Ratio

This essay is Part 2 of "Psyche, Mind" in the series of essays on Anthropiatry that deal with the structure of the mind. In this section we will examine the approach to knowledge that involves reflection almost exclusively: Rationalism.

According to Charles Freeman in his work "The Greek Achievement (1)," Western Civilization began when a Sicilian Greek named Pythagoras proclaimed that a^2+b^2=c^2: The Pythagorean Theorem. Now to say that a simple mathematical equation marks the rise of the most technologically advanced civilization in the history of man is an extraordinary claim. And yet it is quite true. It was the first time a man had ever articulated a universal law arrived at by the use of reason.

As we saw in the previous essay, Empiría, one way of looking at the world is through observation. But with Pythagoras, we see another, quite distinct way of discerning reality. The universe, it seems, can reveal itself to us through introspection and thought; we can cast our minds out into the far reaches of the heavens, and like Noah's dove, they return with the olive branch of knowing. This is as utterly amazing as any natural phenomenon upon which we marvel. Of all the experience that suggest the existence of a creator, to me this one is the most compelling.

As Aristotle is consecrated the Father of Empiricism, his teacher Plato carries the title for the Rational way of knowing. Plato believed that the reality surrounding us was in some ways illusory, that the elements and objects we observe are actually imperfect representations of things that exist somewhere out there, in the Land of Perfection, in the Dimension of Perfect Reason. Geometry, the only area of mathematics where the Greeks far surpassed their teachers (the ancient scholars of India), illustrates how the Rational reality differs from the Empirical reality. You can in Geometry for example appreciate various the various characteristics of geometric shapes, none of which exists in reality in its pure or exact form. "I can prove that triangles exist," Plate must have said, "but you can't show me one." This character of rationalism can be illustrated by an episode from my third year in medical school.

I was on the Internal Medicine inpatient rotation and we had a patient admitted to our service with lobar pneumonia. My attending Dr. Peter Lichstein (2) examined the patient and said, "this patient's examination is perfect. There is pectoriloquy, aegophany, and dullness to percussion (3). This patient is the Platonic Ideal of the physical examination for pneumonia." We can say with some confidence that the empiricist views reality uncompromised by imperfect reason, and the rationalists views truth as uncompromised by imperfect observation.

Geometry and reason are products of each other. In geometry we encounter reason, for example, as we undertake the proofs we did in high school. Mathematics is pure reason, after all; there is no such thing as an experimental or empirical mathematician. In the proofs we did in high school, Geometry illustrates the essential character of the process of rationalism: our representation of reality is the theorem (or theory), and we prove or disprove theories by the use of reason. The corollary for the Empiricist is to prove or disprove a hypothesis with the use of observation and/or experimentation. Do not lose sight of the fact that the root word for Rationalism is ratio, a mathematical term.

Two examples of great rationalists of the modern age are Freud and Einstein. Freud contemplated the characteristics of the mind and produced one of the great works of the 20th century: Psychoanalytic Theory (4). Einstein considered the characteristics of the universe and produced the Theory of Relativity. Of interest, drawing a connection between rationalism and empiricism, Einstein called his process of applying thought to understand processes "gedankenexperimentazion," or thought experiment.

A sophisticated and accomplished use of reason is like that of observation in that it does not come without training and proficient use. And like Empiricism, Rationalism has certain inherent flaws. Rationalists project thought into the chaos of a problem and upon its return, it bears a theory. Since theories are generally arrived at without a great deal of observation, there is always the possibility that the theory is incorrect. As the great French neurologist Charcot observered, "La théorie c'est bon, mais ça n'empêche pas d'éxister (5)." Similarly, Hippocrates said that theories of disease are good as long as they are accompanied by close clinical observation.

This problem can be illustrated by a Founding Father named Benjamin Rush. Rush was a physician who has been called the Father of American Psychiatry; he was the first American to author a textbook on psychiatric diseases. Like most of the great men of his age, he was a rationalist; it was after all the 18th Century, The Enlightenment, The Age of Reason. He was a practitioner of an old form of old Greek medicine concerned with the Four Humors: Sanguine, Melancholic, Choleric, Phlegmatic. Under this theory, patients with fevers underwent bloodletting because blood is hot and wet and since fevers make patients hot and wet, removing excess blood should be therapeutic. Dr. Rush was so faithful to this theory of medicine that he continued bloodletting feverish patients despite the evidence he must have encountered that it was harming them. Rationalists become so devoted to their theories that they risk ignoring observations that refute them.

Because of his allegiance to a harmful medical practice Dr. Rush is held in contempt by many in the modern age. They blame him, for example, for the possibly premature death of George Washington. And yet, to be really fair we should not remember him only that way; he was a passionate patriot, a signer of the Declaration of Independence, and a tireless advocate for the alienated mentally ill. Like most great men, he had his flaws, and who's to say that someday our practices in oncology and other areas of medicine will not be viewed the same way as bloodletting.

Rationalism has one distinct advantage over Empiricism. Reason is the father of Ethics; during my empirical medical training one of the islands of rationalism was our ethics class. The humanistic moral vision (6) that gave profound meaning to practitioners like my father was a direct outgrowth of the rational pillars of scientific medical thought. As our medical profession has surrendered rational ground to empiricism, it has simultaneously lost its lion-hearted character, and since practitioners have difficulty seeing their patients as human beings as opposed to "outcomes," their work is not as meaningful and they suffer burnout.

Another advantage of rationalism is that it is, like observation, a process. Those who are good at reasoning problems through have a distinct advantage in almost every context. Once I met an Ivy League medical student summer intern at the NIH, Paul Krauss, who was doing high level research without ever having done it before. I asked him how he managed to do research with essentially no training. "Knowledge," he said, "is for people who cannot reason."

(1) Penguin Publishing, 2000.

(2) Every medical student has supervising physicians who inspire them and whom they seek to emulate. Dr. Lichstein was such a teacher for me. He was a general internist, but he had had psychosomatic training under George Engel at the University of Rochester. He admitted psychiatric patients to the inpatient unit at East Carolina University's hospital.

(3) These are characteristics of lobar pneumonia that can often be detected on physical examination. As with most diseases and disorders, the physical manifestations are usually not present in an unmistakable way.

(4) Remember that whenever you hear the word theory or theorem, you are in the realm of Rationalism. When you hear hypothesis, you are on Empirical turf. It is important to remember that theories are no less true or scientific than hypotheses or vice-versa; each has is most appropriate use.

(5) "Theories are fine, but they do not affect reality." Charcot was world famous for his work on hysteria and Freud studied under him at the Salpetrière Hospital in Paris. Freud's time under Charcot was seminal with respect to the formation of Psychoanalytic Theory.

(6) Humanistic Moral Vision, despite the presence of the term moral, has nothing to do with morals or morality except in that it takes the position that it is immoral not to approach the patient humanistically, without caring. In the context of a humanistic moral vision, the physician sees him or herself as a champion for mankind, as a combatant against disease, suffering and meaningless death. Without a humanistic moral vision, contemporary medicine struggles to see patients as human beings as opposed to laboratory results or as an aggregation of statistical characteristics.

(c) Copyright 2011 Robert Albanese