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History of Therapeutic Nihilism

In the 19th century, some leading physicians questioning medical care itself. This led some of them to think that existing drugs and medical treatments useless. This was the start of therapeutic nihilism. Therapeutic nihilism was first considered to be a global disease, more concentrated in English-speaking countries. It was also thought to have a greater effect towards males, elders, and people dedicated in the medical field, but less towards children and females. A paradoxical characteristics of therapeutic nihilism is that despite being a mental affection, it only affects the sound-minded.

Historically, therapeutic nihilism was divided into three categories: acute, sub-acute, and chronic. However, the clinical categorization among different classes of therapeutic nihilism was not determined clearly. In the past, it was thought an unknown “germ” that disrupts the brain to cause therapeutic nihilism. The germ was not considered fatal but also very difficult to observe in a microscopic view, which limited its investigation to autopsies. Yet, the symptoms were relatively conspicuous. Having been most prevalent among the medical profession, people with therapeutic nihilism were found to neglect all the contemporary studies, discard literatures such as books, and disregards the physician’s advice. Instead, they gain a sense of superiority and wisdom, thinking they know what the public don’t. Scientists believed the best way to overcome the noxious nature of the disease was to abide to heroic medicine—which was the prevalent medical treatment of the 19th century—and continue studying to perfect the therapeutics of the treatment. Once the patient did not overcome the noxiousness of the disease, he was thought to fall into chronic therapeutic nihilism and never recover. Heroic medicine was there to relieve the severity, but death—although very rarely occurring as a result of the disease—was thought to be the only ways of terminating the suffering. As a result, until the early 19th century, therapeutic nihilism was met with much contempt from the medical society. Believers of therapeutic nihilism were described as “zealous,” and that their excess of zeal has hindered other physicians from exercising reasonable therapeutics.(Book)

However, towards the late 19th century, therapeutic nihilism was gaining more and more popularity amongst the medical society. More and more leading physicians were criticizing the medical practice as “privileged monopoly” and claimed that every man should be his own physician through democratization of knowledge. Cultural critic Matthew Arnold describes that “the stream of tendency of modern medical thought was toward a therapeutic nihilism.” The most preferred treatment method by the public was taking active medication. When cocaine was first discovered, it was described in the medical literature to have curative properties towards diseases such as gastralgia, childbirth, and nasal hemorrhage. Some, without question or doubt, were dosing newest medication or receiving newest therapeutics. Others preferred taking the same medication repeatedly, in other words, routine therapy. When performing routine therapy, the doctor’s role was simple and easy. For the people who were taking heavy dosage of medication and receiving newest practice of medicine, the doctors were considered “heroic.” If the therapeutics was successful, the physician received credit, but for unsuccessful cases, the patients were considered “unfortunate.” Thus, there were growing concern that physicians only had theoretical knowledge but lacked sufficient experience in practice. Contemporary physicians such as Roberts Bartholow were stating that “the science of therapeutics should be made more certain” and that the “true knowledge of drug knowledge is not widely enough diffused.” In other words, the medical treatments of the 19th century have gained theoretical acceptance but was lacking in practicality. When faced with everyday exigencies, more and more physicians were left clueless. In 1888, the ratio of medical practitioners to the US population was one to 580, an unprecedented statistics. The medical society officially recognized their mischief when the president of the American Medical Association stated that there are “odious defects in the American medical education system.”(NEJM)

Therapeutic nihilism reappeared a century later in the 20th century, but in a slightly different fashion than that of the previous century. The aggressive empiricism of the 19th century has enlightened the medical society of the need to thoroughly evaluate every aspect of clinical practice. Increasing number of physicians grew skeptical of their ability to treat diseases. This led them to think that drugs and medical treatments are not only useless but also harmful to the human being in long term, and that people should rely on the natural healing capacity. Naturally, a physician’s most potent weapon for treatment was not medication, but to regulate the bodily secretions such as extracting blood, promoting perspiration, or urination to regain the natural state of equilibrium.(Stanford) One example of an ardent therapeutic nihilist was Ivan Illich. Therapeutic nihilists claimed that great increase in life expectancy and public health was not due to the contribution of medicine, but because of the improvements in the standard of living; improved nutrition and sanitation enhanced the natural healing capacity of mankind. It was also noted that there was an excess of hospitals and doctors, performing unnecessary surgeries and over-prescription of antibiotics and drugs. They claimed such excess often led to malpractice and an increase in iatrogenic (doctor-caused) injuries and was accused of creating even more illnesses.(Starr) Therapeutic nihilism had mostly faded by the mid-20th century, and researchers have concluded that “therapeutic nihilism was replaced by an armamentarium of therapeutic inventions.”(Cerebrovascular Disease: New Insights for the Healthcare Professional)