Excerpted from Dr. Larry Malerba’s new book, Metaphysics & Medicine: Restoring Freedom of Thought to the Art and Science of Healing.
We have to conclude that science did not start from experience; it started by arguing against experience and it survived by regarding experience as a chimera.
–Paul Feyerabend, The Tyranny of Science
The definition of conventional medicalempiricismhas never made much sense to me. But then one day it dawned on me. Having practiced an empirical form of holistic medicine (homeopathy) for many years, I naturally assumed empiricism to be something that it is not, at least not in the eyes of most mainstream scientists and physicians. It turns out that empiricismtakes on different meanings depending upon how you look at it.
Even among contemporary thinkers, there seems to be significant disagreements as to what is meant by the wordempiricism. Upon close scrutiny, empiricism and empiricalareambiguous terms that tend to suit the needs of those who employ them. Suffice it to say, there is a great deal of confusion regarding the topic.
One popular definition of science goes something like this: science is a systematic method of testing hypotheses against empirical evidence obtained by observation. Very few if any scientists would dispute this characterization. They believe science to be an empirical method of observation and experiment. Confusion, however, can arise from what is meant by empirical. It is my contention that modern medical science no longer adheres to its own definition of empiricism.Neither is it aware of this internal inconsistencyregarding such an important component of scientific discovery.
Historically speaking, empiricism was a philosophy debated among many intellectuals, most notably philosophers of the 18th century Enlightenment. John Locke, George Berkeley, and David Hume were the primary exponents of empiricism, a theory of knowledge that placed greater emphasis on knowledge gained from experience as opposed to the ideas produced through reason. Empiricism was often contrasted to, and believed to be in conflict with, rationalism.
The rationalism of Rene Descartes, on the other hand, set reason above and apart from all other faculties. The thinking power of the mind was assumed to be superior to feeling, sensing, intuiting, and spiritual experience. All forms of experience were not to be trusted. Even the senses of touch, smell, hearing, taste, and sight were considered unreliable and potentially deceptive.
This is more than a bit ironic since science prides itself on its empirical methods of evidence gathering. Empirical evidence is supposed to be unambiguous because it is directly perceived by the senses. Empirical knowledge is knowledge based upon observation and experience rather than theory or logic. Nevertheless, the Cartesian thesis that the rational function trumps all has gone unchallenged within scientific circles for centuries.
History reveals that there was an ancient faction of Greek medical practitioners who called themselvesEmpirics. Physicians of the Empiric school based their treatments on practical experience rather than the rational theories and doctrines of the Dogmatic school of the time.Also known as the Hippocratici, the Dogmatics were followers of Hippocrates and subscribed to the theory of the four humors. This theory of disease is notable for having supplanted a prior belief in the supernatural causes of illness. It put a wedge between medicine and religion and introduced philosophy into medical thinking. Its followers were so enamored of the new rational approach that they attempted to discredit those who were not in agreement. Empirics were labeled quacks because they favored what their experience taught them over the new rational theories. For centuries, most physicians counted themselves as members of one or the other of these ancient medical sects.
Dogmaticsbelieved it was necessary to understand the underlying causes of disease before they could know how to treat disease. They searched for hidden causes by dissecting the body in order to understand its internal workings. Empirics, on the other hand,believed that final, ultimate, or hidden causes are unknowable because it was thought that Nature as a whole will always remain unfathomable. Empirics thought in terms ofevident causes of disease, that which was evident as a result of direct practical experience in treating sick individuals. They focused on their observations of nature, human sickness, and the outcomes of their treatments. Empirics valued empirical outcomes above all else, while the Dogmatic school used logic and reasoning to draw conclusions regarding the origins and treatment of disease.
This philosophical rifthas persisted for hundreds of years and continues even to this day. It comes down to a question of whether physicians should rely more on the lessons learned from first-hand experience or abstract rational theories designed to explain disease and its treatment.This conflict within medicine was understood by Dr. Hahnemann, who did not hide his strong preference for empiricism. He clearly sided with clinical experience and distrusted theories that were not validated by practical outcomes.
So what gives? If the consensus view holds that present-day scientific method is a combination of rational theory, empirical observation, and experimental verification, then why were the Empiric medical practitioners of ancient times disparaged as charlatans? Not surprisingly, the answer lies in how we define empiricism.
A key feature of science is that it depends upon empirical observation.Empiricism is a philosophy of knowledge that emphasizes knowledge gained through experience. But the experiences of Empiric physicians did not qualify as legitimate and somehow made them unscientific quacks, at least according to the opposing medical camp of the day. Dictionary definitions of empiric confirm this truly curious and contradictory assertion. Here are entries from twodifferent sources. The first is from a contemporary dictionary:
Empiric: A person who, in medicine or other branches of science, relies solely on observation and experiment. A quack doctor.13
The second is from a medical dictionary published in 1917:
Empiric: Based on practical observation and not on scientific reasoning. One who in practicing medicine relies solely on experience and not on scientific reasoning. A quack or charlatan.14
The crux of the matter, it turns out, is that the definition of empiricism depends on how we define experience. Empiricism as it is defined by medicine, then and now, is an empiricism of the physical senses—that which can be heard, smelt, felt, tasted, and touched. The Dogmatic or rational school of medicine limited experience to sensory experience. It did not include the contents of mind. It excluded that which most people assume to be the bulk of human experience—consciousness. The conventional notion of empiricism leaves no place for mental experience!
The irony, of course, is that there would be no science at all without conscious human participation, without activities of the mind. It seems as if we have exposed a particularly bold deception in the way that scientific method is portrayed. It claims to be empirical but rejects that other version of medical empiricism by defining empiricism in its own materialist terms. The only experience that counts, therefore, is objective sensory experience of the physical objects that constitute the material universe. Here, we find a remarkable inconsistency in that the historical antecedents of holistic practitioners were derogatorily called Empirics, while medicine simultaneously claimed and continues to claim that its methodology is empirical.
There is yet another problem inherent in this awkward and contradictory characterization of medical empiricism. If conventional medical empiricism is based on observations of physical objects made by the human senses, then how do we account for the notion that sensory experience is, first and foremost, subjective in nature? After all, people often perceive the same object quite differently. And, need we be reminded that the most ubiquitous and important dimension of human illness, pain itself, is a highly subjective phenomenon?
How is it possible, then, that medicine would consider sensory experience legitimate while dismissing mental experience as unreliably subjective? In another twist of rational license, medical science contends that sensory experience has two separate aspects—subjectivecomponents, which it claims to be untrustworthy, and objective components, which are thought to be more reliable. In accordance with this dualistic perspective, medicine splits our experience of the world into two—the objective, which is real, tangible, reliable, and measurable, and the subjective, which is illusory, immaterial, unreliable, and unquantifiable. Medical science believes that empiricism applies only to the so-called objective dimension of sensory experience.
What, then, is objective sensation? As per conventional science, it refers to the anatomical and quantifiable components associated with our subjective sensory experiences. Visual experience becomes concrete, objective, and scientifically permissible when it is spoken of in terms of structures of the eye and areas of the brain that interpret neural impulses coming from the eye. Subjective phenomena like color, shape, texture, depth, and movement become rods, cones, pupils, corneas, optic nerves, visual cortexes, and electroencephalogram readings. Likewise, the perception of subjective auditory phenomena like pitch, loudness, and timbre are reconstituted as tympanic membranes, ossicles, auditory nerves, and sound wave amplitudes and frequencies.
The universal dimension of personal experienceis excluded because it does not qualify as empirical evidence, thereby rendering it virtually irrelevant when it comes to scientific deliberation. Medicinerejects personal experience, redefining and objectifying itto conform to itsway of thinking in order to make it more scientifically acceptable. This self-fulfilling methodology reinforcesmedicine’s erroneous presuppositions regarding the nature of health and disease.
Let us return now to our definitions of an Empiric physician. It is stated that an Empiric is one who relies “solely on experience,” “solely on observation and experiment,” and “not on scientific reasoning.” Thisseems to contradict our understanding of scientific method. It seems to be saying that science is not science without abstract theories, and that a method that involves experience, observation, and experiment cannot be scientific without an accompanying speculative theory to back it up. One can get twisted up in knots trying to make sense of such contradictory double-talk.
It is my belief that this illogical claim to scientific logic is nothing more than ancient medical politics carried down through the ages. This medical war between Empirics, who were the analogs of modern day holistic practitioners, and Dogmatics, who were the predecessors of contemporary proponents of mainstream rational medicine, has been going on for generations. One camp relies primarily on empirical observations made from the trial and error treatments of its patients, while the other occupies itself with theoretical causes and rational explanations of disease.
The rational school, which puts most of the emphasis on logicand theory, has maintained dominance over time not because of the superiority of its methodology, but primarily through persuasion, politics, and power. There is something deceptively appealing about a person’s ability to engage in logical argument, polemics, and sophistry. It impresses people even though it says little about the knowledge, experience, wisdom, or rightness of a person’s position.
The knock against Empiric physicians was that they relied solelyon experience and did not use reason while treating patients. This is patently absurd. Empiric physicians used their rational faculties to draw conclusions from the outcomes of their treatments and used that information to amend their practices over time. After all, that is the very nature of trial and error. This also did not preclude them from formulating ideas regarding the nature of illness and its cure. What they did not condone was the notion that theory should trump concrete results. To adhere to a theory of disease in the face of evidence to the contrary would amount to ideological foolishness—like repeatedly subjecting a sick patient to bloodletting while the life drains out of him over time.
This is the same rationale that justifies contemporary medicine’s bias against most holistictherapies. When alternative systems of healing do not see eye to eye with conventional medical principles, it is believed that they must be based on faulty premises. They are sometimes accused of defying the laws of biochemistry, physiology, and even physics. Holistic practitioners respond to skeptics by asking that they suspend their judgment and preconceptions in order toexamine the results and listen to reports of patients who have undergone holistic treatment.
It is untrue that most empirically oriented therapies do not have theory, knowledge of disease, or reasoning to back them up. The realityis that Empirics were vilified because they disagreed with the theories and methods of the medical establishment—and the samedysfunctional dynamic between alternative and mainstream medicine holds true to this day. The historical lesson is that medical science is not considered science unless it conforms to the prevailing theories of the time.
In my mind, it should be the other way around. It is foolish to adhere to a theory in the face of experience that tells us otherwise. Furthermore, it is an illusion to believe that one camp should prevail over the other, as if there is no place for cooperation. It is far more reasonable to conclude that some medical problemsare amenable to one approach,other situations respond best to the other, and many require both. Absolute reliance upon one philosophy—empiricism or rationalism—is an exaggeration perpetuated by politically polarized camps.
The scientific definition of empiricism quickly falls apart under careful scrutiny. It is a product of several tricks of logic designed to give an appearance of congruency to the internal inconsistencies inherent in modern medical science’s conception of itself. It adheres to materialistic principles by excluding mental phenomena. In order to remain objective it excludes the subjective dimension of sensation. By defining sensation in terms of anatomical parts, it remains consistent with reductionism. And the overall logic of empiricism itself is a testament to rationalism at its abstract best (or worst).
It is troubling that modern medicine thinks it can heal illness without considering the role of consciousness. It was philosopher and psychologist, William James, who proposed a new, more radical empiricism that included the contents of consciousness. Modern empiricism, if it is to be redeemed, must be expanded to include both the subjective and the objective. We must return to a more humane understanding of experience that includes the contents of mind.