Detail of Rembrandt’s The Anatomy Lesson of Dr. Deijman
As excess death throughout the Western world proves beyond any reasonable doubt that public health policies have been an absolute failure over the past few years at least, and some of us are demanding accountability, it seems those at the center of power and the algorithmically endorsed center of opinion want nothing more than hurl us all into the next frantic crisis. But we must ask: Who was responsible for these healthcare policies? Credit for the invention of lockdowns goes to the CCP. We shouldn't forget the contributions of the eschatological modelers of Imperial College, or the moguls and tech platforms making it all financially and technically possible. How many doctors have we heard from? No, I don't mean virologists, our generation of mad scientists that has collected so many implications that there is only one thing we can be sure of: that they can never be trusted. And isn't trust everything between you and your doctor?
How many of us have been able to maintain this personal relationship of trust with their doctor over the past few years? We may assume our doctor would help us decide on what is best for our personal health, but the unthinkable question is not only thought, but spoken too, these days: to whom is my physician beholden? Is all they do transmit the orders passed on from above? Do I still have my own doctor, or do we all have a doktorklatura? The situation is a terribly long cry from my own memories of an austere, authoritative class, to which we entrusted our most vital questions regarding our existence. Things have changed, indeed. The doktorklatura herds us like cattle into some direction that was ordered on a numerical, a utilitarian basis. For what? For whom? Why? Who are they treating? Do doctors still tend to the sick, and tend to our bodies and minds? I have written about the nascence of current, common views about mind and body, and how the history of hypochondria may have something to teach us in our day and age (you can find this essay here). This time I would like to describe the sociological/psychological circumstances that may well explain why our doctors perhaps were the least prepared to stand up for us this time.
Now of course, the last I would like to do is generalize and lump all these poor physicians together. Imagine that: I am from a family of doctors myself. Having that personal experience, I feel safe to claim that there are at least two types of doctors, and you probably are familiar with both variants yourself. But maybe it's practical to start from the top and wonder why we call our physicians doctors to begin with. Originally the term doctor was reserved for theologians. It was the title that those of outstanding learning were allowed to bear, in honor not merely of their own merit, but primarily of their field of specialization and the importance accorded to it in the public imagination. The transfer of this badge of honor from the theologian to the physician therefore marked the secularizing trend of early modern societies, that increasingly gave precedence to body and mind over soul and redemption. This did not mean, however, that the idea of the doctor became separated from the presumption of moral rectitude that was deemed a requirement for the proper execution of this modified function, too. Not only was disease presumed to be intimately related to vice, whoever pretended to hold the key to your recovery was supposed to hold knowledge not only of our physical functioning, but of ethical wisdom and truth as well. The new class of doctors bore the status and the moral authority supported by this understanding. With stakes this high, we probably could have expected vanity to play a part in this story.
The tilting of the primacy of the guardians of our spiritual wellbeing to those who care for our physical health did not simply mark a sociological change or a shift in values, as it was a part of a philosophical reorientation. René Descartes, who in our imagination represents the rationalist revolution of the early modern period, spent his time dissecting animals and other beings, in search of the physical location of the soul. The wider study a hobbyist like Descartes and formal doctors engaged in, however, was directed at determining the mechanical processes our bodies harbored without deliberation and without our awareness. If the solar system was a clockwork we could observe, understand, and describe, the challenge to do the same for ourselves was obvious. Medicine became the preferred field of activity for philosophers who wished to conduct their investigations outside the purview of theology. Initially even a notorious materialist such as Spinoza did not dismiss the mind - along with the soul - as an inconsequential abstract. Not only did he illustrate the importance he attributed to the realm of our mind with his elaborate psychological analyses, he was convinced as well that physical disorders had to be understood as the result of a mental deficiency.
It is rather different for our present generation of physicians, who - whatever values they claim to profess outside their surgery - prefer to treat any disorder (whether physical or psychological) by administering a chemical that in an anonymous trial was registered as having an average effect on symptoms, promising our physiological return to 'normalcy'. Regardless of who you are. If you are looking for a card-carrying materialist, forget about Spinoza, and have yourself a doctor. These days, the greatest medical feat is to formulate a mechanical understanding of any ailment, whether of the body or the mind. Forget about the soul, already, because even your mind is just a machine which, even if our understanding has only just started to scratch at the surface, can be driven to that anonymous place where you'll just fit in, all with the reckless skills of a metropolitan cab driver.
Did I mention materialism? Forget it. You can put your lurid expectations right back in your pocket. There's absolutely nothing wrong with someone making an honest buck. And if doctors make a lot of money, it marks the importance we attribute to their role if not in keeping us healthy, then at least in prescribing us stuff when we no longer are. They don't make quite as much as professional athletes and other entertainers, but they definitely are up there, just a few steps down at the firmament of our boundless appreciation. Of course, were you to find out that the money was outweighing the mission, so to speak, and that - say - your doctor would rather prescribe you something risky and expensive than something safe and cheap because he no longer sees your health as his priority, well, you would probably have less respect for him than for a boxer agreeing to take a dive in the fifth round against a handsome amount in his locker. At least the boxer is putting his own body on the line. But I would be the very last to be dismissive of riches and material wellbeing: these are the things, after all, that enable us to dedicate ourselves to the things that really matter. That it turns out that this mental availability is hopelessly wasted on many of us, because we use it to worry about risk and imagine having control - something I termed mental obesity, which I described here and here - is certainly disappointing, but seems to be a sign that the more we disregard our soul or our mind, the less we know what to do with it.
Clearly not all doctors choose their career out of fascination with human biology and health, or because of their innermost wish to care for and cure other human beings. Money is a big motivator for some - doctors are just like other folks, really. But what no other profession could grant them to an equal extent is their status. The doctor has come as close to the position of the oracle as any human being can hope to reach in our society. Doctors at least used to speak with the authority not merely of their group of peers, but sustained by the academic system and the bourgeois society that uphold their position at the pinnacle of the whole structure, still riding high on The Revolt of the Public's third wave of the information revolution, the age of the printing press (you can read my review of Gurri's important book here). But status is pretty much like the membership of some secret society: it comes at the cost of the scrutiny and censorious opinion of your fellows. It is fine to have your own opinion - do try - but your image - how you can afford to come across - is no longer yours.
If your status has such importance for you, what are the chances you would risk it all over a disagreement? What regime has the 'peer review' system imposed on scientists anyway? If it were just a matter of applying the scientific method, would an editor for a serious journal not be capable of checking whether the requirements had been met? The irony in the term 'peers' of course is that while on the surface it signifies one is among equals, the alternative that is implicit is that one might be cast out among those of a lower status. Is it surprising that doctors were only capable in rather small numbers to resist the pressure to conform? I also realize that some doctors risked or even effectively forfeited their license for taking the side of their patients. That is the type of courage that should make us all feel humbled and admire what it means when someone observes the oath he took, regardless of the consequences.
I am not trying to blame doctors for everything, and certainly not for my own shortcomings. At my age I realize that maintaining my physical and mental health to a large extent means dealing with my weaknesses: gluttony, addictive behavior, vanity, et cetera. Especially in times of plenty. And a good doctor can help me do that. I know very well - thankfully - that there still are a few excellent ones among us. I also believe the frailty of this particular subgroup that I laid out for you really represents the weaknesses of the culture we are all a part of. We are vain, and narcissistic. We teach our children that growing up means to stop asking questions. We give them a device to shut them up. I also wonder what might have happened when that child of children, the Donald, had for once kept his end of the bargain. And instead of being intimidated by some doctor who pretended to be the custodian of truth - even while having lost his moral compass many years before - had insisted on the many questions he was entitled to ask, as a human being. He was going to drain the swamp, but the doktorklatura bluffed that much harder. Vanity, materialism, authoritarianism? Whose, really? What about the second-handedness of choosing status over conscience? It is time we reject these pitiful qualities in ourselves, and in those we put our most vital trust in.