Spinoza and medical practice: can the philosophy of Baruch Spinoza enrich the thinking of doctors?
Hobart, Tasmania, Australia
Portrait of Baruch de Spinoza (1632–1677), ca. 1665. Unknown. c. 1665. Gemäldesammlung der Herzog August Bibliothek, Wolfenbüttel, Germany.
As doctors we seek to assuage the distress of our patients by relieving symptoms, guarding personal dignity, and remaining present even as they are dying. Yet despite these lofty goals, there remain facts suggesting profound disquiet among physicians, albeit well disguised: high rates of substance abuse, burnout, suicide . . . and this in persons of exceptional intelligence, personal capacity, high socioeconomic status, in unquestionably meaningful occupations. Why?
The literature of the great traditions is weighty with exploration of these profound questions. Where are you, Adam? Am I my brother’s keeper? Where do I come from? Why am I here? Where am I going? What shall I do to inherit eternal life? Or, Kant’s three questions: What can I know? What should I do? What can I hope? The great philosophers have searched these questions and religious leaders have formulated various responses—but we may cringe in hidden unbelief. We are limited in the time we have for reading or discussing ideas that may replenish parched wells within us: we are always so busy; we may settle for living without any overarching vision. But without vision the people perish, the prophet says, and so may I perish. Is there any way to enrich our lives, give our roots rain?
Many figures have found the thinking of the seventeenth-century philosopher Baruch Spinoza to be a source of richness: Goethe, Heinrich Heine, and George Eliot, also Hegel and Nietzsche. Australian philosopher Genevieve Lloyd, in her fine introduction to Spinoza, quoting the pertinent comments of French philosopher Deleuze, writes:
This “most philosophic of philosophers,” commanding a highly developed, systematic and scholarly conceptual apparatus, can nonetheless be the “quintessential object of an immediate, unprepared encounter, such that a non-philosopher, or even someone without formal education, can receive a sudden illumination from him, a ‘flash.’”1
Spinoza’s life as a Marrano had layers of complexity that were thoughtfully explored by the philosopher Yovel.2,3 His ideas, despite their complexity, may be worth pondering, especially if introduced by wise guides. Among these, psychiatrist Irvin Yalom has given a sense of Spinoza’s life in his philosophical novel The Spinoza Problem.4 In fact, one of Spinoza’s closest friends in Amsterdam was a physician, and he was also much admired by one of the founders of the Royal Society of London. But his ideas enraged the philosophers and theologians of his time—he was regarded as an atheist and heretic; and was expelled at the age of twenty-four from the (traditional) Amsterdam synagogue. However, Spinoza has come to be regarded as one of the forerunners of the Enlightenment, and a potential light for our twenty-first-century path.
It is a rare delight to free one’s mind to explore the ideas of this extraordinary man, despite the limits of our understanding. The key ideas are listed here, though not in any particular order:
- An ecological view of all reality: we as humans are interconnected parts of the whole—not master, not servant, not interpreter, merely part of Nature. The human person within the whole is an emergent phenomenon: increasing complexity brings with it the possibility of increased awareness. There is order in Nature and each person is a part of that order. We have a place in the pattern of it all.
- Nature is not teleological—there is no “purpose,” no ultimate goal to be striven for, just the energy within all things (which Spinoza calls conatus, reviving an old term), impelling each thing, including each person, to continue in being.
- The mind is grounded in the body, an idea of the body. Minds are inserted into the totality (as Lloyd puts it). The thought-world, grounded in the body, is eternal. There is no personal immortality. Death is not a passage into another mode of existence, but an illustration of how I am part of Nature; as a person, I cease to be, but my thoughts are incorporated into the eternal mind. Spinoza’s concept of the body resonates with present medical understanding. Lloyd writes that “the human body is thus a composite individual, a union of parts acting as a center of communicating and communicated motion. Each individual body exerts a causal force on others. Each need for its preservation a great many other bodies, by which it is, as it were, continually regenerated.”5
- Cognition, or knowledge, is crucial in our personal functioning. Emotions are kept in check not by will (e.g. repression) but by thought/knowing.
- Far from being “Godless,” Spinoza offers many almost tantalizing notions concerning “God.” God is in all, and all is contained in God. There is no concept of God as transcendent, separate from Nature—God is wholly immanent. There is profound unity in the whole—and this unity may be called “God.” It is the atheist of Amsterdam who insists that the “intellectual love of God,” gazing on this wholly immanent God, this unity, in which we as part of Nature are contained, this whole as conatus, is the highest form of knowledge we may attain. The fact that we can gaze on God may be an inspiration and source of strength. There is no end to wonder.
It is noteworthy that Jonathan Sacks, surely one of the giants of wisdom of our times, writes of “the difference between the god of Aristotle and the God of Abraham. . . . This is the god of science, of the Enlightenment, of Spinoza. The God of Abraham is the God who relates to us in our singularity.”6 But Lenn Goodman, in the first paragraph of his masterful work, The God of Abraham, notes, “In Jewish tradition, the God of Abraham [and therefore also of Jesus] is the God of philosophers and scholars.”7
- All is determined. This immanent God does not intervene to break the laws of nature—there are no miracles, and prayers of supplication to change nature are meaningless. But freedom is to be found within contingency, within necessity. Spinoza moves away from Descartes on this matter.
In Descartes’s treatment of freedom, an inherently free will forces back ever further the limits of what must be accepted as beyond human control. The prevailing imagery is of border skirmishes. . . . Spinoza offers instead a vision of freedom as the joyful acceptance of what must be. . . . [F]reedom derives from the active engagement of the mind with necessity, an engagement that flows from the understanding of the truth.8
Freedom understood as the “joyful acceptance of what must be” is surely not a recipe for passivity or fatalism—nor sheer Stoicism! Spinoza is the same philosopher who highlighted the impulse inherent in all living things, what he called conatus—a striving to continue in being.
Spinoza’s notions clearly have relevance to how we live, how we think about our responsibility to realize fully what we as individual persons are or should be as simply one element in an interconnected whole, what we hope for, and how we think about dying, in which we prepare to be more evidently part of the whole. Clearly we are being encouraged to accept freely what must be, whilst at the same time striving to relieve suffering and to enhance human flourishing, all the while striving to continue in being, to become what we may be, and truly are: there is no passive acquiescence to fate here, but deliberate and thoughtful dynamism.
There are pointers also about how to think about “spiritual care” which, when mentioned, often leads busy clinicians to glance away. Any idea that we ourselves need “spiritual care” is usually cast aside, not from disrespect but because the notions spelled out by some people have no resonance in our thought world.
Yet the ramifications of these seminal ideas are precious, and each physician (as a unique person) will appropriate, and indeed embody them in a distinct fashion: the mind is changed, the brain is changed by the acquisition of new concepts. I form a new synthesis as I connect thoughts, and the new synthesis is embodied in the neuronal complexities of the brain—and we remember; neuroscientists have much to glean.9
In the midst of deep disquiet there is the longing in many thoughtful physicians for healing, for “salvation,” for “redemption”—and the ideas peddled by religious institutions seem often so very alien. Can Spinoza’s frame offer anything? I think, yes. My redemption may involve the deliberate and painful turning of my being so that I gaze more and more at “God” rather than focus on myself. Religious rituals may help me undertake such a turn of my inmost being—away from the narcissism, acquisitiveness, and hyperactivity desiccating the soul. Religion has been critical in the making of humanness10 and is best understood not as a matter of belief, but a dimension of human being: we ignore the symbolic universe to our peril. We spend our privileged clinical lives seeking to heal the world in the spirit of the Hebrew Tikkun olam:11 we may ourselves find healing in this gaze, this awareness of the whole and one’s place in it, this radical connectivity. Spinoza, at the end of his masterpiece The Ethics, writes of “true contentment of mind” as the fruit of such awareness. He concludes with the following words, which could have been written for us:
If the road I have shown to lead to this is very difficult, it yet can be discovered. And clearly it must be hard when it is so seldom found. For how could it be that if salvation were close at hand and could be found without difficulty it should be neglected by almost all? But all excellent things are as difficult as they are rare.12
Can one say that there is a basis here in the seminal ideas of Spinoza, for a new and radical humanism? Maybe. Maybe indeed.
- Lloyd G. Spinoza and the Ethics. Routledge, Milton Park, 1996. p. 23.
- Yovel Y. Spinoza and Other Heretics. Vol 1 The Marrano of Reason.
- Yovel Y. The Other Within: The Marranos, Split identity and Emerging Modernity, Princeton University Press, Princeton, 2006. p. 358.
- Yalom I. The Spinoza Problem. Basic Books, New York, 2013.
- LLoyd G. Spinoza and the Ethics. op cit. p. 55.
- Sacks J, Essays on Ethics. Koren Publishers, Jerusalem, 2016. p 284
- Goodman LE The God of Abraham. Oxford university Press, Oxforand New York, 1996. pvii.
- Lloyd G. Providence Lost. Harvard University Press, Cambridge Mass, 2008. p. 200. ff.
- Damasio A. Looking for Spinoza. Vintage, London, 2004.
- Rappaport R. Ritual and Religion in the Making of Humanity. Cambridge University Press, Cambridge, 2004.
- Sacks J. To Heal a Fractured World: The Ethics of Responsibility. Continuum, New York, 2005.
- Spinoza: Ethics Trans A Boyle and GHR Parkinson. Dent, London, 1989. p 223.
NORELLE LICKISS, AO, is a retired consultant physician with dominant medical interest in matters related to cancer and medical education. For decades she was immersed in clinical practice, mainly in teaching hospitals and in medical education, nationally and internationally. The title honorary doctor of medical science was conferred by University of Sydney in 2017. She is currently Hon Professor at the University of Sydney and Consultant Emeritus at the Royal Prince Alfred Hospital and Royal Hospital for Women, and University Associate (medicine) University of Tasmania. She has a long-time interest in the humanities.