Journal of Medicine and Philosophy, 36: 335341, 2011

doi:10.1093/jmp/jhr027
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Medicine as Combining Natural and
Human Science
HUBERT L. DREYFUS*
University of California, Berkeley, California, USA
*Address correspondence to: Hubert L. Dreyfus, Philosophy Department 2390, University of
California, Berkeley, CA 94720-2390, USA. E-mail: [email protected]
Medicine is unique in being a combination of natural science and
human science in which both are essential. Therefore, in order to
make sense of medical practice, we need to begin by drawing a
clear distinction between the natural and the human sciences. In
this paper, I try to bring the old distinction between the Geistes and
Naturwissenschaften up to date by defending the essential difference
between a realist explanatory theoretical study of nature including
the body in which the scientist discovers the causal properties of
natural kinds and the interpretive understanding of human
beings as embodied agents which, as Charles Taylor has convinc-
ingly argued, requires a hermeneutic account of self-interpreting
human practices.
Keywords: Charles Taylor, human sciences, medicine, natural
sciences
I. INTRODUCTION
Medicine is unique in being a combination of natural science and human
science in which both are essential. Therefore, in order to make sense of
medical practice we need to begin by drawing a clear distinction between
the natural and the human sciences. In my talk, I will try to bring the old
distinction between the Geistes and Naturwissenschaften up to date by
defending the essential difference between a realist explanatory theoretical
study of nature including the human body in which the scientists discovers
the causal properties of natural kinds and the interpretive understanding of
human beings as embodied agents which, as Charles Taylor has convinc-
ingly argued, requires a hermeneutic account of our self-interpreting human
practices.
Hubert L. Dreyfus 336
II. HOW NATURAL SCIENCE CAN DISCOVER TRUTHS ABOUT NATURE
AS IT IS IN ITSELF
Before spelling out Taylors view, I need to dene what I mean by scientic
theory. Theorizing is a special form of intellectual activity discovered by
Socrates and rened by the philosophical tradition. It has six essential char-
acteristics, never fully achieved, but approached to varying degrees. (The rst
three are introduced by Socrates).
(1) Explicitness. A theory should not be based on intuition and
interpretation but should be spelled out so completely that it can be
understood by any rational being.
(2) Universality. Theory should hold true for all places and all times.
(3) Abstractedness. A theory must not require reference to particular
examples.
Descartes and Kant support the Socratic account of theory by adding
three further requirements:
(4) Discreteness. A theory must be stated in terms of context-free
elementselements that make no reference to human interests,
traditions, institutions, etc.
(5) Systematicity. A theory must be a whole in which decontextualized
elements (properties, attributes, features, factors, etc.) are related to
each other by rules or laws.
1
(6) Closure and prediction. The description of the domain investigated
must be complete, that is, it must specify all the inuences that affect
the elements in the domain and must specify their effects. Closure
permits precise prediction.
Many recent philosophers of science hold that science cannot even approach
the ideal of theory. They contend that scientic entities are social construc-
tions essentially related to human purposes. Such thinkers conclude from the
fact that background practices are necessary for access to theoretical entities
that these entities must be dened in terms of these access practices.
Martin Heidegger opposes this view in Being and Time. Heidegger argues
that only human beings make sense of things. So the ontological intelligibility
of the mode of being of each kind of thing, including natural things,
depends upon our practices. Still nature as a being, or as an ensemble of
beings, need not depend on us. This is one way we make sense of things as
occurrent (vorhanden), that is, as natural kinds whose ontic intelligibility is
only contingently related to our access practices.
Occurrent beings are revealed when we take a detached attitude towards
things and decontextualize them. Then things show up as independent of
human purposes and even as independent of human existence. Decontextu-
alizing takes place in two stages. First we use skills and instruments to isolate
Medicine as Combining Natural and Human Science 337
things and their properties which then appear as meaningless objects, colors,
shapes, sounds, etc. Such data are independent of our purposes but still
dependent upon our senses.
We then complete this deworlding by inventing theories in which the
occurrent data are taken up as evidence for quasars and quarks and other
entities we cannot directly experience. These theoretical entities need not
conform at all to our sense experience nor to our everyday understanding of
objects, space, time, and causality. According to our current successful un-
derstanding of nature, such entities belong to natural kindstypes of things
like water, gold, iron, etc.and if correct, our natural science describes the
causal powers of these natural kinds. There is no way to stand outside cur-
rent science and give it metaphysical support by arguing that there must be
natural kinds or that these are what our science must be about. All that
philosophy can do is show that the natural scientists background assump-
tion that there is some way nature is in itself is not incoherent.
If we encountered things only in using them, never in detachedly reect-
ing on them, that is, if availableness (Zuhandenheit) were the only way of
being we knew, we would not be able to make the notion of entities in
themselves intelligible. But since we understand occurrentness, we under-
stand that occurrent entities can have existed even if human beings had
never existed. Indeed, given our understanding of occurrentness, we must
understand things this way. To take a Heideggerian example, what it is to be
a hammer essentially depends upon Dasein and its cultural artifacts. It be-
longs to the being of a hammer that it is used to pound in nails for building
houses, etc. In a culture that always tied things together, there could be no
hammers. But there could, nonetheless, be pieces of wood with iron blobs
on the end since wood and iron are natural kinds and their being and causal
powers make no essential reference to human purposes.
But even if physical science is progressing in its understanding of physical
nature, a theory of the causal powers of natural kinds tells us only what is
causally real, so modern science need not be the only way of understanding
nature. As Heidegger, rightly, sees, many different practices can reveal nature
as it is in itself.
What is represented by physics is indeed nature itself, but undeniably it is only
nature as the object-area, whose objectness is rst dened and determined through
the rening that is characteristic of physics .... Nature, in its objectness for modern
physical science, is only one way in which what presenceswhich from of old has
been named physisreveals itself. (Heidegger, 1977, 17374)
This leaves open the possibility that acupuncture, for example, taps into
some sort of energy and causality unknown in our Western medicine.
It follows from the above considerations that what counts as real for a
culture depends upon the interpretation in its practices, but this does not
make what is thus revealed any less real. We could call this position plural
Hubert L. Dreyfus 338
realism. For a plural realist, there is no point of view from which one can
ask and answer the metaphysical question concerning the one true nature of
ultimate reality. Given the dependence of the intelligibility of all ways of
being on our practices, and the dependence of what counts as elements
of reality on our purposes, the question makes no sense. But since differ-
ent practices reveal different realities or domains of intelligibility, and since
no one way of revealing is exclusively true, accepting one does not commit
us to rejecting the others. We can hold that our natural science can be getting
it righter and righter about how things work, even if there can be no one
right account of how things are.
III. WHY CURRENT HUMAN SCIENCES MUST BE HERMENEUTIC?
The phenomenon that leads one to expect a basic difference between the
natural sciences and the disciplines that study human beings is clear. The
natural sciences may not be as rational nor as cumulative as once believed,
but they still show stability and progress. For extended periods, sciences like
physics exhibit an agreed upon way of doing research. Occasionally dis-
agreement arises as to how to account for anomalies. This can develop into
a crisis that continues until the anomalies are removed by some new scheme
that gains agreement, establishing a new normal science. But even when
previously accepted theories are abandoned, many results are conserved.
The human sciences, on the other hand, have been neither stable nor
cumulative. These dubious disciplines, to use Foucaults pejorative phrase,
do not progress through revolutions like physical science but merely go
through episodes in which certain fads tend to dominate research until some
competing fad lures most researchers onto its bandwagon. One style of re-
search gives way to another not because the new research is based upon a
theory which explains certain anomalies the old theory failed to explain but
simply because researchers have become bored and discouraged with the
old approach. The new style, introducing new methods and problems, al-
lows everyone to forget the old problems. Thus, the human sciences are
subject to frequent factionalism and reorganization, but this is not a crisisa
period of competing paradigms. It is a pre-paradigm state. The human sciences
are not even generally stable nor are they even occasionally cumulative.
But disagreement arises as soon as one tries to interpret the above con-
trast. For example, Richard Rorty holds that although at present the human
sciences are unable to nd an agreed upon vocabulary, this fact has nothing
to do with the essential nature of man or of science. It is simply an effect of
the complexity of the domain and the immaturity of the human sciences.
But this way of dismissing the difference is too simple. The argument that
the human sciences are young is beginning to show its age. Looked at his-
torically the social sciences make a quite different impression than sciences
Medicine as Combining Natural and Human Science 339
such as genetics or climatology that are struggling with a very complex
domain. These latter sciences are making slow but steady progress in devel-
oping more and more complicated theories that take into account more and
more factors, whereas the human sciences rst seek to develop a general
theory using one approach, then scrap that attempt in toto, and take up
some other equally simplistic general research program.
To take a recent example, the behaviorists sought a complete description
of human action in terms of elements of behavior and covering laws that
predicted the occurrence of particular behavioral events. When this approach
came up against hard problems such as linguistic behavior, it was quickly
abandoned and cognitivism became popular. Cognitivists rejected all the
behaviorists carefully compiled results as artifacts and sought to explain
human behavior by analyzing the rule-like relations holding between mental
representations. Both approaches aim, in the ideal limit, at attaining the sort
of complete explanatory account which allows one to predict precisely the
effects of alterations in an objects internal and external environment, and
each fails to achieve its goal. It looks more and more like there must be
something about human activity, on the one hand, and the nature of theo-
retical explanation, on the other, which do not t together.
Why does the sort of theoretical explanation that succeeds brilliantly in
the natural sciences fails in the human sciences? The problem Taylor holds
lies in the attempt to apply theory to the everyday world. Just as physical
science predicts and explains everyday changes of place in terms of mean-
ingless, context-independent properties such as mass and position that can
be abstracted from the everyday world, so a theoretical science of human
beings seeks to abstract meaningless, context-free features from every-
day, context-dependent, meaningful human activities, and then predict and
explain these everyday activities in terms of formal relations between these
elements. Insofar as these would-be sciences follow the ideal of physical
theory, they must predict and explain everyday activities, using decontextu-
alized features. But since the context in which human beings pick out the
everyday objects and events whose regularities theory attempts to predict is
left out in the decontextualization necessary for theory, the everyday objects,
and events human beings pick out do not always coincide with those entities
over which the theory ranges. Therefore, predictions, though often correct,
are not reliable. Indeed, predictions will work only as long as the elements
picked out and related by the theory happen to coincide with the objects and
events picked out by human beings in their everyday activities.
A striking example of what happens when one tries to study human
beings as objects was given inadvertently by a Stanford psychologist who
announced that his science had discovered that although people classify
some people as talkative and others as taciturn, and although there is gen-
eral agreement among participants in the everyday world as to which people
belong in which class, the concept of talkativeness is unfounded. If you
Hubert L. Dreyfus 340
count the number of words uttered by an individual in a day, the would-be
theorist explained, you nd that there is no signicant difference in the
quantity of words uttered by so-called taciturn and by so-called talkative
people.
It never occurred to this objective psychologist that what makes a person
count as talkative may be the meaning of what is said and the situation in
which it is said. Talkative people presumably say little of importance and say
it during other peoples lectures, at funerals, etc. The general agreement
among participants in the everyday world as to who is talkative is presum-
ably no illusion. Rather the sort of data collection appropriate to the natural
sciences, where one studies objects and counts words, is simply inappropri-
ate to the study of human beings understanding of themselves and other
human beings. People making judgments such as who is talkative agree be-
cause they dwell in a shared background of meaningful practices. In general,
in the human sciences, if one is to understand what is going on, one must
share a general human background understanding with the person or group
being studied. Shared agreement disappears as soon as the meaning of the
situation is excluded in the attempt to attain the sort of objectivity appropriate
to natural science.
This thesis can be further illustrated by the sort of difculties that, according
to Pierre Bourdieu, confront Lvi-Strausss structuralist theory of gift exchange.
In Outline of a Theory of Practice, Bourdieu argues that Lvi-Strausss formal,
reversible rules for the exchange of giftsabstracted as they are from every-
day gift-givingcannot account for and predict actual exchanges. His point
is not that theory leaves out the subjective, so-called phenomenological,
qualities of gift exchange. That would not be a valid objection. The natural
sciences legitimately abstract from subject-relative properties. Bourdieus
point is that Lvi-Strausss abstraction of the pure objects exchanged leaves
out something essential. The tempo of the event actually determines what
counts as a gift. Bourdieu notes:
In every society it may be observed that, if it is not to constitute an insult, the counter-
gift must be deferred and different, because the immediate return of an exactly identical
object clearly amounts to a refusal. (Bourdieu, 1977, 5, my italics)
Predictions based only on formal principles fail in those cases in which what
formally counts as a gift in the theory is rejected in everyday practice be-
cause it is reciprocated too soon or too late to count as a gift. According to
Bourdieu
It is all a question of style, which means in this case timing and choice of occasion, for
the same actgiving, giving in return, offering ones services, paying a visit, etc.can
have completely different meanings at different times (Bourdieu, 1977, 6).
In general the meaning of the situation plays an essential role in determining
what counts as an object or event that is it constitutes the event. It does not
Medicine as Combining Natural and Human Science 341
just give us access to it as in natural science. Yet it is precisely this back-
ground meaning that theory must ignore. Thus, imprecision in the human
sciences is inevitable because what counts as an everyday fact depends on
a background of meanings and skills that is excluded by the decontextual-
ization required by theory. Predictive failure is a constant possibility in any
area where facts such as being talkative or being a gift depend on back-
ground practices not integrated into the theory. Prediction will fail whenever
an object that according to the theory has the dening features of a given
type is nonetheless not counted by those in the culture.
I have tried to elaborate Charles Taylors arguments for a hermeneutic
distinction between the natural and social sciences. It must be taken into
account if one wants to understand the peculiar status of medicine as both
a human and natural science.
NOTES
1. In asserting that theories range over decontextualized, uninterpreted facts, I am not endorsing a
positivist account of theories as based on brute data. The basic data are meter reading and computer
printouts. These uninterpreted facts are cut off from our everyday world of equipment and purposes
but they are, of course, recontextualized or theory laden, otherwise they could not ll in variables asking
for mass, charge, etc.
REFERENCES
Bourdieu, P. 1977. Outline of a theory of practice. Cambridge, UK: Cambridge University
Press.
Heidegger, M. 1977. Science and reection. In The question concerning technology and other
related essays (pp. 15582), trans. W. Lovitt. New York: Harper & Row.
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