knowing the body: abstract reason vs direct experience

Through my entire life I was never interested in American or Western history. I studied the history of Japan and Korea at Columbia and then for eight more years at UCLA. That was a long time ago, but I have been thinking more about the body and I have returned to history. However I have become a kind of somatic historian.

I have been researching the shoulder very deeply, and my hypothesis requires that I study the history of how the shoulder has been thought of. This has taken me deep into American and European medical history. But lately I have been looking more broadly at issues of knowledge and what is rational.

What does it mean to understand anatomy? What does it mean if we fundamentally misunderstand something as simple as the shoulder? What does it mean to understand our own body better? Why is it that scholars can talk about the shoulder in their patients, in dissected corpses, and in the work of other scholars, but they cannot talk about what it means in their own bodies? How can we know the truth of a basic anatomical debate like the current one over the definition of the shoulder, without ever referencing our own body?

In studying the history of how the human shoulder has been described throughout history, going as far back as anatomical writing from 1708, my interest in American and European history has been sparked. I am interested in how different people saw the shoulder in different ways and it seems to me that it has a lot to do with their beliefs about what is rational. For some, there is a very clear commitment to a sense of a larger cohesive structure and of the mystery of the interconnectedness of the body. For others the structure, the mystery and even the facts of anatomy are subordinated to a rigid sense of higher order.

In the case of the shoulder it is a belief that the ambiguous muscular connection of the scapula to the rib cage, must be subordinated to the “true” clavicular joint, because this to conforms better to the classical definition. Although the scapula is a common mammalian structure, it is unique compared to other bones and does not conform to any of the classical categories of joint typology.

I came across Thomas Paine from 1794 and his famous book, The Age Of Reason. It is the most concise critique of religion and mythic thinking I have ever read. While it is a critique of religion and Christianity in particular, it nevertheless affirms a belief in God and shows a real sense of respect for Jesus as an example of a very good man. While it is a critique of religion, and a very interesting one, it is more important as an expression of the nature of modern reason, of enlightened and moral understanding grounded in observable truth. Even if you just read the first few pages, you will see it is startling and feels very relevant today.

While I am looking very specifically at the problem of the false anatomical definition of the shoulder that is dominant today, on a deeper level my work is about the problem of medicine and more generally how we think about the body.

These more somatic and structural medical scholars have always emphasized very strongly that the scapula is the center of the shoulder. Others have taken more reductionist view and tend to focus on the importance of the clavicle for anchoring the arm to the body, although on the face of it, this is a ridiculous claim in terms of bony mechanics. The joint between the sternum and the clavicle on the front of the chest, however, is a very weak one.

The clavicle is not a strong mechanical anchor for the arm. Many mammals, like horses and dogs, do not have a clavicle. Despite this, the clavicle is given priority over the scapula in medical descriptions of shoulder anatomy.
The scapula is a large and muscularly very powerful bone attached very securely to the rib cage. In mainstream medical scholarship it is not currently considered to be the functional center or anchor of the shoulder.

In contrast, the connection of the scapula to the rib cage on the back, although a very unusual type of joint sometimes referred to as a false joint, is large and heavily muscled. It is clearly the bony mechanical anchor and base of the arm. This debate is the topic of my research, but through it I have become more interested in the larger epistemological problems of how we can know the body.

This is related to a philosophical debate between rationalism and empiricism. Rationalism finds truth in abstract reason and sees mathematics and physics as the best example of this. But it is clear that the medical scholars I am studying were also seeking a sort of greater truth in the sensory motor system of the body. This is related to a philosophical standpoint called empiricism, in which sensory experience is understood to be an important source of moral and scientific truth.

I have been looking at David Hume, a British philosopher from around the same time as Paine. His Enquiry Concerning Human Understanding was published in 1748. He is interesting to me because he argued powerfully against abstract reason in favor of experience as a source of truth. This is a little bit closer to my own position as a somatic thinker and is also much closer to the thought of the medical scholars that are important to the scapulocentric history I am studying.

The sciences have tended to emulate this supremacy of abstract reason, but this tradition of abstract reason is not the only one by any means. Hume’s philosophy is an example of this. The dominance of abstract reason has produced an approach characterized by methodological reductionism and objectification of the body, with dire consequences for medicine as it underwent explosive institutionalization and professionalization in the 20th century.

Despite tremendous improvements in pharmacology, molecular biology, and imaging technologies in the 20th century, modern medicine has lost sight of the important fact that the body is a profoundly interconnected living system of systems that heals itself. The problem of the false anatomical shoulder is a particularly clear casualty of this historical bias and to understand this basic error in perspective we must revisit many of our accepted beliefs about what is reason and how we know things.


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