In the previous thesis, we saw some of the many ways that civilization has been catastrophic for human health: the introduction of epidemic disease, the promotion of a diet utterly divorced from the expectations–or even abilities–of human digestion, and the adoption of a generally unhealthy, maladaptive lifestyle turned civilization into a Pandora’s Box of horrors unleashed on the human race. If that is the case, though, then, like Pandora’s Box, civilization also offers hope to deal with all of those terrible afflictions, in the form of medicine. Interestingly, the Cherokee tell a similar story, wherein the plants take pity on humans and give them medicine. That in itself gives the lie to the terrible trick played on us; though we have more than paid for it in diseases and generally terrible health, the hope we have thus bought is universal among all human cultures. Every culture has its own ethnomedicine–and though our afflictions are greater, our medicine is not proportionally more powerful.
This is not to say that Western biomedicine is ineffective in the least. The very fact that it is powerful enough to sufficiently balance the disastrous health effects of civilization and not only keep us alive, but even allow us to live nearly as long as the natural human lifespan is a great testimony to it. That said, we have also often over-valued its contribution. In thesis #16, we discussed the great hygenic efforts of the early twentieth century to clean up the cities, and how that medical victory led to the rise of polio. Then, another medical victory was won with the polio vaccine, but there is some evidence to suggest that that victory may have created AIDS. No medicine is 100% effective–not even ours. Any doctor can tell you a series of terrible stories of patients they could do nothing for. Our pharmaceuticals, as powerful as they are, still owe most of their effectiveness to the placebo effect. For all the diseases our medicine has cured, they are more often cured by our own bodies–or they simply run their course. For all the strides we have made, Western biomedicine has–and will always have–its limitations.
Some of those limitations are systemic. There is a growing awareness, even among the professional practitioners of Western biomedicine, that the Cartesian duality of mind and body is very misplaced. The brain is an organ like any other, and its operation is as integrally tied to the condition of the body as the operation of the heart or liver. Though many quarters have been resistant to the notion, the natural implication of this contention is that psychological is basically a biological phenomenon, like heart rate or the immune response. Given the deep, indivisible interrelationships between all the regions of the brain, and the brain with the body as a whole, it should not be at all surprising that the brain can also have an effect on the condition of the body, just as the body forms the conditon of the brain. That is to say, because Descartes’ duality of body and mind is no longer defensible, we should not be surprised that our psychology impacts our physical health–as the objection to such notions has always been a reiteration of such disproven Cartesian duality.
Evolution has not left us without a certain ability to see to our own health, and as any medical student knows, the human body is replete with any number of systems to fight infection and disease, ease symptoms, or simply kill the pain. When the brain expects to be cured, that becomes something of a self-fulfilling prophecy, as the brain activates those systems. This is what we call the placebo effect, and it is probably the single most powerful force in any medicine. The reverse is also true; believing ourselves ill can have observable, negative, physical effects, too. This is called a nocebo effect, but the division is largely arbitrary, based on our perceptions of “good” and “bad”; in both cases, the body’s own, internal systems work to match one’s health to the expectations in one’s mind.
This has led to the distinction adopted by many medical organizations, including WHO, of “illness” and “disease.” Marshall Marinker’s distinction is still the most generally accepted form:
Disease … is a pathological process, most often physical as in throat infection, or cancer of the bronchus, sometimes undetermined in origin, as in schizophrenia. The quality which identifies disease is some deviation from a biological norm. There is an objectivity about disease which doctors are able to see, touch, measure, smell. Diseases are valued as the central facts in the medical view…
Illness … is a feeling, an experience of unhealth which is entirely personal, interior to the person of the patient. Often it accompanies disease, but the disease may be undeclared, as in the early stages of cancer or tuberculosis or diabetes. Sometimes illness exists where no disease can be found. Traditional medical education has made the deafening silence of illness-in-the-absence-of-disease unbearable to the clinician. The patient can offer the doctor nothing to satisfy his senses…
Sickness … is the external and public mode of unhealth. Sickness is a social role, a status, a negotiated position in the world, a bargain struck between the person henceforward called ‘sick’, and a society which is prepared to recognise and sustain him. The security of this role depends on a number of factors, not least the possession of that much treasured gift, the disease. Sickness based on illness alone is a most uncertain status. But even the possession of disease does not guarantee equity in sickness. Those with a chronic disease are much less secure than those with an acute one; those with a psychiatric disease than those with a surgical one … . Best is an acute physical disease in a young man quickly determined by recovery or death—either will do, both are equally regarded.
Western biomedicine, with its historical basis in the naturalism of Hippocrates, and later Cartesian dualism, has excelled in the treatment of disease, but has been utterly abysmal in its treatment of either illness or sickness. This emphasis has led to a maligning of the single most powerful healing effect we have ever found, the placebo effect. We speak of something as “just a placebo,” and when someone recovers by placebo, they believe there was never any physically wrong with them in the first place if, after all, it was “all in my head.” This laser-like focus on only one dimension of health has made Western biomedicine myopic, and constitutes its single greatest institutional limitation.
Western biomedicine is an ethnomedicine, comparable to other ethnomedicines. The fact that it is our ethnomedicine means we believe it a priori to be more effective than all other ethnomedicines, which are only superstitous mumbo-jumbo. Of course, other cultures say the same of us. This is merely an expression of ethnocentrism–an evolutionarily adaptive attitude to hold, but not necessarily related to reality in any way.
Where Western biomedicine tries to eliminate the placebo effect, most traditional ethnomedicines are built around enhancing the effect. They spend more time treating illness and sickness, and thus are usually less effective at treating disease. Overall, though, the effectiveness of other ethnomedicines remains roughly comparable to our own, more specialized variety. For example, Michael Winkelmann makes a strong case in Shamanism: Tne Neural Ecology of Ecstasy and Healing that shamanism helps to activate and enhance the body’s natural healing systems. He revisits many of those same arguments in his 2002 paper for American Behavioral Scientist, “Shamanism as Neurotheology and Evolutionary Psychology,” [PDF] where he writes:
Shamanic ASCs [altered states of consciousness] and their slow-wave synchronization patterns activate functions of the paleomammalian brain involving self, attachments, and emotions. Shamanic cognitive capacities based in presentational symbolism, metaphor, analogy, and mimesis express the dynamics of the lower brain systems and provide a medium for ritual and symbolic manipulation of these systems. These physiological aspects of ASCs facilitate healing and psychological and physiological well-being through physiological relaxation; facilitating self-regulation of physiological processes; reducing tension, anxiety, and phobic reactions; manipulating psychosomatic effects; accessing unconscious information in visual symbolism and analogical representations; inducing interhemispheric fusion and synchronization; and facilitating cognitive-emotional integration and social bonding and affiliation. The neuroendocrine mechanisms of meditation indicate that stress reduction also occurs through enhancement of serotonin functioning and stimulation of theta brain wave production.
While shamanic healing differs from Western biomedicine in its emphasis on–rather than its shunning of–the placebo effect, neither is this the entirety of ethnomedicine. While these methods are extremely effective at treating illness and sickness, and are far more effective even at treating disease than we normally give them credit for, most traditional ethnomedicines also have more directly physical means of treating disease.
Perhaps the most impressive example would be the archaeological evidence that foragers in the Mesolithic successfully performed brain surgery. The procedure, called trepanation, involves boring a hole in the skull, and is often effective to treat head trauma or pressure. A news brief in Archaeology magazine described one such discovery:
New accelerator radiocarbon dating of the Dnieper Rapids cemeteries near Kiev in Ukraine by the Oxford Radiocarbon Laboratory has produced evidence that trepanation, the surgical removal of bone from the cranial vault, was performed during the Mesolithic period. During a study of 14 individuals at the Vasilyevka II cemetery, Malcolm C. Lillie, a geoarchaeologist and palaeoenvironmentalist at the University of Hull, found one skeleton (no. 6285-9) to have evidence of trepanation. The cemetery, excavated in 1953 by A.D. Stolyar, has been dated to 7300-6220 B.C., making the trepanned cranium the oldest known example of a healed trepanation yet discovered. The skull, which was originally reported in Russian by I.I. Gokhman in 1966, has a depression on its left side with a raised border of bone and “stepping” in the center showing stages of healing during life. The complete closure indicates the survival of the patient, a man who was more than 50 years old at his death. The dates for the individual are 1,000-2,000 years earlier than those of the skull at Ensisheim in France, recently reported by Kurt Alt to be the earliest evidence for trepanation.
Today, trepanation is still done around the world and with great success by many primitive peoples, including the Gusii and the Tende from the hills east of Lake Victoria.
There is also an interesting point that, having past its point of diminishing returns (see thesis #15), medical research is increasingly relying on ethnobotanical knowledge of medicinal plants for drug development, by isolating the active compounds in traditional remedies used by shamans for millennia. Perhaps the single most effective drug ever developed by Western biomedicine is aspirin–originally isolated from willow bark, a remedy for headaches used by Native Americans as much as by Hippocrates in the fifth century BCE. One pharmaceutical company built on this premise, “Shaman Pharmaceuticals,” explains its rationale thus:
Tropical forest plant species have served as a source of medicines for people of the tropics for millennia. Many medical practitioners with training in pharmacology and/or pharmacognosy are well aware of the number of modern therapeutic agents that have been derived from tropical forest species. In fact, over 120 pharmaceutical products currently in use are plant-derived, and some 75% of these were discovered by examining the use of these plants in traditional medicine. … Yet while many modern medicines are plant-derived, the origins of these pharmaceutical agents and their relationship to the knowledge of the indigenous people in the tropical forests is usually omitted.
In both of these cases, traditional medical knowledge is often rejected on the basis of the religio-philosophical frame it is placed in. When shamans speak of good or evil spirits, Western researchers usually stop listening. This neglects the fact that shamanic knowledge usually operates on multiple, simultaneous levels, and they are usually fully aware of the physical level. For instance, one example of shamanic “fraud” often cited is the practice of some shamans to spit out rolled up plants and tell the patient that they are the evil spirits sucked out of his body. In fact, the shaman placed those plants in his mouth prior to the ritual and hid them there. This is often cited as an example of shamans as charlatans, but it actually fits in well with the shamanic worldview. The plants hold the same spirit that is being sucked out of the patient–the shaman holds them in his mouth to “catch” the spirit so he does not become infected himself. When they are spat out, the shaman indicates that they are the evil spirits–and to him, they are: the evil spirits were trapped inside of them. This display prompts a stronger placebo effect, and is not in the least bit deceitful from the shamanic worldview.
Under this same notion of disease coming from invasive evil spirits, we have a means for shamans to memorize ethnobotanical information. By placing plants and diseases into a mythic context, the shaman can keep a full medical library in his memory using the same mnemonic tricks that help astronomers keep track of the stars by reference to a full mythology of constellations. It is also interesting to ponder the strange similarities between “evil spirits” and germs: neither can be seen, both invade our body, both have “good” analogues that actually help us; both make us sick by the way they seek to use our bodies; both can be driven out by ourselves, or by introducing new elements to fight them. The distinction between germ theory and the superstitions of “evil spirits,” in that regard, seems to become little more than insistence that another culture express one’s same ideas in the same, mechanistic terms.
Every culture believes its own ethnomedicine to be the only valid one. Every ethnomedicine is based in a given view of the world, a given understanding of human nature and the world. Each culture’s ethnomedicine is based in that. The inustrialized West sees the world as a physical clockwork mechanism, and though we can easily recognize the fallacious cornerstones of other cultures’ worldviews, we are blind to our own, such as the bankruptcy of Cartesian dualism. Our ethnomedicine–Western biomedicine–is based in our worldview. We see other ethnomedicines as superstitious poppycock, because they are not based in our mechanistic worldview. They are based in the worldview of the culture they come from–in the case of foragers, that is usually an animistic worldview. Yet, we cannot deny their effectiveness, even as they cannot deny ours–even when we can’t explain that effectiveness (and when they can’t explain ours).
In the final analysis, the effectiveness of Western biomedicine has been greatly exaggerated and its limitations conveniently forgotten, while traditional ethnomedicines have been denigrated. A correction for these problems reveals that our ethnomedicine, while unique in many ways, by no means has a monopoly on medical knowledge or effectiveness. In fact, though an overall comparison is difficult, most ethnomedicines fall within a fairly narrow general range of effectiveness. Even our own does not significantly outclass the others, while there is a minimum effectiveness required to keep a society competitive.
Thus, the protest that civilization improves our health is utterly without merit. The overall effect of civilization on human health has been disastrous, introducing innumerable diseases and maladies unknown before. A more nuanced argument cites a “Pandora’s Box”: civilization has unleashed these terrible diseases on the world, and we cannot rewind time to undo the damage. We need civilization now to produce the medicines necessary to combat the diseases civilization unleashed. But, as we have seen here, that is not the case, either. Most of those diseases are the effects of the civilized lifestyle, and would be cured as a consequence of rewilding. Of those that remain, their ability to sweep across the world as an epidemic would be greatly reduced in a world of small, nomadic bands. And finally, as we have seen above, every culture–civilized or not–has medicine. Other forms of medicne tend to be less specialized in treating disease only, and instead also treat illness and sickness, but none of them are much more effective than any other, including our own. Our ability to treat disease would not be diminished without civilization, only the means by which we do so. It would mean a shift in emphasis from the dehumanizing, clinical introduction of foreign substances to combat invasive pathogens by an aloof, unquestionable authority to a method that emphasized communal bonds and deep emotions in a process that helps the patient take control of his own illness and, ultimately, empowers him to heal himself.