The Bioethical Mandala
A Reflection on the Moral Structure of Health Care
The considerations of Bioethics are increasingly important in the 21st century, as the old ways of looking at moral issues become clouded by technological developments and the flattening of structures, marking the transition of the world into the Aquarian Age. Although this article is not strictly astrological, it does address some difficult issues, many of which require us to step out of the "scientific" medical paradigm and into a more holistic, earth-centred concept.
Certain intricate sets of patterns illuminating ancient manuscripts and wallpaintings form what are called in tantric and northern buddhist scriptures, mandalas.(1) The ancients intended such devices to draw ritual participants into mysterious states of intensified awareness, while authors of these pictorial, symbol structures sought to use them to express the insights of a knowledge which somehow defies expression in words.
Complex mandalic structures were believed to give access to deep truths concerning the composition of the self and its relationship with nature. Many of these truths were found to be attainable only through the systematic pursuit of methodologies prescribed within the designs. The disciplined application of these techniques was intended to disperse the fog of ignorance believed to obscure the empowering structures of the psyche. Learning to understand and harness powerful energies incorporated in the subconscious was known as the process of initiation.
An integral part of this process required the complete surrender of the participant's body into the care of the master, the guiding initiate and his acolytes. Access to these subtle, empowering truths was effectively denied to those who had not yet received appropriate degrees of training and the consequent acceptance by an empowered elite. To the uninitiated, mandalas were generally felt to be incomprehensible, disturbing, or even threatening.
The mandala's importance lay in its direct relevance to the central preoccupations of the time: liberation, salvation and other matters to do with the health of the soul. In a sense, life in its entirety was viewed as a mandala, a cultural overlay of meaningful patterns located in concourse with an interactive environment. The primary essence of interaction was thought to consist in the confluent exchange of energies within the spiritual body of the world.
Physical, flesh and blood bodies, it should be remarked, were perceived by thoughtful people as little more than gross obstacles to purification; many needs that we consider essential today were mostly ignored and physical suffering, given the state of science, had mainly to be endured. The human soul was believed to be diseased, or polluted to the extent of its contamination with the material interests of bodily life in the world. The suffering of the body was believed to be a direct consequence of such soul-pollution, the inevitable condition of material life. The public imperative was, therefore, to seek the surest cure for the suffering of the soul – for soul, not body, was the focus of life.
Cure of Souls
In the Europe of the Middle Ages we find a similarly all-consuming and public interest in the cure of souls,(2) which were thought to be dangerously contaminated with sin and (unlike those of the Eastern buddhists, who believed in a form of reincarnation) bound for eternal damnation, in the absence of an immediate "cure" in this very lifetime. Michael Walzer notices that our communal focus has moved from a concentration on the cure of souls to one applying to the cure of bodies:
In Europe during the Middle Ages, the cure of souls was public, the cure of bodies private. Today, in most European countries, the situation is reversed. The reversal is best explained in terms of a major shift in the common understanding of souls and bodies: we have lost confidence in the cure of souls and we have come increasingly to believe, even to be obsessed with, the cure of bodies. (3)
With the tidal advance of rationality and religious scepticism, a broad concern with eternal life has receded, having been largely replaced by a neoCartesian, humanistic obsession with bodily health and physical longevity.
Renée Descartes, the prophet of a mechanistic, mind/body dualism, proposes that practical knowledge should be diligently applied, not to the business of salvation, but to generating conditions which would "make ourselves, as it were, the lords and masters of nature", such a state being desirable "not only for the invention of countless means of enjoying the fruits of the earth... but principally for the preservation of health which is no doubt the chief of all goods".(4) He even proposes that, the mind being so dependent on the "temperament and the bodily organs" we must look to medicine (and, presumably, medical practitioners) for a way to make men "wiser and more skilful than they have so far proved".(5) This would no doubt be the medicine of the future, for he recognised the medicinal skills of his own time to have been somewhat rudimentary. Notwithstanding some undeniable successes of modern, scientific medicine, it is debatable as to whether Descartes' optimistic prognosis can be shown to have proven entirely justified, at least so far.
Reshaping the Mandala
The ancient, hierarchical structures that nurtured the mystery schools and their initiatory rituals have long faded into obscurity. Central perceptions of need in our society have shifted away from any formal awareness of a spiritual iconography. The personalised discourses of doctor and therapist have displaced the public rituals of priest and shaman; the living room soap opera has replaced the passion play in the public square.
Michel Foucault argues that our community, over the last two centuries, has become subject to a new hierarchy: a set of unyielding disciplines that ensure our docility by the construction, through discipline and confession, of a false self.(6) This worldview, he argues, has become dominant throughout the medical, social and administrative arenas, blossoming in the nineteenth century into a powerful set of notions of ideological and bodily normality. These discourses, which have captured the hearts and minds of educated people in the West over the past century, have coalesced to produce the marginalisation of any divergence from these theoretical norms.
We have in the modern era seen the decline of the once ubiquitous parish church, the stanchion of the Christian social paradigm, with its pervasive social rituals based in a conception of the community of faith. The church itself in our time has been displaced to a very great extent by the hospital – and the confessional by the clinic. Our society is undergoing a paradigmatic shift; we are restructuring the imagery of our mandala.
This article continues in part two to consider the relationship of care and the surrender of autonomy, the nature of health and disease, ethical positions, and the implications of harmony and wellbeing.
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