CONCEPTS: VITALISM Vitalism–A Worldview Revisited: A Critique Of Vitalism And Its Implications For Naturopathic Medicine Ian Coulter, PhD; Pamela Snider, ND; Amy Neil, MS, MAP Ian Coulter, PhD, Rand Corporation, Author, Foundations This paper represents a philosophical “critique” in which of Naturopathic Medicine Institute. Pamela Snider, ND, we will systematically explore and characterize vitalism, its Executive and Senior Editor, Author, Foundations of position within metaphysics (a branch of philosophy,) and Naturopathic Medicine Institute and Faculty, Bastyr its ontological (core question) and teleological (purpose) University, Associate Professor, National University of perspective, to discern if its concepts can be elucidated in Natural Medicine. Amy Neil, MS, MAP, Medical Editor, a rational format; i.e: explicitly operationalized to enable Author, Foundations of Naturopathic Medicine Institute scientific inquiry, and to assess its viability as an enduring and future concept within clinical medicine. The authors suggest that although worldviews are a Philosophy and Medicine focus of many branches of philosophy, and although they What is the relationship between philosophy and are metaphysical in nature, they are (and perhaps should be) medicine? What is the purpose in studying philosophy subject to critique by health professions. It is one thing to be and the philosophical roots of current medical practice? a vitalist—or a scientific materialist—but is something else Many branches of philosophy address the nature of being, to use such a worldview as a dogma. We attempt to show and the nature of existence and reality, which are of how this happens. More importantly we lay out a method of ultimate concern to our existence as humans, and thus of critique for metaphysics and worldviews that Naturopathic influence in medical practice.i The influence of philosophy medicine can use in mounting both a critical, inquisitive on medical practice extends throughout the history of and reflective approach to vitalism in teaching, practice and medicine, as emphasized by Nordenfelt1: research. With this approach, worldviews then become fertile soil for scientific discovery. Through diverse worldviews Health has not generally been viewed as a proper object of society, and health professions have the opportunity philosophical study. It is not well known that health and to broaden scientific and clinical theories, questions, health care were important topics for Plato and Aristotle, practices and hypotheses; in service of evaluating what the as well as for Descartes, Locke and Kant. Few people know nature of health, healing and illness is. Understanding the that the dominant school of medicine in Europe until the seventeenth century—Galenic medicine—was an application vis medicatrix naturae, a vitalistic concept and world view, is of central themes in Aristotle’s natural philosophyi or that the central ontological question of naturopathic medicine, many of the schools that followed were highly influenced and the work of naturopathic physicians. by Descartes’ philosophy of man. Even fewer would believe that philosophical analysis or speculation could make any A Brief History Of Vitalism valuable contribution to modern medicine. Medicine has There are many opinions about what vitalism actually for a long time … been liberating itself from the bonds of is. In general, it is the doctrine that life originates in a vital philosophy in its move to become an empirical science. principle, distinct from chemical and other forces. It is a belief that there is a vital force operating in the living Vitalism is a worldview and a key philosophical root of organism and that this cannot be reduced or explained naturopathic medicine as well as a focus of criticism among simply by physical or chemical factors. As Lipman its detractors. It is a concept notoriously difficult to elucidate observed,2 “We can then define vitalism as the belief in and often is roundly debated among naturopathic physicians. the existence of some operating principle which is not Vitalism is not simply an isolated principle in naturopathic found in inorganic nature and which distinguishes a living medicine—it is an integral part of the naturopathic paradigm organism from the physico-chemical world.” and is the foundation for many of its underlying principles. Vitalism has a long history in both Western and It leads to a different philosophy about health, about health non-Western societies. In Western societies, the concept of care, and about the role of the health provider. It is the basis i. Throughout much of 1100-1600, and preceding the Newtonian Scientific of the claim that biomedicine (conventional medicine) and Revolution, medicine was considered a “natural science” though this was naturopathic medicine are distinct paradigms. debated. The natural sciences emerged from natural philosophy. 60 Integrative Medicine • Vol. 18, No. 3 • June 2019 Coulter—Vitalism vitalism appears in health writings, almost continuously, mark on Western thought. The Aristotelian view was from the ancient Greeks to contemporary health that the body had pneuma (spirit) or vital breath.8 The professionals. pneuma is located in the heart, whereas the soul (psyche) Yet, there also has been a long history of controversy is located either in the breast or in the head. This idea was concerning vitalism. Although a detailed history of assimilated into Jewish, Christian, and Muslim practice this worldview is beyond the scope of this article (and and philosophy.8 is presented elsewhere),3-5 summarizing its history The division between the Aesculapian and Hygeian here, allows us to place contemporary vitalism and the schools of thought continues to influence today’s controversy about it in a historical context. It is important healthcare practices and system. Each school of thought to note, however, that the debate around vitalism intensified continues to exist in modern society—biomedicine considerably in the 18th and 19th centuries,6 during which represents an essentially Aesculapian worldview, and vitalism increasingly was used as a derogatory term. Even Integrative Health (IH) care professions referred to today, it is used by some to imply, “lack of intellectual rigor, formerly primarily as Complementary and Alternative anti-scientific attitudes and superstition.”6 Medicine (CAM)ii (including naturopathic medicine, and traditional world and indigenous medicines), represent a Roots: Aesculapian Vs. Hygeian Worldviews Hygeian worldview. In ancient Greece, there already existed a division Likewise, the close association between Greek between two schools of philosophical thought and medicine and philosophies (such as vitalism) continued practices of healing: to influence healthcare practice until quite recently, in historical terms. By the mid-twentieth century, • Aesculapian philosophy embraced a mechanistic biomedicine generally had lost this connection with view of health and illness, and adopted what we philosophy, while IH care practices continue to be very would now consider a scientific, investigative philosophically based. Although we will return to this point approach to nature. Within this approach, diseases later in this chapter, it could be argued that biomedicine were considered to have material causes that gave is still highly philosophical in embracing science which, rise to specific diseases and symptoms. in its contemporary version, is the philosophy of critical • Hygeian philosophy, the alternative view, was based rationalism and scientific materialism proposed by Karl on the philosophical principle of vis medicatrix Popper.9,10 Yet, biomedicine tends not to acknowledge this naturae, which adopted a holistic, vitalistic and, in fact, tends to hide its philosophical base.11,12 approach to health; did not separate the mind and the body; and believed the body had natural healing The Influence Of Vitalism On Integrative Health And processes and that healthcare providers simply CAM Disciplines. facilitated these natural healing processes.7 Although naturopathic medicine is the focus of this textbook, it shares much of its vitalism and some of its Among the Greek philosophers, the conflict between philosophical foundation with other IH care practices, these worldviews is evident in the disagreement between including traditional and indigenous world medicines. Democritus and Aristotle7 Democritus’ deterministic Placing it in this broader context allows us to illuminate theory proposed that nature, including humans, consisted the distinct features of naturopathic medicine that are of atoms. Aristotle’s vitalistic theory proposed that living influenced by vitalism. organisms consisted of a primordial substance (soul) Integrative health disciplines and systems are extremely and form, which transformed it into a specific thing.5 diverse; however, a key characteristic they share is vitalism. The Aristotelian worldview (also shared by Galen and All of these disciplines (or systems) ascribe—in one way or Paracelsus), was the dominant worldview throughout another—to the principle of vitalism; all living organisms Europe until the 16th century.5 It is important to note are sustained by a vital force that is both different from, that in the Aristotelian worldview, soul and body were and greater than, physical and chemical forces. As shown not considered separate (dualistic), but as insoluble parts in Box 1 there are several ways of expressing the vitalist of a whole. It is only later, with the works of