Philosophy, Psychiatry, & Psychology

When a person in pain seeks medical attention, but his doctors cannot help him, a quest begins for alternative treatment, with its attendant imperative to identify the difference between genuine solace and snake oil. This is the task undertaken by Scott Waterman, and the situation faced by millions of people in chronic pain for whom conventional medicine proves ineffective, and who likewise then embark on a desperate search for comfort.

Alternative treatments sit on a spectrum of empirical plausibility, from some like hypnosis or mindfulness with demonstrable mechanisms of action in the brain and nervous system to others like Reiki and craniosacral therapy that purport to channel mysterious energy fields beyond the frontiers of known physical reality. A liberal society guarantees the freedom for its citizens to believe whatever they want. Medical ethics impose limits on beliefs when they inspire purported treatments that are useless or likely harmful. Yet there is a class of beliefs in constructs orthogonal to naturalism that apparently confer benefits for health and well-being. Wisdom since Socrates has been understood to prioritize an epistemic stance that recognizes that human knowledge is incomplete. Science is still far from forming a total and unified theory of the universe. Perhaps we stand in psychiatry today on the verge of a forward leap in our understanding of the mind akin to the days in physics just before the quantum revolution: who can say? The puzzle Waterman describes thus involves the reconciliation of two antithetical attitudes. Science is a method of testing beliefs about reality in which the default position is the null hypothesis: a disciplined practice of doubting. Pluralism by contrast on its surface would appear to affirm an unbounded scope of possible beliefs.

The necessary synthesis of doubt and belief entailed in solving Waterman's puzzle will emerge I suspect from establishing a philosophically cogent definition of the prudent scope of pluralism in medicine. Clinical practice is already pluralistic. A good clinician needs to switch back and forth from two modes of knowledge. The first mode presumes the epistemic independence of the knower from the known: the spine does not disappear if a doctor stops believing in it. In the second mode the object of knowledge is constituted by the epistemic stance of the knower: the patient's hope in recovery can depend at least in part upon the doctor's capacity to cultivate it. Future research may illuminate the scope and limits of the second mode's constitutive capacity. Hope is transformative, but it is not magic. The course of a disease surely does not materialize entirely in the eye of the beholder like the meaning of the Mona Lisa.

But as Waterman observes about the patients who responded positively to craniosacral therapy, for the patients "there is such a thing" as the craniosacral rhythm. The principle of parsimony might compel an explanation for such benefits entirely in terms of differential responses to nonspecific effects. But let us consider the implications [End Page 115] of Waterman's therapist's claim that belief in the craniosacral therapy is somehow constitutive of its benefits to an extent that exceeds placebo. Comparable claims exist on behalf of a whole class of phenomena including chakras, qi, and Madre Ayahuasca that are experienced as real and curative by people of integrity, but for which naturalistic correlates remain elusive. Suppose that the craniosacral rhythm really is a thing for those who believe in it: What sort of thing is it?

Philosophy has long contemplated the idea that there could be multiple forms of thinghood (Heidegger, 1967; McDaniel, 2017). The cranium is a thing. So is a hole, the imaginary number i, and an encounter with Avalokiteśvara or the resurrected Jesus in the minds of the faithful. The confusion that arises from considering the extent to which the cranium and the square root of minus one can both equally be said to "exist" derive from the limits of our language.

The perplexing ontological status of the craniosacral rhythm is a function of the tension between two incommensurable forms of thinghood embedded in the language of the construct. The cranium and sacrum are externally verifiable...