A. J. Heschel's Vision for the Re-enchantment of Medicine: Possibilities and Limitations
Alan Astrow, M.D., Chief, Division of Hematology/Medical Oncology, New York Methodist Hospital/Weill Cornell Medicine
In 1964, Jewish theologian Abraham Joshua Heschel, was invited to address the annual meeting of the American Medical Association in a program on The Patient as Person. He was joined by psychiatrist William Menninger. The AMA was then a deeply conservative organization dedicated to the defense of physician economic privilege and the choice of Heschel, known as an outspoken liberal critic of the structure and values of contemporary society, was surprising. Heschel did not disappoint. His address was part critique of the crass materialism of American culture, part jeremiad directed at physicians. In this presentation, I will examine Heschel's rhetoric in an attempt to assess whether his language still resonates. Heschel criticized the "nightmare of medical bills, the high arrogance and callousness of the technicians, splitting fees, vested interests in promoting pharmaceutical products, suspicion that the physician is suggesting more surgery than absolutely necessary . . . " He acknowledged Weber's thesis by pointing to modern medicine as another area of modern life suffering from "disenchantment." Pace Weber, however, he did not see this as inexorable, but instead saw disenchantment as the by-product of the conscious choices physicians had made. "The admiration for medical science is increasing, the respect for its practitioners is decreasing," he argued. "The depreciation of the image of the doctor is bound to disseminate disenchantment and to affect the state of medicine itself." He suggested that physicians had succumbed "to the common virus of commercialism--the temptation to make a lot of money" and suggested as remedy "a personal decision to establish a maximum level of income." He advanced a novel theory of public health: "according to my own medical theory," he argued, "more people die of success than of cancer." Still, Heschel had hope; physicians, he believed, had the power to re-enchant medicine and through medicine, all of modern life. "The doctor must realize the supreme nobility of his vocation, to cultivate a taste for the pleasures of the soul," he urged. "The doctor is a major source of moral energy affecting the spiritual texture and substance of the entire society." In this vital task, religion was an essential ally. "To minister to the sick is to minister to God," Heschel stated. "Religion is not the assistant of medicine but the secret of one's passion for medicine." Contemporary physicians might see these assertions as out of touch with current conditions. Heschel spoke to a group of physicians, predominantly white, male, and Christian, and largely in solo practice. They were highly respected in their communities, their authority unquestioned and incomes relatively secure. Today, physicians are no longer on the sort of pedestal that Heschel described. Physicians are increasingly employed, with practice tightly overseen and fees regulated. Increasing numbers of Americans consider themselves consider themselves "spiritual but not religious." Still some large hospital systems have seen the need to adopt credos, offering tacit support to Heschel's claim that a physician's "commitments" matter, and suggesting the need to explore the source of those commitments if medicine is to regain its stature.
In 1964, Jewish theologian Abraham Joshua Heschel, was invited to address the annual meeting of the American Medical Association in a program on The Patient as Person. He was joined by psychiatrist William Menninger. The AMA was then a deeply conservative organization dedicated to the defense of physician economic privilege and the choice of Heschel, known as an outspoken liberal critic of the structure and values of contemporary society, was surprising. Heschel did not disappoint. His address was part critique of the crass materialism of American culture, part jeremiad directed at physicians. In this presentation, I will examine Heschel's rhetoric in an attempt to assess whether his language still resonates. Heschel criticized the "nightmare of medical bills, the high arrogance and callousness of the technicians, splitting fees, vested interests in promoting pharmaceutical products, suspicion that the physician is suggesting more surgery than absolutely necessary . . . " He acknowledged Weber's thesis by pointing to modern medicine as another area of modern life suffering from "disenchantment." Pace Weber, however, he did not see this as inexorable, but instead saw disenchantment as the by-product of the conscious choices physicians had made. "The admiration for medical science is increasing, the respect for its practitioners is decreasing," he argued. "The depreciation of the image of the doctor is bound to disseminate disenchantment and to affect the state of medicine itself." He suggested that physicians had succumbed "to the common virus of commercialism--the temptation to make a lot of money" and suggested as remedy "a personal decision to establish a maximum level of income." He advanced a novel theory of public health: "according to my own medical theory," he argued, "more people die of success than of cancer." Still, Heschel had hope; physicians, he believed, had the power to re-enchant medicine and through medicine, all of modern life. "The doctor must realize the supreme nobility of his vocation, to cultivate a taste for the pleasures of the soul," he urged. "The doctor is a major source of moral energy affecting the spiritual texture and substance of the entire society." In this vital task, religion was an essential ally. "To minister to the sick is to minister to God," Heschel stated. "Religion is not the assistant of medicine but the secret of one's passion for medicine." Contemporary physicians might see these assertions as out of touch with current conditions. Heschel spoke to a group of physicians, predominantly white, male, and Christian, and largely in solo practice. They were highly respected in their communities, their authority unquestioned and incomes relatively secure. Today, physicians are no longer on the sort of pedestal that Heschel described. Physicians are increasingly employed, with practice tightly overseen and fees regulated. Increasing numbers of Americans consider themselves consider themselves "spiritual but not religious." Still some large hospital systems have seen the need to adopt credos, offering tacit support to Heschel's claim that a physician's "commitments" matter, and suggesting the need to explore the source of those commitments if medicine is to regain its stature.