Magic as Psychotherapy

This book contains essays by two prolific French writers on alternative medicine: an essay by self-styled ethno-psychiatrist Tobie Nathan, and comments on it by philosopher Isabelle Stengers. The book rests on the following true observation. Until late in the 19th century, all medical practice embodied folk traditions; some of it still does—even in the most advanced countries; unavoidably (pp. 89-94).

What then is science (and what is science-based technology)? Oddly, even contributors to the literature on popular beliefs (once called superstitions or popular prejudices and now called “folk science”), even those who dwell on practical—especially on medical—differences between the traditional and the science-based approach, even they do not discuss this question: they tackle the difference between scientific and folk medicine piecemeal. Here, it is the general question that pops up: what is science? On this approach current popular views amount to popular prejudices.

Science is often—if tacitly—considered co-extensive with up-to-date scientific theories or current science-based practices or both. Even the writings of some very sophisticated authors suggest this idea. It is obviously false: out-of-date theories of Galileo and of Newton are scientific and their current applications are unproblematic. Correction: we identify science not with the application of theories and practices but with our beliefs in those current and up-to-date. This modification too is easily shown to be false: most of us are not familiar with the latest scientific theories and practices; even the educated among us lack the background knowledge necessary for understanding them. What then can our belief in them signify? Popular science is necessary and occupies a stable market just because this modified idea is false.

This false idea of science and scientific technology is not easy to dismiss: it plays a major role in the hostility to metaphysics. When Ernst Mach was asked how he could possess a comprehensive worldview without the aid of metaphysics, he answered, his comprehensive worldview consists of the sum-total of the extant up-to-date scientific theories. These, however, notoriously do not crystallize into one system. Moreover, the opposite is the case: a theory or a belief is scientific if and only if it accords with what is called scientific metaphysics or the scientific worldview. This is usually called naturalism, anti-magic, namely, anti-spiritualism or anti-superstition ¹ (p. 4). The paradigms of unscientific practice are both sorcery and faith-healing (p. 5).

On the scientific character of experience, philosophers of science often differ from practicing scientific researchers. Philosophers of science deem information to be what we experience. Scientific researchers differ. ² They endorse as unproblematic only repeatable observations. ³ The volume at hand that discusses scientific and magical information shows hardly any trace of this. ⁴ Rather than endorse the complaint common in the literature that much medicine claims scientific status with no right, this book argues that much folk medicine is unobjectionable. This has to be discussed in detail. ⁵ In general, there is a broad field between the obligatory and the objectionable. A popular prejudice that also most scientists and philosophers of science share is their denial of the obvious fact that most magic is in this gray area. The present text opposes the anti-magic that many scientists advocate and advocates a pro-magic attitude; both are in error. The rule that governs science since the scientific revolution is that only repeated and generalized factual information is admitted and other information is neither endorsed nor rejected.

Nathan complains that most “psychotherapists can only think of ‘savage’ therapies as … ‘magical thinking,’ in short (which we take to mean infantile thought)” (p. 33). Among these psychotherapists, Nathan counts Freud in particular (p. 184). He objects, and even with some bitterness, he says,

Typically, psychopathologists dismiss ‘savage thought’ by pretending to ‘understand’ its symbolism. They think that if ‘primitive’ people use magical methods, it is because they are symbolically displacing the deep thoughts that the scientists themselves are able to grasp through ‘direct contact’ that is, without their fantastical veneer. (p. 34)

Nathan recognizes here the contrast between belief and thought, a contrast that I have never seen before, between the magical and the scientific approaches. I find this appealing, especially in view of the erroneous concern of most philosophers of science today with what they call rational belief which they characterize as the same as belief in science, utterly disregarding the unavoidable hypothetical element in thinking, in research, and even in diagnosis. To bridge between magic and scientific diagnosis as well as healing, Nathan recommends oversight: “We will systematically avoid discussion of how much ‘truth’ the ideas carry and try to concentrate our attention on the concrete effects of the actions” (p. 35). This, I now report, is an attitude that psychotherapists often voice. We may take this as the starting point of this venture.

Over 20 pages of ethnographic material convey a simple moral: “concepts of sorcery are deeply coherent, and give rise to perfectly codified social procedures … taken up by the sorcerers …” (p. 58). Nathan finds this impressive; it is not. He reports a case of magic healing of paralysis (pp. 61, 63). He recommends taking magic seriously as proper treatment of mental maladies of magically minded people (pp. 65-68). How is this different from the position advocated in Edward Evans-Pritchard’s 1937 classic Witchcraft, Oracles and Magic among the Azande? Nathan answers this question by an observation. Calling magic-healing tools “spell-objects,” he declares that they do exist and are usable. (pp. 72, 81) This can be tested and the ability to identify them was repeatedly tested and confirmed (p. 72). The test comprises two items: ascertaining that an object has characteristics of a spell-object and that healers can identify it repeatedly. For this, the characteristics have to be clearly and quite unequivocally identifiable. One of them, being the vessel of a genuine spell, is not (p. 76). Hence, Nathan’s claim is problematic. And since scientific observation reports have to be unproblematic, it is not scientific.

What matters here is the information that Nathan provides about spell-objects as usable for successful cures (p. 81). Whereas in folk science, any favorable information counts, scientific information is limited to the outcome of severe tests, of efforts to refute. This difference is easy to observe; when you ask a mechanic to test your car, it is at times not easy to find its faults; much as you hope that it has none, if it does have any, you prefer the mechanic to find it rather than that you find it on the road. The theory of confirmation as observation is usually ascribed to Carl G. Hempel (although he has ascribed it to Jean Nicod) and the theory of confirmation as the outcome of severe tests is that of Karl Popper. The supreme court of the United States ⁶ rejected Hempel’s view of the matter and adopted Popper’s, since the latter is indeed sheer common sense—notably with regard to pharmaceuticals, perhaps regarding medicine in general.

Next comes the essay by Isabelle Stengers on rationality. She observes that as charlatans play a role in medicine, the way we look at them alters whenever the way we look at scientific medicine does (p. 94). She proposes a definition of the charlatan that “does not carry any value judgment, since it only functions to define those against whom modern medicine is inventing itself” (p. 95). This depicts not the practitioner around the corner who conceals his being unlicensed but the witchdoctor in the far corner. She advisedly uses the label “charlatan” rather than “witchdoctor” to include the practitioners in modern society, whose practices are often viewed as alternative medicine. One may be willing to go along with her on the ground that full-fledged impostors are very rare—in any field. This will not placate her; she sees things differently: “unlike astrology, alchemy or creationism in biology, the ‘other’ in medicine, the charlatan, has not been disqualified once and for all. It is because the charlatan does not just feed off gullibility and ignorance” (p. 96). This is disappointing: she presents “astrology, alchemy or creationism in biology” as items that do “feed off gullibility and ignorance.” I did not think a philosopher could still advocate such a hostile view of any intellectual tradition simply because it is now heterodox, especially not when advocating a favorable attitude toward alternative medicine. Admittedly, “astrology, alchemy or creationism in biology” are futile; we need not denounce them, and so they are (traditionally) on a par with magic. That some practitioners of some trade “feed off gullibility and ignorance” is no argument against that trade, since such practitioners are present in every trade. Suffice it to note that since some trades are inherently futile, its practitioners either “feed off gullibility and ignorance” or are victims of it.

Stengers presents magic as more effective than astrology, since it serves as placebos. I daresay, at times both do and mostly neither does. This dispenses with her essay. Let me proceed nonetheless. She finds in the placebo effect license to approve of magic although she accepts the traditional demand to condemn all false moves as irrational, and she finds the placebo effect in magic but not in astrology. To put magic and medicine on a par, she redefines charlatanism: charlatans use their success as scientific proof; as traditional magicians have no idea of science, this makes them genuine (pp. 94-95). Her tacit identification of magicians with charlatans-by-her-definition is a serious fault. Possibly, the fault is merely due to a confusion about rationality.

Stengers notices that the received criterion of rationality renders the demand for it a bit too high. “There is no doubt that we have here a strange use of the notion of irrationality” (p. 96). She refers to Jacques Derrida who found problematic even Plato’s application of his criterion of rationality as proof (that is still traditional) (p. 97). Freud dismissed the use of suggestions as cures of mental ills as lacking proof. His own results are questionable for the same reason (p. 98).

We tend to consider all this irrelevant now that the double-blind test method precludes the placebo effect (pp. 99-100). Stengers deems a great exaggeration our reliance on the double-blind test method. She argues not specifically against it but generally against all methods “able to satisfy the requirements of experimentation.” The argument is very brief: “Experimental purification and manipulation must be validated as what allows it to answer, not as what forces it to answer” (p. 101). In other words, results of tests are not obligations but permissions. True, and quite generally so: the FDA grants permission to use medication, not obligations. When parents refuse to administer medications to their offspring (say, for some religious reasons), only court orders can change the situation, and these are not easy to come by.

Stengers goes further: possibly, all of modern medicine, in all of its successes, is not much more than placebo. She admits that she finds it difficult to sustain this idea (p. 109). Yet, the significant question lies elsewhere: what makes a practice rational? This depends on the aim of the practice in question. Classical rationalist philosophy considered rational all and only practices that are conducive to the aims they are supposed to serve. A more reasonable view is that practices are rational to the extent that their advocates suppose that they are conducive to the aims they are supposed to serve. ⁷ English common law exonerates a physician who applies magic and is accused of neglect, provided the said physician comes from a community that practices magic.

This is where the contribution of Stengers signifies. She rightly notices the gap between rationality as the rejection of the refuted and rationality as the rejection of the unproven. She declares that “Tobie Nathan’s proposition may be disturbing but it is anything but irrational” (p. 124). What we see here is vacillation between two intuitive feels of rationality; the demand for proof is easier to endorse when considering frustrating lines of research and the demand to heed disproof is appealing as it is tolerant (p. 126). The demand for toleration of magic is valiant; we should support it while rejecting the arguments of this volume.

The second essay by Stengers advocates pluralism. It begins by presenting the difference between physical and mental treatment, as well as between individual and group therapy. In a sense, all therapy is group therapy as the feminist (partially successful) rebellion against medical discrimination by gender indicates (p. 136). All systems that allow for alternative medicine agree with her. The question is: what does this agreement amount to? Will it allow for a lobby for the proliferation of alternatives? (p. 139).

The phenomenon known as disease mongering occupies the rest of the essay. It is a laudable cause that I will skip. The same holds for the few last pages of this volume on the open-endedness of the diverse concepts in the literature on medicine, especially on psychiatry. Here, the greatest and most conspicuous damage is from redundant operations. This is due to conflicts of interest of the diagnostician-surgeon. Insurance companies know this and always approve of second opinions.

We need a strong alternative medicine to keep the medical system on its toes. Unfortunately, alternative medicine is weak. In particular, it is the social aspect of medicine that is crying out for improvement ⁸ and on this there is no contribution from alternative medicine, even though its advocates, especially the authors of the present volume, rightly stress that medicine is a social phenomenon, irreducible to individual affairs.