Health and disease: from gods to robots

The first organized beliefs about health and disease in human groups, apart from the instinctive medicine itself as in the rest of the animals, must have appeared around half a million or a million years ago and must not have been very different from those of the current peoples living more or less isolated and in similar conditions. All nature is sacred and all the phenomena of the material world are influenced by spiritual beings that control everything that exists.

Health and illness, in this religious animist concept, would be the consequence of being or not in agreement with these superior forces, all-powerful divinities. These ideas evolved slowly until about ten thousand years B.C. with the development of agrarian cultures, especially around the rivers, where the religious concept of disease as sin, disobeying the rules imposed by the gods and following the guidelines of the demons, became clearer.

One of the most advanced cultures is the Mesopotamian. At the end of its evolution around 2000-1500 B.C. it already showed, however, glimpses of a more rational medicine, based on the variations of the state of health with the seasons, temperature and a very detailed study of the stars.

In other cultures, such as the Egyptian, Persian, pre-Columbian or Israelite cultures, something similar occurred, all of them understanding health and disease in a religious way, although with time it became increasingly philosophical.

In India, a philosophical medicine was developed, within religion, but also independent of it. It is the medicine of the Vedas, or rather of Ayurveda, which meant knowledge of life, and related to them was yoga and Buddhism.

An important part of these philosophical theories are based on a negative idea of life, that it is full of pain and suffering and its supreme goal is to acquire a higher consciousness that allows to escape from life on earth and achieve total pleasure through the merger with “the absolute”.There is another more optimistic view of yoga for which life is not so rejectable and earthly performance is necessary, serving yoga to obtain the balance and serenity necessary to face the reality of existence.

A rational cosmology is more accurately described in Chinese culture. In the I Ching treatise, the relations between the macro and micro cosmos are clearly described. Everything must be in accordance with the Tao, the balance, which is regulated by its opposites, Yin and Yan.

From these ideas, the concepts of health and disease, which also served as a basis for Confucian philosophy, were established according to the theories of the elements, beliefs that also existed in other cultures such as India. One of the first objectives of Taoism was to lead a simple and natural life in order to achieve health and longevity. The basic principle for this was to conserve vital energy.

These concepts formed the basis of Chinese medicine which, with multiple vicissitudes, has reached our times with renewed interest. Thus, all these civilizations had advanced a long way towards a disconnection of the role of the divinities in the appearance of diseases, but the great step forward took place from 500 B.C. in classical Greece. There, the philosophers of nature, full of freedom and strength, excluded the gods as the cause of diseases and affirmed that it is Nature itself that influences for better or worse their appearance.

Apart from this disconnection, the ideas of philosopher physicians, such as Thales of Miletus or Alcmeon of Crotona, the new medicine went from being philosophical to physiological. Otherwise, their ideas were close to those of other great cultures already mentioned, equating health with equilibrium and disease with its opposite. They also related the elements of the macrocosm, water, air, fire and earth, with those of the body, blood, phlegm, yellow bile and black bile.

In the basic medical treatise on rational Greek medicine, the Corpus Hippocraticum, it was clearly stated “regarding the sacred disease, here is what happens: it seems to me that it is not in any way more divine and more sacred than other diseases, but that it has a natural origin”.

Greek medicine took the giant step of discovering that it is nature itself that, when it becomes unbalanced, makes us ill, and of considering human nature as different from others because of its rational capacity. Then would come times of regression and darkness, which would last for a long time.

The Roman era, with its great practical sense together with the rejection of speculative ideas, directed medicine towards research and anatomical study, maintaining eclectic attitudes on the origin of disease that combined Hippocratic ideas with others of a materialistic and also divine order, until its decline when there was a rebound of magical practices and occultism.

In spite of everything, the Roman concept of disease can be represented in Galen, who lived in the second century A.D. and who affirmed categorically that “the wrath of the gods is never the cause of ailments”. With the exhaustion and decadence of Rome, the influence of mystical and occult cults grew greatly and something similar happened with Christianity in its early days in the 1st century AD. It was a religion of Eastern origin, both mystical and practical, based on divine revelation and the promise of eternal salvation, but which also wanted to restore on earth a new life full of love for men and virtue, “there are no longer last and first, Greeks and Jews, barbarians and slaves” said Jesus Christ. Moreover, Christianity, like the pagans, considered man as the noblest being because he was made in the image and likeness of God, who also became man to prove it.

But, on the other hand, Greco-Roman enlightened thought based the knowledge of things on the use of reason, while for Christians the only valid method of knowledge was blind faith in God. Moreover, unlike the vital optimism of the Greeks and Romans who saw existence on Earth as the only possible paradise, with its exaltation of the concept of nature, Christians believed that earthly life was only a painful test that human beings had to overcome to achieve true happiness in the next world. Something similar also happened among the Arabs, who until Mohammed, had divine cults of naturalistic type, but after the prophet, who rejected idolatrous cults and only admitted to comply with the wishes of only one God, Allah, whose will had to be rigidly accepted and the diseases were the punishment of that only God. The doctrine, contained in the Koran, would lead through faith to impose justice on Earth and then to achieve a happy life in paradise eternally. Immediately after the death of Mohammed, the Holy War began and the Arabs, supported by their faith, reached India and the decadent Empire of Byzantium, conquering Syria, Persia and Egypt. Then North Africa and Spain, up to the Pyrenees, where they were defeated more by the weather than by the resistance of the French. At the time of Arab splendor, from the 9th century onwards, their concept of health and disease was religious, but they also accepted many of the rational ideas of the Greeks, without any dogmatism.

It was the Arabs who preserved the legacy of Hippocratic wisdom during the dark Middle Ages of the West, in times of pessimism in the West, as St. Ambrose warned in the vicinity of the 5th century, “we are approaching the dissolution of the times and certain diseases only announce the approaching end”. The medicine of the monks, within a destructive environment of everything pagan, kept in their libraries the great classical treatises, and although it had a religious character, it softened it with rational and naturalistic criteria.

Later, from the beginning of the High Middle Ages at the end of the 11th century, the decline of monastic medicine began, with the monasteries being gradually replaced by the great cathedrals that expressed the crisis of the medieval order. Towards the end of the 13th century, the West began to awaken and to soften, in part, the previous hard religious conceptions, when knowing the customs of the Arabs and their in many aspects greater tolerance together with the rise of the bourgeoisie and the life in the cities, where the confidence in the world and in the man was accentuated. In the translators’ schools of Salerno, Toledo, Paris, Oxford or Bologna, many philosophers and physicians adapted naturalistic ideas, not without great difficulty, because of ecclesiastical barriers. By the end of the Middle Ages, the secular character of the universities had become well established in the face of intolerance, foreshadowing the beginning of the Modern Age.

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After natural catastrophes, epidemics and wars, the population of Europe did not exceed 40 million people and the life expectancy of 30-40 years. Then, in the 15th century and especially in Italy, confidence in the human being increased and many artists, philosophers and humanists relied on ancient wisdom to advance knowledge. Already then, in the Renaissance, two tendencies began to stand out, one more speculative, relating the universe and man in an organic whole in which each part influenced the rest, and the other, more and more dominant, which referred to the concrete, from which all modern science will start, through rational experience and organized by schemes of a mathematical nature.

The Renaissance concept of health consisted for many in recovering the Hippocratic ideas and the prevailing humanism was conformed without going further, but others in a less explored way, since philosophy was very important, affirmed like Fracastoro that “substances and bodies, like the sky and the living, have a certainty that is not small and the things that can be known are almost infinite”. These were the ideas that prepared the forthcoming demolition of the entire medieval scholastic edifice, preparing a different way of seeing the world, which would take place in the following years. The science of the seventeenth century would involve a very different way of approaching reality, very different from the classical Greco-Latin one. The great innovation of the experimental method became the appropriate instrument to know the reality of things and to explore the world. This is what Francis Bacon, the main proponent of empiricism, who was the first to imagine a human society driven by technology, believed. The method started from induction, systematically comparing concrete observations to establish scientific laws, without introducing previous speculations. Science was conceived in only biological, concrete terms, completely separated from theological or metaphysical ideas; scientific knowledge will be linked to the technical transformation of nature. These new considerations were supported by Descartes who proposed a mathematical mechanical method to understand the human body. In spite of the rationalist advances, the ecclesiastical force was powerful as was proven by the trial of Galileo by the Inquisition for his mathematical ideas that were “a demonic contraption”.

Paradigms were changing, but the concept of health and disease could be understood in practice in very different ways and magicians, alchemy and occultism or all kinds of similar performances continued to be very present within a very general context dominated by religious ideas. The scientific criterion had a great development in the eighteenth century with the Enlightenment and through experiment and on the basis of the concrete, mathematicians, mechanics, physicists and chemists objectified more and more reality and announced little by little the exact laws to which the phenomena obeyed. But not everyone thought alike and some, like Rousseau, called for a return to the balance of nature and the rejection of all that was artificial.

These profound changes were stimulated towards the end of the eighteenth century with the development of machinism in England and the new industrial society, which had a greater impact in the nineteenth century. From the existing hardships, from the end of the XVII and in the XIX, the technological and hygienic advances gave rise to a great increase of the European population, from about 100 to about 200 million inhabitants.

In the 19th century epidemic waves appeared with many tens of thousands of deaths and living conditions improved, but with new situations as a consequence of the change of life from the countryside to the industrial cities, with exhausting working hours, extensive pollution, personal frustrations, turning the workers into one more piece of the mechanical gear. Overcrowding, infant mortality, alcoholism, prostitution and begging were the result of deplorable ways of life for many people who must have been very hopeless. Dirty neighborhoods, little light, poor food and inhuman dwellings populated the new industrial centers, and tuberculosis became a plague of the 19th century.

All this meant that the authorities began to take measures to deal with the many problems that threatened to turn the cities into veritable hotbeds of disease. On the other hand, positive medicine and scientific-technical advances led to a remarkable demographic growth in industrialized countries in relation to pre-industrial ones. The European panorama was very changing, with large migratory movements from the countryside to the city and also to other countries such as the United States, where more than 20 million Europeans arrived by 1900. On the part of the middle class, perhaps astonished by the technical process, there was a loss of confidence in the healing force of nature, with some doctors saying that nature, left free, only produced scars and vicious attitudes, but there continued to be more sensible and less dogmatic people.

During the first half of the twentieth century, the greatest war catastrophes in the history of mankind took place, but also a hitherto unknown deployment of science and technology which, to a large extent, was a consequence of the stimulating action of war situations. On the other hand, at the beginning of the twentieth century there was a change in ideas, beginning to reject the excesses of materialism. The influence of Albert Einstein and his theory of relativity was enormous and some scientists went so far as to say that his ideas were a return to the scholastic methods of the Middle Ages. But the same later investigations were confirming the genius and reality of Einstein’s ideas. Many ideas of today’s science can be related, saving the distances with animism with primitive peoples and their energetic concept of life. Einstein himself affirmed that there were two forms of knowledge, an intuitive philosophical one and a positive-scientific one, more utilitarian through the control of objects.

Optimism after the Second World War led to a very important degree of prosperity in many parts of the world, although there continued to be many populations in minimum subsistence situations, with an estimated 800 million people at the beginning of the 21st century without sufficient food for an active and healthy life. In the last part of the twentieth century and up to the present time, technical progress in all areas, including medicine, was enormous, favorably changing the lives of many people and increasing the current population to 7.5 billion people, which has doubled since 1970. The advances in medical technology help in all areas for the “mechanical” knowledge of the human organism. There is a very advanced technology that discovers lesions in the most unsuspected parts of the body with substances that inform of the altered cells, PET-CT, MRI, Ultrasound, sophisticated analytical, genetic studies, new robotic machines … and many other assessments and tests help for the knowledge of many diseases. But the “philosophical” criteria that all human societies have used since the beginning, understanding health and disease as ways of manifesting the relationship between living beings and the environment around them, is on a darker plane.

And within these criteria, the most important of them, the one established by the Hippocratic physicians, is not sufficiently valued. Health and disease are responses to a state of harmony or disharmony with ourselves and the environment in which we live, between the microcosm and the macrocosm. If we alter the natural balance we alter ourselves, because as the Hippocratic Code says, Nature is the only divinity to which we must obey.