The soul in medicine: what is it, what has happened and how can we restore?
What is soul?
Arthur Kleinman writing in the Lancet Perspectives about his book states, “Soul according to a not at all religious general practitioner in the 1950’s ‘appeared to mean the moral and spiritual core of the sick person, the family carer, and the professional healer,’ and in this gentle yet passionate family doctor’s ordinary speech, soul simply signified the way the sick experienced illness as a threat to their values, their deepest emotions, and their faith, and also the human way physicians treated their patients.”
“William James, the physician, psychologist and educator, had banished the soul from his magisterial turn of the 20th-century Principles of Psychology, which presented the by now conventional materialist view of mind as brain- based. Yet, later still, he turned into his still popular Varieties of Religious Experience, he resurrected the term and crafted an entire chapter on “The Sick Soul”. There he made the case for religion as an answer to the fundamental plea of people threatened by serious disease and other human crises to understand why bad things happen to them and to ask for help, divine and secular.”
What is the human soul? [Ref]
The soul, in certain spiritual, philosophical, and psychological traditions, is the incor- poreal essence of a person or living thing. Many philosophical and spiritual systems teach that humans are souls; some attribute souls to all living things and even to inani- mate objects (such as rivers); this belief is commonly called animism. The soul is often believed to exit the body and live on after a person’s death, and some religions posit that God creates souls. The soul has often been deemed integral or essential to consciousness and personality, and soul sometimes functions as a synonym for spirit, mind, or self, although the soul is said to function in a distinct enough way from both the spirit and the psyche that the terms should not be treated interchangeably.
In Alexander Bolonkin’s opinion, the soul is only the knowledge stored in our brain (see Part II of this book). More than 99% of it is the permanent knowledge about our own history (all that we have seen, heard, spoken, felt, and done), knowledge received in school, college, university, from books, TV, radio, and so on. A very small part (1%) is variable, our own opinion about people or their actions. That part is changed by new knowledge, information, and situations.
The problem with soul
Kleinman states that “Over the years I have come to use this antique term— which resonates with religious meaning—to represent that innermost existential centre to our being.” and he goes on “And here I would humbly suggest that the contemporary crisis of caring in health-care systems globally is implicating the soul, at least as define it,through the frequent complaint that medicine and institutional health care are “soulless”. Meaning, I believe, that they fail to engage the most deeply human experiences that require care—not management.”
Max Weber, the early 20th-century German sociologist, characterised as the problem of the dominance of institutional bureaucracies that colonise everyday life in the interest of efficiency. By implementing technical rationality to categorise and control social experiences like illness and suffering, ordinary people and professionals are imprisoned in an iron cage of rationality that leaves out tradition, sentiment, and spontaneity—which for Weber meant humanness.
Kleinman concludes that “In my own writing on care and caregiving, I find the expression “soulless” a resonant one to depict what is happening to caregiving in medicine in our times where the health system’s goals of efficiency and cost- effectiveness, new technological requirements that absorb the clinician’s alertness and attention, and the sheer pressure of insufficient time to listen and explain have a dire effect on providing the best of care. It is in the teeth of such dangerous charges that medical schools worldwide are experimenting with how to repurpose technology to support quality care and how to introduce the art of caring into the curriculum so as to prepare young doctors for crafting quality care in otherwise unpromising conditions and, in so doing, to inoculate themselves against burnout. As an old clinician I may sound like my clinical teachers from the 1960s who lamented changes in medicine and in their role as caregivers that were negating their moral and spiritual significance. Perhaps this is the perennial complaint, and to express it clearly we need soul to specify the human quality at the heart of care in order to animate the souls of patients, family members, and clinicians.”