One of the functions of meditative reading in late antiquity was for the purpose of healing. Meditation was proposed for the treatment of specific conditions, such as melancholy, as well as for creating a general equilibrium in individuals between mind and body. The type of meditation used for healing was usually the by-product of sacred reading.
This chapter is devoted to exploring the connection between reading and healing in the centuries between late antiquity and the early modern period. In taking up this subject, I am returning to the questions concerning reading and the self that were discussed in Chapter 1, however from a different direction. This consists in placing the uses of meditation within the context of the history of medicine as well as that of religion. In introducing the theme of healing to this collection, I am aware that I am diverging from the philosophical perspective on the self that is found in Chapters 2 to 5. The detour is justified in my view, since it is through the practice of meditation in clinics and hospitals that a significant contribution has been made to contemporary thinking on the topic of an integrated self.
I begin by reminding the reader that in Western medicine disease is normally accounted for by means of changes in chemical and biological processes. In recent years, another focus for the understanding and treatment of illnesses has arisen through forms of alternative, complementary, or unconventional medicine.1 This type of healing, which has always existed on the margins of biological medicine, has been the subject of scientific inquiry for two to three generations and forms part of a movement in both Western and non-Western societies in which a reassessment is being made of the potential contribution to health of such factors as diet, exercise, climate, and the life of the mind.
Within the health sciences, studies in this field are classified under the heading of “mind-body medicine.” This is a scientific program, whose achievements can be illustrated by the experimental research of figures like Jon Kabat-Zinn and Richard Davidson.2 It is also an eclectic endeavor, which draws on the healing traditions of religions, ancient cultures, and indigenous peoples. These approaches to healing have in common a concern for the interconnectedness of mind and body, in contrast to thinking in some branches of biological medicine, which is alleged to maintain a dualistic outlook.3
Owing to the longevity of interest in this sort of healing, it is not surprising that studies in mind-body medicine frequently go beyond physical health and illness and address broader philosophical questions, including the search for a happy, fulfilled, or meaningful life, which is a reiterated concern in Plato, Aristotle, and other ancient thinkers.4 Mind-body medicine claims to have discovered, or rediscovered, important connections between mind, body, and philosophical themes such as these, which were known in former times, or in non-Western cultures, but have been overlooked in the development of rational or scientific medicine, especially during the experimental epoch that began with the publication of William Harvey’s De motu cordis in 1628.
However, even those who are enthusiastic about this field acknowledge that it suffers from two limitations. One is a lack of controlled and randomized trials,5 which has prevented mind-body medicine from being accepted by many trained physicians. The other consists in the failure of historians to chart the history of mind-body techniques within Western medicine, which would have provided reasons why these approaches to healing took so long to enter the scientific field. In this chapter I limit myself to the second question, and, within that, to one type of mind-body technique, namely meditation. I ask why scientists and historians alike have so little understanding of the cultural roots of the meditative methods of healing that are presently under investigation and have been deployed, sometimes with considerable success, in contemporary clinics and hospitals.
Meditation has a fully continuous history in Eastern religions and a less continuous history in Western philosophy and religion. In the East there is a lengthy tradition of thinking on the ethical and religious value of contemplative practices as well as on their role in creating an equilibrium between mind and body. In the West, a comparable history exists and reaches its high point of development during the Middle Ages in the three “Abrahamic” religions, Judaism, Christianity, and Islam. However, after the Reformation, the practice of meditation in the West is reduced in both Catholic and Protestant communities, owing to changes in religious attitudes and the introduction of the printed book. A new phase of meditative or contemplative thinking based on the appreciation of nature rather than on religious principles takes place in German and English Romanticism in the nineteenth century. These two developments form the background to the introduction of Eastern types of meditation in clinics and hospitals in our time.
In all traditions of meditation, instruction begins with two points, namely the focusing of attention and the awareness of the inner life of the mind. Mental concentration results from a variety of simple exercises, such as deep, regular breathing, listening to a sound, looking at an object, or, in Christian meditation, reading a sacred text. The awareness of mind and body is taught by a number of methods; for example, in Buddhist mindfulness meditation, which is a popular form of practice in the West, an attempt is made to empty the mind of its contents and to permit thoughts entering the field of consciousness to come and go, without any effort being made to arrest them, reflect on them, or orient them to some form of activity. After a few lessons, those practicing meditation can experience an awakening to the life of the mind as well as to a sense of interconnectedness with the animate and inanimate things around them. Accomplished meditators claim to reach higher states of self-awareness or self-consciousness; some have even spoken in mystical terms of attaining a sense of transcendence or timelessness.
Beyond the initial stages in the learning process, which, I would emphasize, are largely practical in orientation, there are some notable differences in these training exercises in individual traditions. One of these concerns movements. In hatha yoga, meditation is linked to disciplined physical movement, whereas in Buddhist mindfulness, one is asked to sit perfectly still and cross-legged on a mat, frequently in a darkened room. Sufis induce a meditative state of mind through a five-step, mentally concentrated dance. In Zen, the goal of inwardness is achieved, not by movement, but by reflecting on a koan, a story containing a paradox that cannot be resolved through the use of reason. By contrast, during the Middle Ages, Jewish, Christian, and Muslim meditation was associated with sacred reading and liturgical devotions, and in both Byzantine and Latin Christianity with contemplation on external or internal narrative images, which complemented the texts that were read during the office and became in themselves an important focus of attention.
The medical research community has been studying visual, textual, and abstract methods of meditation for some time. The emphasis in contemporary investigations is on the physiological or psychological effects of such techniques. Less interest has been shown in their origins, evolution, and applications within different religious or cultural milieux, even though pioneers in their use in the field of medicine, such as Herbert Benson, were invariably taught how to meditate by means of apprenticeships with experts within such communities (in his case with Hindu holy men).6 As a consequence of this orientation in the field, successive generations of clinicians and experimenters in mind-body medicine have become increasingly removed from the cultural roots of the techniques they are using, even though at times attempts have been made to recreate them. Within the ever-growing literature on the subject there is seldom mention of the historical background of the type of meditative technique that is being recommended; an example is the widespread use of the term “mindfulness,” frequently without reference to its context in classical Buddhism. In the medical literature on the subject the different styles of meditation tend to be merged in a single model, and the products of meditative experience are usually described in terms of their behavioral results rather than their historical associations. This has resulted in a consolidated view of meditation in which an ancient and diversified discipline has effectively entered an ahistorical phase in its development.
The separation of the cultural and medical approaches to meditation has had a considerable advantage from a scientific point of view. It has permitted medical research to proceed with investigations into the influence of meditation on a variety of pathological conditions without having on each occasion to take into account issues that do not fall within the orbit of medicine. As a result of these types of inquiries, the list of mind-body treatments involving meditation has grown over the years in which experimentation in the field has taken place, and positive results are nowadays routine. To give just a few examples: meditation based on visual imagery has proven valuable for pain relief, the control of anxiety and depression, as well as in preventing nausea in chemotherapy;7 it is also employed regularly in the treatment of asthma, eating disorders, and post-traumatic stress.8 Lifestyle changes combining diet, exercise, and various styles of meditation have been shown to lead to the regression of coronary atherosclerosis, thus complementing earlier experiments in which it was proven that disciplined meditation can decrease heart rate, blood pressure, and oxygen consumption.9 Recent experiments have even suggested that practiced meditators are able to alter a small number of involuntary mechanisms in the autonomic nervous system.10 There is a growing if controversial literature on the use of meditation in the treatment of schizophrenia,11 as well as in other mental disorders. Meditation is regularly employed in programs of rehabilitation from substance abuse and alcoholism. Inmates in prisons have for some time been engaged in the writing of autobiographies as exercises in meditation, often with beneficial results.
Attempts have been made to isolate “meditation” and to study it as a distinctive physiological state. It has been established that meditation differs from sleep, as well as from forms of relaxation when one is awake. This is the case, for example, when subjects are watching films or television, in which it has been calculated that there is only roughly half the decrease in the rate of respiration that occurs in meditation. Changes in skin resistance and conductance have been recorded during yoga and Zen meditation, as well as distinctive electroencephalographic effects, including an increase in the amplitude of the slow brain waves that are associated with feelings of well-being. In the field of psychology, researchers have noted that people who meditate often have a more focused attention in the present, rather than the past or future, and a better attitude toward work. There is increased emotional stability, especially among deviants and criminals, and a greater interest in the ethical, familial, and social dimensions of life. In general, those who meditate are said to be concerned with long-term rather than immediate needs. In contrast to the general population, they are less prone to forms of aggressive behavior. They own fewer firearms. They appear to have fewer anxieties about death than those who do not engage in some form of contemplative practice.12 These features of meditation have been summed up by Daniel Goleman as the acquisition of “emotional intelligence.”13
The existence of a growing literature on the topic in contemporary scientific research has in turn altered the context in which historical, religious, or anthropological inquiries into the traditional mind-influencing techniques of meditation and visualization are carried on.14 The entire enterprise, consisting of both the humanistic and scientific studies, has acquired a type of social relevance that differs from the functions of meditation or contemplation in more traditional situations, where the practice tends to be restricted to participation in religious ceremonies. In the ancient West as well as in contemporary non-Western communities, knowledge of the techniques of meditation is normally restricted to a small number of people in society who are usually members of an élite, such as priests. By contrast, contemporary meditation has become a mainstream activity: it is taught in formal and informal groups everywhere by professionals and amateurs, and, with the exception of specific traditions, such as Catholic lectio divina, it is no longer associated exclusively with religious or cultural settings.
The recent rise of interest in meditation cannot be described as a mass movement, but it has had a democratizing effect within the field of personal health, since a great many people in different walks of life are for the first time interested in its potential. The reason for this is clear. If meditation has a provable therapeutic value in medicine, then it is lives that are ultimately at stake, to say nothing of the sums spent annually on health insurance, a part of which can presumably be diverted to other social needs if inexpensive alternatives to costly drug or surgical interventions are found. As a consequence, for the first time in history, interest in the medical potential of mind-body practices threatens to overshadow the public understanding of their traditional cultural or religious contexts. In premodern societies little was known about mind-body therapy by scientific standards as presently understood; however, there was a large literature on mind-body relations in the fields of religion, pseudo-science, magic, and prognostication. Nowadays, the scientific appreciation of mind-body practices is expanding at all levels of society, while the understanding of the historical background on which these practices rest is increasingly confined to the academy. Those who are engaged in the application of meditative disciplines to the treatment of disease do not have time to investigate their cultural background, while those engaged in research on the history of meditation generally lack the scientific education necessary for understanding what is involved in their clinical use.
From another viewpoint, however, the research community in alternative medicine is increasingly convinced that the traditional associations of meditative methods of healing play a role in determining their effectiveness. The precise nature of this relationship remains unclear, and, as noted, is not the major focus of scientific interest. However, repeated experiments have established that mind-body therapies are not “magic bullets,” like antibiotics, but are one of a group of healing procedures that depend for their effectiveness on the patient’s beliefs and mental disposition. The best known treatment of this type is the placebo,15 in which patients are treated with a pill that has no known medical benefits but are told the contrary. In experiments with placebos it is usually found that a percentage of patients taking the false remedy show improvements that are comparable to those who have taken the real thing. While there is no irrefutable evidence that it is the placebo that has brought about the positive changes, there is no doubt among researchers in the field concerning the effects of the pseudo-remedies on the brain. It is for this reason that they have proven effective for such conditions as recurrent pain, immunosuppression, chronic fatigue syndrome, and depression.16
A great deal remains unknown about this broad category of healing, in which doctors and patients are aware of the effects of the treatments in question but have no scientific appreciation of how they have come about. In the case of the placebo, effectiveness depends on the presence of a figure of authority, usually the doctor, as well as on the dialogue between doctor and patient that deals with the expectations of each party concerning a possible cure.17 Like the true treatment it replaces, the false remedy is rather like a promissory note—a solemn engagement on the part of the physician to perform services in the future. As such, it brings into play the patient’s wishes and long-term goals in a form that is well known in religious traditions of thought. These preconditions of trust, on which the healing is presumably based, can be re-created artificially in a clinical setting, where their credibility rests largely on the prestige of scientific medicine. However, a clinic or hospital has the disadvantage of not being the normal environment in which persons exercise cultural or religious convictions, and sooner or later these structures of belief are weakened, reducing the effectiveness of mind-body treatments.
There is another dimension of this type of healing that must also be taken into consideration, and this, as noted, recalls a number of ancient schools of thought. Quite apart from their medical applications, meditative techniques, as they arise in clinical settings, may be playing a role in society’s search for a supplement, or even a replacement, of the metaphysical framework of institutionalized religion. In other words, the use of meditative techniques in medicine may be associated with a broader movement in contemporary belief systems in which emphasis is placed on a secularized and largely personalized type of spirituality. Within medicine itself, men and women appear to be rediscovering a dimension of the healing process that people once knew about and believed in, along with the forgotten matrix of ideas in which they had their social underpinnings.18
Some doctors adhere to a purely biological model of healing that rules out a role for such concerns; however, increasingly beliefs, including those of health care professionals themselves, are receiving attention as factors potentially affecting the health and well-being of patients. It is not unusual nowadays for medical personnel to form groups in hospitals and to engage in quasi-literary studies of the dramas, narratives, and rituals that take place during the healing process. A vocabulary once reserved for religion has been transferred uneasily to medicine, and, although the pace of change has been slower, medical perspectives based on mind-body relations have seriously invaded the field of religion for the first time in centuries. This change in attitudes suggests that there is something about contemporary society’s beliefs, or their absence, that has compelled the health sciences to take on a part of the task traditionally assigned to the spiritual side of life.
If there is a degree of bewilderment on these relationships in the public mind, some of the responsibility must rest with historians for failing to provide thinkers in the field of medicine with a map of the earlier territory they are traversing. There are popular books on the history of mind-body medicine in the West, but no scholarly account of contemplative practices that takes as its point of departure contemporary changes in attitudes toward disease and healing. One of the reasons for this absence is that such an account would not find a place in standard reviews of the advancement of medicine. Healing practices that share a frontier with the spiritual or contemplative life do not play a large part in official histories of medicine in the premodern period. The familiar topics are the rudiments of anatomy and physiology, the Hellenistic pharmacopoeia and classification of diseases, the deployment of surgical interventions, and the development of social welfare programs to aid the poor, malnourished, and chronically ill.
To move farther back in time, mind-body procedures do not figure significantly in the writings of the founders of Western medicine, Hippocrates and Galen, both of whom championed what eventually became the medical model of illness. This is based on the view that every pathological condition has a traceable cause and that this can be determined through the use of diagnostic tools, narrowing the range of treatment to the source of the illness.
Hippocrates is the model for this approach. Within the sixty books of writings on medicine, there is an occasional mention of mind-body issues, for example, in the advice to physicians on the benefits of taking case histories and paying attention to a patient’s psychology. Also, the Hippocratic Oath, in defining the norms of professional conduct for future generations of physicians, draws attention to their moral responsibility and to the adoption of an ethical mode of life (bios). Nonetheless, healing is considered to be essentially a technical art (techne), which is “result-oriented . . . , learned, practiced, and transmitted by individuals,” while in its scientific dimension it is said to “transcend . . . their private lives, representing a transpersonal community.”19 The orientation of the text of the Oath, as well as the influential inscription in a sanctuary dedicated to Asclepius’s cult at Epidaurus, is toward directed self-conscious activity rather than any type of meditation, contemplation, or philosophical inwardness. These writings
make human cognitive activity central to their expectations. . . . The oath-taker’s promissory self-vision prominently includes numerous cognitive acts, such as making distinctions and passing judgments, engaging in analogical reasoning, teaching those who wish to learn, lecturing and sharing learning with students, avoiding giving certain kinds of advice, being alert and continuously watchful, distinguishing between intentional or voluntary and unintentional or involuntary injustice, hearing and seeing things and deciding about which of these on which he should remain silent, reflecting on the consequences of fulfilling his oath and of committing perjury, and so on. In short, the oath-taker not only envisions himself as an agent (or potential agent) performing deeds or refraining from acting, but also as a cognitive being, reasoning, discerning, hearing, seeing, differentiating, deciding, judging, comparing, anticipating, and so on.20
In the light of such considerations, it is appropriate to speak of Hippocratic medicine, in both its design and practice, as being based on observational rather than philosophical or psychological criteria. This was the chief objective of the schools established at Cos and Cnidus, where physicians were instructed in the physical examination of patients, the observation of abnormalities, and the search for the causes of disease.21
Once this tradition of medical thinking was established, its basic principles were followed in succeeding centuries. Galen was more philosophical than Hippocrates, but he too considered the empirical approach the most secure foundation for medical science. This view is documented in two works that develop Hippocratic themes, On the Elements According to Hippocrates and On Mixtures; in his great study, Anatomical Procedures, Galen likewise adopts a purely scientific outlook, despite the limitations in his anatomical experience that arose from his lack of opportunity to dissect cadavers.22 The Arab physicians who played an important role in the discipline of medicine after the seventh century, for example al-Razi, ‘Ali ibn al-Abbas, Abu-l-Qasim, and Avicenna, considerably expanded diagnostic procedures and treatment in hospitals, but they did so within a Hippocratic and Galenic framework. This approach remained the norm among medical practitioners in the West until the seventeenth century, when it was reaffirmed by William Harvey, who considered his study of anatomical procedures to be a revision and improvement on Aristotle. The progress of medicine has subsequently relied entirely on biology, chemistry, anatomy, and physiology, despite the occasional expression of interest in mind-body factors in figures such as Thomas Sydenham and Claude Bernard, and in a different context by Freud.
If we examine the use of healing within religion, a comparable picture emerges. Meditation was practiced in Hellenistic Judaism and in first-century Christianity; however, there is no record in the period’s religious history for the use of disciplined meditation as a technique for curing specific illnesses. In the New Testament, the methods most frequently mentioned for healing are miracles and the casting out of evil spirits. There are some 65 reports of miraculous cures in the Gospels and 49 in Acts.23 Other methods of healing that are frequently mentioned are prayer, exorcism, and occasionally the revival of the dead. In Matthew and Mark the use of prayer in healing usually concerns individuals, whereas miracles typically take place before an audience, as in the accounts of Peter, Philip, and Paul. One of the questions that remains unanswered in these episodes is about the role of the surrounding community in establishing the preconditions of belief in which these arbitrary and dramatic scenes are enacted.
These miracle stories are largely popular in focus. Among educated people in both Jewish and early Christian communities during the period in which the Gospels were written, the prevailing view of disease was that of Greek and Roman society in general. This relied almost exclusively on the methods of physical medicine. Illness was associated with internal causes and visible symptoms, and cures involved the removal of these through a variety of scientific and pseudo-scientific means, rather than by the establishment of the long-term conditions for health and well-being associated with mind-body techniques.24 The picture changes somewhat during the patristic period, when there are occasional references to healing involving the use of contemplative practices. However, for the most part, stories of healing in the lives of the saints likewise involve miracles, while among radical ascetics there is, in addition, a distrust of medicine, since it represents a causal force that rivals healing by means of divine intervention.
Within the period’s spiritual writings, there are nonetheless passages in which serious consideration is given to mind-body relations, as in John Cassian, although these do not often raise medical questions.25 A comparable orientation is found in Byzantine hagiographic sources, in which there are discussions of the emotional and cognitive implications of disease as well as reflections on meditative technique involving visualization, especially during the period of the iconoclastic controversy. It is difficult to generalize about the medieval centuries that follow; however, as noted, advances in medicine usually concerned the etiology of disease and the setting up of centers of care rather than mind-body issues.26 Again, there are occasional accounts of interest in this area, for example, in the book written for Frederick II by Adam of Cremona on the regime to be followed by pilgrims and travelers to insure their stamina and mental stability.27
At the beginning of the modern period, mind-body practices were mainly found in the ill-defined territory between magic, medicine, and religion.28 They did not form a part of learned or scientific medicine. If they played a role in the treatment of disease, it was largely because the majority of ordinary people could not afford the services of doctors. Even those who could were sometimes reluctant to call upon them, since it had become clear that they had no true understanding of the causes or cures of disease. Keith Thomas notes that
the population at large disliked Galenic physic for its nauseous remedies and were frightened by the prospect of surgery. Some of the most intelligent laymen of the day expressed total contempt for conventional medicine. . . . King James I regarded academic medicine as mere conjecture and therefore useless. Francis Bacon thought that “empirics and old women” were “more happy many times in their cures than learned physicians.” Some scientists and intellectuals followed the example of Paracelsus and were prepared to learn from herbalists and wise women.29
It is not surprising, therefore, that many people still relied on healing practices that were lodged in religious concepts and practices—for example, in relics, icons, pilgrimages, blessings, amulets, consecrations, sacraments, and the intercessory power of miracles and prayers. In the wake of the Scientific Revolution, many of these were abandoned, as were the principles of Galenic and medieval medicine.
The contemporary revival of interest in alternative healing did not arise from either the Greco-Roman medicine or from the healing practices embedded in Western religious traditions, but from Eastern religions and from scientific investigations of mind-body procedures such as meditation. As a consequence, there has been a transformation in what the medical community considers to be the type of healing activity from earlier times that has relevance to contemporary medicine. The ancient and medieval therapeutic practices described in histories of medicine are of no clinical use today,30 but the medical research community is deeply involved in the investigation of mind-body relationships that distantly recall miraculous cures, that is, interventions in which a subject apparently inspired by beliefs alone was able to trigger the body’s resources into reversing a potentially threatening condition; as did a woman called Innocentia, of whom Augustine speaks in The City of God (22.8), whose breast cancer went into remission after she prayed at the shrine of St. Stephen in Carthage.
Also, it would appear that the rise of scientific medicine was not the cause, or at least not the principal cause, of the decline of meditative healing in premodern Europe. If this had been the case, there should have been a confrontation, or at least a conversation, between these approaches to healing. Scientific medicine and meditative spirituality were in fact rarely in contact after the translation of the corpus of Aristotle’s writings, which began in the late twelfth century. Early medical science saw Aristotelian and Galenic natural philosophy as its intellectual predecessors, not ancient or medieval mind-body procedures. Finally, the rise of scientific medicine does seem to have played a significant role in the post-sixteenth-century decline of types of spirituality involving textual or visual meditation. This appears to have taken place within religion itself and affected both post-Reformation Protestantism and Catholicism.
As a result of these historical developments, it is clear that the source of a change that eventually affected medical science cannot be sought in the documented history of the science itself. It is not in earlier medical practices that we should look for the predecessors for contemporary applications for meditation, but in the complex history of Western meditation itself in both its early philosophical phase and its later religious configurations. One of the important chapters in this history concerns the transformation of meditation that took place in the late Hellenistic period and remained an influential force in thinking about meditation down to the seventeenth century, when the modern history of medicine began. During these centuries firm connections were established between the disciplines of meditation and reading. These included reading aloud, which was the dominant form of reading in these centuries, and silent reading, practiced by increasing numbers of people after the fourteenth century. This was a change that pertained to meditation on texts as well as images, since early in its development it was observed by Gregory the Great that religious images were like texts for those who could not read.31
The association of healing words and images with the reading process was both an advantage and a disadvantage for the history of meditation as it is later employed in medicine. The advantage arose from the continuity of reading practices during the Middle Ages, especially in monastic communities, which provided an institutional context for spiritual exercises like meditation and visualization, developing their techniques in ways unprecedented in antiquity. The disadvantage arose when those practices were abandoned in the early modern period, especially after the Reformation. Later education, whether secular or religious, did not give as large a role to the meditative aspects of reading as did the late ancient world or the Middle Ages, except within religious communities. Because meditation was thoroughly embedded in the reading process during this lengthy stretch of time, its disappearance was not noticed during the rise of the modern outlook, even though other changes in the reading and interpretation of sacred writings attracted considerable attention.
One possible reason for the lack of interest was that there was no single force at work, as there was, for example, in the challenge to the inherited view on the laws of bodies in motion by Galileo, thereby bringing about a fundamental change in mentality. The abandonment of meditative reading was not a direct consequence of the change from oral to silent reading, since one can read silently and meditatively, as did Anselm in his meditative prayers in the late eleventh century. Nor was it an automatic result of the new methods of book production that intervened three centuries later, as discussed by Elizabeth Eisenstein, Roger Chartier, Robert Darnton, and Adrian Johns,32 since changes in book formats that preceded the age of print were at work as early as the twelfth and thirteenth centuries, when meditative monastic reading was widespread. Deeper causes have to be sought in education, theology, and social history to account for the fact that the religious and therapeutic effects of meditative reading that were found in ancient and medieval settings were reduced, or restricted to special communities, by 1600. This transformation appears to have taken place in spite of the wave of post-Reformation piety that swept through Protestant and Catholic populations and created the first mass readership for the Bible.
With the exception of the Devotio Moderna, the followers of Ignatius of Loyola, and scattered Protestant groups, early modern people read less meditatively than their medieval predecessors, and read more often in order to get at information that was contained in books. The intimacy of the manuscript codex, which was often written for a single person or group of persons, offered no advantages for this kind of reading; this was also true of the images in such books, which, like those illustrating The St. Albans Psalter, were created principally with one viewer in mind, in this case Christina of Markyate.33 In the age of print texts were standardized, and images became more representational and rhetorically persuasive, as in Bernini’s controversial Santa Teresa in ecstasy, which offended contemporary viewers because it was thought that an interior conversion had been presented as an exterior drama. Hugh of St. Victor, who wrote the first modern treatise on reading in the 1140s, and Petrarch, who was a self-conscious reader in the 1340s, stood at opposite ends of a frontier that separated two ways of looking at the purposes of reading.34 One of these directed the reader’s energies inward toward the self: its goal was self-scrutiny and self-improvement within an institutionalized scheme; the other, although it could be personal as well, was chiefly channeled outward to a reading audience.
These are some of the reasons why the mind-body dimension of healing has been called the forgotten factor in modern medicine.35 In the popular literature on the subject, this omission is usually traced to the medical consequences of the Scientific Revolution. The thinker most often singled out for scrutiny, as noted, is Descartes, who is thought to have established philosophical dualism as the norm in medical thinking about the mind and body.36 This is of course an oversimplification of his views, which based on his Meditations of 1641 rather than later writings, such as The Passions of the Soul, published in 1650. In his mature reflections on the subject, Descartes abandons strict dualism and adopts a notion of the self in which mind and body are integrated.
Also, from a historical point of view, it is questionable whether an elitist discipline such as philosophy can be held responsible for the then prevailing attitudes in the field. Mistrust of mind-body methods for healing has much broader roots in Western medical thinking. As noted, resistance can be traced to Greco-Roman and Islamic traditions of medicine, which consistently favored the physical explanation of illnesses, as well as to the intellectual changes that preceded the Reformation, which discredited many healing practices embedded in magic, superstition, and popular religion, some of which involved connections between mind and body. Among the models that were abandoned during this period were the theory of the four humors, which accounted for illnesses through the disequilibrium of the emotions, and the concept of macrocosm and microcosm, in which it was thought that the same pattern of forces promoting physical harmony was reproduced at all levels of the universe, from the largest to the smallest. While one still finds pseudoscientific schemes of this kind on the fringes of theories about healing, they have no relevance to serious research in mind-body relationships, which is based on experimentation.
It would be more accurate to say that, to the degree that mind-body procedures have Western roots in medicine, they fall into a branch of learning that historians of religion broadly call “spirituality.” The term and the discipline it represents are largely modern in conceptualization. The noun “spirituality” is not found in English before 1500, and its Latin predecessor, spiritualitas, is a relatively late invention in the ancient world, which is first used by Pelagius in the early fifth century.37 Later usage depended largely on context; for instance, in the phrase “spiritual healing,” which is often used by Christian authors to refer to the acts of anointing or the laying on of hands.
During the Middle Ages and afterward, the word was frequently employed in a manner that suggested a close connection with reading and meditative practices. One of the important figures in this tradition was Ignatius of Loyola, whose Spiritual Exercises recommended a combination of sensory impressions, creations of the imagination, theological studies, and the exertion of the will as a way of conquering the passions and seeking a pathway to the interior life and to God. In keeping with this tradition, the term “spiritual” is sometimes employed in the literature on mind-body medicine as a synonym for “‘internal.”
This is a style of spirituality that goes back to the ancient literature on the subject, in which Latin authors sometimes see spiritualis as a translation of the Greek pneumatikon, referring to breathing; the usage survives in Tertullian and Augustine, and is based on the translation and interpretation of phrases concerning pneuma in the Pauline epistles.38 Anyone who enters the field of Western spirituality is bound to be struck by the frequency with which the mind-body theme reappears over the centuries. From antiquity to the present, people at all levels of society have had a continuing interest in this dimension of the meditative or contemplative life. In the Latin West, heresies, schisms, charismatic movements, and theological schools come and go with regularity, but an interest in the fundamentals of the spiritual life is reasserted in every period.
This thinking has ancient roots in the history of asceticism. Isocrates said that the training or exercise that pertains to philosophy (philosophias askesis) is for the soul what medical attention is for the body.39 Xenophon compared the disciplined methods of hoi asketai, the war-hardened soldiers, with the amateur approach of hoi idiotai, the inexperienced in battle.40 Plato, followed by the Sophists, used askesis as a synonym for melete,41 which was (sometimes) translated into Latin by meditatio. Stoics, Cynics, and Epicureans situated ascetic exercises within the practices of their respective schools: to pursue mind-body equilibrium, as a preparation for the pursuit of wisdom, was to become a member of this type of “textual community,” that is, a group of people from diverse backgrounds who altered significant details of behavior in response to a scenario, a plan of living, or a set of principles.
Contributions to ascetic and spiritual thinking subsequently came from a number of different directions. It was through a Jewish thinker writing in Greek, namely Philo of Alexandria, that the Christian church fathers acquired a vocabulary for describing self-improvement by means of disciplined meditative exercises that involved the reading of scripture. In De Vita Contemplativa, Philo wrote an account of an ideal community, the Essenes, in which the Christian use of such exercises is anticipated, even though his writings on the subject do not appear to have influenced early Christian monasticism. Among Latin authors, exercitium or exercitatio was gradually adopted as a translation of Greek askesis, as a way of speaking about this dimension of mind-body relations, although neither term occurs frequently in the Septuagint, Old Latin, or Vulgate translations. In philosophy, Seneca and Marcus Aurelius utilized readings as spiritual exercises for changing long-standing habits and correcting emotions. Seneca recommended the compilation of pithy statements that could be carried about, memorized, and rehearsed as a kind of “medicine” for the soul. Among Christian readers, the routines of asceticism became familiar through such works as the Historia Monachorum, where reference is made to monachorum exercitia, exercitia spiritualia, and spiritualis vitae exercitia in the context of fasts and vigils.42 Cassian spoke of exercitia virtutum; others used such terms as studium, exercitium, spiritualia studia, virtutum studia, and salutaria studia. Isidore of Seville quoted Servius’s maxim: “Exercitium est meditatio”43 (Exercise is meditation or reflective thought). During the medieval revival of spiritual thinking, many monastic authors shared the opinion of Peter the Venerable, who quoted 1 Timothy 4:7–8 to support the view that prayer, reading, and psalmody had greater value in preparing for salvation than exercises involving the body.
Judaism played an important if sometimes unacknowledged role in the formation of medieval Christian methods of meditation.44 In contrast to ancient philosophy, in which the link between reading, meditation, and ethics was a late development, the Jewish tradition incorporated the relationship from the beginning. In the Hebrew Bible, the idea of meditation is expressed by terms derived from the root haga, as mentioned in Chapter 1, meaning to murmur in a low voice; this was translated into Greek by meletan/melete and into Latin by meditari/meditatio.45 The auditory or corporeal element in meditation was associated with a spiritual or mental constituent, for example in Joshua 1:8: “Let the scroll of this law always be on your lips: meditate on it day and night in order to be ready to act in accord with what is written.” Meditation led the believer to govern his or her life by means of the law, including rules relating to health. The same sense of rigorous adherence is found in Psalm 1:2, frequently quoted by Christian writers: “Happy . . . is he who murmurs/meditates the law of the Lord day and night.” The translation of the Hebrew term by meditari expanded the range of meaning of the original. In a comparable manner, the Greek verb meletan meant to take care of, to watch over, or to take to heart. The notion of an exercise involving routine physical activity and reiterated mental activity reappeared in the Benedictine Rule, as noted, in which reference is made to students and monks who are engaged in the exercise of reciting the Psalms (c. 8.3). The term was frequently used to refer to the devotional life of the community as a whole (c. 58.5), which differed from its ancient predecessors in that its foundational writings were explicit and accessible to all members.
Earlier in this volume I noted that the history of spirituality after Augustine, Benedict, and Gregory the Great is commonly divided into two types of reading, lectio divina and lectio spiritualis. By way of conclusion, I would now like to extend the discussion into a later period of time and to say a little about the therapeutic implications of these styles of reading. In addition to these categories, it is also possible to speak in this context of a phenomenon called lectio saecularis: this refers to writings on the subject composed by lay persons, dealing with religious topics, as well as the nonreligious contemplative practices accompanying the premodern reflective study of literature.
As I have mentioned, these lay and religious styles of reading have much in common in the late medieval and early modern periods, and their chronological boundaries frequently overlap. Lectio divina has been practiced without interruption from the patristic period to the present. The early stages of lectio spiritualis are found in such authors as Augustine, Evagrius Ponticus, and John Cassian, who prepare the way for the full development of this technique of reading in the twelfth century. In the fourteenth century a formal distinction is made between lectio divina and lectio spiritualis. However, during the thirteenth century traditions in lectio spiritualis are already popular in the mendicant orders, for example, figures like the Franciscan David of Augsburg and the Dominican Humbert of Romans, who died respectively in 1272 and 1277.
For ancient authors, clara lectio (reading aloud) was a type of physical exercise, like walking or running, which was recommended as a treatment for illnesses by Cornelius Celsus as early as 30 A.D.46 In adapting oral reading to the needs of monastic communities, Benedict of Nursia added the psychological benefit of reflective silence, however, chiefly in order to prevent disturbances during periods of oral reading.47 Building on this heritage, later monastic authors deepened the notion of silence in a manner in which it no longer referred to the absence of noise but rather to the presence of an inner spiritual quality that was allied with the meditative experience of lectio divina and lectio spiritualis.
The two processes, reading and meditation, functioned together. Reading proceeded from the outside, through the sense of hearing, into the interior of the mind, while meditation, originating in the mind, proceeded toward outer expression in prayer, liturgy, or oral reading. Under the influence of medieval liturgical and devotional practices, the periods of silence associated with meditation and the interior life of the mind increased in length in many religious communities, such as the Cluniacs and Cistercians, and these were linked in turn to the benefits of solitude and the exploration of subjective states of mind. As this type of reading and meditation evolved, the ancient Socratic program of questions and answers, which had, before Augustine, been devoted to the exploration of philosophical questions, became, partly under Augustinian influence, a series of inquiries into relations between mind and body.
By contrast with this type of meditation, lectio spiritualis typically relied on a combination of reading, writing, and mental images. The synthesis of these elements is well represented by the practices of the Brethren of the Common Life, who lived together as a confraternity near the monastery of the regular Augustinian canons at Windersheim and started a school at Deventer, where Erasmus studied between 1475 and 1484. Johann Huizinga sums up their interest in education and spirituality by noting that it
was rather a matter of sentiment and practice than of definite doctrine. . . . Sincerity and modesty, simplicity, industry, and above all constant ardour of religious emotion and thought, were its objects. Its energies were devoted to tending the sick and other works of charity, but especially to instruction in the art of writing. [The brethren] exerted their crowning activities in the seclusion of the schoolroom and the silence of the writing cell.48
This was a new style of meditation, in which there was a union of the activities of reading and writing, since the writing that emerged was the by-product of devotional reading, with which it was inseparably conjoined in the subject’s mind. Also, the mentis exercitatio, as Gerard Groote called it, utilized, in addition to reading, a combination of internal words and images. These consisted in the mental recreation of the narrative of Christ’s life; this was the subject of the students’ devotions, along with the lives of the saints and selected writings of the church fathers.
Groote wrote at the end of a development of some two centuries that witnessed a great increase in the use of images in the religious life based on physical exemplars, that is, on paintings, sculptures, and manuscript illustrations; accompanying this was a revival of the ancient habit of recreating visual imagery from verbal descriptions, which became popular after the Fourth Lateran Council of 1215. Transferred to a largely unlettered public through mendicant preaching, biblical writings were thus recreated as a set of instructive narratives without first passing through the reading process. Physical images were often employed as an aid to preaching, the combination resulting in the creation of secondary mental images, based on both former words and images, in the minds of the listeners. Through Latin and vernacular preaching, biblical narratives and hagiographical cycles were thus incorporated into local liturgies, with the result that healing images, some of them taking as subject Christ’s miracles, became accessible to large numbers of people. The emphasis on internal images in popular religious culture may have been one of the sources of opposition to the emotional qualities of external religious images that reappeared with Protestantism.
Between the twelfth and fourteenth centuries, a number of tendencies developed within the practice of lectio spiritualis. First of all, there was a literary development, which produced a recognizable set of genres and distinctive commentaries, as well as a gradual intellectualization of the process of reading and meditation, in which emphasis was placed on mental activity involving rationes, imagines, and internal narratives, as well as an on interest in the subjective, personal, or autobiographical element of the author’s life, which became, under Augustinian influence, a point of departure for therapeutic meditation. There was also a process of synthesis and systematization, as reflected in treatises on meditation and manuals of meditative technique, and through them, a transformation of institutional affiliations, such as those in monasticism, permitting authors of meditative works to speak not as members of a group but with individual voices. Their numbers included religious, as well as lay persons and many women; as a result, spirituality was given a gendered context.49 Furthermore, within such reading communities, a distinction was increasingly made between lectio divina and lectio spiritualis as interrelated approaches to spiritual healing: the one was built on the relationship between sound and silence, the other on the internal coherence of words, images, and narratives, leading in time to the appearance of lectio saecularis.
Finally, let us recall that in the early modern period meditative and non-meditative readers approached the text in different ways. If the goal was meditation, then reading was considered to be a means to an end, and if ethical questions arose during the reading process, the answers were to be sought during a period of post-reading meditation, not during the reading itself. On the other hand, if the goal was the understanding of the text, then the reading was an end in itself; there was no post-reading, cognitive experience, except that which pertained to the explication of the text. If ethical questions arose, the answers had to grow out of the acquaintance and re-acquaintance with the text; through its rereading, and from the search for meaning within a philological framework, which could of course continue after the text was put down. These differing configurations of the reading process, the one subjective, the other largely objective, were conceptualized at a time when reading was ceasing to be a mind-body exercise and beginning to become a philological discipline. In order to establish empirical, observational, and philologically defensible standards in interpretation, humanist readers, following the suggestions of Petrarch, had to assume that reading was an independent activity. Humanists were no less concerned with the care of the soul than the ancient and medieval thinkers who preceded them. But it was difficult for them to combine the two objectives in the same activity, since one was clearly a part of a philological agenda, while the other was not. As a consequence, the certainty of the premodern reader, who knew that the solution to ethical problems lay outside the reading process, was replaced by the uncertainty of the early modern reader, who was committed to finding ethical values within the autonomous world of reading and interpretation.
One of the most instructive ways to understand the medical dimension of these developments is through narrative and its associations in the premodern age. A useful point of departure for such an inquiry is Thomas Merton’s observation that “meditation has no point and no reality unless it is firmly rooted in life.”50
At a practical level, mind-body treatments involving meditation that arise in a literary context, such as writing a diary, a journal, or a record of treatment for disease, frequently explore the themes of rootedness, authenticity, and spiritual values through the concept of a healing journey. This process, sometimes called “journaling,” attempts to create a personal awareness of the ways in which specific events can be used to present a harmonious narrative view of life as a whole. Alastair Cunningham divides this journey into three stages: (1) “taking control,” which means “learning what can be done to have some control over the way in which we react, mentally and physically, to our environment”; (2) “getting connected,” which implies that “the process of self-understanding has now become of value in and for itself”; and (3) the “search for meaning,” which “seems to evolve naturally from a growing realization that we are not separate entities, but are part of a larger social, natural, and spiritual world.”51
An interesting feature of this type of self-reporting is that historians are able to put rough chronological dates around its appearance, development, and even its application to early mind-body therapy. Unlike some treatments in alternative medicine, such as yoga, quigong, therapeutic touch, and music therapy, which have little connection with reading, writing, or other literary pursuits, the therapeutic uses of confessional, autobiographical, and self-reflective literature can be situated historically in late antiquity. They emerged at the time when meditation was becoming an aspect of sacred reading practices: personal accounts of healing experiences were, so to speak, one of the literary by-products of this connection. The appearance of a specific autobiographical genre is associated with Augustine’s Confessions, written between 397 and 400 A.D., but the broader relationship between healing and personal spiritual development is touched upon by a variety of Christian writers, who gradually evolved a distinctive approach within late ancient theories of healing.
In such writing an alternative is proposed to the purely naturalistic interpretation of disease; this consists in distinguishing between the cause of an illness and its meaning.52 The cause is considered to be natural, but the meaning is cultural and perhaps religious, if one believes, like many ancient Christians, that disease is associated with sin. The cause of a disease can be understood through the analysis of material or physical conditions, but the meaning, however it is conceived, has to be taken up by means of thought and language. In Christianity, this understanding begins with the healing framework for human thought, namely the Word of God. There are numerous discussions of the connection between the classical “therapy of the word” and the Christian dispensation of the Word.
It was here that narrative played a role. This began with Jesus’ miracles, which were invariably related as episodes in his life story. It was through the different versions of this story, each embellished with the transcriber’s interpretation of his healing powers, that the figure of Christus medicus emerged in patristic literature and was passed to later generations of believers.53 For most Christians in late antiquity, the establishing of a narrative tradition meant that in the end it was not Jesus’ words that healed but his words as they were transmitted by a composite work of literature, namely the synoptic Gospels. The entire narrative was considered to be a source of “health” (salus), or, as Clement of Alexandria put it, “gentle medicine.”
The words of the literary interpretation, which were frequently spoken aloud to interested parties, were thus connected with the notion of healing through the actually spoken words of Christ. The two formed a single hermeneutic program within the healing experience. This could be transmitted to other lives, for example, to those of saints, pious religious, and holy healers, provided that they illustrated the same type of relationship between healing and meaning as the original. A tradition was built up in which the connection between mind and body could be thought about as a literary and conceptual matter, even though questions of health and disease might be taken up concurrently in naturalistic terms, as they were in Hellenistic and late ancient physical medicine. The authoritative narrative of Christ’s life and its associated commentaries became the central subject of both religious healing and religious meditation in the centuries that followed. If the accounts of witnesses are to be trusted, healing in this context was brought about by a combination of extrinsic and intrinsic means, that is, through outward forms of worship and through inner expressions of spirituality, the latter comprised chiefly of meditation and visualization.54
Philosophy was only a minor influence on such thinking during the apostolic age but grew considerably during the patristic period, as authors like Gregory of Nyssa, Origen, and Augustine attempted to write defenses of Christian teachings on the spiritual aspects of health and disease. A good example of this combination of healing, religion, and literary themes in Christian writing is found in Gregory of Nazianzus’s conception of the Christian as priest and physician, which is presented in Orations 1, 3, and 6. The notion of healing likewise entered theology: an example is Jerome’s translation of Exodus 15:26, in which God speaks of himself as sanator, healer, rather than as a Greek or Latin physician, medicus.
Christian authors adopted guided visual imagery as a mind-body treatment for disease under the influence of images that were found in the Hebrew Bible. External images were rejected in Judaism, as a form of idolatry, but internal images are found throughout the Bible, particularly in the prophetic books that were read carefully by the Christian fathers for the light that they might shed on the divinely inspired foreshadowing of the incarnation. The vivid images in these writings were frequently recommended by patristic writers as an internal focus of attention for their readers, who might thereby initiate meditation on Christian themes and even bring about a reaffirmation of their faith through conversion, which was itself viewed as a healing activity.
Old Testament images were freely reinterpreted in this process, for example, in Ambrose’s extravagant allegories on the book of Genesis, which were heard by the enthusiastic Augustine in Milan in the spring of 386. If the spiritual sense of Ambrose’s sermons was to be made a part of a personal healing journey, as Augustine observed at Confessions 6.4.6, this freedom of interpretation had to be understood as a stage of spiritual therapy, and as a response to what was interpreted as purely physical imagery in Manichaeism. Through such adaptations of Jewish themes, the Christian concept of meaning in illness came to imply that there was a literary, narrative, and metaphorical context for the notion of healing that combined God’s transcendent power with the immanent force of meditative visualization. These diverse approaches to the problem of meaning in narratives of health and disease inevitably gave rise to conflicting opinions about what healing meant. Christian writers assumed that it was Christ who healed, but this led to the pagan retort that Christianity was an inferior religion designed for only the sick and infirm—an idea that had a long life, turning up, little modified, in Nietzsche. Yet, behind Christian rhetoric about the advantages of spiritual healing, and the need for mercy and humility in dealing with suffering, there was a reliance both on miraculous interventions and on skillful mediation between healers and the communities they served, in which the gap between naturalistic and spiritualistic medicine was frequently a subject of negotiation, as were, in another context, the canonical procedures for sainthood.55
As illustrations of this point, I offer two brief examples, one pagan, the other Christian. The first is taken from the life of Proclus (d. 485 A.D.) by his student, Marinus of Samaria.56 Marinus gives evidence of being acquainted with Christian hagiographical writing; accordingly, Proclus is portrayed as an ascetic, who, along the lines of St. Antony, renounces wealth and seeks spiritual values within a quasi-religious way of life. He was allegedly converted to the practice of philosophy in a series of dreams. In the first, Athena appeared before him, inspiring him to a life of celibacy, contemplation, and the cult of the gods. He was subsequently visited in sleep by Telesphorus, the child god associated with the cult of Asclepius, who cured him of illness by touching his forehead. The philosopher afterward enjoyed some seventy-five years of uninterrupted health.
When he was expelled from Athens for a year by the zealous Christians who had taken control of the city (c. 15), he responded in a manner which they would have recognized as being close to their own traditions. This consisted in fasts, singing of hymns, recitations of devotional prayers, and extended periods of silent meditation. Through the continual practice of spiritual exercises (cc. 21, 24), Marinus notes, he acquired the habit of focusing his attention uniquely on the state of his mind or soul, which, thus nourished, progressed, despite being imprisoned in his body. He gave a dramatic demonstration of his healing powers in restoring the health of a young girl, Asklepigenia, who had been pronounced untreatable by her physicians, by praying continually at the temple of Asclepius, which Christians had fortunately not destroyed (c. 29). In a significant addendum to this event, Marinus notes that prayer likewise prevented Proclus from later contracting arthritis, which had crippled his father (c. 31). This may be the first account of the reversal of a hereditary disease by means of a mind-body technique.
The other example of mind-body arbitrage that I wish to bring forward is from the life of Theodore of Sykeon, who died in 613 A.D.57 One would be tempted to say that Theodore came to spiritual healing by an indirect route, since his mother was an innkeeper, who earned extra cash by entertaining the guests, and his father a circus acrobat, whose specialty was performing riding tricks on camels. He was destined for the imperial service by his mother but was dissuaded from entering by St. George, who spoke to him in a dream. The family fortunes were subsequently improved by his mother, who hired a pious elderly cook called Stephen. Owing to the superior quality of the food, the inn at Sykeon made enough money for her to give up hostelry and procure a wealthy husband.
Despite his culinary expertise, Stephen advised the young Theodore not to profit from gastronomy, but instead to practice fasting and abstinence. Accordingly, Theodore entered the church and after ordination became a radical ascetic who lived for lengthy periods in a metal cage suspended above his cave at Arkea, a few kilometers from Sykeon, clad in a belt, collar, handcuffs, and breastplate of cast iron. He was renowned for his lengthy fasts, continual prayers, and miraculous cures, including the healing of the emperor’s son, who was then suffering from elephantiasis. In his official Life, it is reported that he advised those suffering from illnesses to avoid doctors and to put their faith instead in prayers and blessings;6 but he also prescribed medical remedies and, where necessary, recommended surgery, sometimes choosing the appropriate doctor himself. His career is thus one in which science is aided, but not superseded, by complementary medicine.
Numerous other biographies in late antiquity likewise anticipate uses for narrative that are found in contemporary mind-body medicine. A frequently mentioned topic, which has turned up in experiments in psychoneuroimmunology, is the progressive education of the emotions, particularly through internal narrative. Another is the sharing of feelings by means of the creation of a support community, a theme that is widely reflected in contemporary programs for coping with the symptoms of cancer and the effects of chemotherapy. Ancient hagiographers spoke about the role of improper stories in generating negative emotions, which is a persistent theme in Buddhism as well as in contemporary research in psychology. The emphasis on the behavioral consequences of narratives has permitted medical researchers to link certain types of emotion, for example, random hostility, with the onset of specific conditions, in this case cardiovascular disease. Still another type of narrative in ancient and medieval biographies deals with the emotional support that individuals can receive from fictional, imagined, or deceased communities. Experiments have shown that the body responds to the intense emotions created by these communities of mind and memory as if they were living. There is also the reshaping of personal narrative. Take a patient who suffers from migraine. When the symptoms appear, he feels helpless because he thinks he is soon to be incapacitated. His stress creates changes in blood flow that make his symptoms worse than they otherwise might be. Can such a patient rewrite this internal narrative? It would seem so, at least to some degree, by means of guided visual imagery. In a comparable experiment, potential cardiac patients who experienced high levels of hostility presented their feelings in personal narratives, and their measurable output of adrenalin and cortisol was considerably reduced.
In the late ancient and medieval periods the source of this interest in the interior, imagined, and fictional qualities of healing narratives was not medical but religious. Guibert of Nogent, a twelfth-century critic of the irresponsible trust in miracles and relics, summed up the view of many earlier thinkers when he connected successful spiritual healing to a combination of authenticated beliefs and disciplined inwardness. His statement was part of a widespread revival of interest in the interior life in which, in Giles Constable’s words, “there was a tendency . . . to interiorize and spiritualize all aspects of monastic life and morality.”58 In this revival the notion of healing crept into numerous literary genres, for example, secular allegory. The habit of writing healing allegories was taken over during the Middle Ages from later ancient Neoplatonic writers like Prudentius, Apuleius, and Boethius, in whom it already had a strongly psychological orientation. This was adapted to different ends during the Middle Ages by making the central characters personifications of both positive and negative passions. In the De Planctu Naturae and the Anticlaudianus, two learned but widely studied works in this tradition, Alan of Lille dramatized virtues, vices, and emotions in a manner that permits the reader to visualize thoughts and to follow them step by step as they develop toward good or bad intentions. In contemporary mind-body healing, a comparable method is employed in meditative journaling and narrative writing, in which diseases like cancer are pictured, in order to distance patients from symptoms and thereby to visualize physical changes that may bring about improvement.
What can we conclude? First of all, if the evidence of late antiquity and the Middle Ages is taken into consideration, it would appear that the received interpretation of historical relations between spiritual and naturalistic healing over the centuries is in need of revision. These relations are often presented as conflictual, but by and large they are cooperative.
Second, we must take into account in evaluating the mind-body field that the major tradition of medicine in the West since Hippocrates has been naturalistic. It is only minor traditions that have been concerned with mind-body factors in disease. Even before the rise of biological medicine, there was no period in which mind-body healing was preferred to standard medical practices. On the other hand, it also has to be observed that the triumph of biological medicine was not as swift or thorough as has been imagined. Mind-body factors continued to be taken seriously as late as 1871, when Sir Thomas Watson observed that “mental stress [was] influential in hastening the development of cancerous disease in persons already predisposed.”59 What is new in contemporary mind-body medicine is the unwillingness to accept such statements uncritically, without experimental corroboration.
The fact that spiritual and naturalistic medicine enjoyed a mutually beneficial relationship in the past is a clue to another distinctive feature of the Western handling of mind-body issues. In contrast to Eastern religions, where purely contemplative traditions are not unusual, the typical ancient and medieval situation in the West is an alternation of contemplative and noncontemplative traditions (or, as some would prefer, nonrationalistic and rationalistic). In later ancient and medieval thought in the West, mysticism and rationalism are pictured as rivals: however, in the fields of healing and religion, they were often good neighbors. In the past, as nowadays, mind-body healing can be divided into two parts. In the one, healing is concerned with specific illnesses; in the other, it has to do with a general philosophy of life. The philosophical inquiries form part of a lengthy discussion, which has been undergoing development since antiquity. In my view, this conversation will continue well after the scientific questions are settled because the inspiration for this part of the debate is not scientific, and because the answers to the questions that are being raised are not scientific either. They are cultural and religious.
We have an accepted method for testing the scientific results in the mind-body medical field. But we do not have a method for examining the ethical dimension of the subject, as ancient and medieval thinkers did, through contemplative practice itself. With the abandonment of meditation in early modern sacred reading, it became difficult, if not impossible, to make ethical decisions as the ancients did, and, in the present climate in literary studies, it is doubtful that those methods will soon enter curricula again. As long as reading practices incorporated meditation, they were in contact with a spiritual exercise by which philosophers and theologians for centuries related mind and body. These exercises demanded an ascetic commitment, not an intellectual orientation: the individual seeking an answer to questions concerning a philosophy of life engaged in a series of tasks that were designed to separate himself or herself from the material, the sensorial, and the circumstantial, as a first step in attaining the detachment that was necessary for achieving valid self-knowledge. By contrast, in analytical reading this possibility was greatly reduced in scope. One could advance with some degree of certainty toward the meaning of the text, but one could not advance at the same time or by the same methods toward knowledge about oneself. Literary studies, which had been strongly associated with ethics in the ancient and medieval periods, gradually abandoned the view that ethics and literature could be meaningfully connected through inquiries involving the individual’s inner spiritual life. In view of this situation, it is not at all surprising that patients in clinics and hospitals are discovering the spiritual dimension of their lives quite outside the traditional study of literature, theology, or academic religion.
Finally, in comparison with ancient attitudes on this subject, the contemporary experience is different in at least one respect. This concerns the time of life at which the fundamental questions are asked. In mind-body medicine, spiritual questions are only posed at a moment of grave crisis. The assumption in mind-body clinics that utilize meditation is that the patient arrives, so to speak, spiritually bankrupt: he or she is thought to have no resources to fall back upon; these have to be generated from within the clinical environment. By contrast, in the ancient view, whether among pagans, Jews, or Christians, the journey of life was conceived to be a preparation for the moment when such resources were needed: these were like a small capital sum that had been put aside for a period of economic turbulence, which, if unused, might continue to accrue interest. If that capital is missing, mind-body medicine can only supply it in the short term. Our society has not yet relearned what the ancients knew, namely, that the time to prepare oneself for a crisis is not the moment when the crisis takes place: then it may be too late.