Loading summary
Transcript43 lines
- [00:00]
Dr. Dan Koch
Limu Emu.
- [00:02]
Dr. Nathan Carlin
And Doug, here we have the Limu emu in its natural habitat, helping people.
- [00:08]
Dr. Dan Koch
Customize their car insurance and save hundreds with Liberty Mutual.
- [00:13]
Dr. Nathan Carlin
Fascinating.
- [00:14]
Dr. Dan Koch
It's accompanied by his natural ally, Doug. Uh, Limu is that guy with the binoculars watching us.
- [00:21]
Dr. Nathan Carlin
Cut the camera.
- [00:21]
Dr. Dan Koch
They see us.
- [00:22]
Commercial Narrator
Only pay for what you need@libertymutual.com Liberty.
- [00:25]
Dr. Dan Koch
Liberty. Liberty.
- [00:26]
Dr. Nathan Carlin
Liberty.
- [00:27]
Dr. Dan Koch
Savings vary unwritten by Liberty Mutual Insurance Company and affiliates. Excludes Massachusetts.
- [00:30]
Commercial Narrator
@Blinds.Com it's not just about window treatments. It's about you. Your style, your space, your way. Whether you DIY or want the pros to handle it all, you'll have the confidence of knowing it's done right. From free expert design help to our 100% satisfaction guarantee, everything we do is made to fit your life and your windows. Because@blinds.com, the only thing we treat better than windows is you. It's your last chance to score Cyber Monday. Megadeals shop up to 50% off plus a free professional measure. Right now at blinds.com rules and restrictions apply.
- [01:08]
Dr. Dan Koch
All right, welcome back, everybody, to Religion on the Mind, the podcast that focuses on the overlap of psychology and religion and spirituality. I'm Dr. Dan Koch. I'm a licensed therapist and a spiritual abuse researcher. And my guest today is Dr. Nathan Carlin, professor of medical humanities at the McGovern Medical School in Houston, Texas, and author of the new book the Secularization of How Religious Ideas Migrate into Modern Healthcare, published by Oxford University Press. So. All right, Nathan, we get it. You're a big fucking deal, okay? Take off the lab coat. Come join us in the pit. No, I'm kidding. Really glad to have you here, man.
- [01:54]
Dr. Nathan Carlin
Well, this is a lot of fun. Thank you so much for asking me to be here today.
- [01:58]
Dr. Dan Koch
Yeah. So I'm so intrigued by this idea of doctors as the new priests. I think it goes all the way back to Freud. And I think you talk about this a bit in your book that, like, Freud thought that therapists were kind of the new priests, or anyway, that idea somehow gets traced back maybe as far as him. I've heard it said in grad school, I've heard it said, you know, all around this idea of, like, somebody is the new priest, somebody is the new religious leader, the clergy of a secular society. And anytime such a claim pops up, I'm intrigued because I'm just curious how these things migrate around and what they. What they mean to people in their day to day life and, and medicine and health care, you know, is an area of, by definition, existential Concern, which is just always a good button for me, gets me interested. So maybe before we get into any of the ideas here, could you say a little bit about what made you interested in this overlap of, oh, is there a sort of religious role being played, or are there older religious ideas finding their way into modern medicine? Like, where did that germ of that interest come from for you?
- [03:15]
Dr. Nathan Carlin
Yeah, I would say it goes back at least 20 years for me. My college history professor, Russ Martin, he taught European history, and in one lecture, it was just so striking. It was just so moving to me. He was talking about the old cathedrals of Europe. Think of Florence or something like that. And you're walking around town and. And he says, the highest point in the city is always that steeple. You know, it's always that steeple. And he says, and that's meant to teach a moral and spiritual lesson. And the lesson is, when you are lost, you look to the church. You know, when you were lost, you look to the church. And so that's both geographically, it orient you, but then also sort of morally and spiritually, you know, so that was the lesson. I just thought that was fascinating as a college student, you know, and, you know, I went to Europe and then just saw it, and that comment stuck with me. Then I came to. I moved to Houston. I went to graduate school at Rice University to study psychology of religion, you know, And I'm walking around campus at Rice, and it's right next to the Texas Medical center, the largest medical complex on the planet. You know, the Texas Medical Center. It's a city unto itself, really. And so that skyline is just right on the edge of Rice's campus. And Martin's comment comes back to me, and I look at them, and I think, and those are the cathedrals of our time. Those are it. And, you know, and I just kept thinking about it, and I thought, you know, it's. You know, people make pilgrimages there. You know.
- [05:01]
Obviously, a lot of people still make spiritual pilgrimages, go to Mecca or something like that, but a lot of people come to the Texas Medical center or the Mayo Clinic or whatever, and so they make pilgrimages here. And then I was thinking about clergy wear black robes and doctors wear white coats, and clergy give the sacraments and physicians give prescriptions. And it just seemed to me sort of over time, thinking about Martin's comment, seeing the buildings then having all these other associations that cardiologists, oncologists, other specialists, you know, back to your point, these are the high priests of our time. And it's the salvation of the body that matters now in secular society, not the soul. It's the salvation of the body. And so that's what makes it these people, the high priests of our time.
- [05:58]
Dr. Dan Koch
Yeah. The primacy of the soul versus the primacy of the body. That's already. That's a really intriguing question to me. I think if I'm trying to think historically about that. Not my field, but where my mind first goes is something like, well, in older eras, human life, human bodily life was sort of manifestly cheaper. Not necessarily that people valued their own lives any less than they do now. As a, you know, as a therapist, I'm likely to sort of consider individual psychological processes as roughly fixed over time. Everybody wants to survive, Everybody wants to be loved and to love back. Everybody wants these basic things. But in terms of, like, the messages that you are sent, especially like, maybe if you are a member of the lower classes 500 years ago versus now. I mean, life is cheap. The cathedrals you've mentioned, like, many people died building every single one of those in a way that would be literally illegal today. If they're gonna finish Gaudi's Sagrada Familia, for instance, in Barcelona, there's a lot more red tape. There's a lot more OSHA safety regulations. Right. And so in one sense, there is the fact that the religion and sort of like the dualistic idea of a body with an immaterial spiritual soul in it, you know, that that idea has lost cachet, especially in the west, especially in the educated, industrialized West. But also the individual life has gotten more valuable. You know, secular humanism and the spread of democracies and stuff like that. Like, that's kind of where my mind goes. Is that where your mind goes, or would you shade that story with anything else? Well, no.
- [07:41]
Dr. Nathan Carlin
I mean, I like the idea of the individual as being important. I would see that as related to some of these movements. And for me, I guess I didn't trace specifically that line between soul and body to the individual, but there could be something there sort of related to the priesthood of all believers, that every single individual is important. Your reading of the Bible, when your reading of the Scripture sort of is important, I mean, it likely is a Western idea that this individual soul sort of matters is sort of important, you know, and it's probably played up a bit in Protestant Christianity as well. When it's your individual, like, different traditions that would sort of emphasize your individual decision would sort of matter with regard to salvation and so forth. I think, for me, the idea that was really important in the book, especially in chapter one, with regard to ritual and the priesthood of all believers and the Protestant Reformation and those kinds of issues was that with that destabilizing of authority and opening up to sort of plurality, sort of creates a crisis in Western thought that sort of what would the word be magnified, perfected, something completed during the Enlightenment, where there's just a crisis of authority and a crisis of epistemology where if anybody can read the Bible and if all interpretations are sort of valid, how do we know sort of what is right? If it's not the Pope or if it's not the priest, priest who can tell us what to think or what to believe, where do we turn to for an answer? So I think it's the Reformation that really starts this and it trickles down to the present. I think just right now with a crisis of truth, how do we know what is true and who gets to decide what is true? And I think it just becomes bananas in the age of social media, I guess.
- [10:06]
Dr. Dan Koch
Yeah, well, and it kind of recenters bodily health over sort of this marketplace of ideas or spirituality where anything could be challenged and you know, whatever. There's no final arbiter of authority or truth there, there. But you know what is a final arbiter? Fucking death. And so let's just focus on not dying, you know, like being physically healthy. It is like a, it's almost like a safer place to put your investment in some ways in a time of, you know, such, such plurality of views, such diversity and lack of centralized, agreed upon culture or authority. I'll just say briefly, your thesis will ultimately be proven the most right if like 50 years from now people are writing articles about how Donald Trump set the initial stage for the type of corruption we are now seeing with the Surgeon General. Like imagine the Surgeon general is like the most powerful civic role.
- [11:13]
Yeah, yeah. And he's like enriching himself through fucking backdoor deals and private jets and stuff. That would be funny.
- [11:20]
Okay. It's interesting to me to say, oh, has medicine sort of replaced religion? Have these medical centers replaced the cathedrals and the temples? But you actually, you make a more fine grained point. You say it's not just about replacement, but it's that it used to be that religion and medicine were intertwined. And I don't think that's the kind of thing that a modern person necessarily knows or thinks about or, you know, like, are there vestiges of this in the way we talk about it? Like, like when and how were religion and medicine intertwined in the past?
- [11:58]
Dr. Nathan Carlin
Yeah, I don't think we have to even go back all that much farther. I think there can be lots of examples sort of of that. Like, one example exercise I like to do with medical students is I give them different translations of the Hippocratic Oath, you know, and Steve Miles, he's retired now, but he was at Minnesota. Internal medicine, physician. But Miles is just an interesting guy in his own right. He's an important figure sort of in bioethics. And so he writes this book about the Hippocratic Oath, and he also provides his own translation from the Greek. Goes back to the Greek, you know, like, it's like a good New Testament kind of study.
- [12:38]
Dr. Dan Koch
It's like a good pastor. Yeah, yeah, yeah.
- [12:41]
Dr. Nathan Carlin
So he goes back to the Greek and he translates it. And so, you know, maybe some people know this, maybe other people, but in the original, it's I swear to Apollo, you know, it's I swear to Apollo, you know, so you say the Hippocratic Oath at sort of the vast majority of American medical schools today. Not all. Some other schools do different oaths and things like that, but a lot of them have a modern version of the oath. And currently it'll say something like, I swear by whatever it is that I hold sacred. Not Apollo, not God, but whatever it is that I. Back to your point about the individual, whatever it is that I hold sacred, you know, so it's. So it's trying to recognize some kind of diversity, some kind of pluralism.
- [13:27]
Dr. Dan Koch
Right.
- [13:27]
Dr. Nathan Carlin
And. But it's also, at the same time, grappling with how do we provide a moral foundation sort of, for medicine. So medicine and religion were very close right at the very beginning, back to sort of the ancients. And that really even continued up to the modern period, where in the preface to the first code of the American Medical association, their Code of Ethics and the preface to it, it was written that the basis of medical ethics rest in religion, that medical morality rests in religion. And I found that so striking that that would be in the preface, because. And it's not that long ago. It's just.
- [14:03]
Dr. Dan Koch
What year is this?
- [14:04]
Dr. Nathan Carlin
It's something. What is. It's maybe 1850, something like that.
- [14:08]
Dr. Dan Koch
Okay.
- [14:09]
Dr. Nathan Carlin
And so it's really not that long ago. And I just couldn't imagine that statement now at any of our hospitals unless it's sort of explicitly religious, like a Catholic hospital or something like that. But it was just amazing to me. And then I began thinking of, like, well, when did that go away? How did that kind of go away. And then if you look at what's fascinating about that, about the removal sort of of that language related to the code of ethics, the rise of the field of bioethics, and the spread of the Hippocratic oath and the oath itself, also becoming secular, it all happens at the same time, which is the 1960s and 70s. So it's a time in American culture that is becoming much more radically secular or less religious or less traditional. You know, the 60s and 70s, and authority is being questioned in a deep and profound way. We think of the 60s and 70s as a time of women's rights. You know, father doesn't know best anymore is the message of feminism, Right? And that is also the era of patience rights. If father doesn't know best, neither does the doctor. Doctor doesn't know best. I get to decide, make decisions about my own sort of body if I want them, if I want. And then there were also, just by chance, just these really remarkable case studies or case examples in the history of bioethics. One here in Texas called the Case of Dax, where he's just north of Dallas, and, you know, he's with his. I think he was there with his dad, and they were. They were trying to close on this property deal, and they just happened to park in a bad spot, and they turned the car back on and it was over. Gas leak. And it just blows up. And he's severely burned. And Dax wants to die, saying, let me die, let me die, you know, don't save me, you know. But they take him to Dallas. I think it was Parkland Hospital. And the doctors say, no, we can save him, we can save him. He says, no, let me die, let me die. We could save him. And then he eventually comes down to Galveston. We had a burn unit down there. And you can watch all the videos of this, a documentary of Dax being dropped in these. I guess it would have been probably chlorine baths or something like that. And he's just screaming, he's burned, he's burned. And they just dropped these baths to disinfect them, and they rewrap all of his bandit. And this just goes on. And he's consistently saying, let me die, let me die. So he becomes blind. He loses his eyes. He loses, you know, lots of things. And he's just saying, let me die, let me die. And all of the doctors say, no, he's going to thank us for this later. He's going to thank us for this later. And the doctors were right that they could save him. But they were wrong that he would thank them. And so he eventually went to Texas Tech and becomes a lawyer. And then he spends the rest of his career as a disability or sort of a right to die activist saying, like, I should have been allowed to die. Like, he never changed his mind, you know, and so there's this tension between sort of beneficence, doing good for other people, being paternalistic. In what ways do doctors know best? And the rights of the individual, like the autonomy, this fundamental tension between beneficence.
- [17:51]
Dr. Dan Koch
And autonomy, you know, and that tension exists in therapy. You know, we don't, we don't have the ability to prescribe lethal doses of medication to our clients. Right. So that part's different. But the tension of when does therapist know best? When should the. When should the client be centered? You know, like, you know, if, for instance, a client says, I just think we need to end therapy forever right now because I know that I'm never going to get better. And da da, da, da, da, say, they say something like that. Now I'm a cognitive therapist, so I pick up on a few things in that statement. There's some fortune telling, there's some catastrophizing. I might think in my own mind. There's some emotional reasoning going on. This person is extremely upset. And the type of language that is meeting his or her sort of, you know, current emotional state is going to be very extreme language, otherwise it's going to feel untrue and inauthentic. And so they are saying this to me in truth, to their current state. But I am sort of aware of ways in which they will later come to question some of these statements. And they might be glad that I put a little extra effort in to trying to see if we could continue therapy and not simply going with their wishes. Right. Like, that's a lower stakes example. But I think it's gotta be logically similar to the type of discernment there around competing values. So in that case, while I do have this client autonomy, they're giving me a straightforward request. At the same time, in my clinical judgment, I think that they are probably gonna change their mind on this maybe within 30 minutes. And I think it's in their larger interest that we continue working on this trauma treatment that we're doing, or whatever we're doing is in their larger best interest. And so I have to sort of balance those things. I just imagine it's a similar form of balancing of competing goods, competing values. Just that. Yeah, like that's an example from my world yeah.
- [19:54]
Dr. Nathan Carlin
It would seem to be irresponsible on your end if you didn't probe, if you didn't ask. Right. Because you don't want to accept somebody at face value. Then they walk out and then they die by suicide or something like that.
- [20:09]
Dr. Dan Koch
Right.
- [20:20]
You've hinted at this other thread besides your book that I want to bring into the conversation and we can sort of come to it and come back to it, whatever. But the reason I reached out to you is actually doing some research around this piece. I guess probably by the time this comes out, it'll be two months ago. It was the Atlantic's September issue, so maybe it came out in August, but it was their main feature. It's, it's like an hour long read. It's like a 44 page article and it's called Canada is Killing Itself. And it looks at, you know, I'll summarize the article here briefly. We'll have a link to it and if people want to read the whole thing. But for the purposes of our conversation, it is exploring Canada's Medical Assistance in Dying program, which is shortened to MAID as an acronym, MAID, which was legalized in 2016. It has rapidly expanded from serving terminally ill patients to including those with chronic conditions that are not terminal. So chronic conditions that will not result themselves in a patient's death. And soon, potentially, it is gonna be opened up to people purely with mental illness or psychological disorders. And already before that change, the MAID program accounts for about one in every 20 Canadian deaths, which is more than Alzheimer's, more than diabetes. And the piece in the Atlantic profile some doctors and patients navigating this new landscape, showing how assisted death has become this, like, normalized part of medical practice for some, a real sense of meaning or vocation. Now, we are very much in your world, Nathan. Right? Vocation, That's a religious term. And the article just sort of raises some unsettling questions about autonomy versus other values. What happens when the power to heal is. And the power to end a life converge and are held by the same people? I mean, I just. This makes me immediately think of your analysis around, like doctors and medical professionals as clergy, as sort of having this highest sense of authority, maybe besides judges or something like in the, you know, in the criminal system. Okay, we give them a lot of authority, but like kind of right below a judge would be something like your doctor, your surgeon, your oncologist, like this kind of thing in the modern mental landscape. Anything you would change there or nuance?
- [22:53]
Dr. Nathan Carlin
No, I would say that's a Remarkable article that you picked up on just before. Just another association that I had. Just what you're saying about judges. I first got interested in the idea of secularization during seminary. I went to Princeton Seminary, and there was a sociologist there named Richard Fenn. He's kind of an unusual sociologist. He's more interpretive, not empirical in anything. But he was also sort of very psychoanalytically sort of oriented. And I just loved Fenn. He was just great, you know, and one of his early books sort of was on your point there about judges, and it was called Liturgies and Trials, you know, the relationship between a church liturgy and a judicial trial.
- [23:40]
Dr. Dan Koch
Interesting.
- [23:41]
Dr. Nathan Carlin
And so I just wanted to kind of flag that, you know. Yeah, but on the article that you've picked up on, I would say that it is so valuable for the stories that it's telling. You know, these are fresh and new. It's disturbing. You know, the stories are disturbing. But the light that's being shown here is very much needed that we have a related problems sort of in the United States, in Canada and all over the world, where we have rapidly aging and expanding aging sort of population, just huge, paired with social support systems that are profoundly unequipped to deal with the problems that are coming. And it's just going to get worse much faster, you know.
- [24:34]
Dr. Dan Koch
Can you give us some concrete examples of what you mean, like what types of services are in the coming, let's say, 10, 15 years, do you think are going to be overwhelmed and sort of beyond their ability to handle the need?
- [24:47]
Dr. Nathan Carlin
I would say, you know, for the article, the vignette that was just so sort of devastating, and I'll lift it up and it would just be sort of case after case after case. Like this one here. This is Sand Bookman. And the article says not everyone has coastal homes or children and grandchildren who can gather in love and solidarity. So this is sort of coming after, you know, these tends to be rich, educated, white people who want to die in a peaceful way. So he's saying, yeah, not everyone has these coastal homes and children and grandchildren who can gather in love and solidarity. This was made clear to Sandy Boukman, a palliative care physician in Toronto, during one of his early maid cases where a patient, all alone, gave final consent from a mattress on the floor of a rental apartment. Boukman recalls having to kneel next to the mattress in an otherwise empty space to administer the drugs. It was horrible, he told me. You can see how challenging, how awful things can be. So what I'm saying is that's the end result. Like if you just look at Americans now, like people in the United States Now 50% of Americans, this is just regular people, this is not aging people. Just 50% of Americans have no savings. They're not living paycheck to paycheck, right? So then you push people with no savings into retirement and Social Security is sort of not going to be able to sustain everything. So just very basic question is where are people going to live? Where are they going to live? And then with advancements in sort of medicine in general, with advancements of different kinds of medications, like say medication for cholesterol, high blood pressure, diabetes and things like that, we can in a very sort of relatively easy way expand the lifespan. A whole population that then eventually ends up disabled and they're unable to work, unable to pay for their housing and then they become disabled. And then, then what do you do? What do you do if you're in that situation? Especially if you're estranged from your children or grandchildren, you know, but who do you turn to? And if the answer is no one in Canada, what this journalist is sort of pointing out is in Canada, then it's like, okay, well then I can make a phone call and I can have maid, you know, like that's not sort of allowed here in the United States. You know what I mean? That's not allowed. But it's, it's an, it's an interesting, if that's the right word, that's one word for it, experiment in Canada. You know what I mean?
- [27:26]
Dr. Dan Koch
Well, I mean in one way it's like letting the fucking market decide, you know, it's like that is literally a big part of what's going on is like the, it's a market decision. And, and like that just feels, you know, like in my circles of like left leaning Christians and former Christians, I'm like the pro capitalism guy. I just like regular capitalism. Not unfettered, but I just don't think there's been a, yet a better way of exchanging goods and services other than for money. This is not the kind of use of the market I'm in the market for. It's, it feels like so ill equipped to the task. Just like that doctor was in this empty rental apartment, like essentially giving last rights with no training to do so. You know, I think about the way that like sometimes nonprofit and other social services providers, especially like the, the lower level employees of these organizations, like they have so much vicarious trauma because they are the front lines for like the individuals, you know, in US cities who are struggling the most with physical, mental health issues, stuff like that. And they don't have the kind of training that I have around dealing with that trauma and not becoming secondarily traumatized and all the self care and talking with supervisors and consulting with colleagues, like all these buffers that are built in there and, and you know, there are people who are trained to sit with people while they're dying in poverty when everything is shitty and it's just the worst moment. They're called fucking priests. They're pastors, they're clergy, they're chaplains. We have those people. That's not the person who was in there. I mean, maybe there could have also been a chaplain or something. You could imagine a slightly better scenario. But like, it's like role confusion, it's. There's a lot of chaos sort of as I try and get my mind around this reality. And if you're right about these trends, then we should anticipate more such chaos and less clarity or at least greater market pressures that are going to sort of squeeze a bunch of underprivileged individuals into these inhumane, ultimately for many of them, inhumane paths. And I can say that while also recognizing the power of the first story you told of the burn victim guy, which like some people, it does make sense. So, so you can't just, I don't think you can just cut it off on one side or the other and turn it into black and white, but the stakes, they are so high, you know.
- [30:14]
Dr. Nathan Carlin
You can listen to the rest of this episode by joining the patreon@patreon.com Dan Koch.
- [30:23]
Sam.