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Surgery Reflections

In a letter in Issue 3 Dr. John Shenkman said that philosophers were failing his patients, who needed real answers to real philosophical questions. The response was considerable. Here Dr. Shenkman explains his own philosophy.

It is a Monday morning in January. By 9.45 a.m. the surgery has grown from its normal 18 appointments to 47, through extras and emergencies. Noise increases in the waiting room. Babies howl for their food. A child bangs mindlessly on a toy xylophone. One after another they come to see me, tall ones, short ones, bald ones, hairy ones, happy, tearful, content, restless, too busy, unemployed, too tired, cannot sleep, smoking too much, drinking too much, and fornicating too much.

At 10 a.m. my mental whistle blows for half time. I call for coffee. Down tools and time for a day dream. Monday, bloody Monday. What is it all about? What am I trying to achieve? I lean back in my chair and take a deep breath. I think of my study with its shelves full of books. Beyond the light cast by the anglepoise, Nietzsche, Mendel, Michelangelo, Berenson, Croce, Spinoza, Crick, William Morris, Freud, Thucydides, Heisenberg, Chagall, Aristophanes, Gombrich, Ruskin, the Wright Brothers, Whittle and The Golden Bough peer down through the half darkness. Tranquillity returns as I recall the pattern to human development those and other books have revealed. Philosophy Now might call it applied philosophy.

In the beginning there is nothingness. Dislocations of time/space cause quarks to appear and disappear. When three come together there is a proton. Protons, neutrons and electrons form atoms. Atoms form molecules and molecules form planets and humans. The universe that humans inhabit consists of time, space, energy and matter. Like all other living things, humans have evolved in response to these four constituents of nature. Monday morning in the waiting room is the result of a less than successful response to nature’s flux.

Let me explain how I see personality as being related to nature’s four constituents. In our everyday experience time is the past, present and future. To allow us to deal with the past, we have memory; for the present consciousness and the five senses and for the future both an ability to reason from past experience and an ability to imagine what might happen next. To appreciate space in its three dimensions we have developed a mathematical part to reason. Energy and motivation are needed to change personality and the surroundings as nature changes. Matter consists of animal, vegetable and mineral. The commonest animals most of us meet are our fellow human beings. They relate to each other with emotion and language, but particularly emotion. Hands are used to make and grow the things needed to use and eat from mineral and vegetable. Because the seven abilities I have listed can conflict with one another, another ability, call it association, is needed to co-ordinate them.

To recap, then, the eight basic abilities are:

Memory
Energy
Consciousness and 5 senses
Use of the hands
Reason
Emotion
Imagination
Association

Humans are not alone in possessing them. Not only are chimpanzees 98.4% genetically identical to humans, but they have those same abilities although not to the same degree and much less well associated together. Many other animals have some of them. Elephants remember. Dogs feel and dream. Even birds make nests.

This is a very simple concept of human personality. It also seems to me to be a very rich one. It explains how humans unravel the workings of the universe. It explains what they are expressing to each other in their arts. Philosophers would call this a theory of aesthetics. It allows for a common sense theory of education. It explains what goes wrong in illness. As a spin-off it explains why we have to behave in a neighbourly way to each other and why we need democracy and freedom. I believe this is called morals and ethics. There is an abundance of evidence from accounts of scientific and technological discovery, the history of art, child development, descriptions of mental illness and anthropology to support it. Unfortunately, the telling of these is prevented by the length of the coffee break. A brief outline might help.

Sir Karl Popper’s approach to scientific understanding fits snugly alongside this concept of personality. The imagination is used to dream up hypotheses. Facts are recalled from memory both in the mind and from books and other records. Consciousness and the five senses are used to make observations. Hands are used to make apparatus, carry out experiments or produce prototypes. The mathematical part of reason calculates the results. Energy, patience and passion are needed to see the whole process through. And there is humour to face the disappointments and surprises inherent in the inevitable falsification of the original idea.

It provides a theory of aesthetics which enables anyone to understand what art is trying to do. It encompasses the width of artistic expression from pop art and the Pre-Raphaelites to Abstract and Surrealists, or from jazz and the Top 10 to Mozart and Mahler. However, it is easiest to explain with reference to the visual arts.

Art is the expression of one or more of those eight abilities. The only one which can be expressed by itself is reason. The eight are seldom expressed all together; it is too much for visual digestion. Reason is always present in art and is expressed as form. Balance or symmetry say that one side of a piece of visual art is roughly equal to the other. Without = there can be no reason. Contrast is not equal (?). Harmony and variation are multiplication and division. Line, point, area, perspective and chiaroscuro are expressions of 3 dimensional space. Subject matter and content express consciousness and the five senses. Past events on canvass represent memory. Representation of dreams and daydreams express imagination. Diagonals, whirls and spirals show energy. Texture (impasto) shows the use of hands. Emotional expression is obvious.

The schools of painting, as they come and go in and out of fashion, favour one or other of the expressions of human abilities. Abstract painters and cubists sought reason. Subject matter was favoured by the Victorians and Pre-Raphaelites, the imagination by the Surrealists and emotions by the Romanticists. Turner expressed the energy of nature. David recorded the drama of past events. But what they all also achieved was an association of those disparate abilities in the same piece of work.

Education is about teaching the next generation how to use those eight abilities. In their first 5 years, children are taught how to relate to people through their feelings. They are encouraged to use their hands by playing with toys and making things. Fairy stories and makebelieve encourage their imagination. At school they are taught reason, both logically and mathematically. The common memory of mankind is taught as history. Handicrafts foster manual skills. As they pass from adolescence to adulthood they learn to reconcile the conflicts induced by the eight abilities.

In illness, sick people complain of tiredness, lack of energy, inability to concentrate or think properly, inability to sleep, being too switched on or having too much mental energy, of feeling anxious or depressed, of being unable to remember or having diseases of the mouth, eyes, nose, ears or hands. These are all symptoms related to those eight abilities. In schizophrenia the imagination becomes untempered by reason. Manic depression shows extreme of variations in psychic energy level. The patient’s mood swings from hyperexcitement to deep depression.

When fit, humanity can use and express those eight abilities to the best of its inheritance. It may happen in everyday tasks or the heights of science or the arts. But it can be prevented from doing so by the behaviour of neighbours or the oppression of governments. So neighbourliness and democracy, ethical behaviour and freedom are needed to enable the individuals to use and express what they have. Nobody has all those abilities to perfection. Different people have different strengths. That is why humans have to live in groups.

Dealing with people and watching the behaviour of nations it becomes obvious there can be no nirvana, no earthly paradise or brotherhood of man. Tranquillity has to come from understanding man’s oneness with nature.

The relationship between his personality and nature discussed above gives answers to those who ask what is the meaning of his existence. He is what he is because nature shaped him so. The process of how this happened is evolution. The answer to why will have to wait until the presence of life is confirmed on other planets. When this happens it will mean that given the right conditions life just evolves and that there is nothing special about man being on earth. It will appear obvious that in nature simple changes into complex, quarks evolve into humans. Being an inescapable part of that process I will continue to see 47 weary humans on Mondays in January who are failing in their struggle with restless nature.

I drift out of my daydream and take a last gulp of half-cold coffee. I press the buzzer. In a few seconds there is a knock at the door. It opens and I am back in the reality of the present.

Dr. Shenkman is a general practitioner