health

health is commonly thought of as the absence of disease, and indeed it is difficult to discuss one without the other. Equally problematic is the consideration of the health of the body apart from the state of the mind or the spirit, because historically the topics were closely connected, especially before the seventeenth century. Even with these difficulties in mind, it is still possible to focus on certain notions about the health of the human body as a natural state and about how this natural state could be restored or maintained.

One idea about health that unites many cultures, from the classical Indian, Mesopotamian, Egyptian, ancient Greek, sub-Saharan African, Semitic, and native American, is the notion that there was a time when the human body existed in a perfect state of health and when no diseases beset it. People lived in harmony with nature, in a childlike state of material plenty and spiritual obedience. Bodily ills came into the world, so many stories go, when a ‘sin’, often one of disobedience, angered divine authority. One thinks of the myth of Pandora's box or the expulsion of Adam and Eve from the Garden of Eden, as told in Genesis, as examples, but other cultures provide many more such tales. Stories about original sin and the fall from grace are, in short, as common as creation myths in their explanations for why humanity no longer experiences natural health and, in some cases, long physical life.

Such myths carry in them crucial meanings for understanding the history of the body and its health that are with us still. The idea that there was a time when perfect health existed naturally is a powerful one. The author of Genesis wrote of painless childbirth before the Fall, and of, even after it, the remarkable age and sexual prowess of the Patriarchs. These stories also link health, or lack of it, to moral or religious conduct, and often join good health to a vigorous old age.

If perfect bodily health existed once, some argued, it could exist again. The restoration of balance and harmony with nature and with the divine was commonly offered as a way to achieve this restoration. Taoist thought sees good health as a balance between the opposing forces of Yin and Yang, which exist in the individual as well as in the world at large. The ancient Greeks viewed good bodily health as the duty of the aristocracy, along with military service and good governance. Medical texts are among the earliest surviving philosophical writings of the Greeks, indicating an eager audience for this type of advice.

Ancient Greek notions are perhaps the most important for defining how health would be regarded, at least in European and Islamic cultures. Most important is the nearly universal idea of microcosm and macrocosm. Very simply put, the body (microcosm) was thought of as a part of the larger world of nature (macrocosm). The four elements of nature: earth, air, fire, and water, and the four qualities: hot, cold, moist, and dry, found their counterparts within the body in the four humours: blood, which was hot and moist; choler, which was hot and dry; phlegm, which was cold and moist; and melancholy, which was cold and dry. Health lay in balancing these humours within the body through a regimen consisting of diet, exercise, and regulation of the emotions. Moderation and balance in all these natural factors was the road to good health and long life. Indeed, the Greeks counted gymnastics among the liberal arts, along with rhetoric and logic, as activities proper to a gentleman and ones leading to moral virtue.

Roman Stoic philosophers and Christian thinkers who followed after them held physical health in rather less esteem. Stoics sought to free themselves from bodily concerns by philosophical contemplation, while some Christians found value in mortifying the flesh, thereby turning their thoughts to the immortality of the soul. Medieval Islamic culture elaborated the Greek ideal of the healthy, happy aristocrat, and cultivated royal doctors famous for entertaining stories and jokes. It also promoted musicians, all to preserve the health of noble patrons. Medieval scholastic philosophers, rather surprisingly, took up another Islamic pursuit, alchemy. From the thirteenth century the Pope, who ideally ruled for life, patronized Christian alchemists. They argued that the recovery of knowledge about the philosophers' stone (which was known to the ancients) would not only make one rich, but return the body to its pristine state before original sin brought disease and the ravages of old age into the world.

The rage for medical alchemy, which only grew during the Renaissance, brought into focus the importance of philosophical thinking, drawing upon the ideas of many cultures, to the development of notions about bodily health. Rationality, a peculiar obsession of the Greeks, contributed to the separation of bodily concerns from those of the spirit. Although ancient Greek physicians called themselves philosophers, they excluded from philosophical/medical consideration supernatural causes of disease as being the province of magicians, because they were anxious to define their young profession as different, and better, than that of the faith healer. Medieval Christian and Islamic physicians admitted that lack of health could be associated with sin or magic, but dismissed these factors as outside the realm of Aristotelian medical practice. The seventeenth-century thinker Descartes (1596–1650), as part of a larger mechanical philosophy, made a separation between mind and body that was total. For Descartes, and other mechanists who followed after him, the healthy body was nothing more than a well-functioning machine, soulless and subject to chemical and mechanical remedies.

Cartesian medical philosophy not only excluded religious concerns from the proper duty of the learned physician, but also made easy the postulation of ‘mental’ illnesses and ‘mental’ health as being separate from the state of the body. Vitalist views of the body and health did not fade from consideration all at once. Individualized, pastoral-style medical care of the whole person experiences periodic revivals, especially when Westerners study subcontinental and far-Eastern methods of healing. But the notion of the body as a machine emphasized the sameness of all bodies rather than their uniqueness. The remarkable growth in medical technology from the end of the eighteenth century allowed medical scientists to ‘look inside’ the normal, living body and define its typical characteristics as never before. For example, the discovery of auscultation and later the stethoscope made individual patient reports of symptoms less important than the physician's own collection of diagnostic signs. Doctors could listen to the internal sounds made by hundreds of healthy bodies and easily isolate the ‘abnormal’, leading to a kind of medical objectivity never imagined before. The modern diagnostic laboratory of today allows the isolation of ungendered, raceless, classless tissue samples from subjective judgement and, for better or worse, minimizes the patient's own assessment of his or her state of health.

Nostalgia for a lost golden age never disappears from the medical scene, of course. Nineteenth-century Romantic thinkers offered the ‘noble savage’ or the ‘primitive’ hunter-gatherer as an ideal of bodily (and sometimes of moral) health. Even today, experimental studies with animals suggest that living in a state of near-starvation the way our ancestors were forced to do would lead to longer life and greater health — as if such a life would be worth prolonging. ‘Quality of life’ considerations will always be foremost in the mind of the patient, and this is an aspect of health that technologically-based scientific medicine, almost by definition, may appear to neglect. But in the contexts of clinical trials and medical audit the profession increasingly acknowledges the importance of quality of life as a component of outcome assessment.

Faye Getz

Bibliography

Ackerknecht, E. H. (1982). A short history of medicine. Johns Hopkins University Press, Baltimore and London.
Bynum, C. W. (1995). The resurrection of the body in Western Christianity, 200–1336. Columbia University Press, New York.
Temkin, O. (1991). Hippocrates in a world of Pagans and Christians. Johns Hopkins University Press, Baltimore and London.

See also creation myths; illness; medicine.