Health care is both failing and succeeding because of modern medicine's quest to cure by separating the social from the medical, even as physicians incorporate complementary and alternative therapies into their practices. Successes are evident in the cures of biomedicine. Failures are seen in the distribution of these cures and the care of the chronically ill and disabled. The Cartesian legacy of curing the mechanical body inherently excludes the biographical, social, skillful, embodied person who inhabits a particular lifeworld, the world as experienced or lived. The disabled and chronically ill require daily care that may be either supported by a nurturing lifeworld or worsened by one filled with violence and poverty. Modern medicine as curative system honors disengaged reasoning to both isolate disease and secure freedom from the entanglements of the social world, including systems of shame and blame for illness. A disinterested clinical gaze, initiated in medicine by Bichat's (1771–1802) successful scientific methods of dissection, objectifies the patient's disease. Many cures are achieved in this tradition. However, medicine can effect cures only if supported by reasonably well functioning lifeworlds with caring practices that sustain the patients. A positive lifeworld may entreat a person to recover; a chaotic, deprived lifeworld may offer little promise or incentive for recovery. Pain and disability infringe on a person's self and lifeworld, even as they may be ameliorated by a supportive lifeworld. Cure of a disease or quiescence of a chronic illness are not the same as recovery from an illness and the regaining of a livable embodied relationship to world and others.

Unfortunately a clinical gaze has the tendency to be totalizing, in that it recasts all other forms of understanding or explanation, and may extend both to the one who gazes and the one gazed upon. How can medicine relate itself back to the person's embodied world without turning an objectifying, disenchanting clinical gaze on the richness of the person's world?

Syncretism—the attempt to reconcile differing principles or practices—turns curative medicine and lifeworld care into a single-paradigm medicine that runs the risk of imperialistically colonizing the patient's self-understandings and lifeworld into pathologies, procedures, and cures. The primacy of care and lifeworlds in preventing illness and promoting healing and recovery are distorted when they are reduced to elemental medical cures. Instead of syncretism we need a symbiotic or synergistic dialogue, which will include evaluating what is harmful to health both in the lifeworld and in medical cures. Technical cure and restorative care need not be mutually exclusive. Choosing between the powers of nurture within lifeworlds and therapeutic medical interventions is unwarranted. The question is: How do we synergize the strengths of each?

One way to encourage equal dialogue between medicine and lifeworlds is to understand the healthcare professions as practices that encompass more than the science and technologies used to cure. Aristotle began this dialogue when he contrasted the logic and nature of techne and phronesis. Medicine and nursing as healthcare practices require both techne and phronesis. Techne, or the activity of producing outcomes, uses a means/ends rationality where the maker governs the thing produced by gaining mastery over the means of production, often standardizing the means in the process. In medicine, techne, characterized by procedural and scientific knowledge, is made formal, explicit, and certain—except for the adjustments needed for particular patients. Phronesis, in contrast, depends on relationship and is the kind of engaged practical reasoning that requires discerning the human concerns at stake. In medicine, phronesis is the practical reasoning of an excellent practitioner, who as a member of a community of practitioners, experientially develops and improves practice.

This dialogue between techne and phronesis furthers a synergistic dialogue between biomedicine and complementary and alternative therapies. The goal is to avoid domination, subordination, or an incoherent syncretism. A subjugating discourse reduces the richness and resourcefulness of phronesis to standardized techniques and control. Syncretism between biomedicine and lifeworld healing practices misuses the strategic aims of biomedical cures. Medicine becomes a dominating curative paradigm and cures are conflated with healing and healing relationships. And as Michael Polanyi noted in his book Personal Knowledge, we can create an untenable syncretism when we import curative, prescriptive recommendations into the empirically discovered health benefits garnered from social and sacred worlds.

Religious rituals can allow participants to dwell in meanings, creating integration and wholeness. However, if religious rituals are viewed as superstitious or as having a placebo effect, they are reduced to a therapeutic dialogue about the integrity of a physiological system rather than wholeness experienced in a person's life. Discovering that belonging to a religious group and engaging in religious practices correlates with good health outcomes cannot be translated into a scientific warrant for "prescribing religion for health," even though one might find healing and comfort in a religious quest for wholeness, integrity, and faith. Likewise, the practice of prayer is diminished when reduced to its efficacy claims.

In a more secular example, discovering that rich social networks and friendships correlate with health benefits led the California Department of Health to mount an advertising campaign suggesting that "Having a friend is good for your health." While this is often true, developing friendships "for your health" may not be experienced the same way, or offer the same benefits, as being engaged in long-term meaningful friendships on their own terms.

The skillfulness of diagnostic and therapeutic interventions depends upon the physician's relationship with the patient in at least three crucial ways: (1) The relationship and the emotional climate of the physician-patient encounter determine what aspects of the patient's ailments and suffering can or will be disclosed. (2) Knowing the patient in his or her lifeworld uncovers contributions and restraints to recovery. (3) The physician's caring practices and rhetorical skills determine what information the patient will hear from the physician about diagnosis and treatment, and how the physician may or may not help the reintegration of the person back into her lifeworld. All three require both phronesis and techne. The physician must learn to be critically reflective about what a detached concern or clinical gaze discloses, what possibilities it creates, and what it excludes. (See Jodi Halpern's From Detached Concern to Empathy: Humanizing Medicine.) When the clinical gaze spreads out into all areas of the patient's or physician's life, engagement in the world is diminished. A consistent style of detached observation prevents adequate engagement for phronesis—living out one's concerns and being in relationship with others, or experiential learning that fosters character and skill development while opening one's world.

As human beings, we engage in constituting and sustaining worlds for others and ourselves. Cartesian medicine as science and technology derives much of its power and efficacy from overlooking the world of the patient/person suspended in webs of human care. But this does not mean that medicine can afford to ignore the symbiotic and synergistic possibilities in human families, communities, and religious practices. Nor will simply annexing them to medical regimens create a respectful dialogue, one that encourages caring and healing practices or a critical examination of unhealthy aspects of our lifeworlds.

Works Cited
Joseph Dunne, Back to the rough ground, practical judgment and the lure of technique (Indiana: University of Notre Dame Press, 1997).