Healing

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HEALING

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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

BIBLIOGRAPHY

Bishop, Anne H., and Scudder, John R., Jr. 1991. Nursing: The Practice of Caring. New York: National League for Nursing Press.

Bolton, Jonathan. 2000. "Trust and the Healing Encounter: An Examination of an Unorthodox Healing Performance." Theoretical Medicine and Bioethics 21(4): 305–319.

Brody, Howard. 1987. Stories of Sickness. New Haven, CT: Yale University Press.

Brody, Howard. 1992. The Healer's Power. New Haven, CT: Yale University Press.

Cassell, Eric J. 1976. The Healer's Art: A New Approach to the Doctor-Patient Relationship. New York: Penguin Books.

Cassell, Eric J. 1991. The Nature of Suffering and the Goals of Medicine. New York: Oxford University Press.

Cohen, Michael Howard. 2001. Future Medicine: Ethical Dilemmas, Regulatory Challenges, and Therapeutic Pathways to Healthcare and Healing in Human Transformation. Ann Arbor: University of Michigan Press.

Foucault, Michel. 1973. The Birth of the Clinic: An Archaeology of Medical Perception, tr. Alan M. Sheridan Smith. New York: Pantheon.

Gilligan, Carol. 1982. In a Different Voice: Psychological Theory and Women's Development. Cambridge, MA: Harvard University Press.

Grady, Christine. 1998. "Science in the Service of Healing." Hastings Center Report 28(6): 34–38.

Hauerwas, Stanley. 1985. "Salvation and Health: Why Medicine Needs the Church." In Theology and Bioethics: Exploring the Foundations and Frontiers, pp. 205–224, ed. Earl E. Shelp. Dordrecht, Netherlands: D. Reidel.

Ingelfinger, Franz J. 1976. "The Physician's Contribution to the Health System." New England Journal of Medicine 295(10): 565–566.

Kass, Leon R. 1985. Toward a More Natural Science: Biology and Human Affairs. New York: Free Press.

Katz, Jay. 1984. The Silent World of Doctor and Patient. New York: Free Press.

Kestenbaum, Victor. 1982. "Introduction: The Experience of Illness." In The Humanity of the Ill: Phenomenological Perspectives, pp. 3–38, ed. Victor Kestenbaum. Knoxville: University of Tennessee Press.

Laín Entralgo, Pedro. 1956. Mind and Body: Psychosomatic Pathology: A Short History of the Evolution of Medical Thought, tr. Aurelio M. Espinosa, Jr. New York: P. J. Kenedy & Sons.

May, William F. 1983. The Physician's Covenant: Images of the Healer in Medical Ethics. Philadelphia: Westminster.

May, William F. 2000. The Physician's Covenant: Images of the Healer in Medical Ethics, 2nd edition. Montville, NJ: Westminster Publishing House.

Moravcsik, Julius M. 2000. "Health, Healing, and Plato's Ethics." Journal of Value Inquiry 34(1): 7–26.

Noddings, Nel. 1984. Caring: A Feminine Approach to Ethics and Moral Education. Berkeley: University of California Press.

Numbers, Ronald L., and Amundsen, Darrell W., eds. 1986. Caring and Curing: Health and Medicine in the Western Religious Traditions. New York: Macmillan.

Ortega y Gasset, José. 1963. Meditations on Quixote, notes and intro. Julian Marais, tr. Evelyn Rugg and Diego Marin. New York: Norton.

Pellegrino, Edmund D. 1982. "Being Ill and Being Healed: Some Reflections on the Grounding of Medical Morality." In The Humanity of the Ill: Phenomenological Perspectives, pp. 157–166, ed. Victor Kestenbaum. Knoxville: University of Tennessee Press.

Pellegrino, Edmund D. 2001. "The Internal Morality of Clinical Medicine: A Paradigm for the Ethics of the Helping and Healing Professions." Journal of Medicine and Philosophy 26(6): 559–579.

Pellegrino, Edmund D., and Thomasma, David C. 1997. Helping and Healing: Religious Commitment in Health Care. Washington, D.C.: Georgetown University Press.

Pellegrino, Edmund D., and Thomasma, David C. 1997. A Philosophical Basis of Medical Practice: Toward a Philosophy and Ethic of the Healing Professions. New York: Oxford University Press.

Scarry, Elaine. 1985. The Body in Pain: The Making and Unmaking of the World. New York: Oxford University Press.

Sherwin, Susan. 1992. No Longer Patient: Feminist Ethics and Health Care. Philadelphia: Temple University Press.

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

Encyclopedia of Bioethics