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Sep 9, 2019

Modern Medicine and the Shadow of Illness

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Aasim Hasany

McMaster University

Aasim Hasany is a respirologist and sleep physician.

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Modern Medicine and the Shadow of Illness

Tomb of Salim Chishti, Fatehpur Sikri, India

As a Muslim physician, I face a strange conundrum. On the one hand, I am proud to be part of the discipline of modern medicine, which has led to miraculous breakthroughs that have advanced the way we understand the body and treat its various diseases. On the other hand, I am restrained in my admiration, for I realize that this very discipline, due to its unshakeable commitment to a mechanical philosophy of nature, has obscured our view of the qualitative and spiritual meanings of the human body. Modern medicine, like a Promethean fire, gives light but also burns. While it may shed light on the complex workings of our body, it blinds us from seeing the deeper spiritual message that is woven into our flesh and sinews and flows through our arteries and veins.

Many Muslim scholars acknowledge that there are ethical challenges that stem from modern medicine and its technologies, but very few consider the metaphysical concerns that arise from its mechanistic view of the human body. In fact, despite the growing number of Muslim physicians around the world, very few see any issue at all with the current scientific understanding of the human body.

The Mechanistic Paradigm and Its Shortcomings

I suppose the body to be nothing but a statue or machine made of earth.
Rene Descartes1

As someone who has recently passed through the hoops and hurdles of becoming a physician, I can say for certain that the mechanical conception of nature continues to pervade all aspects of medical theory and practice. From day one in anatomy class to the final years of preparing for board exams, we as physicians are acculturated to speak in the language of mechanism and understand the body as a complex amalgamation of parts and sub-parts, almost identical to a complex machine. The mechanistic paradigm clothes our understanding of the body in the language of industry. It slowly begins to creep into our consciousness during medical school and eventually takes firm root as we graduate, when as qualified physicians, we speak of the body as if it were in fact, as Descartes once dreamed, an earthly machine. A look at any modern medical textbook will corroborate this finding. For instance, it is common to read in introductory biology books that the cells of our body are like “factories” with “machinery” that can transcribe and translate DNA, like parts of an assembly line, until a specific protein is produced. Likewise, in human physiology textbooks, our endocrine organs are likened to advanced thermostats with feedback loops, the lungs are bellows, and the heart is a pump.

This mechanistic paradigm is closely linked to what Rene Guénon refers to as the “quantitative point of view,”2 which has dominated Western society for centuries and is characterized by a strong commitment to regard natural phenomena as mere instantiations of mathematical laws. Thus, when it comes to understanding the biological processes—such as respiration, digestion, and circulation—that sustain our life, we are taught as physicians to focus on those mathematical formulae (i.e., Boyle’s law, Starling’s law, Ohm’s law, etc...) that model these phenomena rather than to appreciate them for their rich qualitative, symbolic, and spiritual meanings.

However advantageous our current mode of thinking is in advancing scientific discovery, it neglects the deeper meaning of the human body, which, from the Islamic perspective, is a work of art and a locus of spiritual meaning that cannot be fully accounted for by the mere analysis of its quantifiable parts. Our current scientific understanding of the body provides a partial understanding—albeit extremely detailed—akin to an image generated by a digital camera. This understanding, despite its “high resolution” and clarity, remains subject to the deficiency caused by its own sophistication, for as the camera fails to capture the breadth of meaning embedded in the actual object, modern medicine, with its mechanistic aperture, overlooks the deeper qualitative meaning of the human body.

Figure 1

Figure 1

The commitment to this reductionist worldview also leads to an undervaluation of sickness and its reduction to mere disease. Instead of appreciating sickness as a reality based on both quantitative (disease) and qualitative (illness) aspects, modern medicine often overlooks the shadow of illness and focuses its spotlight only on the disease. One can sum up the effects of the mechanistic worldview on our understanding of the human body in Figure 1. In this figure, we see how mechanism reduces our understanding of the human body and sickness to its quantifiable parts (blue circle) and fails to consider the wider zones of meaning that encompass this dimension (pink circle).

Beyond Mechanism

On the intellectual level, what we need to do is to be brave enough to show the shortcomings of modern science and try to provide another intellectual and spiritual framework for understanding that science.
Seyyed Hossein Nasr 3

The desire to pay attention to the qualitative features of nature and apprehend its deeper symbolic and spiritual meanings was a zeal that began early in my medical education. It was a passion ignited through my reading of the Qur’an, the writings of contemporary Muslim thinkers,4 and the inspired poetry of Rumi and Iqbal. This passion soon became a conviction, and as I progressed through my medical training, I slowly began to realize that the various physiological processes and diseases we study as physicians cannot be overlooked as complex workings and mishaps of mere mechanical parts. Rather, human physiology, like all natural phenomena, is a sign of God (āyah) akin to scripture and needs to be interpreted in both a literal and a symbolic sense. To truly study the human body, therefore, as a committed Muslim physician, I realized we need a dramatic shift in perspective. We must see the body not only through the microscope and the lens of mathematical formulae but also through our spiritual insight (baśīrah), which can peer into the inward meaning of things.

When we set aside the lens of the mechanistic worldview and open our “inward eye,” we begin to see the human body as a spiritual theophany (tajallī) rather than a complex earthly machine. The organs of our bodies and our physiological processes reveal themselves as more than impersonal instantiations of “laws of nature,” for they are existential symbols that teach us about our journey from God and return back to Him.

When we move beyond mechanism, the cell is no longer a factory processing the code of DNA into various proteins but a symbol of how “divine writ” (kalām Allāh) is transcribed, translated, and concretized in specific formulations in the universe. The lungs are more than bellows moving air in and out of the body; they are a symbol of the soul, which expands and contracts with the coming and going of divine inspiration (nafas al-raĥmān). Likewise, the heart and the blood circulating through its network of arteries and veins represent the spiritual center (qiblah) and the pilgrims who travel to and from this center in order to transmit and receive the blessing of God (barakah).

This move away from mechanism is not a move toward obscurantism and fanciful poetry. It does not mean we should ignore the truths discovered by modern science, but rather it is a call toward a broader paradigm—rooted in the Qur’an—that allows us to take seriously the qualitative, symbolic, and spiritual meanings embedded in nature.

This shift to a more inclusive, spiritually centered framework also has practical implications in the way we treat disease. When we realize that the quantitative and qualitative are intertwined aspects of nature, we begin to focus our efforts not only on treating disease but on healing illness. As a specialist in lung disease, I can definitely see the promise of this broader framework, especially chronic conditions such as dyspnea, when inhalers, oxygen, surgeries, and muscle strengthening only go so far. To effectively treat dyspnea, one often needs to move beyond the physical ailment itself and appreciate this problem as a human illness related to profound psychosomatic disturbance.5

The Symbolism of the Respiratory System and Its Diseases

Science according to Islam is ultimately a kind of ta’wīl or allegorical interpretation of the empirical things that constitute the world of nature.6
— Naquib al-Attas

On a daily basis, I work as a medical specialist focusing on the lungs and respiratory system. My goal is to tackle various respiratory issues that arise in my patients and offer treatments to ease their distress. One reason I chose this field was the essential function of breathing in maintaining life. This fact is even alluded to by the Arabic language, for nothing is closer to the human soul (nafs) than its breath (nafas). Breathing is also referenced in many passages of the Qur’an, notably 38:72, where God says about man, “I breathed into him from my Spirit.” This famous verse, which echoes in the scriptures of other traditions, gives us a hint that the ordinary cycle of breathing is connected in a mysterious way to the extraordinary reality of creation. For when God “breathes out” (i.e., into man), He creates, and when our breath expires, we return to Him. As humans immersed in the cyclical process, we re-enact the symbolism alluded to in the Qur’an when we breathe in oxygen and rid ourselves of carbon dioxide. Our act of breathing, which on the surface appears to be a mere biologic fact, contains a deep spiritual reminder that all creation is originated in and will return back to the divine reality (mabda' wa ma'ād).

Another symbolic meaning of breathing can be gleaned from other verses of the Qur’an (6:125 and 94:1). In these verses, the cycle of breathing, with its associated movements of the chest, is related to ease and difficulty, virtue and vice. As such, inhalation and exhalation can be seen as symbols of divine inspiration and guidance on the one hand, and as human struggle and effort on the other. The physiological process in which oxygen and carbon dioxide are inhaled and exhaled correlates to their spiritual analogues—qualities such as divine virtues and human vices. When we breathe, we are symbolically enacting the ethical task of acquiring divine virtue and ridding ourselves of destructive human vices.

When we expand on this symbolism in greater detail we can see some very interesting real-world applications. If we regard breathing as a symbol of the ethical struggle of virtue acquisition, diseases of the lungs that restrict our breathing encode a symbolic lesson that can advance our understanding of the difficulties we experience in living an ethical life. For just as there are lung diseases that restrict inhalation and exhalation, such as fibrosis and asthma, respectively, so too are there analogous spiritual infirmities that prevent us from acquiring virtue and expelling vice. For instance, in chronic obstructive pulmonary disease (COPD) and asthma, the lungs restrict one’s ability to fully exhale. This can lead to a build-up of carbon dioxide, reduction in inspiratory capacity, and often significant respiratory distress. In an analogous fashion, in many “spiritual diseases,” there is difficulty in ridding oneself of human vices. This will eventually lead to a build-up of negative qualities, reduction in the ability to attract divine virtue and grace, and spiritual distress.

The Faithful Physician

Like many other Muslim physicians, my work as a physician and my faith as a committed Muslim seek consonance. While it is essential for us to provide our patients with high-quality care that is delivered compassionately and in accordance with rigorous scientific research, we must also look into the broader qualitative and spiritual meanings that are on display in our daily encounters with patients. Although it may be difficult to loosen the mechanistic noose that shackles our thinking, we must try through sincerity and prayer to seek the divine teaching that echoes in the temple of the body. This will not only help us address the qualitative illness experienced by our patients, it will deepen our faith and wonder in relation to the spiritual message encoded in the body. So when the next patient walks into our busy clinic with a complaint of shortness of breath, we should pause and think not only about the physical reasons for this ailment but also about its spiritual message and instruction. For while we may not share with the patient the physical complaint of dyspnea, we do encounter its spiritual analogue in our struggle to rid ourselves of vices and our desire to be “in-spired” by divine virtue.