The Cartesian melodrama in nursing
quoted from: Nursing Philosophy, 3 (2002), pp. 189–192
A recent book on Descartes observes that he is quite possibly the most reviled philosopher in history. No other thinker ‘has had such a bad press for so long [or] . . . been the object . . . of such vituperative criticism’ (Bracken 2002, p. 110). The hostility got started early, with the Jesuits prominent during the seventeenth century and has continued, more or less unabated, to the present day. Even the current Pope has taken a swing at Descartes, blaming him for . . . well, pretty much everything that has gone wrong in the western world since about 1640 (John Paul II, 1994). As Bracken wryly notes, little has changed in over 350 years. The arguments are much the same, and there is still a tendency to attack Descartes without first bothering to read him. As a consequence, he comes over as the philosophical equivalent of a James Bond villain (actually, in one painting, he bears an uncanny resemblance to Robert Carlyle): someone quite clearly up to no good, and obviously intent on world domination.
This picture of Descartes is especially characteristic of the health care literature. Cartesian dualism is said to ‘underpin’ the ‘medical model’, and it is often claimed that the impact of Descartes’ philosophy on medicine was immediate and profound. The fact that these claims are contradicted by the historical evidence (Brown, 1985) has not prevented regular appeals to the idea that modern medicine remains, in essence, ‘Cartesian’. In nursing, this idea is normally associated with the view that there is something intrinsically dehumanizing and reductionist about the ‘Cartesian’ perspective because the implication of separating mind from body is that the patient comes to be regarded merely as a biological mechanism. One consequence of this line of thought during the past 20 years is that a lot of nursing theory has been almost aggressively antidualist, antiCartesian, and therefore (in effect) antimedicine. As with positivism, Cartesianism is now known to be a Bad Thing. It represents an easy and uncontroversial target, so criticizing it is safe (and guarantees an appreciative audience). Open any academic nursing journal, and it quickly becomes apparent that Descartes-bashing is the new rock ’n’ roll.
There is, of course, a small paradox in all of this. If the hostility to Descartes has been so widespread for so long, in what sense has he been influential? How can it be said that Cartesianism permeates the modern world if virtually no-one has had a good word to say about it? To take one obvious example, mind/body dualism never caught on, and for three centuries it has been dismissed by the vast majority of philosophers who have considered it. So why is it routinely assumed to be the ‘traditional’ view? Is it possible that Descartes could somehow have influenced ‘the common man’ (a familiar figure, once upon a time, in analytic philosophy), even though ‘intellectuals’ were queuing up to refute him? Did the idea that there were two forms of substance, one material and the other immaterial, somehow seep into western culture, like a disease poisoning the water supply, while philosophers, physicists and biologists were all looking the other way? How exactly is that supposed to have happened? Anyone taking this line has got an awful lot of explaining to do.
The matter is complicated by the observation that what we call ‘Cartesianism’ has very little to do with Descartes (or perhaps it’s the other way round). Marx famously claimed that he was not a Marxist, and Descartes could certainly have echoed him: ‘je ne suis pas Cartesien’. The number of historical and philosophical studies that can now be cited in support of this view – that ‘Cartesian’ ideas do not reflect Descartes’ own position – has grown so large that philosophers have taken to putting ‘Cartesianism’ in inverted commas in order to acknowledge the discrepancy (Schatzki, 2000). For one thing, Descartes may have been a dualist, but he was not a dualist in anything like the sense usually ascribed to him. He did not, for example, believe that mind and body are ‘separate’; and what he means by ‘mind’ does not include such things as emotion, pain, images, sensations, or even memories. All of these are features of the mental landscape, according to ‘traditional Cartesianism’; but for Descartes himself, they belong to the realm of the body (Baker & Morris, 1996; Sutton, 1998). So reflex assumptions about the nature of mind/body dualism, or the version of it that can be attributed to Descartes, have to be revised, fairly radically.
At one level, of course, this might seem a trivial point. Okay, Descartes isn’t a Cartesian. So what? ‘Cartesianism’ is still a coherent set of views, and is still worth criticizing, even if Descartes holds few, if any, of the views in question. But this claim is, itself, a bit odd. If Descartes isn’t a Cartesian, who is? Who has been? It’s rather difficult to say, since (as I noted earlier) the general line on ‘Cartesian’ views has been kick-ass rebuttal, rather than enthusiastic welcome. And if that’s right . . . why on earth is so much time spent arguing against a position no-one believes a word of? A position which, so the evidence suggests, no-one who counts ever has believed a word of? All right, I exaggerate; but not by much. The key question remains: why does anyone bother? We are back to the small paradox. Only now it is a little bigger.
I suspect that there is more than one answer to the ‘Why bother?’ question; but let me quickly sketch a possible answer to the question of why nurses, specifically, bother. Putting my cards immediately on the table, I think the reason has to do with displacement. When nurses attack ‘Cartesian dualism’, what they are really attacking is materialism, mechanism, physicalism, or whatever you want to call the view that there is nothing in the world other than physical matter. In fact, the deep irony is that many of the writers who represent themselves as vehemently opposed to dualism are, actually, dualists themselves. The last thing they want to do, I would say, is undermine the idea that there are two types of substance –mind and body – because abandoning this idea leads inevitably to the conclusion that there is only one type of substance (which is going to be matter, not mind). That result, in their view, has precisely the dehumanizing consequences they attribute to ‘Cartesianism’: people are just slabs of meat. What they want to do instead is bring the mind (or the soul, or the spirit) back in. Their concern is that science, in the form of the ‘medical model’, has left something important out, and their main purpose is to retrieve it. Attacking ‘Cartesianism’ is the method of choice.
Now more slowly. In the nursing literature, the most popular way of describing ‘Cartesian dualism’ is to say that it means the ‘separation’ of mind and body.I used to think that this was just an imprecise way of putting it. The point is (I would have said) that, on the ‘Cartesian’ view, mind and body are two radically different types of thing. ‘Separation’ is not the issue; and, in fact, it is perfectly consistent to say that, in human beings, these two distinct substances are conjoined in such a way that ‘separation’ is impossible. (As it happens, this is more or less what Descartes thought.) But I now realize that, for some nurses, ‘separation’ is the issue. The ‘dualism’ they oppose is a dualism which ‘separates’ mind and body . . . and then leaves mind out of the picture. This is something we might call ‘methodological dualism’ (dualismm) because it says that, for all practical purposes, it’s okay to ignore the mind. And ignoring the mind is just what the ‘medical model’, inspired by ‘Cartesianism’, is accused of doing.
Crucially, however, it is possible to oppose dualismm, and still adopt ontological dualism (dualism°), the view that mind and body are radically heterogeneous types of stuff. Indeed, it looks to me as if this is precisely the position that many nurses want to adopt. They think that the mind is something different from the body (dualism°); but they also think that Cartesianism, in the guise of medical science, ignores ‘the mind and the mental’, pushing them beyond the horizon of health care practice (dualismm). This is why, for example, some of the writers who most passionately resist dualismm, the methodological form, can simultaneously appeal to concepts such as ‘mindbodyspirit’, and talk with a straight face about the mind’s ‘transcendence’.
For many of those who think along these lines, opposing dualism° (as distinct from dualismm) is just not an option. For what would that entail? Well, presumably, if there are not two heterogeneous types of substance, then there can only be one (unless you get really trigger-happy and start proliferating). And this one type of substance is inevitably going to be physical matter, not mind (unless you find out-and-out idealism attractive, in which case I would recommend a more tranquil environment). Virtually all contemporary philosophers are happy with this idea, of course. For it is a striking fact that every postwar philosophy of mind – behaviourism, the identity thesis, machine functionalism, eliminativism – is a variation on the theme of materialism. Essentially, the point is not whether mind is something which transcends physical states and processes – the vast majority of philosophers are agreed that it isn’t – but exactly how this lack of transcendence can be construed.
It is a question, in other words, of trying to understand what the mind is, using only the resources of physics, biology, cognitive science, and so on. This is postwar philosophy’s radical form of ‘antidualism’ (where the dualism concerned is dualism °), but my very strong impression is that most of nursing’s ‘antidualists’ (dualismm) would reject it. For it would again imply (from their perspective, at least) the human-beings-as-slabs-of-meat scenario. On any physicalist view, the mind is, ontologically, just one form that physical matter happens to take; and the apparent consequence of this is that human beings can be regarded simply as ‘machines’. I would think that any writer who opposes the ‘separation’ of mind and body (dualismm) is very likely to oppose radical physicalism – and for pretty much the same reasons. One might ask why nurses don’t simply attack physicalism, instead of directing their fire at ‘Cartesian dualism’. Conceivably, this is about safety in numbers. If you confront physicalism, you are pitting yourself against, not just a massive philosophical orthodoxy, but also a highly sophisticated network of arguments and counter-arguments. If you aim at ‘Cartesian dualism’, however, it looks as if you are just doing what comes naturally (everyone opposes ‘Cartesian dualism’, including physicalists). But in this case, of course, your antiphysicalist strategy turns on fudging the difference between dualismm and dualism°.
There is a final double-irony in all this. First, nursing authors resist the ‘separation’ of mind and body, which they attribute to Descartes (via ‘Cartesianism’). But what they mean by ‘mind’ includes things like feelings, sensations, and emotions – which Descartes assigned to the corporeal, not the mental. So all those characteristics of the ‘person’ which nurses want to see holistically reintegrated with the body, Descartes never took away in the first place. Second, however, in seeing Descartes as the prototypical mechanist, nurses have got it right (like the Jesuits before them). For in failing to ‘separate’ sensations, feelings and emotions from the body, Descartes was announcing that these person characteristics could be studied in purely physicalist (that is, physiological) terms. In this respect, too, Descartes contrives to be something other than a ‘Cartesian’.
The Cartesian melodrama in nursing, as in a number of other disciplines, involves an impressive series of translations and displacements. Most attacks on Descartes are really attacks on ‘Cartesian dualism’, which is different. Most attacks on ‘Cartesian dualism’ are really attacks on methodological dualism, which is different. Most attacks on methodological dualism are really attacks on physicalism, which is different. And most attacks on physicalism can, strangely, be referred back to Descartes. It’s a funny old world.
John Paley, University of Stirling
Baker G. & Morris K.J. (1996) Descartes’ Dualism. Routledge, London.
Bracken H.M. (2002) Descartes. Oneworld, Oxford.
Brown T.M. (1985) Descartes, dualism, and psychosomatic medicine. In: The Anatomy of Madness,Vol. 1 (ed.W. Bynum), pp. 40–62. Tavistock Press, London.
John Paul II. (1994) Crossing the Threshold of Hope. Knopf, New York.
Schatzki T.R. (2000) Coping with others with folk psychology. In: Heidegger, Coping, and Cognitive Science: Essays in Honour of Hubert L. Dreyfus,Vol. 2 (eds M. Wrathall & J. Malpas), pp. 29–51.The MIT Press, Cambridge, MA.
Sutton J. (1998) Philosophy and Memory Traces: Descartes to Connectionism. Cambridge University Press, Cambridge, UK.
© Blackwell Science Ltd 2002 Nursing Philosophy, 3, pp. 189–192