in Cairo had four large quadrangles complete with fountains. The same hospital had wards for male and female patients, a library, a lecture hall, and a mosque. Such a hospital could indeed be the envy of modern hospitals in the modern Muslim world. In 1160 c.e., Baghdad city had some sixty dispensaries and infirmaries.

Early Islamic and Modern World Medicine

The eleventh century saw Europe just beginning to awake from its long period of oblivion. It was Europe that was behind the Arabs in every field. The march to regain supremacy in medicine began with the rebuilding of knowledge, most of which was available only in Arabic scripts. In 1085, Toledo of Spain was won back from the Arabs and was soon to house the School of Translation founded by Domenicus Gundissalinus (1020–1087). Other scholars were also commissioned, most notably Gerard of Lombardy (joined 1150), who translated hundreds of Arabic works, including the masterpieces of Rhazes and Avicenna.

Italy, too, had its center (Salerno), which far exceeded Toledo's establishment. It was the Tunisian-born scholar Constantinus Africanus (1020–1087) who helped to realize the European dream of ascending to supremacy in medical knowledge. Salerno's medical establishment was reputed to be the first organized medical school in Europe. In his visit to Italy as merchant, Constantinus was appalled by the poverty of medical knowledge in Italy. He decided to go back to Tunisia for three years to study medicine and bring worthwhile knowledge to his new abode. That he did with spectacular success and he was later to rank among the most diligent translators of his time. These medical centers proved valuable sources of information and were replicated in other European cities. For many years to come, the same sources of knowledge were used in the other European schools, which mushroomed in Seville, Montpellier, Paris, Padua, Bologna, and elsewhere. While many texts of Arab origin continued in use in these European medical schools throughout the Middle Ages, names of their Arab authors continued to be filtered out through translation or otherwise.

See alsoMedicine ; Miracles ; South Asian Culture and Islam ; Southeast Asian Culture and Islam .

BIBLIOGRAPHY

El-Tom, Abdullahi Osman. "Drinking the Koran: The Meaning of Koranic Verses in Berti Erasure." Africa 55, no. 4 (1985): 414–431.

Savage-Smith, Emilie. "Attitudes Toward Dissection in Medieval Islam." Journal of History of Medicine 50 (1995): 67–110.

Ullman, Manfred. Islamic Surveys II: Islamic Medicine. Edinburgh: Edinburgh University Press, 1978.

Wright, D. L. "Medicine in the Golden Ages of Islam—The Islamic Legacy." The Journal of Kuwait Medical Association 20, no. 1 (1994): 98–103.

Abdullahi Osman El-Tom

healing The expectation of a cure for all ills among people in the developed world increases enormously with the growth of medical technology and with scientific exploration of the human body. In America, they say, death is optional, and indeed plastic surgery, organ transplants, heroic chemical therapies, and any number of diets and exercises almost make a joke seem reality, for the very rich at least. In countries with high living standards and universal health insurance, life expectancy is increasing among all social classes, and infant mortality is dropping to record lows. Hope for physical well-being has never been higher among the fortunate, and among the unfortunate, the conquest of disease seems only a matter of time and money. And yet, everyone has died of something sooner or later, so far, and it would seem that just as one disease is conquered, another pops up, more dangerous and mysterious than the last. Equally as worrying for the wary consumer of health news are the conflicting reports of what one should do to stay well. Some fats are good but others will kill you; alcohol is bad except red wine; vitamins can prevent cancer, or maybe not. The choices are staggering and the stakes are high. What we all need, whether to avoid illness or to be restored to health is a reliable source of learned advice. But where can such a source be found?

Philosophers (and politicians) advise self-reliance, but whether the vagaries of science or the caprices of the gods, the ways of healing are just too complex for most people to manage without help. The ill and the worried turn to books, television, physicians, quacks, relatives, priests, and neighbours, all in search for deliverance. Ultimately they fail, of course, but the quest is revealing of the many ways in which humans have regarded illness, and of the ways in which they have sought relief.

Spiritual or religious healing is found in most cultures. Even now some television ministers claim to cure sufferers if they touch the screen. We tend to sneer at such antics as the province of the ignorant lower classes, but in fact not until recently has any method of healing united every level of society. The Greek god of healing was Apollo, who counted among his patients the Olympian gods themselves. His son, Asculepius, a demigod, became so proficient at the art of medicine that the poets report he angered Hades, the god of the underworld, who accused him of depopulating Hell. Zeus killed the doctor with a thunderbolt and he became a god himself, with a cult of priest–physicians at his service in temples scattered throughout ancient Greece. Temples to Asculepius, called Asclepia, were located in cities like Cos and Cnidus, later to become famous for the presence of Hippocratic philosophical physicians. The most famous of the Asclepia was at Epidaurus, a fashionable mineral spa, which was celebrated by some of the most famous gentleman writers of antiquity.

At the temple, the sufferers would be greeted by authoritative physician–priests, who assured them of the greatness of their god and of his many cures. Ritual purification followed, which consisted of soothing baths in the mineral springs, which were often themselves associated with divinities. Massages and animal sacrifice accompanied these rites, followed by the famous ‘temple sleep’, during which the afflicted had a dream or vision of the nature of the problem which suggested treatments. If they were very lucky, a sacred dog or even a snake would appear to them and lick the affected part. After relief was achieved, the gods were thanked, sometimes with the story of the cure inscribed on a tablet for the temple collection. Many such temples throughout the ancient world also are littered with images of body parts offered by the thankful, sometimes of arresting anatomical correctness, and often moulded in terra cotta.

The Old Testament of the Christian Bible recounted how the Children of Israel were cautioned to observe complex purification rituals after intercourse, childbirth, or menstruation, and were cautioned to eat only certain foods and avoid others, as a sign of their covenant with God. In the Gospel, Jesus commanded his followers to heal the sick. In one of the most impressive miracles recorded in the ancient world, Jesus caused devils tormenting two madmen living among the tombs to inhabit a herd of swine, who subsequently rushed into a lake and drowned (Matthew 8: 28–32). Elsewhere he healed lepers, caused the blind to see, and even raised the dead, usually by a simple word or touch. Anxious to demonstrate that these miracles were meant to teach and were not magic, Jesus often repeated that it was not he himself, but the faith of the sufferers or those surrounding them that accomplished the healing.

During the Christian Middle Ages the tradition of healing miracles was taken over into the cult of saints. Monarchs, merchants, and peasants all sought out miraculous healing at the shrines of holy women and men. Certain saints specialized in healing certain ills. Mothers, lepers, even people with bones caught in their throats, all had patron saints. The body parts of saints were preserved in ornate boxes called reliquaries, often made of gold and studded with jewels. So widespread was the rage for collecting saints' relics that church legislation had to be enacted to prevent the faithful from boiling down the bodies of the saintly dead for their bones until a decent interval had elapsed. Raging disputes erupted over whether a holy person really were dead, which often lasted for days before putrefaction settled what theology could not.

The boundary between life and death in the medieval period was much more hazy than it is now. An interval of a year or more was not an unusual time to elapse before friends and relatives were satisfied the soul had left the body. Even learned university physicians visited the bodies of friends thought to have healing powers, confident that the personality of the dead person remained and might exert a helpful or comforting influence. Conversely, the recovery of people from what we would call comas or deep sleep could be interpreted as an example of miraculous resurrection, perhaps accounting in part for the enduring popularity of saintly healing.

The popularity of religious healing endures even today, especially when scientific medicine is not available, or when the sought-after cure lies outside the boundaries of scientific medical practice. Once the person in need of healing has accepted the authority of the god or gods to perform the healing, further advice is often not necessary. Usually communication between sufferers or their advocates and the divine is direct, or with few intermediaries. This is not often the case with the use of more familiar methods of healing like pharmacy and surgery, which are nearly the sole instruments of scientific medicine today.

Diet and pharmacy were almost indistinguishable in early medicine — foods could act as drugs and drugs could be nourishing. Dietetic medicine, which was developed by the ancient Greeks, emphasized the preservation of health and avoidance of disease much more than its cure. In order to accomplish this, the person was compelled to seek the advice of a philosopher–physician, who understood the client's place in the larger world, and could tailor that particular regimen of health to the particular individual. Every aspect of the client's ‘lifestyle’ — occupation, time of birth, habits, ancestry, gender, and class — all were important in dietetic medicine to preserve health and prolong life. Astrology was a useful tool to the dietetic physician, as was a knowledge of the broader world of nature and of how each person fit into it. When something went wrong, this was attributed to a falling out of harmony with nature. This imbalance could be corrected gently, over time, with mild remedies intended to purge offending substances from the body and restore its well-being. Such a system implied an excess of leisure, and certainly a great amount of faith in the practitioner, for a regimen of health is much more difficult and expensive to maintain than is taking a pill or two when something goes wrong.

An important break with the dietetic tradition in medicine came with the medical and religious reformer Paracelsus (1493?–1541). Paracelsus was one of the first exponents of chemical therapy. He believed that illness was not caused by disturbances in the entire complexion or constitution of the body that were peculiar to individuals. Instead, he argued that diseases ‘attacked’ the body from outside and were poisons, excited into action by chemical disturbances taking place among the stars. Healing was accomplished not by gradual readjusting of the humoral balance, but by using chemicals against the poisonous attacker which would act on the disease at its particular site. What is more, these chemical remedies worked the same for everybody, worked quickly, and did not need the complicated (and expensive) advice of the learned physician. It is little wonder that Paracelsus has been called by some the Martin Luther (1483–1546) of medicine. Like Luther, Paracelsus wanted to ‘eliminate the middleman’ and make healing simple, quick, and mystical rather than logical.

Paracelsus and his followers ushered in what historians have called an age of radical medical interventionism. Chemical therapies like mercury for syphilis, surgical procedures like cutting for the bladder stone (without anaesthesia), and letting buckets and buckets of blood for fever, or nearly anything else, became the mainstays of medical therapy. Patients demanded these tortures, and submitted to them, because they thought they worked and because there seemed no alternative. By the nineteenth century, the discovery of anaesthesia allowed surgeons to take their time, and, more important for patients, allowed them to sever the experience of bodily suffering in hopes of a cure.

The development of bacteriology by Louis Pasteur (1822–95) and Robert Koch (1843–1910) revolutionized medical understanding of disease, and the invention of various antibiotics, beginning early in the twentieth century, revolutionized their cures.

Medical technology has enabled scientific medicine to vanquish its rivals in the medical marketplace in the quest for patient patronage and health insurance funds. A health care machine, centred in the hospital and university, is where we are born and where most of us will die. But as healing grows more complex, the knowledge required to make healing choices becomes more and more difficult to accumulate. Issues of trust and authority continue to challenge the suffering and the fearful.

Faye Getz

Bibliography

Cook, H. J (1993). Physical methods. In Companion encyclopedia of the history of medicine, (ed. W. F. Bynum and R. Porter, Routledge, London and New York.
Finucane, R. C. (1977). Miracles and pilgrims: popular beliefs in medieval England. Rowman and Littlefield, Totowa, NJ.
Pouchelle, M. C. (1990). The body and surgery in the Middle Ages, (trans. R. Morris ) Rutgers University Press, New Brunswick.
Temkin, O. (1991). Hippocrates in a world of Pagans and Christians. Johns Hopkins University Press, Baltimore.

Healing

Healing includes diagnosis of illness and various methods of curing. Human health is in a state of constant fluctuation and change. Any particular change is construed as follows: If waxing toward life, it is wellness; if waning toward death, it is illness. Healing is the negotiation between these two states. It attempts to increase life and wellness, but it is not always successful.

Issues of health and healing constitute a significant measure of the reality of everyday human existence. For humans to live, they must defend against illness and have strategies for responding to illness when it occurs; or the inverse—they must promote wellness as protection against the onset of illness. In almost all cultures, and throughout human history, healing has been inextricably related to religious concerns, themes, and practices. Whether part-time or full-time professionals, healers in most societies are religious specialists of some kind. Since health maintenance is a phenomenon that has religious dimensions, it represents a focal point for various beliefs, mores, practices, rituals, and observances. Examples include laying on hands, healing prayers, blessings, exorcisms, and purification practices. Many religions attempt to explain the causes and origins of illness. Some of these theories include spirit and demon possession, human Witchcraft, infractions of morality, or ritual offenses.

One reason why healing and religion have always had a historical relationship is that in dealing with illness they must also face the issues of suffering, pain, angst, and dying. Religion addresses these issues through establishing meaning, interpretation, and practices that are responses to suffering and death. Religious interpretive systems attempt to reduce the anxiety and fear associated with illness. In this context, illness has often been associated with sin. Religious healing attempts to accomplish curing through ritual, practice, and faith. Although modern empirical medicine can promote wellness and combat bodily pain and suffering, it does not always address the accompanying existential crises of human mortality.

Americans inherit a largely Judeo-Christian world-view, although indigenous and minority peoples have contributed significantly to contemporary health practices. The large influx into the United States of Asian peoples and ideas in the late twentieth century has also affected religious views and responses to health issues. Christian history is replete with images of healing as religious practice. As depicted in the Christian New Testament, Jesus is explicitly represented as a faith healer. One of his disciples, Luke, is identified as a doctor. A significant portion of the gospels' accounts record stories of healing.

American Christianity includes the practices of praying over the sick, laying on hands, and anointing with oil. These practices are rooted in the rituals of early Christians. These practices are also considered to convey forgiveness of sins, suggesting that sinfulness is connected with illness. Roman Catholics have maintained several rituals of healing and expiation of sin throughout their history, the rite of unction being one such expression of healing power through ritual. Early Protestants rejected formal rituals of healing, preferring informal practices such as praying and reading the Bible in times of sickness.

With the shift in recent decades of members away from mainline churches toward Evangelical and fundamentalist churches, several healing practices have gained increasing popularity: laying on hands and anointing with oil, as well as others. These "faith healing" practices occur throughout evangelicalism but are especially concentrated in Pentecostal and nondenominational charismatic churches. "Faith healing" is a term that generally refers to Christian practices of healing conceived as mediated through God's intervention, or through the power of the Holy Spirit. Faith healing practices include touching and laying on hands but also gesturing and other dramatic movements. With the growth of television evangelism, traditional "hands-on" healing is being supplemented by believers touching their televisions to receive healing. In some cases healing is received through television simply by viewing the ministry or by praying and reading the Bible while watching. Healing and evangelical TV ministries are a multimillion-dollar phenomenon in the United States today.

Another dimension of faith healing is represented by such groups as Christian Science. Christian Science is a movement, started in the nineteenth century, that rejects empirical medicine in favor of faith. This, and other such groups, do connect illness with sin. Christian Scientists conceive of empirical medicine as a challenge to God's authority and as a lack of faith. Jehovah's Witnesses do not adopt all the practices of other churches of this type but do reject the use of blood transfusions. Although some of the evangelical churches share similar attitudes, there is not as much consensus over whether faith replaces modern medicine or is a supplement to it.

Among some faith healing ministries, adherents accept and use modern medicine. Like more mainline denominations, many evangelicals do not see faith healing as a replacement for modern medicine, but instead accommodate their religious practices with visits to medical practitioners. No Christian institutions view empirical medicine as a substitute for faith, prayer, and miraculous healing. Often modern medicine is understood as an instrument of God's healing work, as exemplified in prayer meetings at hospitals to guide the hands of a surgeon.

Religious healing has ethnic dimensions as well. Many minority groups have members who are suspicious of modern medicine. Reasons for this suspicion include a general distrust of majority culture institutions and practices and their eroding effects on ethnic traditions. Healing has a strong traditional place in the religious beliefs and practices of most Native Americans. Practitioners of Vodun (Voodoo) and Santería also figure among those who rely on religious approaches to illness.

A recent trend in religion and healing is the popularity of herbal and alternative medicine. Alternative medicine includes a host of practices with religious or pseudo-religious affiliations. Alternative medicine with religious valences includes aroma therapy, acupuncture, herbal healing, massage therapy, macrobiotics, biofeedback, Āyurveda, Chinese medicine, homeopathy, various exercise and dietary movements, and others. All of these fields of practice tend to be holistic. They treat physical, psychological, and existential imbalance as illness. Their popularity is partially based on their respect for the human as a social and religious being and also as a physical organism. They also place significant emphasis on wellness—keeping people healthy and fit as a precaution against illness. In addition, they offer curing in response to illness.

Some of these traditions are modern imports; others developed in American religious history. In the nineteenth and early twentieth centuries, numerous groups appeared that can be loosely categorized as religious human potential movements. Mesmerists and Swedenborgians are two such examples that subsequently led to the development of more recent fields, such as chiropractic medicine. Swedenborgianism is a religion in which healing is the central religious practice. Herbal medicine has several streams of historical confluence: traditional European and African-American folk remedies, Chinese medicine, Native American botanical knowledge and theory, and South Asian Ayurveda. In many ways, theories of herbal medicine have been combined with empirical dietary research to increase sales of vitamins and minerals in the latter twentieth century. The longstanding links between religion and medicine are also seen in the popularity of vitamin and dietary supplements among some Evangelical Christian groups.

Modern medicine developed during the period of secularization and empirical science and has sometimes devalued religion and religious healing. Although there are still many fronts of contention between science and religion, some medical professionals consider religious practice and belief helpful to healing. In the 1990s the medical effects of religious practices and beliefs have begun to be assessed by the medical profession. Psychologists and therapists have studied how religious affiliation contributes positively to mental health. Some studies suggest that members of religious communities tend to suffer fewer personality disorders, such as depression. The use of Asian-inspired meditation methods has been shown to be helpful to sufferers of chronic pain or incurable disease. This field and its developing research are usually referred to as mind/body medicine. In a historical context this is not a new field, but instead a recognition by scientific medicine that some forms of religious practice and belief have transformative effects on immunity and general health. Many empiricists would not replace heart surgery with prayer, but they are beginning to recognize and study how prayer and meditation shorten the recovery time of patients.

See alsoAlternative Medicine; Christian Science; Evangelical Christianity; Exorcism; Health; Holistic Health; Jehovah's Witnesses; Miracles; Nature Religion; Pentecostaland Charismatic Christianity; Ritual; Televangelism.

Bibliography

Albanese, Catherine L. Nature Religion in America: Fromthe Algonkian Indians to the New Age. 1990.

Dayton, D. "The Rise of the Evangelical Healing Movement in Nineteenth-Century America." Pneuma (1982): 1–18.

Goleman, Daniel, and Joel Gurin, eds. Mind Body Medicine: How to Use Your Mind for Better Health. 1993.

Kinsley, David. Health, Healing, and Religion: A Cross-Cultural Perspective. 1996.

Kowalchik, Claire, and William H. Hylton, eds. Rodale's Illustrated Encyclopedia of Herbs. 1987.

McGuire, Meredith B. "Religion and Healing." In TheSacred in a Secular Age, edited by Phillip E. Hammond. 1985.

Jeffrey C. Ruff

Healing. In the religious perspective, disease and dis-ease are never far removed from each other. Since an aim of religions is to offer the means through which health in body, mind, and spirit may be attained (unless countervailing causes supervene, such as karma, the will of God, invasion by demons, etc.). Thus Augustine observed succinctly that ‘all diseases of Christians are to be ascribed to demons’; and the contest with demons is familiar in the descriptions of the healing of particular disorders in the ministry of Jesus, which was to him (and others) a demonstration that the dunamis (power or dynamic) of God is active in the world.

The contest against disease was continued in Islam, through which Greek medical knowledge was preserved and extended. al-Ṭibb (‘medicine’) became a major part of the Muslim commitment to ʿilm (knowledge)—e.g. al-Rāzī (Rhazes).

Indian medical science is known as Ayur veda (‘the knowledge of longevity’), and is based on a theory of five elements (bhūta) and three humours (dośa), wind, bile, and phlegm. Health consisted in maintaining all in balance and equilibrium, correcting imbalance by an array of herbal and other remedies. Thus health matters are not isolated from the general condition of life. Carakasamhita is a classic text on medicine (compiled in the 1st cent. BCE; Suśruta Samhita is a slightly later text on surgery): it combines health and medical matters with general instructions for the achieving of a good and satisfactory life.

The same catholicity of attitude is evident in China, where the quest for immortality in religious Taoism (Tao-chiao/Daojiao) is not restricted to an endeavour to emancipate a self from society or a soul from a body. Taoists seek to relate the microcosm—which is present in the body in the three life-principles of breath (ch'i/qi), vitality especially in semen (ching/jing), and spirit (shen)—to the macrocosm, so that the whole of life, internal and external, becomes an unresistant (wu-wei) expression of that which alone truly is, namely, the Tao. It would thus be impossible to isolate some part of disease or disorder from its context.

Healing, therefore, in all religions takes place in a much larger context of life and its purposes, and remains closely related to modern insights into the psychosomatic unity of the human entity.

For the Buddhist ‘Master of Healing’, see BHAIṢAJYAGURU.