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We know that the medical profession largely ignores mental disorders. That’s why, according to the Healthy People initiatives, only 25 percent of patients who need mental health care receive any of that care at all (compared to 60-80 percent of patients with disease problems)—and what care they do receive rarely meets minimum standards (1, 2). Not surprising, medicine mostly ignores the psychosocial issues in all patients, which can range from transient anxiety over work, family, or social issues, to chronic and debilitating anxiety and depressive disorders that adversely affect one’s work, family and social life—as well as their physical health. In a figurative sense, we might say that medicine decapitated itself by ignoring what occurs in the head.
You might be surprised—shocked even—to learn that there is a literal basis for this metaphor. The head actually was cut off as part of medicine when it dismissed the mind during the scientific revolution of the 16th and 17th century Enlightenment. Let’s explore.
The research centerpiece in early medicine was human anatomy, but rarely had human dissections been conducted to learn about our anatomy (3). As Christianity became widespread, what little human dissection there was disappeared altogether because it was prohibited by the Church who branded it blasphemous (4). During the more than 1000 years before the Enlightenment, church teachings were considered superior to science, and medical knowledge remained limited to that which conformed to their theological views (4). Because moral concerns and opposition by the Church precluded human dissection (3, 5, 6), scientists conducted dissections on the bodies of cows, pigs, goats, and sheep—erroneously believing them to represent human anatomy.
After gaining some traction in the 14th and 15th centuries, it wasn’t until the 16th century that human dissection gained widespread acceptance when, in 1537, it was officially sanctioned by a decree from Pope Clement. Why had the church relented? The Enlightenment had begun and burgeoning scientific and medical advances were occurring. To maintain its power and influence in society, the church accommodated this rising challenge.
But the Church didn’t give in easily. It had a restriction. Considering the head as the seat of the mind and soul (7), it insisted that before any dissection could begin, the body was first decapitated and the head turned over to Church authorities (8, 9). No one, not even the rising sciences, tampered with the brain (6). This practice, both symbolically and realistically, established that the mind and soul were irrevocably off limits to science and medicine—the Church’s province alone.
As an interesting, if macabre, aside, now that human dissection could be conducted for scientific purposes, where did the bodies come from? You guessed it, the bodies came from criminals. Once the spectacle of a public hanging had concluded, a new spectacle followed. For a fee, one could attend the dissection of the corpse. This practice became exceptionally popular and dissections became as much for public entertainment as for physicians’ education (4).
It will not surprise you that human dissection generated advances in other medical areas. For example, anatomic dissections of patients suffering various illnesses, such as cancer or appendicitis, led to better understanding of these illnesses, as physicians could literally see the cancer growths and inflamed appendix for the first time—but only in diseases of the body below the head. Similarly, because these advances spawned progress in chemistry and physiology, scientists eschewed the brain and mental dimensions in these areas as well. This pattern of success building on success continued and expanded many orders of magnitude over the ensuing centuries, but it applied only to the body and not to the mind and its disorders. Disease progress, however, has been remarkable, for example, the average life expectancy has risen from about 40 years in 1900 to nearly 80 years in 2000.
But medicine’s failure to similarly address issues of the mind led to the sorry state of mental health care we suffer today. The mind and spirit that had been integral to medicine since the time of Hippocrates vanished in the 17th century by Church decree.
There’s considerably more to this topic. The scientific focus on the body paralleled the powerful philosophical impact of Descartes, Locke, Hobbes, and others at the same time. Indeed, science and philosophy went hand-in-hand and mutually reinforced one another. In another post I’ll discuss the impact of Descartes on modern medicine and whether he should be blamed, as is often the case, not for the mind-body split but for the ravages it wreaked.
For now, we have at least some understanding of why medicine today behaves in such an inexplicable, seemingly uncaring fashion—ignoring its most common health problem, according to the National Alliance for Mental Illness, and ignoring the personhood of all patients. In losing its mind, medicine saw no reason to train physicians to care for mental disorders or even to appreciate the minor stresses and strains of everyday life that patients experience. From the National Institute of Mental Health, we know that 85 percent of all mental health care is provided by non-psychiatry physicians. By not training these practitioners to care for the most common problem they face in practice—mental health problems—we now face an opioid crisis due to prescriptions written by untrained physicians and we face 43,000 suicides each year where many have seen their physician shortly beforehand. Even more common problems like depression and anxiety disorders are not diagnosed, much less treated properly if they are recognized.
Medicine’s efforts to solve its worsening and extraordinarily costly mental health problem go nowhere, as Health People 2020 tells us, because its efforts omit the very mind it must address, a Gordian Knot it will never solve until it elevates the mind to equality with the body. Once it accepts that, the problem vanishes. Medicine can do better, patients deserve better. Medicine could begin tomorrow to train its graduates to provide care for the most common patients they will encounter in practice. It wasn’t permanently decapitated!
References
1. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. In: Services USDoHaH, ed. 2nd ed. Washington, D.C.: U.S. Government Printing Office; 2000:76.
2. Dept. of Health and Human Services. Mental Health and Mental Disorders. Healthy People 2010. Washington, D.C.: U. S. Government Printing Office; 2000:18-3 to -32.
3. Friedman M, Friedland G. Medicine's 10 Greatest Discoveries. New Haven: Yale University Press; 1998.
4. Ghosh SK. Human cadaveric dissection: a historical account from ancient Greece to the modern era. Anat Cell Biol. 2015;48(3):153-69.
5. Walker K. The Story of Medicine. New York: Oxford University Press; 1955.
6. Porter R. Medical Science. In: Porter R, ed. Cambridge History of Medicine. Cambridge: Cambridge University Press; 2011:136-75.
7. Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977;196:129-36.
8. Garrison F. An Introduction to the History of Medicine -- Scholar's Choice. Philadelphia: WB Saunders Company; 1913.
9. Garrison F. An Introduction to the History of Medicine -- With Medical Chronology, Suggestions for Study and Bibliographic Data. Philadelphia: WB Saunders Company; 1929.
