Jacob Needleman
Sun Francisco State College
Sun Francisco, CaliJ
What does it mean to regard another human being as mortal? At first glance,
this question seems very easy to answer. To regard another as mortal means simply
to realize that some day he will no longer exist. But what does that mean? What is
it to cease to exist? What ceases to exist? I suggest that the answers to these
questions will vary enormously, depending on the way we understand life, man,
and the self. Further, the way this understanding varies will be an expression of the
more existential issue as to how we comport ourselves toward other mortals. This is
the general theme I wish to explore with special reference to the medical
perception of mortality.
Living in the modern world that has been shaped by the attitude of natural
science, most of us are, whether we know it or not, Cartesians. The world we know
scientifically is a world devoid of purpose, quality, will, consciousness, and
individuality. It is the realm of what Descartes called the res extensu, pure
extendedness, pure corporeality, quantitative, and thoroughly describable by
mathematics. Descartes opposed another realm to this res extensu, the realm of the
thinking being, the mind, the knower of res extensu, and called this res cogituns.
His great-indeed unsolvable-problem was how to explain the interaction between
these two realms of mind and matter that are so utterly different from each other.
In any event, however, he had no doubt that reality was split into these two
disparate realms or substances. In the West, it is our habit to equate the real with
that which is knowable. Since our ideal of knowledge came to be mathematics, it
was not long before we began to suspect that this self, or mind, since it was
mathematically unknowable, was not entirely real-or that, if it was real, it must
really be res extensu, not mind at all.
As Cartesians, we are thus bound to a world view in which fundamental reality
tends to be understood as lacking any of the signal characteristics of mind or life,
even while, out of the other sides of our mouths, we speak of the existence of a
reality such as mind and selfhood. In the striking language of Hans Jonas, it is a
world in which death is more natural than life and in which the phenomenon of
life is a puzzle that will give us no rest until we can show it to be death. To put it
more prosaically, the world view of modem Cartesian natural science is such that
all explanation involves the reduction of what is explained to the nonteleological,
nonmental, nonvital stuff of pure corporeality or res extensu.
If Cartesianism is the fundamental metaphysical framework of our age, what
does it mean for us, in this age, to ask: what is death? We are, in Cartesian
language, a union of soul and body, mind and matter, a linking of res cogitans and
res extensu. When a man dies, does it mean that at a given point the res cogituns
becomes res extensu? This is impossible, for these two substances, mind and
matter, have nothing in common, and there can therefore be no transition from
one to the other. Must we, then, see death as the separation of mind and matter?
This notion would lead us in hot pursuit of a proof for the immortality of the soul,
in which case we would simply be trying to say that there is no death. IS our only
alternative to say that there neither is nor ever was a mind or thought? In this
event, death will be at most a quantitative change and not an essential loss.
It will not help, logically, to say that death is the reduction of a whole to its parts
and that what is lost is this overall organization. This is simply to push the question
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734 Annals New York Academy of Sciences
back one step: are the component parts also organized entities? If so, are they
organizations of the same order? A table, an organized whole, can be broken down
into fragments of wood, also organized wholes, but of a similar order, as are even
the cells of wood and its molecules. However, the organization of the nonvital res
extensa presumably is qualitatively different from the organization of the mind.
Understood in this way, death is no different from the idea that mind becomes
matter.
All of this is to say that the only concept of death that is consistent with our
Cartesianism is either that the soul or mind is immortal and that there is no death,
or that in death the mind vanishes! We may feel that the latter view sounds
perfectly acceptable: when we die we vanish. We may say that, but do we-indeed,
can we possibly-believe it? What does it mean for an entity to vanish? It means
that it passes from something into nothing. It disappears! The exact logical
counterpart of this is the idea that it is possible for something to appear out of
nowhere, uncaused, to spring into existence all by itself. Both of these notions-the
idea of something appearing out of nowhere and the idea of something vanishing
into nowhere-belong in a catalogue of magic tricks rather than among the
furniture of rational thought.
The problem as to the nature of death is thus a crucial stumbling block of our
Cartesianism. I mentioned at the beginning that, in the Cartesian spirit, our
modern scientific explanations of life and mind attempt to reduce one primal order
of reality to another. I suggested that this simply cannot be done; to attempt to do
so is, on a conceptual level, to try to make the phenomenon to be explained vanish.
I see an uncomfortable parallel here between what science does to us when it
explains us and what it thinks we really are. For natural science we, as mortal
human beings, in actual fact are taken to share the fate of that in us which is
expla’ined. When we die we are “explained.” This inanimate corpse is what we
really are and have been all the time!. It begins to appear that, as modern
Westerners, we do not see another’s mortality because we see him as already dead.
How does medicine perceive mortality? What is the medical concept of death?
To approach this question we must first realize that our Cartesian has deeply
clouded the idea of medicine as a discipline. We are not a little embarrassed by the
question: what sort of an enterprise is medicine, and what is its object? The reason
for this embarrassment is not hard to find. Since Cartesianism separates conscious-
ness and matter, there are said to be two distinct types of science in the world.
That which studies matter is called natural science, although it must be noted that
most natural scientists think of themselves as the only scientists, an unmistakable
symptom of that deeply ossified form of Cartesianism that completely equates
reality with pure corporeality. The other disciplines that study conscious phenom-
ena are known as the human or social sciences (Geisteswissenschaften).
Some sciences can get by reasonably well by understanding the objects of their
investigations as totally nonconscious res extensa-such sciences as physics,
chemistry and, to a lesser extent, biology. Others can hobble along and perhaps
successfully persuade themselves that their object is only the conscious and
distinctly human-such sciences as some branches of history and some schools of
psychology. Time does not permit me to amplify this distinction now; suffice it to
say that it is not a nominal one. Depending on how you classify yourself, it is not
just the object of your investigation that is different; the whole concept of method
may differ, as well as your standards of explanation and, indeed, your very
purposes as a scientist.
Without presenting an argument for the point, I submit that medicine is a
discipline that is exactly in the middle; to an equal degree, it is both a natural and
a social or human science, which makes it very difficult to classify. This is so
Needleman: Perception of Mortality 735
because, as Cartesians, we believe that all disciplines must be either human or
natural, just as our reality is at the best an unholy and unhappy wedding of pure
mind and pure matter.
What I suggest here is not the rat‘her obvious point that some medical
phenomena are best handled by natural science and that other medical phenom-
ena are best handled by the human sciences. Rather, I am asking you to consider
the possibility that all phenomena that fall within the purview of medicine-from
so-called purely psychological or social problems down to histologic and microbio-
logic entities-to an equal degree and throughout involve both the element of
consciousness and the element of the material. I am not even saying simply that
each medical phenomenon is partly mind and partly matter; that would simply
reestablish the Cartesian dualism in miniature. The idea is, rather, that each cell,
each tissue, each emotion, and each thought cannot be understood by medicine as
either pure matter or pure mind or as their problematic, indeed impossible,
linkage.
With all due respect, I therefore submit that so-called psychosomatic medicine is
simply medicine trying to talk out of both sides of its mouth and that genuine
psychosomatic medicine is simply another and clumsier name for medicine. I
would like very much to try to carry this line of thought further on an abstract
philosophic level to speculate what these ideas imply as to concepts of health,
illness, therapy, as well as on the implications regarding the interrelation of “fact”
and “value,” this being another dualism that finds its source in our Cartesianism.
Unfortunately, space does not permit such speculation. Our interest here is
primarily in the medical perception of mortality. In the light of the foregoing, it
becomes clear why this perception is, in the vulgar sense of the word, schim-
phrenic. In the modern world, no discipline but medicine has as its object the
whole man while it simultaneously attempts to address itself to an abstract part,
the “pure” body or the “pure” mind, or, once again, their weird and inexplicable
union. What or whom is the doctor treating? The body? The mind? The person?
All of them? Does he have three patients or only one? Who or what is sick? The
body? The mind? The person? Most important, who or what dies? The body? The
mind? The person? As a physician, Z treat your body, but you die? Did what I treat
die?
The body, considered as part of the Cartesian res extensu, is a mechanically
organized material complex and is ultimately describable by mathematical
formulae. It is, presumably, the object of somatic medicine; it is what is treated.
Surprise of surprises, or horror of horrors, however, something else is connected to
it! When it, the Cartesian body, breaks down-whatever we may understand by
that-this “something else” which is the mind somehow goes with it. The person
dies. But I, as a doctor, never undertook to treat the person; I am engaged to treat
only the body. As a physician, I must say that you, the person I know and relate to,
are something totally different, totally unrelated to what I am treating when I treat
your body. Yet I, as a patient, know that Z am sick, that Z will die.
What medicine lacks is any fundamental notion as to the nature of man and any
remotely adequate understanding of that to which we refer as a person. Cartesian
philosophy, and therefore the world view of natural science, fails utterly on these
questions, and because it fails in this, it cannot come to grips with the idea of
death.
Now, obviously, this is not to say that other disciplines are any better in this
regard. All of us, being more or less Cartesians, lack an adequate understanding of
man and the person; none of us, therefore, knows how to perceive or conceive of
mortality. It is simply that the issue is most intense and the lack is starkest in that
discipline that deals with living and dying as its main and urgent concerns.
736 Annals New York Academy of Sciences
Our schizophrenia consists in this: the discipline that would treat us has as its
metaphysical foundation a view that we are a Cartesian body, but at the same time
our picture of ourselves is that we are a mind, a soul, an individual person. A
Cartesian body is nonmortal; if it is destroyed-that is, reduced to parts that are
not qualitatively different from it-it is destroyed by a cause extraneous to it. Its
destruction is therefore not an essential part of its make-up, and in that respect is
not inevitable. Thus, medicine, handling us as though we were Cartesian bodies,
sees us as essentially nonmortal.
Death then becomes an accident, but at the same time this accident is seen, not
simply as the reduction of the whole to its kindred parts, but as a total,
stupendously qualitative transformation: a vanishing, a disappearance! Therefore,
death is not only nonperceivable, nonconceivable, rooted in an inadequate concept
of man and person-being an accidental vanishing, it is also unutterably horrible.
The conclusion, intellectual as well as emotional, is that I need never die. We
wind up expecting doctors to keep us alive forever, and unfortunately doctors wind
up believing somehow that they should do so; for we are all, ultimately and
inevitably, patients. If we are all also patients with a Cartesian outlook, then it
must be very difficult, indeed, to be a physician, as well. Here the schizophrenia
will be compounded: I, as human being and potential patient, invest myself, as a
doctor, with powers I do not have to defeat an enemy I do not see and cannot
begin to understand. On the other hand, if I, as doctor, do not assume that I have
these impossible powers, then I, as human being, can myself die. This I cannot
accept for, as we have said, within the Cartesian frame, either it is unutterably
horrible to die or I am simply a piece of matter that is already dead.
We are thus brought to the opening question: what does it mean to regard
another human being as mortal? I have tried to suggest that, whatever else it may
mean, it requires that we understand what man is and what a person is. Therefore,
if I am to regard you as mortal, I must know what you are and who you are.
However, I have also tried to suggest that in fact we have no adequate knowledge
of man, no clear understanding of what a person is, yet this realization itself can be
an opening of a sort. To see that our perception of mortality is wedded to
contradictory thought may allow us to be truly empirical about death.
What, in the hardest possible sense, are the empirical facts? When someone dies,
what are the unquestionable experiential facts? Are they not these: I try to speak to
him, but 1 cannot; I want to see him, but I cannot; he is no longer to be seen, no
longer to be spoken to? This is all we have: the dead are no longer “in view.” All
the rest is interpretation, based either on fear, confusion, or wishful thinking, three
modes of mental activity that lead to foolish notions of vanishing or of earthly life
beyond the grave.
In sum: the first step in regarding another as mortal is to acknowledge with all of
our being that we do not know what a person is or what death is, but that we have
fears about these things and a contradictory view of reality that goes hand in glove
with these fears. This awareness of our own ignorance and fear would be, if we are
to believe Socrates, the beginning of wisdom. The hasty flight from this awareness
either into philosophical presumption, religious sentimentality, or dogmatic faith in
the Cartesian natural science would be the reversion to ignorance. And what good
can come of ignorance?
DISCUSSION
OF THE PAPER