Submitted by Andrew McCarthy MD, Sep 19, 2007 05:38

I think what has me so dismayed by rational science in regards to human beings, as we want to practice it in is that it has left its reason to be- it is supposed to solve problems instead of creating them. How can this happen? Well when we make science into something that it was never supposed to be. Science, as I have understood it, is based on the hypothesis. We can then come up with experiments that can prove or disprove that hypothesis. But never ever does that hypothesis become a fact. It is an hypothesis for ever and ever. Thus one needs to accept probability as a kind of religion. If it is probable that the sun will come up again in the morning then it is a fact that the sun will come up in the morning. And that is a great way to live life in a practical sense. But it is not something that one should accept as an answer to the questions that plague us. Are you absolutely sure that the sun will come up in the morning? Well at some point this will not to be true for us because we leave this world of perceptual sensation. And what really does die- the person who used to see the sun come up or his perception of what he had held of the sun?? Details that do not bother us you would say. But it is not what I would say for I have no way of knowing the answer. But a rationalist seems to accept the version that it is the person that is lost but such a fact is not scientific because it cannot be verified for the person in question, even if the rationalist still gets to see the sun come up every morning! It is all from your perspective.

Who wants to question science as we now see it- certainty, practical, problem-solving- who questions these? But I am with Wittgenstein on this. He said science, as a means to metaphysical truth or what life really should mean to us, is a way to send man to sleep. And his pupil Drury explains how this happens. Drury points out so amazingly well that hypothesis often becomes a kind of dogma and people stop questioning it. And that is why I have trouble with the view that the world is entirely only rational as is man. It went from being a question to a fact. And now it is dogma, even for scientists who study the mind. And what is more important is that the idea of questioning it seems to have left us. We are on to Evolution, Cognition, Discovery, Progress- all in capital first letters. These have become dogma. When I look up these words I see their definitions wrapped up in circular reasoning. (I do believe in logic, especially the first steps of logic, which most of us fail to pay attention to, especially with words.) I will give examples...

Here is where medical rational terminology fails us in philosophical terms. We all love our definitions and they are very helpful. But they make us seem more intelligent and caring than we really are. Let us go back to my example of the person in the emergency room. I have set the scene. Car accident, pt comes into ER dazed GCS of 9, CT of brain shows a left frontal hypodense area. He has a left hemiparesis. (Not all lesions are measurable even in medicine.) Well over the next week or so he gets better but also very agitated. So he is seen by the clinical neurologist who gives him a diagnosis of an acute confusional state secondary to trauma. Now the rehabilitationist comes to see him and gives him a different diagnosis. He calls this a TBI and at the Rancho IV level. The patient is sent to the Rehab wing and gets 15 days in the Unit for that is the time we give these patients now a days. We talk to his family and give them data and information on what he has and what he will need and send them all on their way. The patient then goes home with his weakness resolved but still with emotional and cognitive deficits (yes I use these terms more than you would imagine).

He starts to act up and sees the psychiatrist in the area. The patient is seen as an almost classic manic depressive and he treats him accordingly. Pt responds to the medication but cannot seem to get back to work. He gets sent to a community social worker who acts as a source for reemployment. And she works with him for about 6 months but can never get him back to work. So he goes home and starts to drink and his poor mother is left handling him for the next 10 years till she dies. When she dies he has no one to help him and he gets in a fight with a neighbor and gets thrown into jail. He gets worse in jail and gets into more trouble and never leaves the institution.

So here we have all these institutions that are set up in a rational way. We have docs who make rational observable diagnoses. We give rational medications that make rational sense. We set up return to work systems in a rational manner. And we all get paid for our work and we work only for what we get paid. What is more rational than that. But because of our cost constraints we can only do so much of this rational health care for it is all about what rations we can dole out.

But as is the case so often no one really tries to get to know this patient for we do not have the time. We ourselves have an overload of cases and we cannot devote too much time to this patient and that patient. And thus even if all of us knew that this case was going to have problems, no one stamped their foot down and said, "This is madness!" And if someone said this, he or she would have been correct. We labeled this man the whole time in rational terms that we rely on as a kind of coverup from our shared humanity.

This is a mixture of cases that I have seen and it is becoming a much bigger problem. And thus I have a very hard time relating to rational cognitve scientists who are so transfixed in terms such as Evolution, Progress, Cognition, and Discovery. For perhaps George Allen, the ole ballcoach of the Redskins was right- to heck with the future, what about right now? I see no evolution in this case just devolution. I am left believing that a cognitive approach may work well for docs and staff but it didn't work so well for this patient. We may have discovered memory issues and abnormal CT scans. We found a left hemiparesis. We could examine his abnormal neurotransmitters and come up with theories of why he acted as he did. But again we only look for the answer in his brain lesion. It is a much easier thing to view this as just the result of what happened to his brain architecture, to his neurophysiology, to his lack of premorbid cognitive skills, etc. But do we ever place any of the blame on ourselves and our approach? No we don't because we do believe in survival of the fittest. We believe that life goes to the stronger and that such cases are just a result of natural selection. Sad but what are we scientists to do with nature?

But if that is the case why have medicine or hospitals at all? After all that is where we seem to be heading whether we like it or not. It just may not be rational to waste all these resources on such cases for the problem was his brain lesion. It was his brain lesion. it was his brain lesion...you just keep telling yourself that... and thus perhaps you start to see Drury's warning

Note: Comments are screened, and in some cases edited, before posting. We reserve the right to reject anything we find objectionable.