Towards an ecumenism of medicine

Towards an ecumenism of medicine

European School of Governance, position paper #34 by Daniel Dick and Hartmut Schröder.

“Medicine is constituted by the task of helping sick people. This task unifies medicine. Medicine can accomplish the task not through knowledge but through effective action. Hence, medicine is a practical science,” states the German medicine historian Urban Wiesing, postulating a pluralistic and pragmatic medicine.

Seen from the perspective of cultural studies, health and diseases are always societal constructs and cultural practices relying on cultural patterns of interpretation. However, cultural studies are not only concerned with a theoretical interest in different cultural terms (health, illness, healing) and the worldview underlying these concepts, but rather they make a contribution in a practical way towards:

  1. the development of integral holistic science oriented towards a holistic worldview, taking into account all knowledge and experience for healing and maintaining health;
  2. the development of a scientific and practical competence for the cultural transfer of culturally distant medicine as well as,
  3. to develop a transcultural competence for the study and treatment of culturally foreign patients.

Throughout the course of several centuries of health care and medicine, various cultural differences have led to a whole range of epistemologies for understanding the symptoms, causes and treatments of disease and well-being. This development has led to the four major fields of health care practiced today:

  1. conventional medicine,
  2. complementary medicine, which prominently combines alternative approaches with conventional medicine and involves sometimes traditional medicine and spirituality,
  3. e-medicine, which analyzes and treats illness according to algorithms and pattern recognition, and last but not least,
  4. health and well-being services in the form of civic engagement, such as phone services for suicidal emergencies; self-help groups like Alcoholics Anonymous, and other kinds of communities that actively support health and well-being such as tai-chi groups and wellness tourism.

The Polish physician Ludwik Fleck was the first who related the established modern concept of syphilis to various collectives and styles of thoughts in its development, that cannot compete against each other for legacy according to the other’s rules: “Both, thinking and facts, are changeable, if only because changes in thinking manifest themselves in changed facts. Conversely, fundamentally new facts can be discovered only through new thinking.”

The paradigm shift in the health care system, which is based on changing patterns of disease, the increasing importance of prevention, health education and health communication, makes terms such as psychosocial health and quality of life increasingly important. This requires a holistic healing approach and has already found concrete expression in a large number of new study programs. Günter Stock, President of the Berlin-Brandenburg Academy of Sciences, writes in a brochure from Health Capital Network Healthcare Berlin-Brandenburg: “Health is more than the opposite of illness, and ‘studying health’ means more than ‘medical studies’. Today, this topic is about quality of life in the broadest sense: medical informatics as well as biochemical Alzheimer’s research, rehabilitation as well as health education, pharmaceutical research or nursing management as well as neuroscience, nutrition or health tourism.”

The importance of cultural studies has become increasingly relevant in health sciences and medicine in recent years, so that one can speak of a cultural turn in these areas. Within medicine, reference is made to bridging the gap between the humanities and social sciences on the one hand and the more science-oriented subjects on the other hand, to which the cultural sciences are capable.

From a cultural-historical point of view, medicine was an anthropological discipline that combines science and humanities. However, modern medicine has been largely driven by scientific approaches, and research activities are still largely devoted to the study of pathogenesis and pharmaceutical and technological therapeutic approaches. Increasingly, however, there is the realization that health and disease have not only biological, but always also mental, social and mental aspects. The aspects belong at the same time to nature and culture and are not reduced to one-dimensional considerations from biomedical or psychological or sociological perspective. Scientific evidence is demonstrating the importance of the spatial, social and cultural contexts for health and well-being, and cultural health in particular describes those cultural, social and political dimensions which need to be investigated for an understanding of the emergent properties that affect health and disease.

Medicine as a human science is also confirmed from a jurisprudential point of view. This is how German physician Jörg Jeger states: “The medical assessor is primarily a doctor. Medicine is both nature science and human science. As a natural science, medicine is based on biological research as well as on clinical research. Here, causal-logical thinking and scientific methodology play a major role, but also the personal professional experience of the doctor has to be taken into account. Medicine as a human science deals with doctor-patient relationships, with ethics, worldview and social competence. This also includes the personal life experience of the doctor.”

Despite the continuing dominance of natural sciences in modern medicine, the paradigm shift from a biomedical to a bio-psycho-social approach to understanding has at the same time brought about a “communicative turn”, in particular by Thure von Uexküll in his contributions to psychosomatic medicine and medical semiotics. Psychosomatics and medical semiotics seem to offer the appropriate approaches for dealing with metaphors and for analyzing the encounter of the worlds of life and medicine, where medicine and the humanities meet directly. They are supplemented by modern linguistic discussion research, which provides methods that can describe interactions in detail on the one hand and reconstruct on the other hand how disease models can be developed in discourses and treated therapeutically.

Therefore, cultural health is not only a cultural and critically engaged effort to pave the way towards a profound multi-modal ecumenism of medicine, but cultural health is also a political agenda to question the culturally accepted discourse of one-way thinking.

Through gathering experts and professionals of health-related fields and focusing on holistic well-being, the Cultural Health Lab challenges the sovereignty of one-dimensional interpretation and leads to diversity. It represents a paradigmatic shift and the necessary claim to regard illness not only as a culturally shaped form of inquiry, but also as a generative inquiry into health in order to anticipate and shape the continuous improvement of sustainable life quality.

The most relevant scientific discipline of curating health and enabling healthy behaviors in culture and society today is known as apithology, derived from its counterpart pathology, and its findings should ideally find expression in political policies and a flourishing society. The Cultural Health Lab’s inquiries examine the ongoing processes and the governance of a healthy society with the help of technologies and techniques. It focuses on cultural-sensitive approaches to conventional medicine, compares medical systems of various cultures, emphasizes traditional European medicine and enables synergies between the four evolved approaches towards an ecumenism of medicine.

The living body, the conscious self and the social other are key fields of inquiry which form a holistic view that involves the best and sustainable outcomes of all approaches. This enables the recognition of the respective strengths of contemporary science and traditional medicine as well as their mutual support, not only since “the whole is greater than the sum of its parts“ (Aristotle), but also since it is better together.