CURING AND HEALING:

TWO GOALS OF
MEDICINE.
LECTURE 5
INSTRUCTOR : D.BABAGULYYEVA
Content

 1. The Problem.
 • 2. Three Approaches.
 • 3. Healing Without Curing.
 • 4. Curing and Healing as Two Aspects of Medical Care.
Introduction

 Curing and healing are two categories that appear central to the practice of
medicine. And yet given the variety of healthcare systems, practices, and beliefs
present in the world and the universal problem of illness and vulnerability, there is
some doubt as to the validity of the distinction between the terms.
The Problem

 Being ill and in need of medical assistance is a universal human experience. At times, we all need
specialized help in order to make us better. What is different is the way a health-related problem is
approached in various cultural contexts and the explanatory models of illness that are present.
Once attempts at self-curing or perhaps self-healing are exhausted, one will presumably contact a
specialist. In a provincial small British town, one probably will pay a visit to the general
practitioner, who will prescribe some medicine and a course of action fitting with the Western
medical tradition. In an isolated indigenous community in the Amazon, one will probably turn to a
traditional healer or a shaman, who will provide the sick with herbal medicine and perhaps
perform a healing ritual. In a multicultural city such as Hong Kong, one will face a choice
between Western medicine and traditional Chinese medicine and depending on circumstances and
personal beliefs will choose accordingly.
 Both were successful; both patients were made better; the problem was solved. Perhaps the source of
some of the discomfort one might feel in swapping the terms, or using the word “heal” in a formal
Western context, lies not so much in the difference between “healing” and “curing” but in what we
consider to be proper medicine. Perhaps the GP was successful because she employed the principles of
scientific, evidence-based medicine, whereas the shaman was just lucky, and his actions, despite existing
system of beliefs in the given part of the Amazon, were groundless, especially from a Western point of
view, “healing” being some fuzzy concept, free from common sense, and an efficacious practice. But if
we so lightly discount non-Western medical systems and traditional healers as medicine proper, then
why the problem of “healing and curing as two goals of medicine”? Is not “curing” enough? And if we
do not disregard non-Western medical traditions and accept that indeed traditional healers have the basis
to help their patients, cannot we just use the terms curing and healing interchangeably in the context of
non-Western medical practice? Perhaps the processes of curing and healing are two sides of the same
coin – namely, making the patient better (see also Hutchinson et al. 2009).
Three Approaches

 There are three broad ways to approach the differences between curing and
healing. One is to focus on the difference between rational Western medicine as
opposed to nonrational healing lying outside of medicine and the problem of
defining “medicine” as a scientific practice. The second is to consider what the
terms might mean to the people experiencing curing and healing as patients or as
practitioners of medicine broadly understood. The third possible approach is to
explore the terms not so much by contrasting them but by analyzing the
relationship between curing and healing in the context of the relationship between
patients and practitioners. This last approach will be briefly considered in the
section “Curing and Healing as Two Aspects of Medical Care.”
1

 Contemporary medicine as a rational system of knowledge and practice is

governed by laws of science and is evidence based. The results of actions based
on that system are predictable and repeatable and work regardless of cultural
context. Curing comes about as a result of applying appropriate medical
knowledge and practice to the medical problem at hand. Medical practitioners,
thanks to an organized and thorough system of education, know and can usually
explain and provide evidence for why certain actions bring about a cure and why
they occasionally fail to do so.
 In turn faith healing can be said to lie outside of the rational. Healing comes about
as a result of applying through prayer and laying on hands of a supernatural,
mysterious power that cannot be explained, taught, or rationally acquired. The
healer heals but does not know why he can heal, how his gift works. In a case of
miraculous faith healing, one focuses on the persona of a healer, where as in the
case of curing, one focuses on a system of knowledge and practice. The results of
thus understood healing are unpredictable, are unrepeatable, and from the point of
view of Western medical practice are accidental. There is no causal connection,
unless one takes into the account the placebo effect, between the actions of a
healer and the state of health of his patient. From the point of view of Curing and
Healing: Two Goals of Medicine 3 Western medicine, faith healing is a potential
source of harm and should be discouraged.
2

 It is sometimes said that one cures a disease and heals an illness, where simply
speaking illness is the personal experience of being unwell, shaped in part by
one’s culture, place in society, and personal circumstances and the disease is the
underlying organic, physical cause of being unwell (Cassell 2004, 2012; Lerner
1994), and together, disease and illness describe a sickness. From the differences
between illness and disease follows another important dichotomy, namely, the
difference between pain associated with a disease and suffering associated with an
illness (Lerner 1994). All those elements have an impact on the place and role of
the medical practitioner (or practitioners) and the patient in the process of getting
better.
 Imagine for a moment that the practitioner is a firm believer in the biomedical model, with its focus on curing the
disease. This approach is said to limit the involvement of the patient in the process of getting better: the patient is
interviewed, various tests are performed, diagnosis is given by the physician, and a course of action is prescribed
– it might consist of further tests, or taking some form of medication, or some more advanced treatment
performed by the physician or a whole medical team on the patient, with limited contact between the patient and
at least some of the individual members of the team. In short, things are done to the patient (Milstein 2005), and
the patient is expected to comply with the action prescribed. Can this approach be valid and successful?
Certainly, provided one is dealing with relatively simple matters that are easy to resolve: a straightforward case of
appendicitis or some simple infection easily treated with a series of antibiotics, easy to diagnose, and easy to
treat. It is worth remembering during this thought experiment that while many good physicians also take into the
account the needs of their patients as human beings with specific social circumstances, worries, and resources,
healthcare systems in developed countries tend to focus on the underlying organic causes of medical problems,
simply because it is easier to put a price tag and a time frame on the treatment required. 4 D. Szawarska And yet
to focus entirely on curing a disease might not be sufficient to make a patient completely better, simply because
patients, apart from having a disease, are also part of a wider sociocultural fabric, which makes them react to
being unwell in a specific manner and which also makes them attach a particular meaning to the episode of being
unwell. Patients not only feel pain, they also suffer. And while a pain killer might be sufficient to deal with
physical pain, it might not be sufficient to deal with suffering. This is where healing comes in. As argued by
Egnew: “Healing is the personal experience of the transcendence of suffering” (Egnew 2005: 258).
 Given the definitions of illness and disease, it is debatable whether humans ever experience
disease as such. Being aware of being unwell is already a part of the cognitive, emotional,
cultural, or even spiritual experience of being ill. And therefore a physician’s focus on curing a
disease might not be sufficient to deal with the problem, especially if we are dealing with a
chronic or incurable condition. Healing on the other hand is said to take into the account the
human condition and experience of being unwell, including social, cultural, historical, and
economic factors (Crandon Malamud 1991; Finkler 1994; Waldram 2000). But what exactly is
healing and how is it achieved? It is said that healing is a process that promotes health and
restoration of balance between mind and body (McGlone 1990: 77–84). There is no agreement
among academics as to what exactly the process entails, but the following elements appear in
various accounts and definitions of healing (e.g., Glaister 2001; Hutchinson et al. 2009; Egnew
2009):
 (a) Healing actively engages the patient.
 (b) Healing is multidimensional. (
 c) Healing is creative and meaning making.
 (d) It leads to restoration of balance and the acceptance of status quo.
 (e) Healing process can involve a whole group of people. The problem does not
have to be an individual one. Neither the healed nor the healer needs to be an
individual.
Healing Without Curing

 Healing is sometimes said not to necessitate a cure in the biomedical sense (e.g.,
Glaister 2001: 64). It is argued that getting better in terms of a patient’s
selfassessment can be achieved by better coping with sickness and a restoration of
balance, both achieved through the process of healing. This process sometimes
requires that the point of balance is shifted and that what is restored is not so
much the previous status quo but a balance resting on a new understanding and
acceptance of self in the world. This is particularly the case of people coping with
chronic diseases and those nearing the end of their lives. The easing of suffering is
achieved through gaining acceptance of the situation, giving it meaning, and
adapting.
 Curing Without Healing
 Hypothetically, curing, in the biomedical sense, can also be achieved without healing. This is
especially so in cases where the patient is not aware of being sick and of having a disease. In such
cases the problem might be diagnosed by some routine testing during, say, a health check and easily
treated, without giving the patient the time to consider herself unwell. Perhaps a good example of this
is a case of mild vitamin D deficiency. Before diagnosis, symptoms associated with it, if at all noticed,
might be blamed on the time of year, overwork, etc. but might not be connected to one’s health.
Another type of situation in which one might be dealing with a kind of curing without healing is one
in which from the biomedical point of Curing and Healing: Two Goals of Medicine 7 view the
problem is sorted or managed as well as possible according to current medical knowledge, with any
physical symptoms being well taken care of, without the patient regaining their sense of well-being
and balance. This might be, for example, the case of a woman recovering from stab wounds inflicted
by her partner during domestic abuse incident. Her physical wounds might be cured, but she might, as
argued by Erickson (2007: 10), never feel truly healed. That is, in spite of a successful cure, her
quality of life continues to suffer (see also Eisenberg 1977).
 Curing and Healing as Two Aspects of
Medical Care
 For all the importance attached to the distinction between curing and healing in Western medical practice
and thought and philosophical and anthropological work on both Western and non-Western medical
systems, it is worth remembering that each and every medical system is a cultural system (Rhodes 1996)
and each involves elements of both curing and healing. Indeed, it may be argued that the distinction
between curing and healing is overstated as is the dichotomy between illness and disease. Cassell (1976)
points out that the very notion of an organic disease as a cause of a sickness is the central concept in the
Western medical model. The notion that a malfunctioning body is what makes a person feel ill lends
itself to the formulation of the distinction between curing and healing, where we cure the disease and
heal the person. But what happens in contexts where there is no concept, or only a limited concept of
disease as a cause of a sickness, and where the explanatory model of illness is completely different from
the Western one? In such a context, the distinction between curing and healing is unlikely to be valid. If
the sickness is believed to be caused by an invasion of evil spirits, or witchcraft, or upset ancestors there,
the medical practitioner needs to take culturally appropriate action to deal with the problem, and that is
not identical to dealing with a disease.
 And even within the Western context, Waldram (2000: 606) argues that healing an illness and curing
a disease are not separate, unrelated aspects of the treatment of sickness. As argued by Lown (1999:
313): “Whereas the medical transaction is largely concerned with curing a disease, the patient
craves to be healed. The object of the patient’s art is to have the doctor incorporate healing in the
process of curing.” This is apparent, for example, in the effect the interaction between patient and
physician has on how one judges the efficacy of treatment. Consider how in the biomedical system
the patient’s self-assessment of how he or she is feeling following treatment is taken into the
account in order to judge the effectiveness of the curative treatment. Similarly, a physician’s positive
proclamation on the effectiveness of treatment may lead to an improvement in the patient’s
subjective well-being (Waldram 2000: 607). This suggests that despite doubt as to the validity of the
dichotomy between curing and healing, it is worthwhile to explore the relationship between the two
processes as they are understood in the Western context.
Thank you for your attention!