Reviewed by Tyson Sukava, University of Winnipeg (t.sukava@uwinnipeg.ca)
Given the increasing scholarly attention to ancient medicine and its cultural context over the past decade or so, Susan Levin's project investigating Plato's changing impressions of medicine and its relationship to philosophy is both important and timely. During the fifth and fourth centuries BCE Hippocratic writers were particularly concerned with defending the status of medicine as an independent, specialized, and superior technê ("rational purposive discipline" as Levin defines the term's meaning in Gorgias). Plato had similar designs for his philosophical model, and as a result we find both parallels and tensions between the two disciplines. Levin concentrates upon competing claims to authority in two particular areas: nature (phusis) and flourishing (eudaimonia). Her core argument is that Plato initially exploited medicine's intellectual cachet as a vehicle to support his developing claims about philosophy's functions and benefits; he then subordinated the technê of medicine to philosophy more aggressively in later dialogues, until medicine's status qua technê was tacitly revoked in Republic; finally, in Laws, Plato restored this status through a re-evaluation of physicians' place in his model city, Magnesia. Levin's project is therefore not aimed at comparing the particular methodologies and theories of medicine and philosophy per se, but at elucidating the increasing friction between the two disciplines in Plato's dialogues and his eventual resolution of the strife. Levin begins her study in medias res among Plato's works by first examining Gorgias, before proceeding to Symposium, Republic, Statesman, and finally Laws. This produces an elegant narrative. By limiting her core discussion to these five dialogues, Levin is able to rely upon conservative relative dating to demonstrate changes in Plato's responses to medicine (5 n. 1). Some space could have been spent at the outset on an overview of some of Plato's earliest impressions of medicine, for example Ion 531e and 537c and Charmides 156b-157d, although Levin does refer to these in later notes. Timaeus, an eccentric dialogue that deals extensively with medicine, is also omitted from concentrated analysis for thematic reasons, presumably because of its emphasis on medical theory as a way to explore philosophical concepts rather than on explicit analysis of the profession's position in the hierarchy of human endeavors. Since it is probably one of Plato's last dialogues, an examination of its privileging of medicine might have provided further context for Plato's reappraisal of the medical technê in Laws.1 Problems concerning chronology, authorship, geographical origins, and transmission of individual medical writings contained in the Hippocratic Corpus are far more difficult to negotiate. As Levin acknowledges, some treatises contained in the collection were composed later, but she again follows conservative scholarship that a majority of these texts—those that she relies upon most—date to the Classical period. Furthermore, at least as it pertains to broad notions about the functions and proper status of the medical art, there does exist a homogeneity across most of the collection (43 n. 6). We can be less certain about the degree of Plato's familiarity with concepts either identical or similar to those that survive in the Hippocratic Corpus. (At Phaedrus 270a-d, Plato famously alludes to the theories of the historical Hippocrates; however, attempts to connect these remarks to specific Hippocratic works have remained inconclusive.) By demonstrating conceptual parallels, Levin works under the defensible view that Plato was familiar with the core tenets of the medical milieu reflected in surviving Classical-era Hippocratic treatises (19 nn. 42, 43). This is ultimately sufficient for Levin's purpose, since her project centres around Plato's impressions of medical practice as he saw it, not around claims in any specific medical writings. Chapters 1 and 2 concentrate on Gorgias. In Chapter 1, Levin postpones concentrated discussion of medical thought in Plato's dialogues to explore Plato's earliest articulation of what a technê is and the human endeavours that meet his criteria for it. Levin illustrates how Gorgias, Socrates' main interlocutor in the dialogue, cannot justify his claim that his trade, rhetoric, is in fact a technê as Socrates defines it (satisfying his criteria of subject-matter, understanding, and goodness: 19); it remains an empeiria (knack). As such, Gorgias cannot support his position that rhetoric is at the apex of human skills. On the other hand, according to Plato medicine stands as an epitome of a technê, since it fulfils all of the normative criteria. Yet to Plato it remains subordinate to philosophy because maintenance and treatment of the physical body is secondary to that of the soul (the domain of the philosopher), which should be of the highest importance. The crux of the issue is each discipline's ability to regulate epithumiai ("desires") for sex, food, and drink, which Levin frequently refers to as "The Big Three" (27). Chapter 2 examines in greater detail reasons for Plato's favourable treatment of medicine in Gorgias by illustrating parallels between Plato's definition of a technê and approaches described in select Hippocratic writings. In anticipation of further schism between Plato's philosophy and medicine, Levin also demonstrates that Hippocratic writers were sometimes inclined to promote "The Big Three" desires for the sake of bodily health (i.e. eudaimonia in a physical sense). For Plato, these practices are necessarily detrimental to the well-being of the soul, and thus antithetical to the aims of the philosopher. In Chapters 3 (Symposium) and 4 (Republic), Levin argues for the increasing subordination of medicine's status as technê in Plato's dialogues. In Symposium, the tone and broader purpose of the physician Eryximachus' speech has often been debated. Previous assessments of the speech as a parody of bombastic medical talk undervalue its significance (73). Using Hippocratic works to establish parallels, Levin argues that Eryximachus' discussion of eros demonstrates Plato's profound reservations about physicians' confidence in going beyond the confines of their profession into areas where they have no business (i.e. philosophy). In Gorgias and even more forcibly in Symposium, Plato resists physicians' claims that their knowledge of bodily (viz. material) phusis also puts them in a position to know the path to eudaimonia, which Plato holds is properly the intellectual domain of the philosopher. Chapter 4, likely the most provocative of the book, argues that this line of thought led Plato to withdraw medicine's status as technê in Republic through the demotion of physicians to the producer class; yet, as Levin is careful to stress, this move is only implicitly made (138). In Plato's model city Kallipolis, philosophy alone can claim technê status (111). The flourishing of the city requires the infallible oversight of the philosopher-king(s) over all aspects of human endeavours, including medicine, since they alone know the Good (131). Those who do not know the Good are ignorant about all goods (138-9), so they cannot be permitted to work autonomously, which is a necessary criterion for Plato's definition of technê. Physicians' circumscribed professional activity is by itself insufficient to foster eudaimonia. In Kallipolis the medical discipline includes treatment but excludes maintenance (regimen), which is an important aspect of Hippocratic medicine. Two particularly important threads in this chapter are Republic's claims that the quality of treatment is in part dependent upon the "caliber of the doctors' souls" (126); and that medical attention should be withheld in serious (but not necessarily terminal) cases, either when a patient's contribution to the city qua his profession is impeded (118-19) or when a patient is "psychically corrupt" beyond redemption (136). As Plato would have it, philosophers are the only arbiters of such states, and this severely undermines physicians' autonomy. Chapters 5 (Statesman/Laws) and 6 (Laws) are especially important contributions, since scholarship concerning Plato's relationship with medicine has all but neglected these works. Levin tracks Plato's eventual reinstatement of medicine's technê status in Laws. Key to this change are Plato's re-evaluation of the average layperson's abilities and his acceptance of the potential fallibility of all humans, including philosophers. As such, Plato adopts a more collaborative and transparent approach to the flourishing of a society. In Laws' model city Magnesia, the education (paideia) of its members ensures that they would have the requisite tools to make sound judgments about a wide range of issues. Although these changes have broad ameliorative effects across professions, medicine comes out particularly well: in Laws physicians are no longer in competition with any other group over their claims to phusis and eudaimonia (177-8); and they alone of the metics are permitted to stand as specialist jurors for certain cases (204-5). Further, because of the increased emphasis on paideia, fruitful dialogue is promoted between doctors and patients in their shared search for proper courses of treatment. This collaboration is strengthened by several conditions that would foster transparency of physicians' activities to ensure that any particular physician's mistakes in clinical care would be brought to light (208-9). Chapter 7 makes a convincing case for why exploring Plato's treatment of medicine from Gorgias to Laws is relevant to modern studies of bioethics. Levin surveys scholarship on modern bioethics that has looked to Plato and Aristotle for insight, and demonstrates that these studies have tended to overlook the significance both of Plato's changing views of physicians' place within society and of the particular concepts he posits in Laws. Further, a crucial issue in modern bioethics is the conflict between two extremes of clinical care: the paternal model (in which the doctor's authority is paramount) and the autonomy model (in which the patient's judgment is paramount). Levin is not claiming that Plato's Laws offers the correct solution (213). Rather, her intent is to suggest that there is some value in considering Plato's attempt to mediate the complex doctor/patient relationship in medicine through the education of laypeople and the transparency of clinical care within and outside of the profession (258). Plato's Rivalry with Medicine is aimed at a broad audience, beyond scholars of ancient philosophy to bioethicists and medical historians (4; the OUP web page also includes doctors and nurses as other potential readers). Those without specific backgrounds in Plato or ancient medicine might find themselves disoriented at times by some of Levin's more nuanced discussions; however, these instances are few, since the author takes special care to ensure the work's accessibility, and the most dense scholarly comments are reserved for the footnotes. Key concepts and terms are defined in the body of the text, all Greek is transliterated, and both the occasional select Greek passages and individual words are translated for the reader. A robust glossary of Greek terms is included at the beginning of the work (xi-xiv), as is an index locorum to Platonic dialogues and Hippocratic treatises at the conclusion. Plato's Rivalry with Medicine is a well-argued, intellectually challenging, and edifying work that is accessible to a wide range of readers. The fresh light that it shines upon the professional location of physicians within Laws' Magnesia is a particularly valuable contribution, made all the more so by Levin's arguments about how Plato eventually arrived at that point. Of no less importance, though, is Levin's demonstration of how the works of Plato – and ancient thought more broadly – can provide useful insights for exploring contemporary philosophical issues in productive ways. It is my opinion that Levin has achieved this here, and I look forward to seeing further discussion that the book promotes.
Notes:
1. For a useful discussion, see Laura Grams, 'Medical Theory in Plato's Timaeus,' Rhizai 6 (2009), 161-92.
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Funny that the book, judging from the review, doesn't take up the Timaeus, the most medical of the dialogues! The only note to the review is a study on the Timaeus...but shouldn't it have an important place in the book?
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