Medicine of the Person - the Evidence of Benefit
Part One
Does the practice of medicine that considers the whole person, rather than just a physical or mental pathology, bring greater health? Is there reliable evidence to show that it does?
Before exploring these questions, it is helpful to be clear about what we understand by the terms in our title. Medicine is straightforward: most commonly, an activity to restore the health of an ailing individual.
Of the hundreds of aspiring medical students whom I have interviewed, most seek to enter the profession with this as their goal. Overwhelmingly, their subsequent training has a similar objective, focussing intensely on physical illness. More widely, and much less popular with our trainees, ‘medicine’ includes identifying future health risks and implementing strategies to maintain disease-free individuals and populations.
The meaning of persons was the focus of the life and deeply thoughtful writings of Paul Tournier over 70 years ago. The following quote from his book of that title succinctly presents his view of the defining shape of our individual humanity:
‘Life, then, is characterised not by a material function accessible to science, but by an immaterial, spiritual, purposive function.’1
By the time he wrote this, the explosion of scientific enquiry that began in Europe in the 18th century was being applied increasingly to the world of medicine: to studies of the normal and diseased mechanisms of the body and, to a much lesser extent, of the mind. Science-based medical diagnosis and treatment was already on a sharp and productive ascent. But Tournier, while genuinely appreciating this progress, offered caution. In his view, a rising scientific fervour with a cultural shift towards secular rationalism, threatened the hitherto holistic approach essential to effective healing.
Tournier was at the forefront of a growing cry for ‘modern’ medicine to maintain its connection with patients, not just as harbingers of physical pathology, but as people formed of far more than physics and chemistry. He emphasised that human life is complex – indeed, in many ways indefinable, elusive and mysterious. Its material component, he implied, might even play only a modest and dependent part – an established cultural view held persistently by many communities across the world.
This is not to deny the remarkable design and physical reality of our bodies with which the scientific method can engage extensively. They are a construct of remarkable complexity and interdependence. The many trillions of cells of which we are made know individually how to form and maintain a co-ordinated whole unaided. The 100 billion neurones of our brains spontaneously generate some 100 trillion connections creating an extraordinary capacity to store and retrieve data and to co-ordinate all of our bodily functions. These remarkable facts sit among many concerning the mechanisms of our existence; but the assertion of Paul Tournier – and many others – is that, in total, they are insufficient to explain ‘us’ as persons.
Tournier regards our physicality as the presenter of the character we wish to display to the world (our ‘personage’). At the same time, this is closely connected to our innate immaterial (that is, non-material) and spiritual function – the essence of our person. From this intangible dimension flows our formative energy and direction, providing the definition of our true selves. He proposes that, by its nature, this foundational reality cannot be accessed by conventional scientific methods; we become acquainted with it subjectively and by intuition. Understanding personhood demands the sensitivity, receptivity and the ‘mystery’ of another person.
How in Tournier’s characterisation of persons are we best to interpret the word, ‘spiritual’? Within the Christian and other major faiths, this customarily refers to the nature or person of an invisible, Supreme being. Thus, it has a firm transcendental and religious connotation. In the bible, the word ‘spiritual’ is used just 18 times, all in the apostolic letters of the New Testament and all referring directly to the person or work of the Holy Spirit.
But the bible also uses ‘spirit’, with a lower-case ‘s’, to refer to an essential, non-material component of man. The human spirit that conveys life and drives us forward is likened to the invisible wind in its force and unpredictability. It also carries the attributes of personality. Linked with ‘sarx’ – the Greek word for the physical body – it provides the complete definition of a human being. Two other biblical words refer to our intangible dimension: ‘soul’, denoting a life-force associated with moral and emotional responses; and ‘heart’, indicating the governing centre of a person which, above all, makes us unique individuals. In both biblical and non-biblical language, the word ‘spirit’ also commonly denotes a non-material being, visible or invisible, that has the attributes of persons: autonomy, reason, sentience and communication. Such spirits may or may not interact with people and the world, and their influences may be beneficial or malign. Such beings and their activity are an important reality to most people, but, understandably, are readily dismissed within a rationalistic world-view. In our post-modern societies, the word ‘spiritual’ – and even more so its derivative, ‘spirituality’– have diffused into a number of different concepts including the notions of existence, morality, purpose, meaning, awe, values, and connection.
Thus, ‘spiritual’ and ‘spirituality’, while increasingly prevalent in ‘first-world’ health-related discourse, have no clear or unified definition. In 2005, McCarroll and colleagues published a survey of reviews on the topic of ‘spirituality’ from which they identified twenty-seven different explicit definitions.2 Among these, they noted, there was little agreement.
Current concepts of whole person medicine – combining both the material and the non-material – emphasise the need for healthcare practitioners in any therapeutic encounter to engage with the mind and spirit of a person as well as with their body.3 But how, in this context, should we view the mind? We attribute to it key roles in the phenomena of consciousness, self-awareness, emotion, cognitive processing, and motivation. It is tightly integrated with the physical mechanisms of the brain – as shown increasingly by functional MRI and other advanced scanning techniques. Just one example of these is the demonstration of specific areas of cortical activity that accompany our emotional responses of empathy and compassion. On the other hand, the mind is seen not as physical entity. Perhaps the ‘non-material function’ of Tournier’s person equates to the human spirit-plus-mind.
A useful analogy has been made between our body-mind functions and a programmed computer. Our physical ‘hardware’ embodies complex biochemical multiprocessing to sustain, inform, manage and repair itself. It is also constructed to interface with the material world for information input and output. Our non-material function is then identified as our controlling software. It has a complex and multi-layered design so that, both autonomously and in response to a conscious or external input, it will generate an action involving physical and mental processes.
A final dimension needs to be added to the body-mind-spirit model of our existence: society. Our relationships, our social structure and our environment have profound effects on our well-being. In matters of health and healing these factors cannot be ignored.
Medicine of the whole person thus emphasises our need to attend to all four components, with the important caveat that in every individual they are all intensely and inextricably intertwined. They are indeed a whole. A reductionist approach within modern medical science that ignores any one of these dimensions is inadequate for comprehensive patient care and the health-protection of all.
1. Tournier P. The Meaning of Persons, SCM Press, London, 1957, p90.
2. McCarroll P, O'Connor TS-JJ, Meakes E. Assessing plurality in Spirituality Definitions. In: Meier et al, Spirituality and Health: Multidisciplinary Explorations, Wilfrid Laurier University Press, 2005, p44-59.
3. Good Medical Practice, Domain 1.15a, General Medical Council, 2019. See: https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-medical-practice/domain-1---knowledge-skills-and-performance
