Day 26: Quacks: Doctors and Philosophers

In the first book of Plato’s Republic, Plato has Socrates turn to the medical art in order to argue that justice like other technai, or knowledges that serve some practical purpose, benefit those they serve rather than those who have the knowledge.  Socrates is responding to Thrasymachus who thinks justice is a purely conventional effort to use one’s power to serve themselves.  Socrates, as is his wont in Platonic dialogues, introduces the question of knowledge–how can we serve ourselves if we do not know what would serve us well?  Having Thrasymachus agree that we expect the ruled to obey, and that if they were to obey when the ruler was wrong about what serves him well, Socrates also gets Thrasymachus to agree that this view would have justice be both serving the rulers’ end and not.  Thrasymachus explains himself by saying the ruler is only the ruler when the ruler is right about what his advantage is.

Socrates uses this precise distinction to argue that the ends of any particular craft must be distinguished from the ends of money-making.  The end of the craft is to improve the object of the craft, those who do not have the knowledge the craftsperson has, and supplementary to this project is money-making.  The craftsperson makes money precisely because he gets no benefit out of the craft as such, in which case the account of the ruler needing to be paid to rule analogizes back to the craftsperson so that we can conclude that the only reason they do their craft is for the money, not for some benefit to themselves that follows from it.

Socrates uses two examples of craftspersons: doctors and pilots.  In every discussion, I have ever heard of this dialogue, the assumption has been that doctors do in fact have this knowledge which was widely recognized and so Plato has Socrates appeal to a model of knowledge that other Greeks would accept in order to distinguish Socrates from the sophists who seem to peddle in some service or good that really serves them rather than those they teach.

In her discussion of the Hippocratics and the general atmosphere in ancient Greece of medical practice, Helen King describes a world where doctors had to persuade their patients that the doctor was needed.  Doctors would flash fancier and fancier, stranger and stranger treatments, each a little different than what the previous doctor prescribed, not because they had evidence that this would work, but because it made them look more interesting and worthwhile to the patient.  This meant the question of what counted as health could vary from doctor to doctor and could be manipulated to appeal to the patient to make the patient want the doctor’s services.  Like doctors making you think you need more tests done so that they can profit from the testing at doctors-owned hospitals, today.

King writes:

The danger of deceit was also something which which Hippocratic healers were closely concerned; not only because the body could deceive its reader, but also because healers needed to pay close attention to the way they presented themselves to potential patients.  Arriving in a new location with no license, and no recognized training, these healers needed to display an image which would convince their patients of their worth.  In the competitive context of eraly medicine, in which not only different protagonists within one medical discourse, but also adherents of different medical discourses, could be in dispute, rhetoric was important; healers needed to present their arguments verbally, sometimes to defeat a rival in public debate, but more commonly to persuade the client of potential client of the value of specific therapies.  But self-preservation went beyond rhetoric int every aspect of the healer’s own appearance.

There was no single word for ‘quack’ in the Hippocratic vocabulary, but the specifi issues of what we would call quackery in their culture were bound up with their concern for self-preservation and their awareness of the role of deceit within this…. For the ancient world, there was no qualification system; what was ‘known’ was disputed within the techne; and, on one occasion at least, frank admission that trickery of patients occurs is found in the Hippocratic corpus.  As for self-publicity, it is an inevitable part of trying to gain clients, but some who considered themselves as working within the techne regarded others as going beyond reasonable limits in their presentation of self. 41-42

King gives an example of how this worked itself out on the medical circuit:

Because Hippocratic doctors are in open competition, the third healer called in will be under considerable pressure to think of something a little different after the usual remedies have already failed; it is to this, perhaps, that we owe one of the recipes in the Hippocratic corpus, in which turtle liver, removed while the turtle is still alive, is ground up and served in human breast milk, in order to encourage the flow of the lochia. 155

If  King is right that the doctors of the 5th and 4th century BCE had to convince their patients and the patients’ community that they were the true doctor, each one having to offer something better than the one before, much like Socrates tried to convince them that he was a philosopher and not a sophist, then Socrates’ argument in the Republic that the doctors aim not to their own end but to the end of those they serve is an indictment against the doctors who speak to glorify themselves and their art rather than to help their patients.

King again:

In the competitive climate within which Hippocratic medicine existed, however, even others acknowledged as being iatroi [doctors] could be criticized on the grounds that their interventions were showy appeals to the crowd rather than actions backed by knowledge. (116)

Thus the same problem in judging a good doctor was alive and well in ancient Greece as the problem of judging who was the true philosopher. Instead of thinking it was established that the doctors serve the patients, the argument that Socrates makes is critical of doctors and hence also of rulers who rule for their own sake. The analogy does not depend on a truth that is accepted (doctors aim to help their patients) but on a structure of what art must be like which then argues serves as a critique against those who do not follow that structure. This suggests that Plato doesn’t find any parallels to what he is trying to do in philosophy in the craftsmen of his day.

I think King’s account of the rhetorical and sophistic nature of at least some medical practitioners–and once some are possible quacks, all need to be able to prove without some way of establishing their qualifications to those who need their knowledge but do not have it–forces us to reconsider the way that the recourse to the medical analogy in the Platonic corpus works.