Zukier Henri
Graduate Division, Program of Jewish Studies, Rothberg International School, The Hebrew University of Jerusalem, Jerusalem, Israel.
J Relig Health. 2016 Dec;55(6):2174-88. doi: 10.1007/s10943-016-0280-1.
The practice of medicine relies on a combination of two very different sources, and requires two kinds of talents: a cognitive-instrumental, knowledge-based and disease-centered approach; and a psychological, expressive-relational and patient-centered approach. Throughout the centuries, the mix between the cognitive and expressive dimensions, and the relative emphasis given to each approach, has varied considerably. Current evidence-based medicine privileges the cognitive-performative dimension. The recent developments within medicine are indicative of the inherent and lasting tension between the cognitive and expressive dimensions. Not surprisingly, then, related terms of debate are also apparent in medieval rabbinic discussions of medical practice. However, the rabbinic and medical traditions resolved the tension in very different ways. This paper explores a conceptual link between the modern dynamics of the cognitive and the socio-relational dimensions, and a complementary rabbinic controversy starting in the thirteenth century, originally between Maimonides and Nahmanides, both physicians. There are significant interactions between the modern evolution in the roles of doctors and patients, and the rabbinic approaches to physicians and illness. The mapping of the two debates about doctors and patients suggests that the tension between science and soul, and the dynamics of integrating them, has characterized medicine through the ages, though they can lead to different outcomes.
医学实践依赖于两种截然不同的来源的结合，需要两种才能：一种是认知工具性的、基于知识且以疾病为中心的方法；另一种是心理性的、表达性-关系性且以患者为中心的方法。几个世纪以来，认知维度和表达维度之间的结合，以及对每种方法的相对重视程度，都有很大差异。当前的循证医学优先考虑认知-执行维度。医学领域的最新发展表明了认知维度和表达维度之间内在且持久的紧张关系。因此，毫不奇怪，相关的辩论术语在中世纪拉比关于医学实践的讨论中也很明显。然而，拉比传统和医学传统以非常不同的方式解决了这种紧张关系。本文探讨了认知维度和社会关系维度的现代动态之间的概念联系，以及始于13世纪的一场拉比之间的补充性争论，最初是在迈蒙尼德和拿单之间展开的，他们两人都是医生。医生和患者角色的现代演变与拉比关于医生和疾病的方法之间存在着重要的相互作用。关于医生和患者的两场辩论的映射表明，科学与灵魂之间的紧张关系以及整合它们的动态过程，一直是贯穿各个时代医学的特征，尽管它们可能导致不同的结果。
