Azure no. 44, Spring 5771 / 2011

Works Like a Charm

Reviewed by Yaki Menschenfreund

Complementary Medicine and the Reenchantment of the World
by Yael Keshet
Resling, 2010, 247 pages, Hebrew.

British biologist Richard Dawkins, an uncompromising rationalist, once defined “alternative medicine” as a “set of practices that cannot be tested, refuse to be tested, or consistently fail tests.” This sarcastic definition is no doubt shared by many of the experts and professionals in the field of medicine. However, a growing number of people today seek the services of alternative medicine (also known as “complementary medicine,” “unconventional medicine,” “holistic medicine,” etc.). A study conducted three years ago by business information group BdiCoface found that nearly one-quarter of Israelis—some 1.7 million people—were undergoing some sort of “alternative” medical treatment. Data from other countries indicate a similar trend. The conclusion is inescapable: Pace the scientific community, a significant portion of the public is not particularly concerned with the tests to which Dawkins is referring.
The expression “alternative medicine,” it must be noted, is a very general term, and describes a variety of therapeutic practices—some ancient, such as Chinese acupuncture and Indian ayurveda, and some quite modern, such as homeopathy, which was conceived in Central Europe in the eighteenth century. The common denominator of all these practices is the fact that their development generally took place outside the realm of methodical scientific research. Of course, this fact alone does not necessarily diminish their effectiveness, to say nothing of the surge of popularity they have been enjoying of late.
This phenomenon, in its cultural, social, and even political manifestations, is the topic of Yael Keshet’s book Complementary Medicine and the Reenchantment of the World. Keshet, a researcher at Western Galilee College, aims, among other things, to explain the secret of complementary medicine’s attraction and its complicated relationship with scientific research (“bio-medicine,” as she calls it). This is no easy feat: The accelerated progress of scientific medicine, combined with the “therapeutic revolution” of the twentieth century, should by all rights have extinguished alternative treatment methods, whose effectiveness—scientifically speaking—is highly dubious. Yet complementary medicine is thriving, and not only among its practitioners and their clients. In recent years, it has garnered a great deal of interest among people and institutions identified with the medical establishment itself. This trend is, by all accounts, a mystery, and Keshet’s book, based on research she conducted between 1999 and 2009, tackles it from a sociological angle. Unfortunately, in Keshet’s attempt to explain the essence and function of complementary medicine, her research raises some difficult questions of its own—many of which have more to do with sociology itself.
Keshet’s declaration of intent at-tests to the theoretical toolbox with which she proposes to approach the subject. “My goal,” she writes at the opening of the book, “is to demonstrate that complementary medicine, which includes a variety of health treatment methods, creates a new discourse that allows us to speak about what cannot be discussed in modern scientific medical discourse. I suggest that complementary medicine charts an epistemological way of constructing a new type of knowledge.”
These words make no secret of what well-paved path the author has chosen to tread. In accordance with the current geist of contemporary social sciences, Keshet adopts the constructivist approach, which maintains that “knowledge” is never neutral, objective, or universal; it is, instead, “constructed,” reflecting conditions unique to a certain time and place and grounded, in one way or another, in the social order. Science, according to this way of thinking, is no exception: “In contrast to the approach of many scientists, who distinguish between scientific knowledge, which they consider privileged, and other types of knowledge,” Keshet writes, “anthropologists and sociologists of science emphasize their similarity.” This approach owes a special debt to Michel Foucault, who in a number of works highlighted the different ways in which “knowledge” and “power” are inextricably linked to one another. Foucault devoted a great deal of attention to the history of modern medicine, which in his opinion turned man into an “object of knowledge” for experts and developed methods and mechanisms that allow for the systematic regulation of life—what he called “bio-power.”
On this theoretical foundation, Keshet claims that “the growth of complementary medicine is an attempt to restore enchantment and sanctity to the world of modern and rational medicine, to the sober-minded world that has been stripped of magic.” Keshet’s perspective is inspired by Max Weber’s famous thesis regarding the “disenchantment of the world” by its bureaucracy, industrialization, and science. Complementary medicine, maintains Keshet, is one way people living in modern Western society attempt to reinfuse their existence with coherent meaning. It is fundamentally bound up with “New Age” culture, whose rapid growth in the second half of the twentieth century is in many respects a reaction to the imprisonment of man in what Weber called the “iron cage” of rationality.
Nonetheless, Keshet believes that “complementary medicine is not a return to traditional medicine, to an ancient way of life and the nostalgic past, to which we cling and for which we yearn.” Rather, it should be seen as a new, wholly contemporary phenomenon, “a hybrid of opposite modern categories”: spirit and flesh, nature and culture, object and subject, etc. In the second chapter of the book, Keshet fleshes out this idea by discussing the practices of “healers,” who offer their clients “holistic” treatments that go beyond the symptomatic (in contrast, ostensibly, with conventional medicine), seeking instead to find the “root of the problem” and facilitate the “general recovery” of the body. These charismatic individuals, Keshet asserts, represent “a new and creative method that surpasses the routine of the accepted medical treatment,” a method that combines “body with soul, biology with spirit, nature with culture, and healing with sanctity.”
In this synthesis, which flies in the very face of bio-medicine, Keshet finds a “deliberate creation of hybrid knowledge.” The widespread use that alternative therapists make of the term “energy,” for example, illustrates how the “hybrid-establishing linguistic mechanism” operates: While this term appears in scientific discourse in more-or-less defined and measurable contexts, in the vocabulary of complementary medicine, which presumes to convey “alternative knowledge,” it acquires various meanings, all of which are inconsistent with—but do not necessarily contradict—bio-medical knowledge. Practitioners and adepts of alternative medicine in particular, and of “New Age” culture in general, generally regard “energy” as an abstract essence, neither measurable nor quantifiable (nor even properly definable), and attribute it to man as a physical, emotional, and spiritual being. This alternative use of the term does not negate its original, scientific meaning, but rather seeks to place it in a wider framework, one that takes mystical-spiritual dimensions into account. As a rule, New Age adherents repeatedly borrow concepts from the field of physics—primarily quantum mechanics, which they see as consistent with their worldview. Keshet quotes, for instance, Richard Bartlett, a well-known healer, who claims that “quantum physics actually predicts miracles. We now have quantum physicists who are calling this unified field theory the Mind of God…. If you are dealing with [the] Mind of God, and you’re actually a functional part of that mind, you have access to that same awareness.” Such statements, in Keshet’s opinion, attest to an effort to “break through the ‘prison’ of modern rational thought in a discourse of health and medicine, and propose a different linguistic, cognitive, and experiential world.”
The final part of Keshet’s book is dedicated to an analysis of the clash between scientific medicine and alternative medicine. In true Foucauldian manner, she describes this clash not as a controversy about medical truth, but rather as a struggle for the “power” to construct such truth. While bio-doctors rely to a growing extent on “evidence-based medicine” (EBM) and wish to examine the effectiveness of treatments through the objective prism of controlled and double-blind trials, many alternative practitioners maintain that this type of research cannot serve as an effective measure for assessing the merits of complementary medicine, as the latter is based not on “scientific rationalism” but rather on other principles. The conflict between these approaches has a clear anthropological-sociological dimension, as it reflects an ongoing tussle between professions that attempt to protect their borders from the infiltration of external agents. Keshet mentions, in this context, the recent controversy that arose recently surrounding the Zaidise Committee (headed by Itzhak Zaidise, associate director of the Sheba Medical Center at Tel Hashomer hospital), which sought to examine, among other things, the possibility of regulating the study of complementary medicine within an academic framework, under the supervision of the Council for Higher Education. The debate sparked by the proposal exposed the “purist” positions on both sides. On the one hand, many of the bio-medicinists reject what they perceive as an intermingling of science and mysticism, and are averse to granting institutional legitimacy to therapists who have not undergone the appropriate initiation process (namely, the study of medicine within a recognized university). On the other hand, many practitioners of alternative medicine object to academic supervision, claiming that it would undermine the professional autonomy of their methods, which are based more on spiritual intuition than on scientific standards.
Though Keshet’s book is riddled with sociological jargon, her sympathy toward the latter approach, which emphasizes “an ideology of holism as opposed to bio-medical reductionism,” is palpably clear. Like many in today’s academic circles, she tends to side with whatever forces challenge the “hegemony.” Thus, for instance, she stresses that “complementary medicine openly questions the existing social order, modern classification systems, and the medical establishment’s rationalization of information management.” From this point of view, which subjects every social phenomenon to a radical political interpretation, even the campaign against vaccinating children, which horrifies many doctors, is in fact a heroic display of anti-establishment subversion—an attempt to curb “the state’s modern control of the population,” no less.
Despite its political biases, the constructivist approach can indeed serve as an important means of gaining insight into the actual activity of science—in contrast, that is, to the ideal picture often painted by its various advocates. But the drawbacks of radical constructivism, which Keshet adopts in full, far outweigh its advantages, and an excessive dependence on its problematic assumptions is liable to lead to a distortion, and even unintentional parody, of scientific discourse.
The root of the problem lies in one of the basic notions of constructivism: the “symmetry principle,” first formulated by sociologists Barry Barnes and David Bloor. As Keshet explains, this postulate establishes that “in order to understand scientific knowledge itself as a social product, sociologists of science must be liberated from the scientific intellectual hegemony and relate equally to information considered to be true and information considered to be false.” In other words, researchers may not discriminate between scientific theories and practices that have undergone rigorous empirical testing, on the one hand, and theories and practices that either have failed those tests, or were nothing more than pseudo-science to begin with (astrology being an obvious example), on the other. Such an impartial attitude is ostensibly legitimized by the assumption that any description of reality is a cultural construct, which serves the interests of certain groups. Radical constructivists dismiss any attempt to raise the issue of correspondence between different representations (for instance, scientific theories) and the thing they seek to represent (“the world”). The anthropologist Bruno Latour, an influential constructivist thinker, summarized this position by arguing that “nature” is merely the final product of scientific research, not its origin. According to Latour, one cannot explain the resolution of scientific debates by determining that “this is the way things really are,” because all claims regarding the truth (including scientific observations) are themselves no more than representations, constructed through sociological-historical processes.
As aforementioned, this approach, especially when taken to an extreme, often gives rise to an altogether erroneous perception of scientific activity. The claim, for example, that Louis Pasteur and Robert Koch’s “germ theory of disease” is but a contingent “representation” of nature, and is in this respect no different than, say, the debunked “miasma theory,” which holds that “bad air” is the primary cause of ailments, completely ignores the tremendous achievements of scientific medicine in curbing epidemics and curing afflictions. Indeed, medicine owes at least a good portion of its success to the correctness of the assumptions on which it rests, just as refuted theories owe at least a good portion of their failure to their discrepancy with objective truth. The “critical” standpoint championed by the constructivists at times yields patently non-critical conclusions, which place sociological research in a rather unflattering light.
This weakness is evident in Keshet’s reference to the evaluative measures used by complementary medicine to determine the effectiveness of a given treatment. According to Keshet, alternative medicine distinguishes between “effectiveness” and “benefit”: Its practitioners engage, according to their own testimony, in “healing” rather than “curing.” The treatment they provide “benefits” patients, but cannot be evaluated on the basis of medical “effectiveness.” Since alternative treatments are sensitive to the unique circumstances of each individual, they argue, the patient alone has the capacity to judge to what degree he or she has truly benefited. Any attempt to determine the matter from an external perspective is thus doomed to fail.
In the absence of objective and substantial evidence of the effectiveness of complementary medicine, it is difficult to regard the terminology it employs as an effective description or explanation of reality (not only biological reality, but also therapeutic reality, which stands at the heart of complementary practices). There lies, then, a great abyss between the obscure rhetoric of alternative medicine and scientific discourse, which is to a great extent based on systematic research and comprehensive empirical findings. Keshet—who presents herself as a “skeptical researcher”—is unconcerned, it would seem, about these fundamental differences. She creates the impression that the concepts of complementary medicine are no less legitimate than those of scientific medicine—if only because they wish to establish “alternative” knowledge that challenges the hegemonic order.
One of the book’s conspicuous flaws is its sweeping adoption of stereotypes and clichés regarding the “essence” of both science and alternative medicine. Following sociologist Zygmunt Bauman, Keshet presents science in general, and bio-medicine in particular, as paradigms of modern rationality. As such, she explains, they exemplify the modern compulsion to organize and catalog reality at every turn:
The attempt to create order through classification and categorization is a central act in modern science and in nearly every domain of modern life…. The search for order, clarity, and transparency provided by reason is one of the main objectives of modern society, while ambiguity and ambivalence are perceived as waste…. The typical modern act—the stuff of which politics, intellect, and modern life were made—is… the effort to mitigate ambivalence: the effort to define precisely and to efface anything that is not given to precise definition—to overcome the demon of ambiguousness. Modernity takes pride in the division of the world and its categorization. This is the source of its strength.
The claim that scientific activity expresses an “attempt to create order through classification and categorization” certainly contains some degree of truth, but many tend to overstate it. After all, the impulse to organize and catalog did not make its first appearance with the scientific revolution; the ancients—in classical Greece, for example, but also in other civilizations—exhibited similar tendencies. Keshet herself admits that classifying is a “natural” act, which takes place in every culture, but does not explain why science must be accorded a unique position in this context, and why it is modernity that is characterized by the attempt to “mitigate ambivalence.”
In contrast, the portrayal of complementary medicine as a discourse in which “the person is presented and perceived as a whole” and as “an integral part of the energy of the environment and the universe” will probably be acceptable to most alternative therapists. But this description requires qualification: While many “healers” would agree with this claim, we cannot deduce from their statements alone that this is in fact how they regard their vocation. Perhaps they aspire to this type of approach—which demands a high level of “cosmic awareness,” and possibly even “enlightenment” (which, we may assume, is experienced only by a privileged few)—but it may well still be beyond their reach.
Indeed, the weakness of radical constructivism lies precisely in its reluctance to cast doubt on the reports of its subjects of research. Of course, anthropology and sociology do not as a rule encourage the researcher to accuse the people he interviews of lying, but it seems fair to expect that the study of fields such as alternative medicine demands a higher degree of skepticism. Keshet quotes, for example, New Age icon Deepak Chopra, who recounts the miraculous case of a patient of his, who, he claims, recovered from cancer with no actual medical intervention. Chopra presents such cases as “miracles” that occur as a result of “sudden leaps of awareness.” No small number of “conventional” oncologists are likely to balk when reading these claims—and can we blame them for doubting their credibility? Yet Keshet is not particularly bothered by this kind of talk, or by the fact that various and sundry “healers” are time and again exposed as unprincipled charlatans. One can make the case that even distinguished scientists are not above bias, or even displays of unethical conduct. And yet, as a rule, researchers who seek to impart their discoveries to the scientific community must go through an academic Via Dolorosa, withstanding lengthy and nerve-racking processes of validation. Practitioners of alternative medicine, by contrast, are unwilling to subject themselves to external examination or supervision. Their claims must therefore be taken with more than a grain of salt.
Even if we do not question the sincerity of its practitioners, complementary medicine, with its discourse on “energies,” “meridians,” “chakras,” etc., is undeniably rife with conceptual confusion (which Keshet, somewhat romantically, presents as an expression of “ambivalence” and of “crossing borders”). This type of confusion is fertile ground for rhetorical manipulation, which in turn adorns alternative medicine with an aura of both science and mysticism. The popularity of its methods indicates that this is an astoundingly successful strategy, but success, as we know, is no proof of seriousness.
Indeed, a theory’s ability to be verified is only one (and not always the most important) factor in its performance in the public arena. Complementary medicine is flourishing, evidenced by its intrusion into the nucleus of the medical establishment itself, i.e., Israeli hospitals and HMOs. Some will insist that the success of complementary medicine attests to its objective effectiveness, but most studies conducted on the subject do not support this assumption. Rather, the reasons for the success of complementary medicine must be sought on the sociological, psychological, and political levels. If we choose to take this path, Keshet’s book can be of great help to us.
Despite its shortcomings, Complementary Medicine and the Reenchantment of the World is an important work with a compelling thesis. Alongside the fascinating sociological analysis, the book includes invaluable information about the historical development of alternative medicine in the West in general and in Israel in particular. Readers will probably find fascinating the author’s description of the clash between the medical establishment and practitioners of complementary medicine, a conflict in which both sides use different strategies to win public legitimacy and protect the boundaries of their professions. However, Keshet’s evasion of the question of the objective effectiveness of complementary medicine (in comparison to the proven effectiveness of scientific medicine) allows her to grant undue respect to the subject of her research. The attempt to “reenchant the world” is certainly worthy of an in-depth study, but a sociologist should not forget that belief in enchantment is, in the final analysis, a rather childish business.

Yaki Menschenfreund is a researcher of the philosophy of rationalism.