hltb50h3 lec’s 4,5 & 6

Time line 

ancient -> medieval times -> renaissance 

Ancient

• Greece, Rome 5th c. BCE - 5th C. CE

Medieval

• “Middle Ages” in Europe 5th to 15th CE 

Renaissance

• revival of classical learning, beginning of modern era 14th to 17th CE

Continuity and rupture 

• Ancient ideas of balance, nature and cosmos remain influential 

• Medieval and renaissance inherit, translate, and sometimes radically reinterpret ancient thought

Hippocrates  (460 - 370 BCE) 

• “Father of medicine” 

• Transformed medicine from being superstition and holy to an observation-based discipline 

4 vital fluids - humoral theory

Blood, Phlegm, Yellow bile, Black bile 

Blood

• associated with sanguine temperament 

• Sociable, lively and cheerful 

• Linked with hot and wet quality 

Phlegm

• Associated with phlegmatic temperament 

• someone who is calm and reliable

• Linked with water and cold wet quality 

Yellow bile 

• Associated with choleric temperament 

• ambitious, determined and passionate 

• Linked with fire and hot and dry quality 

Black bile 

• Associated with melancholic temperament 

• thoughtful serious and a perfectionist 

• Linked to earth and a cold and dry quality

Hippocratic Oath 

• a pledge to do no harm by physicians:

“Life is short, and the Art is long; the 

occasion fleeting; experience 

fallacious, and judgment difficult. The 

physician must…be prepared to do 

what is right…”

Aristotle (384 - 322 BCE) 

• Greek philosopher

• Emphasized empirical observation and dissection 

Instigated knowledge begins with careful study of nature, bodies and their functions 

Aristotle on Medicine 

• Believed health is essential for happiness and good life, and health is connected to virtue 

Cause 1 - material cause

• what something is made from (body’s flesh and bones) in medicine, bodily substances like blood tissues 

Cause 2 - formal cause

• essential structure or pattern - a things “form”

Cause 3 - efficient cause

What brings something about - the agent or process of chance 

final cause

• intended purpose or “telos” - what something is for 

Catharsis ->

psychological purgation or healing through emotional response ..healing emotional state through empathy or fear, purging intense emotion

Eleos

pity or empathy

Phobos

fear

Tragedy as psychagogia

• power to move the soul 

Galen (129-216 CE)

• Massively influential Greek physician 

• Synthesized earlier medical knowledge (Hippocrates and Aristotle)

Galen’s model of the body 

• believed body operated through three main systems 

• Brain and nerves (sensation and thought), heart and arteries(life force), liver and veins(nutrition and growth

Major factors in loss of medical knowledge

• political and social instability -> disrupted continuity of education and scholarship 

• Dominance of Christian church led to suspicion towards “pagan” science -> promoted prayer, divine intervention, spiritual over empirical explanations for disease

Ancient vs medieval bodies 

• body as part of nature, government by universal principles (humours, four causes) 

Ancient vs medieval bodies 

body intertwined with Christian theology and ideas of sin and virtue souls primacy over flesh

Grotesque body

• bodies were seen as open and permeable -> porous to environmental, spiritual, and social forces 

Spiritual porosity 

• boundaries between body, soul and outside world were permeable 

Rabelais (1483~1494 - 1553)

• French late medieval/early renaissance writer and physician 

• Best known for vivid and comic depictions of “grotesque” body, argued for the therapeutic value for humour

Grotesque body in Rabelais 

• characterized by openness and focuses on “lower stratum” - Mouths, bellies, genitals, other parts 

Islamic Golden Age (8th - 13th c.)

• Persian scholars played crucial role in preserving and extending Greek medicine 

Human anatomy 

• Andreas Vesalius, De Humani Corporis Fabrica (1543) 

• marks beginning of midterm western medicine and medical of the body 

Vesalius (1514 - 1564)

• Work transformed medicine and understanding of human body conducted dissections on human cadavers 

The clinical of medical gaze 

• concept coined by Michel Foucault, historian of medicine and philosopher 

• argued that the ‘birth of the clinic’ (late 28th c.) - and clinical gaze - is a reorganization in depth 

• The modern period dehumanizes a person 

Philosophy and the body 

Focuses on embodied, lived experience, meaning-making

Carel's toolkit

• Draws on Phenomenology - how things appear from out pov 

• Illness isn't just medical condition, reshapes bodily boundaries 

Carels toolkit - step 1 

• Epoche (bracketing assumptions) - notice how illness appears in daily life 

Carels toolkit - step 2 

• Thematization - what has changed 

Carels toolkit - step 3

• Reconceptualization (being in the world) - experience of illness in context of patients whole self 

Practical implication 

• Does not see illness and biological defect 

Early modern

Increasingly challenged medieval reliance on Galen and ancient authorities

Descartes (1596 – 1650)

French philosopher, scientist, mathematician

• Widely regarded as founder of modern

philosophy

Cogito, ergo sum

Radical or methodical doubt

How the doubt proceeds

Sensory beliefs - liable to illusion

Waking-Dream distinction - dream argument

Metaphysics and dualism

Argued mind and body are distinct substances

Mind-body distinction

• Argues that the essence of mind and body are completely different

Subject-object distinction

descartes’s dualism institutionalized the subject/ object split

• Mind as subject à a thinking, non-extended res cogitans

• Body as object à extended, law-governed domain res extensa

Rise of biomedicine

Dualism helped make modern biomedicine possible

• Treats body as mechanistic and measurable

Impacts of biomedicine

Neoliberalization of medical practice

Biomedicine, neoliberalism, and burnout

• Neilson (Ch. 20) argues burnout among physicians is not a personal failing but a symptom of biomedicine’s entanglement with neoliberalism

Neoliberalism’s role

Neoliberalism shifts responsibility from systems to individuals

Finding the subject in the objectified

Hall and Kadetz (Ch. 24) argue that the dominance of quantification and metrics in healthcare has contributed to the objectification of the patient

medical gaze to quantified patient

“Medical gaze” (Foucault) privileges rationality, objectivity, and aQ0”’

Kk.,observation over emotion and subjective experience

“Resilience” and “Wellness” as neoliberal

myths

Wellness programs (e.g., yoga, mindfulness sessions) are offered as

fixes

“Resilience” is measured and ranked (e.g., CMA’s resilience scale)

From medical gaze to quantified patient

“Medical gaze” (Foucault) privileges rationality, objectivity, and observation over emotion and subjective experience

Quantification and loss of subjectivity

US health care policies (e.g., Patient Self-Determination Act, Affordable Care Act) institutionalize data collection as moral and administrative

necessity

tyranny of metrics

“Numbers are assumed to offer objective truth, yet they displace human meaning and relational knowledge.”

Patient as object

Even intersectional models, while more complex, still operate through categorical thinking that fragments the person

Recovering the patient as subject

Genuine care requires dialogue rather than data collection