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Dan Sportiello | Friday, April 15, 2011

I only barely remember medical school.

My one memory is of a skeleton — a ghastly colossus that towered over me, its eyes empty, its teeth bared in a deathly grin. Its arms, still gripped by sinew, were open, as though in expectation of my embrace. It radiated malice. And hunger.

It was only a mural, but it scared the crap out of me.

Of course, I could not have been more than a year old. It is only in hindsight that I realize that what I was seeing was an anatomical diagram — a painting not of a skeleton but rather of the human skeletal system. It was, in fact, one of several such stylized representations of the human body, drawn from the work of the Renaissance anatomist Andreas Vesalius, that decorated the foyer of the Medical College of Wisconsin. His paintings of the digestive system, the circulatory system, the respiratory system and others honored the roots of medicine in the many centuries of scientific labor that had brought humanity from darkness into light. Each painting was a celebration not of death, as I thought as a child, but of life, of the human ability to abstract from her childish reactions to the world — to bring those reactions under the harsh light of introspection and thus to understand herself objectively for the first time. This distinctive sort of introspection, made possible by what Christine Korsgaard calls “the reflective structure of the mind,” is what she argues is the source of not only practical reasons but also theoretical reasons, of not only the endorsement of certain inclinations as right but also the endorsement of certain impressions as true.

“If we fall into doubt,” she argues, “about whether we really ought to believe what we find ourselves inclined to believe — that is, if we fall into doubt about whether our beliefs are true — we cannot dispel the doubt by comparing our beliefs to the world to see whether they are true. We have no access to the world except through the verdicts of the understanding itself, just as we have no access to the good except through the verdicts of the various points of view from which we make judgments of goodness. The only point of view from which we can assess the normativity of the understanding is therefore that of the understanding itself.”

It is this process of reflective endorsement, this distinctive sort of introspection, that makes objectivity out of mere subjectivity — makes, that is, knowledge out of mere impression. While any animal reacts to sense impressions in its environment, only a rational animal reflects upon these sense impressions and, in endorsing some and rejecting others, constructs out of them a theory — constructs, in other words, a set of reasons to believe. The paintings in my mother’s school glorified the rise of medical science, and in so doing, glorified this essential mark of a human being: that she is a rational animal, one capable of taking up the reflective perspective, or, in the terminology of Simon Blackburn’s, of “‘splitting’ the input and the output [so] that the reaction can be seen sufficiently clearly for what it is.”

It was just this that my mother — taking me to class, even as she was pregnant with my sister — was learning to do. To learn to practice medicine is to learn to see one’s patients, and by extension oneself, not just as a subject but also as an object, not just as a person but also as a machine, the components ordered in a way that, while complex, can be understood and thus repaired when damaged. There is not, in this, anything obviously moral, though this is not to say that it did not require the cultivation of a number of virtues, one first among them: Like any medical student, my mother studied and worked during the eight years of medical school and residency without meaningful sleep. During this time, she not only managed to somehow stay alive herself but also to save the lives of others.

I find this almost incomprehensible. I too can function without sleep, but only if “function” means something quite minimal. I lose the ability to really understand much of anything — to say nothing of the ability to interact politely with my fellow human beings. Without sleep, the valence — moral and otherwise — of my world shifts dramatically: I can no longer abstract from my reactions to the world, can no longer pry apart the factual input from the normative output as Blackburn demands. Whatever hostility, suspicion, fear or unbridled glee I feel colors the world that I experience and its inhabitants. The third-person perspective is closed to me. I have no cognition but only impressions, no volition but only inclinations. In Kantian terms, I lose my rationality — my humanity — and become a mere animal. While I am fairly awake while writing this — the coffee helps — I live in the fear that, by the time it is read, I will have lost myself again.

Daniel John Sportiello is in his third year in the philosophy Ph.D. program. Listen to his radio show on WVFI at 1 p.m. on Thursdays. He can be reached at [email protected]

The views expressed in this column are those of the author and not necessarily those of The Observer.