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Abhidhamma, Alasdair MacIntyre, dharmaśāstra, Friedrich Nietzsche, Hebrew Bible, law, Pali suttas
In After Virtue, Alasdair MacIntyre once said that “it is the lawyers, not the philosophers, who are the clergy of liberalism.” That is, in modern societies – liberal in the broad sense – it is lawyers who do the work, and have the status, once given to the medieval European Christian priesthood.
On this point I think MacIntyre is half right – or perhaps three-quarters right. He is quite right to note the low status that the modern West accords philosophers; but he overemphasizes the role of lawyers, because his concept of the good is (to my mind) overly political. Lawyers do play the role of medieval clergy as the rulers’ intellectual assistants in determining what a good state will be in practice. When it comes to the good life itself, however, the intellectual heavy lifting is done by a very different group: namely doctors, and medical researchers. It is medicine, not law (and certainly not philosophy), that plays the greatest role in telling moderns how they should live.
Law merely sets the boundaries, limits beyond which our lives may not go. Medicine tells us far more: what we should do within those boundaries. The point is most obvious in the case of psychology, which has always aimed to tell us what we must do to avoid a miserable and wretched life; now, in the days of positive psychology and happiness studies, it goes further and aims to tell us what a good life is. But it’s not only psychology. The other branches of medicine also tell us what kind of work to do (don’t do something too stressful), instruct us how to spend our spare time (exercise, don’t go out in the sun too long), and provide us with an arcane and ever-fluctuating set of prescriptions on how to eat that make kosher laws and dharma??stra look simple. (At least Leviticus is not supposed to keep changing.) The idea of health has, in practice, become one of the most important concepts in the normative ethics of Western life, the ways we think about how we should live. Sometimes we even think about happiness for its health benefits rather than as an end in itself.
Academic philosophy, however – and “continentals” don’t seem much better than analytics here – has done little to bring the concept of health into dialogue with the rest of our ethical worldview. (Nietzsche, for whom “healthy” was always an important term of ethical praise, is a major exception, though empirical research may have disproven much of what he thought was healthy. But then Nietzsche tends to make himself an exception in many ways.) “Bioethics” or “medical ethics” deals with something very different – ethical decisions made by medical practitioners in extreme situations, not the ethical implications of medicine for everyday life. Bioethicists think about how ethics guides medicine, not about how medicine guides ethics.
For their part, medical researchers, like most scientists, typically claim to be value-free – they’re just telling us about cause and effect, about what phenomena cause us to be healthy or unhealthy. But the normative weight of the concept of “health” is the reason we use it so much – we wouldn’t pay doctors and medical researchers so much to tell us how to be healthy if we didn’t think that, other things being equal, health is a very good thing. And the kind of cause-and-effect relations that the medical sciences establish are not so different from what some philosophers have tried to establish. From the start the Buddha’s teachings, as recorded in the Pali suttas, dealt with psychological causation: suffering is caused by craving. The project of establishing psychological causation becomes even clearer in the Abhidhamma.
We haven’t done nearly enough, it seems to me, to think philosophically about the claims of medicine. What role should health play in our conceptions of the good life? When should we do what is healthy, and when should we ignore our doctors’ advice and seek out competing goods?
How often do we really do what is “healthy”, and how often do we instead seek out competing goods? People are terrible at sticking to diets, even at sticking to prescriptions. How often do you hear, “No brandy or red meat? Eh, I’d rather die sooner than have no fun”? And every doctor complains about how our healthcare system is terrible about preventative care- which means terrible about general health.
It may be that we don’t have a health-driven society: instead, we have the patina of one. This raises questions about the historic origins of this trend. When did health start being such a major focus of our culture? (Though “when” is just a means to get at “why”.) Is this a 20th-century, baby-boomer, marketing-driven phenomenon? Have we just focused so much on health because it’s one part of the good life (or, perhaps, “another part”, after toy acquisition) that can be commoditized and paid for?
But while this discussion is interesting, it only tangentially addresses your main point, which is whether we *should* value health so much. I’ll put my thoughts on that in a second comment later.
As promised, a more direct answer, though I don’t know if it’s a good one.
Health has to play some role in the good life- after all, if your health is bad enough (or nonexistent), there’s not a whole lot else you can do. This very danger, the steep consequences of its absence, make it easy to focus on: it’s easier to fear sickness/death than boredom.
Is that a wise way to weigh things? To some extent, it’s not really an answerable question: it’s a matter of value, a judgment question, and different people can honestly give different answers. Adam will gain more out of being in healthy shape, while Bob will gain more out of enjoying those cheeseburgers. Of course, that’s a cheap answer: part of the mission of philosophy is to work past the judgment errors that arise in such unconsidered decisions. But I’m hesitant to offer such a philosophical answer, because in this case the details are everything. How certain are we that diet/medicine X will appreciably improve health? How much else must be sacrificed to follow through with X? These are answerable questions, but only for each individual X.
I would imagine that people frequently make mistakes about the value of health to their good life, but I imagine that those mistakes don’t differ systematically from the mistakes we make about other potential sources of ‘goodness.’ IIRC, people do tend to have disproportionate/irrational preferences to avoid losses- which could translate to a magnification of factors motivated by fear, as I described above. In that way, it’s possible that people do put too much weight on health. But I suspect that in most of our decision-making processes, small and large, we’re just as afraid of other losses as we are of health losses.
You’re probably right that this is not something that can be answered in the general case. Health is one of the many goods that we’re likely to seek, and while a certain amount of it is a prerequisite for the others, the particular priority that each good gets is going to have to be determined case by case. (That may turn out differently for those with a more radical conception of value – as in the case of medieval mystics who drank the water used to wash lepers – but few of us are in their company now.)
I wonder how much the fear of losses is really irrational. If I recall the happiness studies research, when we gain some new external goods, we get a brief happiness boost then return to a set point; but when we lose them, our happiness goes down and stays down. (The hedonic treadmill.) Since health is something that we’re very likely to progressively lose, that might actually be a sensible reason to put a high priority on it.
“I wonder how much the fear of losses is really irrational.”
The context of this statement comes from the so-called “neuroeconomic” study of decision-making. To oversimplify, it means people behave as if losing $10 is more bad than gaining 10$ is good.
There’s definitely a long discussion to be made about whether this is “really irrational”, but that all depends on what you consider rational. It’s quite plausible that wise decision-making is not quantitatively balanced. But that just begs the question; the “irrationality” is wherever the judgments stop matching the quantitative risks and rewards.
I think the hedonic treadmill may explain health past a certain age, but not for many decades of our lives. But on reflection, that leads me to realize that we (as a culture) have fused health with other aspects of happiness, such as attractiveness. This is actually pretty reasonable, but it also seriously occludes any attempt to determine how much 16-30(or whatever)-year-olds actually value health per se.
On health and attractiveness: good point. I remember someone recently commenting that a heart attack was implicated in Dr. Atkins’ death, and said “so much for that diet.” But I added: was Atkins thin when he had the heart attack? If so, the diet worked, because it was never supposed to make you healthy, just thin.
On rationality, yes, it does depend on what you consider irrational. But as far as I can see, it’s significantly more irrational to be concerned with external sources of pleasure – like money – than with whether you’re actually happy. (Homo economicus makes himself miserable.) And psychological studies tend to indicate that we lose more happiness from loss than we receive from gain; so behaving as if that’s the case is a good reflection of the truth. I guess you could take the rationality question to a meta-level and ask whether loss should lose more happiness than gain increases; but it does seem to me that the answer is yes even there, in at least some cases.
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