Toward a More Materialistic Medicine: The Value of Authentic Materialism Within Current and Future Medical Practice

Introduction

M odern Western medicine is often accused of being “too materialistic”—of having drifted from its primary concern with human suffering into a world of technology and billable services. This charge is brought by many critics including alienated patients, disgruntled health care practitioners, sociologists, policy-oriented progressives, and alternative therapists, who call for medicine to supplement or supplant its reigning materialist paradigm.

Yet this critique is problematic if taken to imply that medicine should retreat from the therapeutic breakthroughs of the modern scientific era. “High-tech” diagnosis and treatment have proven to be potent instruments of healing. They can, for example, save a limb, or save a life, when prescientific interventions would be futile. The task for medicine is not to go backward, but to integrate new discoveries better with that more-ancient awareness of humanistic care, spiritual meaning, and healing environments. We argue that this calls forth a new paradigm of medicine that is more, not less, materialistic.

How so? Much depends on what is meant by the term “materialism.” We distinguish between two of its customary uses, independent in logic though often interlocking in practice: monetary materialism and mechanistic materialism. We propose a third form—an “authentic” materialism—along with examples of current and future applications. Our contention is that, in this authentic sense, medicine is not materialistic enough. It suffers from a series of alienating abstractions.

Monetary Materialism

A person focused on profit and possessions is often called “materialistic.” According to this meaning, it is hard to deny that the health care system in the United States is strongly so—driven by finances, resources, and profits. ¹ Money influences virtually every aspect of the medical world, at least in standard practice settings. Medical time is divided up into “billable” hours. Medical space is allotted into hospital wards, intensive care beds, clinic rooms, laboratories, radiologic units, and the like, each generating its levels of reimbursement. Monetary issues influence access to health care, choice of treatments, the development and marketing of new pharmaceuticals, and the dependence upon powerful, costly, profitable technologies. The training and licensing of health care practitioners is largely market-structured and driven. ² Some people would argue that even the taxonomy of medical diseases has itself been financially distorted, ³ including a subprofession centered on the coding of medical diagnoses and procedures to drive reimbursement levels systematically.

Is all this really “materialism”? Alfred North Whitehead, a twentieth-century philosopher and mathematician, identified what he termed the “Fallacy of Misplaced Concreteness.” ⁴ This is operative when one takes a theoretical abstraction and misunderstands it as concrete reality. For example, Whitehead critiqued the “concept of simple location” used in Newtonian physics. Separate bits of matter, localized to a discrete region of space and time, come to be viewed as the fundamental constituents of reality. Whitehead reminds us that these are actually high-level abstractions. All things exist and are experienced through their interactions with other subjects, entities, and regions. The “isolable thing” is a theoretical simplification, useful for scientific practice but deceptive if misidentified as “concrete reality.”

Much the same can be said about money. “Monetary materialism” is really based on abstraction. As Loy, the Buddhist author, points out, money is the least concrete of entities. “(A dollar bill) can't shelter you when it rains, or warm you when you're cold, or heal you when you're ill, or comfort you when you're lonely.…Money is a social construction that we tend to forget is only a construct—a kind of group fantasy.” ⁵ Medical financing rarely attains even the thin materiality of a dollar bill, unfolding instead in credit card swipes, electronic transfers, or photons on a computer screen.

In his famous work, Das Kapital, ⁶ Karl Marx highlights the abstractions at the heart of capitalism. Concrete objects have “use values”—a piece of bread can be eaten or a bed slept in. However, in a capitalist market, objects take on a primary role as commodities for sale. ⁷ This also occurs in a medical system in which sick people and body parts, practitioners and their services, technologies of diagnosis and treatment, all become commodities. Patients can be abstracted into billable visits and bed-stays. Their illnesses are translated into International Classification of Disease (ICD) codes, which invoke and justify Currrent Procedural Terminology (CPT)–coded treatments, which trigger predetermined reimbursement schedules. Administrators keep a careful watch over disposable resources, profit margins, patient-flow, bed utilization, and the marketing potential, as much as the healing potential, of new technology purchases.

The key point here is to recognize that this is not medical “materialism” at work, but rather abstraction operating. The sick person comes to the practitioner with very concrete symptoms: pain; anxiety; impairment; and/or disfigurement. The practitioner's desires and actions may be similarly concrete, as he/she probes for remedies. However, the “fallacy of misplaced concreteness” threatens to displace this encounter in favor of the primacy of abstract profit and productivity goals.

Mechanistic Materialism

Another meaning of “materialism” is more philosophical, as in this dictionary definition: “The theory that physical matter is the only reality and that everything, including thought, feeling, mind, and will, can be explained in terms of matter and physical phenomena.” ⁸

This sort of materialist metaphysics dates back in the West to ancient Greek atomism and the current incarnation can be traced to the seventeenth-century rise of modern science. Experimenters and theorists, such as Galileo and Descartes, reconceived the natural world according to the new physics and mathematics of mechanics. ^9,10 Descartes envisioned, as he wrote in the Discourse on Method, ¹¹ that this new mechanical science would make it “possible to attain knowledge which is very useful in life…and thus render ourselves the masters and possessors of nature.” This was desirable, “principally because it brings about the preservation of health, which is without doubt the chief blessing and the foundation of all other blessings in this life.” ¹¹ The key to this science was reconceiving the body as machine. Like a watch, or other automaton, the body functions through internal mechanics that can be rewound, repaired, or replaced. ¹¹

This specialized knowledge, and the type of diagnostics and treatments it makes possible, have, in many ways, fulfilled Descartes' dream. For example, since the heart has come to be understood as an electrically driven pump, medications can be prescribed to lower blood pressure, cholesterol, or clotting factors; blocked cardiac vessels can be opened or bypassed; leaking valves can be replaced with artificial or animal analogues; pacemakers and defibrillators can sustain life-giving heart rhythm; and even an entirely artificial heart can be implanted.

Again, these “material” treatments actually arise from—and are associated with—a series of abstractions. The living patient, embedded within a world of involvements, and grappling with modes of suffering and concern, is reconceived on the model of a mechanical device. One piece of this complexity (e.g., the heart) is isolated off as primary focus. This is a form of what Whitehead called “the fallacy of simple location,” wherein we set aside larger contexts of relational interdependence. From the heart, we may narrow attention further to a cardiac vessel or a biochemical parameter examined through specialized test results. For Descartes, as for Galileo, nature spoke the language of numbers; ⁹ only the mathematizeable was objectively real. This is an attitude that finds its place in the statistics and metrics of medical diagnostics and research. Modern medicine thus abstracts progressively away from social context, lived experience, immediate sensory perception, and even language.

Such abstractions, while key to modern medicine's efficacy, can also cause it to seem dehumanized. The physician spends time reviewing X-ray films and other test results, strides into a hospital room, grabs a chart, prescribes specialized treatment in a time-determined “visit,” but may never truly encounter a person lying in a bed. This can compromise patient trust and receptivity, undermine the “placebo effect” of positive clinical interactions, and impair understanding of the causes of illness and the best modes of treatment for this individual.

Toward a More Materialistic Medicine: The Paradigm of Authentic Materialism

How one conceptualizes the problem makes a difference in one's solution. If medicine is seen as “too materialistic,” focusing just on the patient's “body,” one might add psychospiritual counseling to standard treatment. But this still leaves in place the core abstractions of Cartesian mind–body dualism. The mechanical body is treated by the scientist–physician, with “adjunct care” left to the social worker or chaplain.

For people of a more thoroughly “antimaterialist” persuasion, there is a danger of “throwing the baby out with the bathwater.” Modern medicine has developed stunningly effective treatments for a host of acute and chronic ills. To simply abandon these in search of alternative “nonmaterialist” approaches may do patients a disservice, nor will the medical system benefit if quality training for, and delivery of, high-tech services is neglected.

The key is not to abandon, but to integrate, scientifically developed and efficacious treatments into higher levels of healing practice. This is not antimaterialistic. On the contrary, it represents a deeper, more authentic form of materialism. To accomplish this, we need an enhanced emphasis on the embodied experience of the patient, the physical environments in which treatment unfolds, and the material things we use as agents of healing. We can be far more intentional about the symbolic resonances, esthetic beauty, and complex meanings of our medical materials, serving not as agents of depersonalization and expense but as miraculous partners to patient and healer alike.

This could be characterized as a return, without simple regression, to an ancient wisdom. The symbolic investment of material objects with spiritual significance and healing powers is central to indigenous medicines. At the same time, this “authentic materialism” is in harmony with contemporary philosophical advances. Twentieth-century philosophers have proposed alternatives to Cartesian dualism in which mind and body, subject and object, and experience and the concrete world, are not seen as being opposed, but as being ever intertwined.

We see this in the “process philosophy” of Whitehead and his followers. ^{12 –14} Drawing on influences as diverse as Platonism, quantum mechanics, and ordinary experience, Whitehead suggested that subjectivity is present all the way down to the fundamental building blocks of space, time, and matter. Then, too, twentieth-century phenomenologists, most famously Husserl ¹⁵ and Merleau-Ponty, ¹⁶ developed the notion of the “lived body.” ^16,17 The person is not a dualistic “ghost in a machine.” Rather, our living flesh is itself the vehicle of our perception, movement, desire, and language.

Rather than develop these enriched philosophical notions of materiality at length, we now focus this discussion on concrete clinical examples. These are drawn from existing practice and involve suggestions for the future. Together they serve to sketch the outlines of an authentic, holistic medical materialism.

Shawls and Quilts

The “Prayer Shawl Ministry” was begun in 1998 by Janet Bristow and Victoria Cole-Galo, two graduates of the Women's Leadership Institute at The Hartford Seminary. ^18,19 They were inspired to knit shawls for people experiencing illness, loss, and crisis, as well as for others seeking a tangible sign of divine care. The knitters establish a meditative environment and pray while making each knot. Materials, patterns, and colors are often chosen for symbolic meaning. After being blessed with special wishes and prayers. the shawl is given, sometimes in a ceremonial fashion, to the one in need. In a New York Times interview Ms. Bristow described it thus: “It's an embrace. It's a hug. It's tangible. You're basically knitting your prayers, your good intentions and your thoughts into the shawl.” ²⁰ Sometimes referred to as prayer shawls, comfort shawls, or peace shawls, these are now being created by dozens of groups around the country with different denominational and spiritual affiliations. Annual national gatherings have had hundreds in attendance.

In a similar initiative, the Quilts Are Love organization, started by breast-cancer survivor Suzan Maddox, distributes quilts with panels on which friends and loved ones of a patient write personal messages. ²¹ Sick patients can then literally wrap themselves in the healing intentions of their loved ones. Such objects thus embody not only divine love but that of the community. Prayer shawls may be conditioned by the blessings of an entire congregation.

The New York Times article cited earlier supplies an example of a prayer shawl recipient, Jean Maddon, 58, recovering from major abdominal surgery. She reported being very cold and wearing her shawl almost ceaselessly in the weeks following surgery. “I knew that people had prayed over it, and you can rationalize that, but somehow putting it on and wrapping it around you felt very peaceful.…I think it probably helped with my recovery.” ²⁰

This object transcends or antedates any division of “body,” “mind,” and “spirit.” While many patients experience the shawl as being imbued with spiritual energy, this is mediated by the garment's materiality. Care and healing become present with the sensuous immediacy of touch.

In some ways, this is reminiscent of the “healing objects” used in the shamanistic practices of many cultures and periods. These are extensively documented in medical anthropology literature, which has increasingly taken up the theme of embodiment and materiality, ^{22 –25} and in sociologic works on the mythic/magical worldview.

For example, Sir James Frazer, in his groundbreaking work, The Golden Bough, talks of “sympathetic magic” as operating according to laws of “similarity” and “contact.” ²⁶ An object can harm or heal because it is similar to another (holding a doll might help an infertile woman become pregnant), and/or it has been in spatiotemporal contact with another (the garment of a pregnant woman might transmit fertility to another). The prayer/peace/comfort shawl embodies both principles. As something warm, sheltering, and beautiful, it is similar to, and expressive of, divine and communal love. The shawl has also been in contact with the special energies of the people who made and blessed the shawl.

While such “magical” elements are frequently characterized as the antithesis of modern medicine, in fact, they need not imply the abandonment of the scientific worldview. A recognition of the power of the placebo effect—belief in healing—to trigger real psychophysical changes is fundamental to modern medicine. What Dossey called “intermediary objects” help symbolize and access healing power: “We physicians are drowning in them. They range from white coats, stethoscopes, a mystifying vocabulary, and CT scanners, to thousands of pills and surgical procedures.” ²⁷ Many of these medical objects (e.g., pills and surgeries) have mechanistic efficacy independent of the placebo effect, as validated through research protocols. However, the power of these medical objects may be enhanced by their symbolic resonances. ²⁸ For example, Dossey refers to studies that suggest that aspirin tablets scored with a “Bayer cross” had a more powerful effect than unmarked tablets and that blue placebo capsules induced drowsiness far more frequently than pink ones. ²⁷ A thing's shape, color, and symbolic associations make a difference, although precisely why or how remains elusive.

The material richness of the prayer shawl may be similar to—but also far transcends—that of a placebo pill. Disease can sever the patient's habitual trust in his/her own body, community, and universe of belief. ²⁹ The prayer shawl helps “knit” these back together, regathering a world that illness has torn asunder.

To understand this, we invoke the work of Albert Borgmann, a philosopher of technology. He distinguishes between a device and a focal “thing.” ³⁰ A thing—Borgmann takes this term from Heidegger ³¹ —is inseparable from its context, the modes of engagement that brought it into being, and that it, in turn, makes possible. Borgmann gives the example of a wood-burning stove. It gathers family around the hearth, providing the home with a center. The stove's workings demand engagement with the natural world and the rhythm of the seasons, the development of skills and strength, and the distribution of family tasks. This focal thing is thus associated with focal practices that orient life. Borgmann contrasts this world-gathering thing with the device: for example, a central heating system. This device disburdens us of the work and limitations that characterize the wood-burning stove. Heat is immediately, effortlessly, and ubiquitously available. But disburdened by the device, we are also disengaged. We disconnect from the seasons; the family can disburse; and tasks and purposes are dissolved. It is like the contrast between preparing and sharing a festive meal, and ordering fast-food burgers, a kind of food-device. Much ease and freedom is gained by the latter, but much is lost.

The medical world is filled with devices, which can both serve healing functions and trigger alienation. Insofar as they yield rapid, effortless symptom alleviation or cure, this is a clear good. However, such is not always possible, leading to disappointment. An overreliance on devices can also diminish our own modes of engagement with good health practices. Finally, device-laden environments—think of the modern hospital—can exacerbate the modes of depersonalization and world-fragmentation that the disease initiated.

In such an environment, the rich materiality of the prayer shawl becomes a healing agent. Among alien devices, it serves as a world-gathering thing. Its natural fibers reconnect the patient to sun and soil. Through form and color, and infused with blessings, the shawl helps a patient feel close to family, friends, and often a Higher Power. The word “healing” comes from the same root as “whole” and “holy.” Such is not simply represented by the shawl, but is also embodied in it. This is also true for the people who create the shawl. Family and friends may feel worried and powerless. The acts of meditative knitting, quilting, blessing, and giving become “focal practices” that help the helpers, allowing a bodily/spiritual engagement with the loved one. Achterberg et al. explore how such “rituals of healing” reduce feelings of helplessness, and knit together the ill person, community, and cosmos. “Rituals help us face together those things that are too painful, confusing, or awesome to face alone.” ³²

Redesigned Environments: From Hospital to Temple of Healing, from Nursing Home to Eden

An authentic materialism calls us to reimagine not just an isolated thing and its associated practices but also to consider the larger medical world in which the thing is embedded. The modern hospital, for example, not only contains devices but itself aspires to be a large device, maximizing sterility, efficiency, and technology to battle disease. Can we envision a hospital that, like the prayer shawl, itself serves as a world-gathering thing? The goal is not to abandon the powerful technologies of modern medicine but to carry them forward into a more effective and holistic paradigm of application.

A suggestive example is provided by the Sri Sathya Sai Super Speciality Hospital located in Puttaparthi, India (a second has since opened outside of Bangalore). This is a tertiary care hospital with advanced specialty units, for example in cardiology, ophthalmology, orthopedics, oncology, and plastic surgery. ³³ (One of the authors of this article has consulted on the design of cardiologic services for this hospital.) State-of-the-art Western technology is used, but this technology comprises the tools, not the context, of care. Created under the auspices of internationally known guru/avatar, Sri Sathya Sai Baba, and funded by his disciples, the hospital provides all of its services free of charge, making them available to India's poor irrespective of caste. This also enables the hospital to provide a “medicine free of commercialization.…which can be done only when it ceases to be a commodity bought and sold in the market.” ³⁴

This hospital exemplifies what we have termed authentic materialism, including the hospital's very brick and mortar architecture. It was designed by Professor Keith Critchlow, a world-renowned author and practitioner of “sacred architecture.” When entering the main gate, one is greeted by figures of Hindu gods associated with life and healing. This leads to a prayer hall, topped by the central dome, which is 85 feet high and 80 feet in diameter, festooned with images of the Elephant, Peacock, and Lion (symbols of intelligence, skill, and courage, respectively). The dome is architecturally intended to represent a heart whose apex is pointed to God. The two main wings of the hospital wrap the front courtyard and entry, symbolizing God's arms reaching to embrace all who come to walk this path. The building itself is not referred to as a hospital but as a “mandir” (temple) of healing.

Hindu Gods, gurus—and free care—may seem distant from our Western context. Yet, the core principles are illustrative. The hospital speaks through its material symbolism to care, faith, beauty, integration, as at the core of healing practice. This assists the treatment of the ill person (and family) who may be experiencing the disintegrations caused by illness. In addition, the hospital embodies a genuine place of hospitality and focus for those who work there—encouraging a spirit of awareness, compassion, and service to humanity without fiscal barriers. The powerful high-tech devices of Western medicine are not displaced, but rather placed within an enriched context. Martin Heidegger, who first introduced the notion of the world-gathering thing, pointed to the ancient Greek temple as a paradigmatic example; its site, architecture, and purpose disclose a world of meanings. ³⁵ This is also true for the Sri Sathya Sai Super Speciality Hospital for patients, families, and healers.

In a more-Western, more-secular example of the power of authentic materialism to reform an institution, Harvard medical graduate William H. Thomas, MD, found himself questioning the 80-bed nursing home of which he had become medical director. Taking lessons from nature, he realized that elders needed a genuinely human habitat enriched with diverse social and natural engagements. In 1991, he created the prototype of what has come to be called “The Eden Alternative.” ³⁶ Animals were introduced—dogs, cats, parakeets, rabbits, and chickens—providing opportunities for care and companionship. Plants were brought inside the home, and an outside garden was planted for the work, enjoyment, and fresh food it provided. Through starting an afterschool program and summer day camp, children were invited into the community. The nursing home came alive. As documented by the New York State Health Department, this switch of paradigm was accompanied by decreases in infections, daily drug costs, and staff turnover. ³⁷

This model has spread. Some 17,000 “Eden Associates” have been trained, and 300 Eden Alternative homes registered around the world. Dr. Thomas' latest “Green House” initiative moves even further from the institutional model. ³⁸ A Green House, built for 6–10 residents, is thoroughly homelike. It includes a hearth, abundant sunlight, vibrant outdoor space, personal rooms, and a communal living and dining room. Animals and plants, again, are welcome. In 2005, the Robert Wood Johnson Foundation initiated a 5-year ten-million-dollar grant to support the building of Green House projects across the country. ³⁷

Here, again, we see authentic materialism at play, not the abstractions of money and mechanism. The physical environment is redesigned to energize humane care and community. Rather than simply inhabiting an institutional-device, the residents dwell with life-enriching focal things and practices.

The Implantable Cardioverter Defibrillator: Device and/or Thing?

Prayer shawls and Green Houses are wonderful things, yet they do not obviate the need for state-of-the-art technological care. A final question, then, is whether authentic materialism can lead us to reenvision the high-tech medical device itself. We close with a speculative example involving the sort of instrument that seems most challenging to our analysis: an implantable cardioverter defibrillator.

Sudden cardiac death claims some 500,000 people each year in the United States. This defibrillator has become the treatment of choice for patients with life-threatening arrhythmias. ³⁹ An almost ideal exemplar of what conventional “materialistic” medicine could wish for in a device, this defibrillator is small, surgically implanted, long-lasting, highly effective, lifesaving, and even relatively cost-efficient for the benefits provided. If a patient's heart fibrillates, the internal device automatically detects and shocks it back into rhythm, often defeating death time and again.

Though, by modern standards, the benefits are great, and some patients report their sense of gratitude and enhanced security, many studies also suggest that implanting these devices provokes significant distress in patients. Aware that their hearts are so sick that their lives depend on the permanent implantation of a battery-powered generator that might shock them at any time, and that itself requires a lifetime of specialized monitoring, a substantial proportion of patients experience anxiety, depression, and impaired quality of life. ^{40 –42} Although research results are not consistent, attempts to isolate predisposing factors seem to point toward the individual patient's characterology—some persons cope better with this challenge than others—and the number of shocks received from the device. ⁴³ Patients commonly have a fear of being shocked, which can be very painful. It has been described as “like being kicked by a donkey in the chest,” ⁴⁴ or being electrocuted from the inside. ⁴⁵ One's inability to anticipate and control when this will occur is also trying: patients report their dread of being shocked in a public space and fears concerning isolation, sexual activity, driving, and device failure. ⁴⁶ Anxiety thus surrounds both the device working and not working.

This defibrillator also provides continual reminders of death and dependency. Inside one's heart (literally and metaphorically) resides an alien machine. It calls to mind the death one almost had and the death that awaits the patient in the future, as well as the particular one that the device prevents. Thus, the technology's blessing can also be a curse; some patients feel they have “lost the easy death” associated with sudden cardiac fibrillation. Instead, they live the troubled half-life of a cyborg, lined by pain and uncertainty. ⁴⁵

Much has or could be done to alleviate such distress. Recommendations commonly involve patient education; support groups; adjusting the technology to reduce the number and pain of shocks; cognitive–behavioral therapy; relaxation and stress-management techniques; and psychoactive drugs. These are all potentially important palliative-treatment modalities. They also largely adhere to Cartesian divisions, focusing on the “mind” or the mechanical “body.”

What is almost never considered is working directly with the materiality of the defibrillator. What does it look like? How does the patient first “meet” it? Is there a way it can become more of a world-gathering thing—like the prayer shawl—and less of an alien device?

Unlike a prayer shawl, a defibrillator has a mass-produced, synthetic physicality that does not bespeak beauty, comfort, and community. That is neither this device's form nor function. Although it will remain a palpable lump under the skin, and trigger airport metal detectors, when used it will largely disappear from the patient's physical vision.

Yet what if the defibrillator's delivery were more like that of a prayer shawl? What if it was presented to patient and family as something that can be blessed and prayed over; given and received; experienced as friend and material partner; and imbued with a heart-restoring power? How differently might this object be accepted within the patient physically, psychologically, and spiritually?

Imagine, for example, that the patient had the opportunity to become familiar with this device prior to implantation: see it; touch it; explore it; and pray over it. If issues of sterility and security permitted, the actual device to be placed within the body could be ceremonially blessed. Friends, family, and/or a religious figure could endow it with prayer or healing energy as is done with the prayer shawl. The patient might be encouraged to create a poem or a painting to explore the meanings of the defibrillator better and create a personal symbology around it. The way would thus be prepared for this powerful object to be “taken into one's heart.”

This is unlikely to remove all the pain and fear associated with defibrillator shocks. However, working with this device as a “focal thing” can also assist with the development of lifelong focal practices. Jauhar wrote about a patient who struggled with severe anxiety around being shocked: “When the fear hit.…she sang songs to herself that she learned when she was a girl. She chanted a Sanskrit mantra that she learned in her younger days as a yoga instructor. And she prayed.” ⁴⁴

Focal practices can help recontextualize the fearful reminders of death associated with defibrillator shocks. Many spiritual traditions counsel using “memento mori,” the remembrance of one's mortality, to develop authentic relationships with life, death, and the eternal. “Death meditations have been regarded as an indispensable element in a wide array of cultures: the Egyptian and Indian, the Chinese and Japanese, the Hellenic and Roman, the Hebrew and Islamic, in both their ancient and modern forms.” ⁴⁶ Defibrillator jolts present an embodied—literally shocking—memento mori. This can either lead to panic and depression, or, through preparation, ritual, prayer, and the like, be made meaningful within a bodily/spiritual practice.

These comments are meant to be suggestive only. While using the defibrillator as an example, they open a window to reenvisioning the complex world of medical materials, including transplants, dialysis machines, surgical suites, monitors, ventilators, and other clinical devices and environments. Currently these are designed to be congruent with monetary and mechanistic “materialism.” They do the job well of generating revenues and technologic interventions. However, these objects also can contribute to the abstract, depersonalized—even curiously disembodied—texture of modern medicine. What is needed is a medicine that does not abandon functionality, but is attendant to the play of beauty, meaning, and the healing arts, embedded in an enriched materialism.

Conclusions

This article has tried to sketch the outlines of authentic medical materialism. This is something quite different from what is often criticized as the “materialistic” bent of modern medicine—namely, its focus on money and mechanism. These, we have contended, are actually abstractions. The sick person, and his/her family, can feel ignored and replaced, for example, by numbers: identification numbers; laboratory results; diagnostic and treatment codes; and their disconcerting consequence—large numbers on bills for coverage and service. Authentic materialism calls us back to what is concrete and multitextured. It attends to the suffering patient, embedded in a family, community, and universe. This kind of materialism makes use of the concrete clinical setting and materials as a means for healing, making whole that which illness has fragmented.

This process can be assisted through objects like the prayer shawl, not central to medical treatment per se but resonant with symbolic richness. Even medical devices—such as the defibrillator—can be recontextualized in a way that enhances acceptance and efficacy. Not only objects, but entire environments, can be reconceived. The hospital in Puttaparthi, the “Eden Alternative,” and “Green House” homes remind us that people can thrive in enriched, humanistic settings.

Words such as “material” and “matter” may ultimately derive from the Latin “mater” and the Indo-European root ma, meaning “origin” or “mother.” It is that which nourishes, as in the word “maternal.” What is the matter with modern medicine? Partly, it is that it does not pay enough attention to what matters to patients and family, including the material gestures, objects, and environments these people encounter when seeking help. These objects can either (and all too often) instill fear and alienation, or nourish people with hope, symbolism, and beauty. Medicine need not apologize for being “materialistic.” It does need to rethink what that means.