This article appears in the May 2002 edition of the Catholic Medical Quarterly
Shamans and Charlatans: A history of the mystery in medicine
A talk presented at the Guild 2002 annual symposium
Andrew Papanikitas BSc DHMSA
This article aims to give an extremely broad social history of fringe-medicine, perhaps to see why 'Shaman' and 'Charlatan' are two words that have been associated with 'alternative' healers down the ages. The article uses one notable historical example to illustrate this view.
A Shaman is described as a primitive healer, a tribal physician or a witch doctor by the Oxford Companion to Medicine. By comparison a 'charlatan' is described by the Oxford Compact Dictionary as a person falsely claiming knowledge or skill.
I will neither give a description of Native American spiritual medicine, or how to bluff being a doctor, but suggest that to apply either of these terms in a general history is somewhat unfair.
As heretics are unthinkable without religious orthodoxy, so 'quacks' could be seen as the result of a medical orthodoxy seeking to define and enforce a 'proper' mode of medical practice. In former centuries, it makes more sense to distinguish the doctor from the quack on the basis of legal, and professional exclusion, than in terms of the scientific standing or the success rates of the treatments given.
It would be 'as the late Roy Porter put it- historically misleading to imply that official medicine has always been competent whereas fringe medicine has always been ineffectual or fraudulent. The regular profession has often appeared mercenary and domineering, and until the 19th century it could not reliably counter life-threatening diseases, so no wonder that the alternatives have been popular down the ages.
In pre-modern times orthodox and fringe medicine both evolved a certain showmanship. Orthodox healers cultivated a gentlemanly bedside manner, the use of Latin and Greek as mumbo-jumbo, ancestor worship such as the Hippocratic oath, and grave rituals like feeling the pulse or urine-gazing 'a professional shaman. This would seem not dissimilar to the quack's black cats, snakes or neologisms. Certainly historians dealing with practitioners who operated in an unrestricted or varied 'medical market' refer to healers rather than physicians. After all, the physician prior to the 19th century would have practised an art alien to the 21st Century doctor.
Here I must confess to generalising somewhat. Some treatments, as well as the theories behind them might be seen through modern eyes as both effective and the reasoning behind them rational. At times when there were few effective cures however, comfort, reassurance and the placebo effect formed a major component of successful therapy both amongst regulars and irregulars. The boundaries between fringe and core have been fluid 'fringe practitioners have sought to at least bask in the prestige of the establishment, and in the past people have entitled themselves with names like doctor or professor questionably with this end in mind. Conversely orthodox medicine may assimilate fringe practices, such as phrenology and mesmerism in the past, and acupuncture today, perhaps to prevent the loss of patients en masse to alternative medicine. A Roy Porter aptly put it, boundaries between the physician and the shaman, if not the charlatan, have been social rather than scientific.
There are a great many examples of the above phenomenon, but I shall pick one example from history because it illustrates how the shaman, and possibly the charlatan interacts with history'
Theophrastus Phillipus Aureolus Bombastus Von Hohenheim, is usually known by his assumed name Paracelsus. Born to Wilhelm Bomabastus and a local bondswoman in the Swiss village of Einsiedeln, he was nominal Catholic who adopted, and was adopted by the Protestant reformation of the sixteenth century. He is best described as an itinerant healer and is said to have lived from 1493-1541. He has been called the 'Luther' of medicine, been regarded a physician, a pioneering chemist, mystic and magus. His writings are not exclusive to medicine they include religious and social reform. An we have an eyewitness to some of his life in the form of Oporinus, his amenuensis.
Paracelsus began practice in Strasbourg, but in 1527 he cured a wealthy publisher and was appointed town physician and professor of medicine in Basel with the help of his new patron. He refused to take university's oath, or submit his qualifications although he claimed to be a doctor of 'both disciplines'. He refused to wear academic robes, but taught his own syllabus in German, and even admitted barber-surgeons to his lectures. I should point out that at this time Latin was the official language of medicine, and this was just one way in the medical elite was kept exclusive. Needless to say Paracelsus was introduced to this 'establishment', and upset everyone in authority that it was possible to.
The contradictions in the historical Paracelsus, show how tempting it is to label him as a charlatan. He advocated progression in medicine, but talked about elves and fairies. He advocated universal charity, but his denouncements of others were hate-filled propaganda. He held that wisdom came from experience of the universe and not learned texts, yet he wrote constantly and published in German to all and sundry.
He introduced laudanum, sulphur, lead and mercury into western therapeutics and popularised salts and tinctures. He is also is credited with associating cretinism with endemic goitre, and distinguishing mental defect from acquired mental illness. Some of his cures may actually have worked. He took advantage of print, and the used the protestant reform to give his approach an evangelical quality. Given all of the above, he was naturally fashionable with the rich, and while he had money and an influential patron, he could be as obnoxious as he liked. Paracelsus represents someone getting the best of both worlds, membership of an elite club and no inhibition from self-promotion. Naturally he was despised.
It appears Paracelsus refused to do anything 'by the book'. He added fuel to the proverbial fire by burning the 'Canon' of Avicenna on St John's day, and offended the professional elite in every possible way, not least by popularising the practise of medicine, and opening lectures to personae non gratae such as surgeons and apothecaries. He was a liability, and relied solely on his one patron, Froben the Publisher. After Froben died, possibly due to mercury poisoning, Paracelsus rapidly became unpopular among the influential.
So how has history viewed Paracelsus? Certainly Historians are rarely neutral. He is 'the Chemist' as far as the British medical journal is concerned. In a speech on such matters, Prince Charles, referred to him as an 'alternative healer'.
The Nazis laid claim to him as patriotic because he wrote in German and favoured German folk cures, and Godwin and P.B. Shelley regard him as one of the 'necromancers'.
So was Paracelsus a shaman or a charlatan in the context of his day? Arguably both, possibly neither. Many of his cures were chemical but the theories behind his medicine lay in a notion of invisible powers betwixt man and nature in an enchanted universe. This is something which we risk losing sight of, that a sensible treatment might have a rationale behind it which is now recognised as completely wrong or even insane. However reports about him and writings ascribed to him seem contradictory, and many of his cures were probably just as lethal as the physic of the day
Putting any debate about efficacy to one side, why has fringe medicine enjoyed such a huge and lasting appeal? By being forced out of the elite world of medicine, fringe medicine was actually placed in the most fertile ground: a capitalist market place, which orthodox medicine, with its ethical and professional goals, has chosen to deny itself. With the advent of trade, travel, print and now the internet, that market has grown exponentially, but that's the cynical side.
Fringe medicine moved into an area of human experience and need largely abandoned by orthodox medicine, which increasingly treated just the body, in ways often unintelligible to the patient. Modern medicine is also increasingly couched in terms of probabilities both in terms of diagnosis and treatment. By contrast alternative medicine actually appealed to a sense of the whole person 'the unity of mental and physical, and sometimes two other unities: the oneness of the person with the world and the co-operation between patient and healer. Perhaps people prefer mystery to uncertainty. As Roy Porter puts it, 'Quacks often spoke in languages that people understood.'
- Porter R, The Greatest Benefit to Mankind, HarperCollins, London 1997
- Porter R, Medical Cults, in The Oxford Companion to Medicine, Oxford University Press, Oxford 1994
- Porter R, Religion and Medicine, in The Companion Encyclopaedia to the History of Medicine, Routledge, London 1993