20th WCP: The Body as Teacher: From Source of Knowledge to Object of Knowledge

In his book The Mirage of Health, René Dubos refers to the never-ending oscillation between two different points of view in medicine: those who believe that health results from living in harmony with nature (and thus take it upon themselves to know themselves and live in harmony with their environment) and those who believe that health is the responsibility of a medical expert who brings specialized knowledge and the surgeon's knife to conquer disease). He points out that in ancient Greece, doctors worked under the patronage of Asklepios, the god of medicine while healers served Asklepios's daughter Hygeia, goddess of health:

For the worshippers of Hygeia, health is the natural order of things, a positive attribute to which men are entitled if they govern their lives wisely. According to them, the most important function of medicine is to discover and teach the natural laws which will ensure a man a healthy mind in a healthy body. More skeptical, or wiser in the ways of the world, the followers of Asklepios believe that the chief role of the physician is to treat disease, to restore health by correcting any imperfections caused by accidents of birth or life. (1)

The modern debate between the followers of Hygeia and the followers of Asklepios is more than a debate about the relative merits of medical science; it reflects a more fundamental debate about the nature of the self and about the ways in which one can have knowledge of the self. It is a debate about the nature of the body and how we learn about it or from it. It is about the body as teacher.

This paper focusses on one Renaissance follower of Hygeia, Michel de Montaigne who wrote extensively in his Essays about his body as a source of knowledge of his 'self' (his moi ) and about some of his contemporaries, followers of Asklepios, developers of the science of anatomy and the related practice of dissection, for whom the body became the object of knowledge that it still is for medical science today.

When the twenty-five year old Andreas Vesalius performed his first public dissection before an audience of two hundred international students and faculty at the University of Bologna in 1540, Montaigne was only seven years old. But by the time he published the first volume of his Essays in 1580 the "culture in which the opening of the human body was considered a central act in the obtainment of knowledge" (2) was beginning to be well-enconsed. This culture was not, however, Montaigne's.

Montaigne was a true follower of Hygiea. For him, health was a question of living in balance with the world around him, knowing his place in that world, and following his destiny.

Our most great and glorious achievement is to live our life fittingly .........Greatness of soul consists not so much in striving upwards and forwards as in knowing how to find one's place and to draw the line....Nothing is so beautiful, so right, as acting as a man should: nor is anything so arduous as knowing how to live this life naturally and well. (III.13.1261) (3)

And knowing how to live fittingly entails a knowledge of both body and soul:

Those who wish to take our two principal pieces apart and to sequester one from the other are wrong. We must on the contrary couple and join them closely together. We must command the soul not to withdraw to its quarters, not to entertain itself apart, not to despise and abandon the body...but to rally to it, take it in its arms and cherish it, help it, look after it, counsel it, and when it strays set it to rights and bring it back home again. (II.17.727)

This is the reason behind his vivid descriptions of his physical self—the many details of his bodily manners and foibles. In his quest for self-knowledge, Montaigne is not content to speak only of his soul or of his strengths and weaknesses of character or of his intellectual interests and pursuits. As Starobinski points out (in a long chapter of his book Montaigne en mouvement entitled "Le moment du corps"):

...la description du soi ne doit pas s'arreter aux facultés de l'âme; il faut pour être complet, tenir registre des aptitudes et des habitudes corporelles. (4)

For Montaigne his total experience—body and soul, healthy and sick—is part of his learning:

Were I a good pupil, there is enough, I find, in my own experience to make me wise. Whoever recalls to mind his last bout of choler and the excesses to which that fevered passion brought him sees the ugliness of that distemper better than in Aristotle and conceives even more just a loathing for it....I would rather be an expert on me than on Cicero. (III.13.1218)

And he is an expert on himself. He knows what he likes, he knows what he needs—what is 'natural' for him:

.....I cannot, without turning it into an assay of myself, sleep by day, eat snacks between meals, nor eat breakfast, nor go to bed after supper without having a considerable gap...nor have sexual intercourse except before going to sleep, nor do it standing up, nor remain soaking with sweat, nor drink either water or wine unmixed, nor remain for long with my head uncovered, nor have my haircut after dinner. I would feel just as ill at ease without gloves or shirt, or without a wash on leaving the table and when getting up in the morning, or lying in a bed without a canopy and curtains, as I would if forced to do without things which really matter. (III:13.1230)

No details are spared:

"My bowels and I never fail to keep our rendezvous, which is (unless some urgent business or illness disturbs us) when I jump out of bed."

He tells us he is not fond of salads nor any fruit except melons, that he goes on and off radishes and does the same with red and white wine. He likes fish but not with meat, can go without lunch, and tolerates better the rigours of winter than the rigours of summer. He tells us that he accepts "wholeheartedly and thankfully" what Nature has done for him and quotes Cicero: "All things which are in accordance with Nature are worthy of esteem." (III:13.1265). "Nature has provided that such actions as she has imposed on us as necessities should also be pleasurable, urging us towards them not only by reason but by desire. To corrupt her laws is wrong."

This attitude of Montaigne towards his body extends to his attitude towards illness and to his attitude towards doctors. Starobinski points to both of these in his chapter on the body. Regarding the first, he says that in Montaigne, "la conscience du corps, accentuée par la maladie, délimite un lieu où le sujet ne relève d'aucune autre juridiction que de la nature, qui l'assigne à subir son destin corporel". (5) Illness is part of nature; it is part of one's destiny to fall ill and, while all natural means of combatting illness are acceptable, the most important thing is to accept the illness and learn to live with it. As Montaigne himself says about the Order (and he uses a capital 'O') that pertains to man as well as to the flea and the mole:

It owes it to disease as to health that each should run its course. It will not be bribed to favour one at the expense of the rights of the other: for then it would become Disorder. For God's sake let us follow. I repeat, follow. That Order leads those who follow: those who will not follow will be dragged along, medicine, terror and all. (II.37,868)

Montaigne's particular illness (his kidney stones) does not come as a surprise to him. By the time he has his first attack in his forties, he has long been expecting it since it was the disease that killed his father. He expresses amazement at the fact that his propensity for this illness, like all his other characteristics, was contained in the drop of semen that brought him forth and, even more amazingly, lay dormant until its first appearance in him at the age of forty-five. He feared the onslaught of this disease but when it finally came he realized that his fear of the disease was worse than the disease itself. And, much as he would have preferred not to have it or even that his life should have been "amputated at the point where it [was] alive and healthy", he learned to live with it: "...after about eighteen months in this distasteful state, I have already learnt how to get used to it. I have made a compact with this colical style of life; I can find sources of hope and consolation in it." (II.37,859)

Montaigne was not only destined to receive from his father his propensity for kidney stones but also his distrust of doctors:

Doctors will have to pardon my liberty a while, but from that same ejaculation and penetration I was destined to receive my loathing and contempt for their dogmas: my antipathy to their Art is hereditary.....(II.37,864)

For Montaigne, doctors "juggle and trifle with reason—to our detriment". Like all others who claim to have certain knowledge about man and the world, doctors cannot give him "a single proposition against which I could not construct an opposing one equally valid". So they should, according to Montaigne, stop railing at those who, like himself, "allow themselves to be gently led by their feelings and by the counsels of Nature, entrusting themselves to common fate." (II.37, 877)

Montaigne knows himself. He knows his desires and his habits, his likes and his dislikes. He knows when he is well and when he is ill. He knows his unique singularity. How can medicine, which deals with generalities, know his particular illness or cure his pain? How can a doctor, looking at him from without, know what he knows who has examined every detail of himself from within? How can science make an object of his body?

I do not reject practices drawn from the natural world; I do not doubt the power and fecundity of Nature nor her devotion to our needs....What I am suspicious of are the things discovered by our own minds, our sciences and by that Art of theirs in favour of which we have abandoned Nature and her rules and on to which we do not know how to impose the limits of moderation. (II.37, 866)

Montaigne's rejection of doctors and medicine comes at a time when the science of anatomy was making great progress through dissection—a practice which Starobinski describes as turning the body into an open spectacle—and an inventory of organs. But such progress was, for Montaigne, an illusion. As Starobinski says:

...tout l'indique, Montaigne rest indifférent...... aux corrections objectives que la science anatomique rajeunie apporte aux vieilles idées reçues. Tandis que les anatomistes réfutent les assertions de Galien et le dépassent en précision, Montaigne revient, bien en deçà de Galien, à un socratisme qui confie à l'individu vivant le soin de regler lui-même tous les aspects de sa vie: diète de l'âme et diète du corps. (6)

In Montaigne's words:

We have nothing to do with consulting specialists and hearing their opinions: our senses can show us what is and where it is......Can I feel something disintegrating? Do not expect me to waste time having my pulse and urine checked so that anxious prognostics can be drawn from them: I will be in plenty of time to feel the anguish without prolonging things by an anguished fear. (III.13, 1243).

Montaigne does not believe that the science (or as he calls it, the art) of medicine can penetrate the secrets of nature but he does believe that he can know the secrets of his own nature:

"I, unconcerned and ignorant within this universe, allow myself to be governed by this world's general law, which I shall know when I feel it. No knowledge of mine [nor of doctors, he would add] will bring it to change its course: it will not take a different road for my sake." (III.13, 1217)

While Montaigne is often seen as a precursor of Descartes—a view which confounds the Montaignian self (which as we have seen fully includes his body) with the Cartesian subject (which is a knowing self detached from an objective body-machine)—he is in fact much closer to earlier views of the body such as Ficinio's where the body is still perceived as part of the cosmos and affected—for better or worse—by the movements of the stars and planets. While Montaigne would reject the astrological implications of the body's relation to nature, he is still firmly placed within a tradition that sees the body as part of a larger whole and where there exists a sacred relation to that whole. In such a context the body is not a discrete object nor is it composed of discrete parts. This is very difficult for us to understand in the age of medical specialization and organ transplants, but we must make the epistemological leap backwards if we are to understand why dissection represented such a revolution in thinking about the body.

The revolution did not take place overnight. Almost a hundred years separate Vesalius' first public dissection in 1540 and the publication in 1637 of Descartes' Discourse on Method in which he describes the human body as a machine, albeit a machine made by the hands of God, "incomparably better ordered, and [which] has in it more admirable movements than any of those which can be invented by men". (7) And in case anyone thinks there is no connection between the two events, it should be pointed out that Descartes was no stranger to the anatomy theatre, that he lived in Holland, in Leiden, where according to Johnathan Sawday, "public anatomy was to reach its zenith", (8) and that he lived in the part of town inhabited by the city's butchers from whom he purchased carcasses for dissection.

Turning the body into an object of knowledge was not a simple matter. The first problem was the availability of corpses at a time when the dead body was enshrouded in mystery and seeped in taboos and members of the public did not line up to offer their (or their families') bodies to science. In the early days the assignation of a corpse for dissection was strictly controlled by the religious authorities and even as the controls loosened, bodies only came from executions and to be condemned to dissection after execution was, literally, a fate worse than death.

Part of the mystery surrounding the body came from the generally held idea that the bodily entrails held the secret to the individual's nature—that the soul was situated within the body and that opening up an examining the body would reveal the secrets of the soul. As 17th-century anatomical writer named Helkiah Crooke said: "anatomy is as it were a most certaine and sure guide to the admirable and most excellent knowledge of our selves, that is of our owne proper nature". (9) Thus the opening up of the body in search of such knowledge of the 'self' was met with both fascination and revulsion. The fascination is evident in the popularity of public dissections that were attended by large numbers of lay people, including society ladies; while the revulsion is evident in the fact that the 'subjects' of dissection were the most dispicable criminals and in the discourse of punishment that surrounded the whole process. For example, England's 'Murder Act', proclaimed in 1752—200 years after the first public dissections—was designed (in the words of Johnathan Sawday) "to evoke horror at the violation of the body and denial of burial to the offender. The denial of burial, in particular, drew upon widespread belief that lack of a proper burial was not merely a disgrace to offenders and their families, but involved the posthumous punishment of the criminal's soul." (10)

Given this link between the spectacle of execution and the spectacle of dissection in the theatre, Sawday points out that public anatomies were performed "as ritualistic expressions of often contradictory layers of meaning, rather than as scientific investigations in any modern sense". (11) Obviously, a certain amount of rhetoric was necessary in order to overcome the extreme contradiction between what went on at the execution and what went on at the dissection, and, in part, this was accomplished by seeing the anatomist as performing God's work. In an article actually entitled "God's Handy Worke", Katherine Rowe points out that "anatomical illustration, drawing on traditional visual representations of God's hand, returns repeatedly to the image of two clasping hands: suggesting the interlaced and mutual nature of divine and human agency embodied in this part", and that this image of doing God's work provided "a moral framework for dissection that inheres both in the structure of the body and in anatomical procedure." (12) It is interesting to note, however, that God's handy work was performed by the lower-ranking barbers and surgeons while the higher-ranking physicians distanced themselves from the procedures and were content to lecture from texts while others wielded the knife, reflecting a hierarchy of theoretical over practical knowledge which would be reversed in the seventeenth century.

This all-to-brief sketch serves to demonstrate that it took some time before the body, which in the time of Montaigne was still intimately connected with the soul and with nature, could be seen unambigously as an isolated object of knowledge—and this pertains even to the dead body. But the point is, the ambiguities were eventually overcome. The idea that the entrails contained the soul gradually gave way in what Hillman refers to as a 'technologizing' of the interior and a gradual move away from the location of the self within the body and toward a Cartesian or purely mechanistic understanding of the self to standardized corpus." (13) Whether Descartes alone was responsbile for the body becoming a machine in the popular imagination or whether he was simply expressing what had already been accomplished through a century of the 'culture of dissection' is an open question. But it is clear that the Cartesian view of the body as a machine meant that the body became another object in nature, open to investigation like all others and, above all, open to the application of his method. As he wrote to Mersenne: "I have spent much time on dissection during the last eleven years, and I doubt whether there is any doctor who has made such detailed observations as I. But I have found nothing whose formation seems inexplicable by natural causes." In fact, for Descartes the difference between a living and a dead body is the same as the difference between a watch or other automaton that has all its moving parts in working order and "the same watch or machine when it is broken and the principle of its movement ceases to be active." (14) The particularity of the subjective knowledge that Montaigne sought from his own awareness of his body is lost in the generality of the body as a system of organs, bones and musclesa human machine—the knowledge of which is objectively available to the specialist of medicine and medical knowledge. The knowledge of Hygeia gives way to the knowledge of Asklepios and the body as teacher has a different pupil. As René Dubos puts it: " ....it is not surprising that the cult of Hygeia tends to be neglected and that the skill of Asklepios looms large and bright in the mind of man. In our societies the school of public health always plays second fiddle to the school of medicine." (15) And so does the body as a source of knowledge to the body as an object of knowledge.