Part and Whole: A Reading of Care in Plato’s Dialogues

Abstract

The ancient Greek word therapeia originally means service and care (even a religious one) for another person or treatment of the body and soul. In the dialogues of the ancient philosopher Plato, this term has meanings of caring for the soul, idea which participates to truth and justice, intervention on the relationship between the part and the whole, persuasion in the direction of the community’s values. We followed the meanings the term therapeia takes across Plato’s dialogues and how they can be relevant to contemporary bioethics. In Plato’s dialogues, care represents an endeavor far richer in significance than the purely isolated, physical and individualistic medical intervention. This considers the relationship part-whole and speaks about the connection between the individual, his/her soul, the community and values. A different reading of ethical attitudes from the very root of the medical profession, by means of the ancient philosopher, can inspire a change in medical practice itself.

 

Tablet of Contents:

1. Introduction

2. Ancient terminology

3. The main questions

4. Examples in the dialogues

5. Conclusion

1. Introduction

Plato often mentions medicine in his Dialogues. He uses medicine as a metaphor [1], as an analogy for philosophy [2], an example of privileged practice [3], a craftmanship (he techné) sometimes despicable, sometimes respectable, a discourse that seems to match the evolution of his famous Theory of Forms. Some recent works stated that Plato had a rivalry with medicine [4] and that his opinion changed from disdain to praise and then back to reconciliation. There is also some degree of uncertainty with respect to the type of care one receives in the so-called medical context, the type of illness, the means of cure and the characteristics of the doctor-patient relationship.

Concerning bioethics, the discussion in contemporary medical ethics unfolds mostly around the normative model developed by Beauchamp and Childress regarding its four main principles: respect for autonomy, nonmaleficence, beneficence and justice [5]. We are aware that these were meant to simplify the normative framework traditionally built around Kantian deontology, utilitarianism and virtue theory [6]. However, all four of the principles are conceptually dependent of a certain type of medical intervention and doctor-patient relationship [7]. They also contain, in themselves, a certain way of thinking about human biology, which is seen as a mere physical body and not as a souled body [8]. Even when deeper connections with other psychological variables are made, like adult doctors’ attachment styles, the model used is still positivistic [9, 10]. So, when considering Plato as a source of some new understanding about medical ethics, we must consider the fact that contemporary bioethics is tributary to a very precise and limiting set of meanings. For instance, in standard English, patient as noun means a person receiving or registered to receive medical treatment [11]. In this understanding, medical means something quite precise.

It was not the case in Plato’s time. Therefore, his understanding about medical ethics might also broaden our view. This is what we are trying to argue.

 

2. Ancient terminology

For Plato, the intervention or he therapeia is a concept far broader in significance than the purely individualistic and physical action [12]. The word means, at his origin, care for another (including a religious one) or treatment of a boy and his soul [13]. In Plato’s Dialogues, we can detect, for this term, meanings like care for the soul [14], an entity which participates to the form of Truth and Justice [15], an intervention on the relationship between the part and whole [16], persuasion for the community’s values [17] etc.

Plato, himself, when discussing about someone who can be construed as a medical patient, uses a form of the verb kámno [18, 19]. The word means to work, win by toil, labor, toil, to be weary, to be sick, to be suffering, to be distressed [20]. In the Republic (342d) he says

«neither does any physician in so far as he is a physician seek or enjoin the advantage of the physician but that of the patient? For we have agreed that the physician, “precisely” speaking, is a ruler and governor of bodies and not a moneymaker» [15]. He uses the same term in the Laws (IV.10): «But the free-born doctor is mainly engaged in visiting and treating the ailments of free men, and he does so by investigating them from the commencement and according to the course of nature; he talks with the patient himself and with his friends, and thus both learns about himself from the sufferers and imparts instruction to them, so far as possible» [17].

It follows that there are several elements when dealing with the entities that find themselves in a relationship with therapeia. There is an entity that suffers, is weary of or sick from the effect of some other entity. This suffering, enduring or victimized entity is supposed to be in a relationship with someone who cares for that entity (therapeuei). The care itself (he therapeia) is of a larger nature than what we understand today as medical care [20].

 

3. The main questions

The questions that can be raised about these relationships refer to the relationship among those who are suffering, the type of suffering, those who provide care as well as the type of care. We can ask ourselves what kind of suffering is considered and who are the ones providing care in the platonic writings? What type of care is being considered when Plato speaks about patients? From the interrelationship of these four elements: the sufferer, the suffering, the care provider and the care, the question raised in this paper can be summed as follows: who suffers and who gets care in Plato’s Dialogues?

The stake of this main problem can help to understand Plato’s implicit teachings about what we consider medical ethics, nowadays. The significance of therapeia can broaden what we think about medical ethics today, especially when we take into consideration its deep connection with philosophy. Understanding these elements can lead the way towards valuable teachings for the contemporary medical practice.

 

4. Examples in the dialogues

There is an important example of platonic thinking which comes to us through the voice of Socrates’ character, in Charmides (156d-e). The philosopher indicates the vital relationship between the part and the whole. In an attempt to cure young Charmides’ headache, Socrates explains that one cannot find a cure for the part without finding a cure for the whole: «This Thracian said that the Greeks were right in advising as I told you just now: “but Zalmoxis,” he said, our king, who is a god, says that as you ought not to attempt to cure eyes without head, or head without body, so you should not treat body without soul”; and this was the reason why most illnesses evaded the physicians of Greece, that they neglected the whole, on which they ought to spend their pains, for if this were out of order it was impossible for the part to be in order» [16]. The one providing care is Socrates himself, as one able to strip the soul (154e) of the young and beautiful Charmides. This deep metaphysical connection between the part and the whole is an important element of platonic thinking [1]. Therefore, in this example, the patient is a part of a human being, deeply connected with the soul-body whole.

In Symposium (186b-d), the speech of Eryximachus deals with health with respect to two types of love. «Reverence for my profession prompts me to begin with the witness of medicine.

This double Love belongs to the nature of all bodies: for between bodily health and sickness there is an admitted difference or dissimilarity, and what is dissimilar craves and loves dissimilar things. […] in treating actual bodies, it is right and necessary to gratify the good and healthy elements of each, and this is what we term the physician's skill; but it is a disgrace to do aught but disappoint the bad and sickly parts, if one aims at being an adept.

For the art of medicine may be summarily described as a knowledge of the love-matters of the body in regard to repletion and evacuation; and the master-physician is he who can distinguish there between the nobler and baser Loves, and can effect such alteration that the one passion is replaced by the other» [21]. The patient in this fragment is a person who has various body parts under the influence of the bad type of love. The one providing the cure is the master-physician who distinguishes the two types of love and replaces one type with the other.

In the Republic (444d), Plato mentions a strong connection among order, hierarchy and health, with respect to parts of the soul and parts of the body. This key fragment is illustrative for the philosopher’s thinking about the part and the whole. « “But to produce health is to establish the elements in a body in the natural relation of dominating and being dominated by one another, while to cause disease is to bring it about that one rules or is ruled by the other contrary to nature.” “Yes, that is so.” “And is it not likewise the production of justice in the soul to establish its principles in the natural relation of controlling and being controlled by one another, while injustice is to cause the one to rule or be ruled by the other contrary to nature?” “Exactly so,” he said. “Virtue, then, as it seems, would be a kind of health”» [15].

To generate health is to establish a hierarchy among the elements of the body. This order subordinates one to another, in harmony with nature. On the other hand, to generate disease, is to establish a hierarchy which subordinates one another contrary to the natural order. Even today we use expressions like «the health of the soul» or «moral illnesses». These are, in truth, completely platonic metaphors [3]. And, is also worthy of mentioning that other scholars have agreed that Plato explains his ethical views by drawing an important analogy between the healthy body and the good human [22]. It is entirely possible that Plato means more than this analogy, and that the proper order and functions of different elements represent a feature of the metaphysical whole. This includes what we understand nowadays as ethics (health of the soul) and medicine (health of the body), although the separation may prove unfruitful and not in line with global platonic thinking.

In the Laws (V.6), different lifestyles are mentioned, according to their limits in the way pain and pleasure are concerned: «The lives of us men must all be regarded as naturally bound up in these feelings, and what kinds of lives we naturally desire is what we must distinguish; but if we assert that we desire anything else, we only say so through ignorance and inexperience of the lives as they really are. What, then, and how many are the lives in which a man – when he has chosen the desirable and voluntary in preference to the undesirable and the involuntary, and has made it into a private law for himself, by choosing what is at once both congenial and pleasant and most good and noble – may live as happily as man can? Let us pronounce that one of them is the temperate life, one the wise, one the brave, and let us class the healthy life as one; and to these let us oppose four others – the foolish, the cowardly, the licentious, and the diseased» [17]. We can see that the sufferer considered here is represented by every citizen, and the intended cure is a way of life in accordance with a certain balance. The one who provides the cure is a law giver. So, in this passage, the patient is the whole city, a community of people needing guidance about how to better conduct their lives in accordance with a reasonable ratio of pleasure and pain.

 

5. Conclusion

Modern medical care, under the strong influence of positivism, regards autonomy rather with respect to a physical body than a souled body [8]. This physical body is the absolute property of the individual and is less seen as an integrative part of the human person. This can be seen in the already classical framework of the four intensely debated doctor-patient relationship models: paternalistic, informative, interpretative and deliberative [7]. If on the informative side we have a rather extreme consumeristic attitude towards medical services, the deliberative model still carries nuances closer to the relationship with the free man, based on persuasion and described in The Laws.

Neither the words in use along the Dialogues, neither the modern words like autonomy, patient, doctor and medicine can be totally superposed to the various meanings used by Plato when dealing with ailments and cures. The common elements for all the examples in Plato’s work might refer to some higher-level order of man, society and even Universe. What we understand nowadays by «patient» is a part of the whole which, for one reason or another, has become dislocated from this ultimate-level order. We can consider this order to be metaphysical in nature. This order is common for body parts, soul parts and city parts. To alter the connection with this harmony is to suffer, to be weary, to be a victim, to toil and to endure. Care always seeks to restore that specific element to its place and function in this ultimate-level order.

Therefore, in modern medicine, a patient who asks for help might be understood as a piece of a larger order that fell into disarray. Health can gain a broader meaning, as it is more than a cure for the body: health means re-including the individual or the community into the general system of proper functions and places. It reconnects a person or a group of persons to the whole.

But a reading of contemporary medical care through the lenses, provided to us through platonic Dialogues, raises another complicated question. If we are to concede that medical care is the reconnection of a dislocated part into the higher-order of the whole, we cannot escape the question around what that whole should be, in the case of contemporary medicine and modern society. It follows that one could be sick because that individual is torn apart from the community they should normally belong to. An entire group might be ill because that group is disconnected from the broader community of people. An organ could be sick because it simply does not follow its proper function or place in the body-soul system.

Finally, the body itself can be sick because the soul is not in a state of health as it should be. It throws a new light over what modern medicine should do about the relationship between mental health and physical health but also about the role «social health» or even «spiritual health» play in the general harmony of the human being.

 

The authors:

ROTARU Tudor-Ștefan [1] [2]

TOADER Elena [1]

[1] University of Medicine and Pharmacy «Gr. T. Popa» Iași (ROMANIA).

[2] University «Alexandru Ioan Cuza» of Iași (ROMANIA).

 

Contributo selezionato da Filodiritto tra quelli pubblicati nei Proceedings “13th National Conference on Bioethics with International Participation - 2018”

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Contribution selected by Filodiritto among those published in the Proceedings “13th National Conference on Bioethics with International Participation - 2018”

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