As human societies evolved from primitive classless communities where health knowledge production and utilization were for everyone and by everyone, towards class-based societies where medicine entered the service of the ruling class, the first stop was shamanic communities. With the ability of human societies to produce more than they consumed over historical periods, those who seized this surplus became dominant and enslaved others.
While the primary source of domination for the ruling class is often brute force, sustaining it solely through brute force is not easy. It's crucial for them to explain why they are "dominant" and others are "slaves," and why slaves shouldn't object to this and should consent to their condition. Convincing and pacifying slaves, not just through brute force but also by explaining why they are "dominant," is as important as brute force to maintain power (Gramsci's contributions are significant in this regard).
Over time, the rulers organized widespread superstitions and fears of the unknown among people, using them for their own interests. By basing their power on people's fears of gods, they claimed to be kings by divine permission and will, representing gods on Earth. They argued that opposing their rule would be tantamount to opposing the gods. Humanity earnestly believed in these claims for thousands of years, and kings in many countries, until recent times, continued to claim they were kings in the name of gods and represented gods.
MEDICINE AND RELIGION
The first physicians in history are found in the slave societies of Mesopotamia. A seal dating back five thousand years is attributed to a Sumerian physician, and the first written regulations on medicine are found in the Hammurabi Code carved into tablets four thousand years ago.
Ancient Mesopotamian peoples, who believed humans were created by the gods and given life by a divine breath, believed that every baby was given a unique god who breathed into the baby's mouth, becoming their personal deity for life.
In order to deserve protection and care from their god, individuals must fulfill their duties to their god. Otherwise, the god would withdraw their protection, leaving the person vulnerable to the merciless nature. Even worse, the god might become angry and punish the person. People who did not pray and offer sacrifices, who commit theft or kill others would anger the gods and be punished with illness. The rebellions of people today when faced with helpless health problems, saying "my god, what sin have I committed to deserve this punishment," likely stem from these ancient beliefs.
Today, we can easily establish a connection between the societal structure of the time and the reasons for diseases listed above. Prayers and sacrifices provided a secure source of income for temples and priest-physicians while encouraging people to live "honestly" as the rulers desired. However, gods did not get angry at one person enslaving another forcefully (e.g., capturing them as prisoners of war) and exploiting them (stealing their labor) and did not punish them with illness.
Health problems in the Sumerian period were among humanity's most significant issues, just as they are today. Sumerians understood the role of cleanliness in disease prevention and recognized the association of certain diseases with food (eating pork was forbidden), and the importance of cleanliness in disease prevention. They even developed the first notification system for infectious diseases (when a case of diphtheria was encountered, it was announced to the surroundings with horns).
Egyptian physicians also gave little emphasis to magic in treating diseases, if at all, using it alongside other treatments. The Ebers Papyrus, which dates back to before the time of Hippocrates, consists of 875 prescriptions, with magic mentioned in only 12 of them. Therefore, the human being must have known for many years that diseases were not punishments from the gods. Otherwise, why would Egyptian physicians begin to specialize in certain diseases or organs during that time? After all, wouldn't the treatment of the disease require appeasing the gods?
It was not easy to say that worldly rather than divine factors were involved in the etiology of diseases. The authoritarian rule of slave owners, based on the power they received from the gods, could never allow such discussions. There was a need for a democratic and secular climate for such things to be discussed, and this climate emerged for the first time in ancient Greece.
MEDICINE AND SECULARISM
Initially, like in other parts of the world, the approach to health in ancient Greece was religious, with about thirty gods and goddesses related to health. There were many temples built in honor of Asclepius, the most famous health god. However, with the establishment of a democratic government in Greece, the country entered a period of great advancement in science and intellectual life. More than 25 centuries ago, this democratic climate, which lasted just over a century (undoubtedly, this democracy was only for slave owners and rulers), paved the way for the foundations of scientific medicine.
In this environment, Hippocrates of Ionia, actually known in other regions but able to express what could not be said for fear of offending pharaohs or kings, lifted the religious veil from health and laid the foundation for scientific medicine.
Similar situations would occur many times in later periods. Today, we know that long before Galileo Galilei in Europe, many scientists discovered that the sun revolved around the Earth, not the other way around, but no one dared to oppose the sacred texts and the church until Galileo.
Greek democracy could not resist internal and external attacks for long and withdrew from history. Rome, which partially inherited this legacy, continued its path by setting aside the parts of this legacy that could threaten the dominance of slave owners. Efforts to search for worldly causes behind diseases by physicians were abandoned, and with Galen, medicine turned back to the gods.
During the Roman period, while there were significant advancements in secular hygiene services, the influence of religion and magic greatly increased in therapeutic medicine. Threatened by Christianity, the second major monotheistic religion after Judaism, Roman rulers handed over their legacy to Byzantium and withdrew from history.
As slave societies gave way to feudal societies, Islam, the last monotheistic religion to spread in the Middle East and North Africa, began to spread. Unlike previous religions, Islam did not define diseases as divine punishments in its sacred book but did not exclude the divine from etiology and treatment. The influence of Galen can be observed in Islamic medicine.
From about 1,500 years ago, starting from what we define as the Middle Ages until a thousand years ago, was a period when humans began to live in larger communities on Earth and started to connect distant corners of the world with trade, especially maritime routes. These features of the period led to numerous outbreaks and the loss of many lives in Europe, the continent where trade and urbanization were most intense during these years.
Greek physicians briefly managed to bring medicine from the sky to the earth, but with Galen, medicine went back to the sky. The Renaissance (rebirth) came with an appropriate environment for medicine to descend to earth again.
Capitalism, born within feudalism, spread from Italy to the rest of Europe in a few centuries. Accompanied by the reform movement, it created a free environment in Europe similar to what Greek physicians achieved centuries ago in the Near East. This time, Paracelsus (1493–1541) took on the task of bringing medicine to earth, burning the works of Galen and Ibn Sina in the marketplace of Basel, putting an end to the Middle Ages of medicine.
William Harvey (1578–1657), by revealing the secrets of blood circulation, swept away the last remnants of the "soul" inside humans. Blood circulation was not maintained by spirits but by a simple hydraulic pump. Many functions attributed to the heart from Aristotle to Galen evaporated instantly.
As the axis of the world shifted increasingly towards the "West" over time, ancient eastern civilizations such as China and India remained relatively unaffected by these developments. So much so that in these countries, the influence of monotheistic religions, quite common in the West today, is very limited, and while modern health institutions where Western medicine is practiced exist, mystical approaches to health continue to dominate among the people.
With the dissolution of socialism and the spread of religious conservatism, and people resorting to beliefs again, the resurgence of religious approaches in medicine and their release under the guise of "alternative medicine" is not coincidental.
Akif Akalın
Citation: Akalın, A. (2015). Sağlığa ve Hastalığa Toplumcu Yaklaşım. İstanbul: Yazılama. Pp. 97 - 103. ISBN: 978-605-9988-35-3
REFERENCES
Belek, İ., Onuroğulları, H., Nalçacı, E. ve Ardıç, F. (1998). Sınıfsız Toplum Yolunda Türkiye İçin Sağlık Tezi. İkinci Baskı. İstanbul: Sorun Yayınları
Eren, N. (1996). Çağlar Boyunca Toplum, Sağlık ve İnsan. Ankara: Somgür.
Marx, K. ve Engels, F. (1992). Alman İdeolojisi [Feuerbach]. Üçüncü Baskı. İstanbul: Sol Yayınları.
Morris, D. (2000). Illness and Culture in the Postmodern Age. London: University of California Press.
Original article can be reached at https://toplumcutip.blogspot.com/2015/01/tanrsal-bir-ceza-olarak-hastalk.html
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