“A good many times I have been present at gatherings of people who … are thought highly educated and who (are incredulous) … at the illiteracy of scientists. Once or twice I … have asked how many of them could describe the Second Law of Thermodynamics. The response was cold. Yet I was asking something which is about the scientific equivalent of: 'Have you read a work of Shakespeare's?'”
C. P. Snow (1905–1980) The Two Cultures (Snow, Reference Snow1959)Introduction
The academic palliative care pendulum has swung too far.
It is laudable to generate hypotheses and to measure, analyze, and research cause and effect. Over recent years, a number of palliative care journals have changed publishing houses or editors and changed the character of their journal. These journals now emphasize statistically based studies with a dearth of nonstatistical articles. Their impact factors appear to have gone up, although given this is a self-referential system, it does not necessarily reflect knowledge or indeed, wisdom.
It comes back to what questions should the palliative care community be asking?
Certainly, we should use the scientific method to study the clinical effectiveness of cannabis; the use, efficacy, and abuse of psycho-tropics and analgesics; and whether psychotherapies are beneficial or not.
However, there are different types of questions less amenable to scientific rigor. Not so much the quantity of life as, the Nature of life.
Take depression. We can apply screening, diagnostic, and severity tools to measure depression and its treatment, and will publish papers with p-values. Sadly the reader will be little the wiser in knowing what it feels like for the patient to be depressed. However, were I to read a description of depression, from William Styron, I would know.Footnote 1
In the epigraph, C. P. Snow describes the battle between two cultures — the artistic and the scientific. Long ago when the body and the soul were considered as one, there was no such distinction.
The artist tends to describe an individual or a moment in time and use that to build a principle. The scientific approach seeks to know the subject by studying many objectified data points and then makes a generalization, a law.
Feynman, however, took a broader view of Science: “And that is what science is: that it is worthwhile rechecking, by new direct experience, and not necessarily trusting the [human] race('s) experience from the past … Science is the belief in the ignorance of experts … It teaches the value of rational thought as well as the importance of freedom of thought. There is the beauty and the wonder of the world that is discovered through the results of these new experiences.” (Feynman, Reference Feynman1968).
Surely the artist is also subject to the principles outlined by Feynman. Every artist worth his salt has challenged and questioned the previous generation. Every artist aims to reveal beauty and wonder.
To help understand this long-standing conflict, I shall make use of two books: “The Rose” by Charles L. Harness (1915–2005) and “Literature and Science” by Aldous Huxley (1895–1963).
C. L. Harness
Charles L. Harness was an American patent lawyer who wrote some influential and enduring science fiction works. “The Rose” arguably his best known was published in the UK in 1953. In the book, he pitted the arts against the sciences. The protagonists were a husband and a wife, Martha and Ruy Jacques.
Martha the Scientist declaimed:
“There are certain well recognized approaches to the appreciation of poetry … You ought to have the autoscanner read you some books on the aesthetic laws of language. It's all there … Scientific rules for analyzing poetry. Take the mood of a poem. You can very easily learn whether it's gay or somber just by comparing the proportion of low-pitches vowels — u and o, that is — to the high-pitched vowels — a, e, and i.”
Ruy, the Renaissance man, pontificated:
“Science is simply a parasitical, adjectival and useless occupation devoted to the quantitative restatements of Art. Science is functionally sterile; it creates nothing; it says nothing new. … There exists no scientific truism that hasn't been anticipated by creative art … the highest aim of man is not to analyze, but to synthesize – to create.” (Harness, Reference Harness1969, pp. 36–39).
Harness took extreme positions to illustrate the divide. Science tries to understand the beauty of poetry by analyzing and dissecting down to its constituent atoms, maybe missing the big picture. Science relentlessly dissects in order to build a new picture of understanding. Artists describe the eternal truths of the world by combining ideas to create a new vision.
A. Huxley
Huxley identified a curious paradox. That the more science advanced, the more it studied objects not directly available to the five senses, the more it became metaphorical and abstract. The electron and the photon, the "things" of quantum mechanics, cannot be apprised by our senses — yet they are functional and reproducible. He was wryly observing that at the end of the day both Science and Arts deal with the mystery of the abstract world. One could express this differently. That both artist and scientist use their imagination in order to create and to discover. Imagination is the essence of abstract thought.
Maybe Science and Art are more similar than either admits to.
Huxley made another interesting observation. We have emotional experiences that are private but others that are more public. Science deals with our shared public experiences — plagues, architecture, and bushfires; while art delves into private emotions such as sadness and relationships (Huxley, Reference Huxley1963, pp. 4 and 5).
Huxley reminded us that “Blake (18th century) and Keats (19th century) … detested Sir Isaac Newton (17th century) because he had cut the old connections between the stars and the heavenly host … and so had de-poetized the world and robbed it of meaning.” (Huxley, Reference Huxley1963, p. 111). Their critique of Newton is not strictly true. They were heuristically making the point that the power of science should not leave behind the wonder of nature. An amaryllis flower can be described and defined by its DNA. However, its glorious red color, and pistil provocatively displayed in front of the stamens, dancing in the breeze, cannot be described scientifically. It is not a matter of one precluding the other. The challenge is to perceive both, as one and fully complementary.
Concatenations
Science and its laws; the arts and their idiosyncrasies: both are Truths. One without the other is like the body without the soul; like the mind without the brain. At first glance, we might think the arts seek meaning and science provides explanations. However, both approaches — science and art — position ourselves in the universe and allow for meaning-making.
Einstein said it clearly: “The most beautiful thing we can experience is the mysterious. It is the source of all true art and all science.” (Einstein, Reference Einstein2021).
Rene Descartes (1595–1650) was the first to address the mind–body problem in its modern formulation. Descartes identified the mind with consciousness and self-awareness and distinguished this from the brain (physical). Hence two separate entities, Cartesian Duality.
Many modern philosophers, however, consider the mind to be a natural consequence of the brain and disclaim dualism. Others note that the nature of consciousness makes it unlikely that it, consciousness, is simply a product of the brain. (Chalmers, Reference Chalmers2010).
Breitbart wrote about God and science: "I am a scientist and a palliative care physician who is in awe of the material world but I am also a human being who will continue to wonder and explore what lies within, without and beyond." (Breitbart, Reference Breitbart2005).
Conclusion
The journal Palliative and Supportive Care has steadfastly honored the balance between science and the arts — or as Breitbart put it, between science and God. In the process, it has lead the search for truth. Leaving room for — nay, encouraging — poems, personal essays, idiosyncrasy, and reflections to remind us of the raison d'être of palliative care and psycho-oncology and for what purpose there is the “p” value.
There is no answer to the philosophical question as to why there is a divide. A suggestion is that in resolving tension we achieve resolution and a form of unity. A set piece.
A palliative care physician is scientist and artist who treats suffering which is a combination of physical and psycho-spiritual characteristics. Metaphorically, science is physical and arts is psycho-spiritual. It is an unfinishable struggle to keep science and arts together, not just an additive venture, but synergistic.
We could do no better than conclude with Huxley's passionate and curious insight: “Thought is crude, matter unimaginably subtle … That the purified language of science, or even the richer purified language of literature should ever be adequate to the givenness of the world and our experience is, in the very nature of things impossible. Cheerfully accepting the fact, let us advance together, men of letters and men of science, further and further to the ever-expanding regions of the unknown." (Huxley, Reference Huxley1963, p. 118).
Conflict of interest
No funding was received in the writing of this article and there are no conflicts of interest.
