By Michael J. Balboni

This is the second entry in a four-part series examining the social and historical forces that have led to the current divide between religion and medicine. Drawing on Peter Berger’s theory of plausibility structures (particular social processes that legitimize social beliefs and practices, giving them a matter-of-fact quality), this series examines key factors that lie behind the current state of spirituality in medicine. This post focuses on our cultural beliefs about physicians as scientists, and how the late nineteenth century alliance with science has transforming the meaning of the medical vocation.

Throughout the history of Western medicine, physicians viewed themselves as invested with a divine mission and purpose. In fact, according to sociologist Jonathan Imber, the initial ascendance of the medical profession during the middle of the Nineteenth century was due in part to the fact that physicians were allied with and morally commissioned by Protestant clergy. Imber suggests that Protestant clergy empowered the medical profession with a moral and spiritual vocation, resulting in a deeply held public trust of physicians.[1] A vivid depiction of this spiritual/medical vocation can be seen in Luke Fildes’ 1891 painting, The Doctor. In this painting, the physician leans pensively over the sickbed of an ill child. The tools of his trade are pushed to the side, as illness takes the upper hand, whereas a light shines on his thoughtful face and gentle expression. He is here not only to offer his medical skills, but also to shepherd the family through a difficult and painful experience.

As this painting suggests, trust in doctors was not only grounded in their medical competence, but also in their moral credibility and spiritual presence. Patients drew comfort that doctors would care for both body and soul.  In fact, when Fildes painted The Doctor, he drew on his own experience of losing his child some ten years earlier.  It was the presence of the physician in his night vigil, according to Fildes, which long lingered in his mind as a balm even despite the loss of his son.  The Doctor memorializes the centrality of physician compassion, as no amount of science can stave off death and grief permanently.

Around the turn of the century, the relationship between the medical profession and religion shifted.  Clergy began to move away from describing a physician’s calling as grounded directly in faith, replacing it with an emphasis on “humanitarianism.”[1]  At the same time, there was a growing decoupling of physician authority from spiritual sources hastened by medical advances. Technologies spread over a variety of sub-specialties in healthcare ranging from anesthesia to vaccines, from treatments for rheumatoid arthritis to the eventual development of laparoscopic surgery. These massive achievements demonstrated and reinforced social confidence in physicians as authorities of diagnosis and therapy.  All of this occurred in tandem with the development of governing bodies, such as medical associations, guilds, and licensing institutions. Imber and others have shown how doctors began to claim authority by presenting themselves to the American public as scientists,[1,2] thus differentiating themselves from the profusion of nineteenth- and early twentieth-century “medical quacks” who offered inferior, superstitious therapies.  This association between doctors and the scientific establishment enabled a professional monopoly over prescription privileges, eligibility for state-funded research, and reimbursements for patient care. As part of a social contract, physicians provide empirically proven scientific therapies, and in exchange, society grants physicians authority over disease, cultural prestige, and financial success.

When the medical profession began to tether itself primarily to a scientific identity, the profession also took on the science-religion conflict thesis as part of its identity.  Though many historians reject the notion that conflict is the most appropriate lens through which to view relationship between science and religion, the idea of a “war” between science and religion continues to be an enduring cultural metaphor.[3] Historian Colin Russell argued that maintaining a metaphor of war between these domains is a socially constructed myth, an oversimplification, and at times “a deception.” [4] He suggested that it has been aimed to “enhance the public appreciation of science” and simultaneously minimize religious influence from exerting itself within scientific endeavors.  Any large-scale association between the medical guild and religion is therefore perceived as a threat to the profession’s cultural authority [4] because when the medical profession began to tether itself to a scientific identity, the profession took on the conflict thesis as part of its identity. Consequently, spirituality and religion are interpreted as internal threats to the profession itself.  This underlying narrative has become a plausibility structure that shapes how society conceptualizes physicians qua physicians.

Within this larger milieu, it makes sense to call medicine and religion an “Unholy Alliance.” [3] If science and religion are in conflict generally, then it must also mean that physician scientists and religion are deeply incompatible.  Because the physician’s guild staked its cultural authority on this dichotomization at the turn of the last century, notions of partnership or harmony with religion are viewed as immediate threats to the guild’s expert knowledge and its monopolistic hold over the social structures of healing. Thus, a practice of separation of medicine and religion has become embedded within the fabric of a profession that transitioned away from a religious to scientific narrative in grounding its cultural authority. 

While the significance of the physician-as-scientist narrative has highlighted certain important emphases (e.g., evidence-based medicine) this epistemological authority came at a cost: in the pursuit of scientific rigor, the practice of medicine lost some of its person-centered focus. The Doctornow has become a dreamy vision of a bygone era in which hospitality and compassion are increasingly difficult to maintain as chief values in medical practice.  As hospitals have become temples of technology (as suggested in Part 1 of this blog), even so physicians are akin to a priesthood of healing authorized by its scientific powers.  Together, these create a powerful narrative demanding separation, so much so that many have trouble envisioning how medicine and religion could possibly operate as partners. In our forthcoming book, Hostility to Hospitality: Spirituality and Professional Socialization within Medicine, (Oxford University Press, September 2018), Tracy Balboni and I argue that choosing between medicine and religion is a false choice.   We also show that reinvigorating a medical-religious partnership within our pluralistic society is both possible and necessary if hospitality and compassion are to remain core values into our future.

Bibliography

[1].          Jonathan B. Imber. Trusting doctors : the decline of moral authority in American[ medicine.Princeton: Princeton University Press; 2008.

[2].          Paul Starr. The social transformation of American medicine.New York: Basic Books; 1982.

[3].          Richard P. Sloan. Blind faith : the unholy alliance of religion and medicine.1st ed. New York: St. Martin’s Press; 2006.

[4].          Colin A. Russell. The Conflict of Science and Religion. In: Ferngren GB, ed. Science and Religion:  a historical introduction. Baltimore: The Johns Hopkins University Press; 2002:3-12.