Heart Series, Pt. 2: How Do We Know What We Know / Epistemology

Epistemology is more than a four letter word! How does the WAY we seek truth influence how we see our bodies, and our health?

In an age where science is constantly overturning what we thought we knew about the body, and new theories come out every day trying to explain new phenomena, one theory remains unchallenged. Since 1628, when Harvey published his seminal text on the circulation of blood, we have believed more or less the same thing about the heart. But what if the heart isn't a pump at all? And what if it's time that we update Harvey's ideas? In this installment, Dr. James Mohebali goes to the "heart" of the issue, and examines how our underlying beliefs about what it means to be human can color our understanding of the medicine we use. We take a stroll through epistemology, and see how the seemingly simple question of "how do we know what we know" can completely upend our relationship with our own bodies and with one another. Touching on quantum physics, imaginary plants, Chinese family altars, our relationship to scripture and our ancestors, reiki, biofield therapy, and more, we discover that there's a LOT more at stake in the "heart" question than just what a particular muscle is doing inside your chest.

Like what you're hearing? 💪Support our channel! 💪

COOL STUFF I MENTIONED IN THE SHOW:
Vivisection Video — https://youtu.be/n6sTWOU5d6M?t=246
"Classic of Difficulties" on Acupuncture Channels & Scripture (clip from Ep. 3) — https://youtu.be/W2aMndaLqEE
"Classic of Difficulties" Ep. 3 Full — https://youtu.be/uRyUKpB6-gw

"Parallel Botany" by Leo Lionni — https://amzn.to/3gSk1Yf

Flexner Report (PDF) — https://archive.org/details/carnegieflexnerreport
Flexner Report (Print & Kindle) — https://amzn.to/3aOdbPF

Overview of Protagoras' Life and Philosophy — https://iep.utm.edu/protagor/
Plato's "Protagoras", where he disproves Protagoras (Print) — https://amzn.to/3aOdbPF
Plato's "Protagoras" (html) — http://classics.mit.edu/Plato/protagoras.html

📬 Want to hear about our newest projects? Join our mailing list

🎬 Check us out on YouTube

Music Credit:
"Let Yourself Be Huge" - Cloudkicker (under Creative Commons License)

Transcript

Greetings and welcome to “Classic of Difficulties: Difficult Questions in Medicine, Acupuncture, and Beyond”. I am your host, Dr. James Mohebali. I’m a doctor of acupuncture and Chinese medicine, and I will be your armchair-philosopher-in-residence and your tour guide as we try to ask some difficult questions about medicine, health, alternative medicine, and maybe the meaning of life. My goal in this podcast is that, by asking and unpacking these tough questions, we will maybe leave with a couple of answers, but we will definitely leave with more questions than we had at the start.

This is episode 6: The Heart, part 2: How Do We Know What We Know?

If you tuned in for our last episode on the heart, part one of this four part series, you heard some of the evidence that the heart might not be what we think it is, and might not do what we think it does. We talked about alternative theories, we talked about conspiracies, and we talked about the history of the pump theory. And, having heard all that, I know what you’re thinking: “This evidence is pretty convincing, but does this guy really believe that the heart isn’t a pump?”

Well, the answer is “No.” I don’t believe that the heart isn’t a pump. In fact, I don’t believe that much about the anatomical nature of the heart. Why? Because I haven’t seen a living heart jumping and bumping, and maybe pumping, away. And, you know what, most of us haven’t seen one. There are some fascinating videos, that are increasingly difficult to find, of old timey educational movies of the heart that show vivisection of a variety of animals. I’ll link to one in the upper part of the screen for you YouTube viewers, and in the description for you podcast listeners.

There’s a lot of phenomena, a lot of stuff, that they can show you in those videos. A lot of interesting and difficult to think about anatomical facts. The kind of facts that we would need to reconcile if we were to have theory of the heart. Like, one of those facts is that the heart keeps beating despite having no blood flow going to it, and it keeps beating even when it’s removed from the body. And fragments of the heart keep beating even when they’re cut apart from the rest of the extracted heart. Or that arteries squirt in little bursts and veins don’t. This kind of information can give us a lot to think about in terms of anatomy. As we mentioned in the last episode, the heart leaves a lot of unanswered questions about anatomy. And even if we reject the pump theory, we still need to replace it with something. That’s going to be the subject of the fourth installment, by the way; what kind of scientific style, anatomically driven theory can we replace it with?

But part of the question is really: how much does anatomy, does the physical appearance and attributes of the human body, inform our understanding of the human body and human physiology? I mean, there’s a lot more to being human than being a bag of organs and parts, right? After all, there’s mind, there’s spirit, and there’s this whole biography of your life, everything you got done, all the people you met, all the impact you had on the world. What about all that? Well, Western medicine would argue that the physical structure, the anatomy of the human body, is the beginning and end of all investigation into the human experience. Obviously they don’t completely discard mind, spirit, and biography – they just demand, for example, that we root the mind within something physical. Usually when we’re talking about mind, they try to find it within the brain. And that we root the biography in something physical – like, the way a smoker’s lung looks all gross during autopsy because of all those years of smoking, or, the way that great doctors get plaques and paintings of themselves and physical stuff with their name on it in the hospital lobby. It’s really the same thing, in a way. The physical realm, the anatomy is the alpha and the omega; the most important thing for a doctor to know is what stuff looks like when you cut it apart and look at it with your eyes.  It doesn’t matter what kind of question we’re asking, whether it’s about a broken leg, about your first true love, or about God, we need to root it physically in Western medicine. So by cutting and dissecting and by laying our eyes on what’s hidden, we can bring light to the hidden and observe it, revealing the true nature of things. That’s also the meaning of phenomena, according to the Greek etymology, the thing that has light thrown on it.

Without getting all “quantum” on everybody, let me use a clarifying example as to why this might be a problem. Someone you know is in a dark room. Maybe it’s your brother. And he’s in there. You occasionally hear sounds from the outside the door – like typing on a keyboard, like the rustling of papers, the sporadic gentle crunching of what sounds like cheetos. We don’t know exactly what your brother is doing in there. It could be anything. It probably involves some papers, that would be a good guess but we really don’t know. So you kick open the door. I mean, you could have knocked, but where’s the fun in that? You kick the door down. You shine a really bright light on him. You’re holding a scalpel for some reason, you’re staring at him intently trying to take in as much information as possible in the smallest amount of time, and, for what it’s worth, there’s a bunch of med students behind you also looking right at him.

What’s your brother going to do? What will your brother look like when all of this happens to him? I don’t know, I don’t know your brother. He will definitely be surprised, he will definitely act weird, and it will definitely not be the same as the thing he was doing before you came in. If he had a Cheeto in his mouth before you kicked down the door, he might still be chewing a Cheeto, but otherwise I doubt he’s going to keep eating once you come in. And he’s certainly not going to be looking at any of those papers now. So, whatever he was doing, whatever he was up to, he’s definitely not going to be doing the same thing after you come in. In fact, given the situation, it’ll be nearly impossible to draw meaningful conclusions about what he was doing. It’ll take a lot of legwork to put together a picture of what he might have been doing, but no matter how much legwork we do, anything we come up with will all be very speculative. Really, given our method of approaching your brother in his dark room, a fundamentally destructive method, there are certain insurmountable obstacles to understanding his secret life.

In case it wasn’t clear, all of this is an analogy for what we have to do in order to understand the body anatomically. We need to cut open things that aren’t designed to be cut open, we need to shine bright lights in places that have never ever seen a bright light, and again, weren’t designed to see bright lights. We need to stare and examine and try to take in as much information as possible in a very short amount of time, when life is actually best observed over a long stretch of time, a lifetime you might say. In fact, in contrast to the surgical minutes or hours, some would say that the best unit for measurement of an individual life would be the whole thing start to finish. Other people, like the Chinese, and maybe certain Native American tribes would argue that you can’t really know about anything until you take it several generations out – like the five generations on a Chinese family altar, or the “seventh generation” idea attributed to the Iroquois. So we can’t just cut things up and shine light on them and expect to understand them. It doesn’t matter how good we are at dissection, how advanced our instruments are, or how many people we get involved; the whole method has these deep philosophical flaws that we can’t get around.

In the same vein as our discussion on cutting and snipping, there’s a fascinating book called “Parallel Botany” by Italian author and illustrator Leo Lionni. It’s a botany book that he wrote about imaginary plants. It’s pretty nifty. It’s replete with imaginary botanists, imaginary history, and even imaginary science about these imaginary plants. Like he talks about a tree that grows sheep, for example. And he cites a variety of historical sources where this sheep growing tree was first discussed. But here’s the thing, none of those historical sources are real. It’s quite a fascinating undertaking, and a very interesting book. In the book, he claims that imaginary plants generally have no interior anatomy. The reason he gives is that, if you cut into an imaginary plant, you haven’t accessed the inside of the plant, what you’ve done is that you’ve actually just created a new exterior. Two new exteriors, to be precise. And then you cut again, and you now have three new exteriors. And even if we repeatedly cut over and over again into infinity, what we do is we just create an endless series of new exteriors.

In truth, the same issue could be raised about dissections of real plants, or of real animals, or even of real humans. The inner world of man, both the inner world in the sense of our literal insides, but also in the sense of our spiritual world, this inner world cannot be accessed and it certainly cannot be evaluated using means for discovering and evaluating the external world. External things need external techniques. Internal things need internal techniques. So in order to access and understand the inner world, we have to develop and train the tools that are appropriate for examination of inner-worldly things. Just like an artist has to train their eyes to perceive the external world correctly in order to paint it, in order to understand the inner world we have to train our inner eyes.

What am I even talking about with all this? I am talking about epistemology! Which is just a fancy word for asking “how do we know what we know?”

So, how do we know what we know about the human body? What do we think is a valid source of information about the human body and about its inner workings?

There are a lot of possible valid sources of information, depending on how you think about the world. It really depends on your perspective and what you personally value. History is littered with philosophers with differing opinions about epistemology. Long story short: they all had different epistemologies, they all disagreed with one another, and a person could make an argument for any of them being totally and completely right. That’s philosophy, right? It’s a lot of fun.

Since I’m a doctor of Chinese medicine, and I obviously think it’s pretty cool, and since I suspect it answers some questions about the heart that regular scientific western medicine has trouble answering, I think it would be a good place to start. So what then is a valid epistemology for Chinese medicine? Or, in other words, how do Chinese medicine doctors know what they know? Well, first and foremost, we have these classical texts. These scriptures. Same word as Holy scripture. This word, scripture, and this concept comes up in episode 3, when I talk about the fact that acupuncture channels themselves are referred to as “scripture,” —check out the link for that—but we also have scriptures that are just normal books. Like The Huang Di Nei Jing, like the Nan Jing, which, the word jing, is the same word as Dao De Jing, and Yi Jing, also known as I Ching. What are these texts, what are these scriptures? They are a bunch of ancient words written down by some ancient guy and passed down to us by our dads and our granddads and our moms and our grandmas too. That’s right, we Chinese medicine doctors, we actually believe what our ancestors passed down to us. We think that your Granddad was probably right! Which, by the way, this reliance on traditional, ancestral belief is the exact epistemology that Flexner tried to destroy in the Flexner report. The Flexner report, by the way, is a report funded by Carnegie and Rockfeller that is probably the single most important document in the history of the creation of modern Western medicine.

So we in Chinese medicine rely on our ancestors, and we rely on our classical texts. The often cryptic statements written in these texts, which are probably over 2000 years old, these statements inform our medical thinking. But anyone who has read a text that’s 2000 years old knows that, no matter what, there’s going to be some room for interpretation. And these texts of ours, they’re written in a 2000 year old form of Chinese that no one really speaks anymore. So there’s even more room for interpretation. And of course, we don’t just have like this perfectly preserved book that’s just sat on a pedestal somewhere undisturbed for the past 2000 years. Our version of these scriptures is actually from the Song dynasty, which is only like 1000 years ago. So, on top of all that interpretation of the words, if something doesn’t make sense to you, you can always say that it’s just an error in the text! But we can tell from historical record and all kinds of scholarly wizardry that the version we have today is probably pretty good. And, besides, it’s the version we’ve all been talking about for the past 1000 years, so, even if it’s not very good, then at least we’re all still on the same page.

You can see that the simple answer of “believe what your ancestors told you” actually becomes very complex very quickly. No one said epistemology is easy!

Part of how we figure out these scriptures is by using the commentary left by other smart people over the years, and what they thought about the scripture. After all, they are a lot closer in time period, perhaps closer in lifestyle and closer in culture, and they did have the opportunity to think about text for a while. And they decided that, whatever they thought about the scriptures was true enough and important enough that they should write it down for all posterity. But even these commentators often disagree with one another. So we try to rationally make heads or tails of it, comparing one to the other: “Oh, that guy is an eleventh century neo-Confucianist, of course he thinks that.” “Oh that guy, he’s a Daoist from the Tang Dynasty.”

But, even looking at these commentators, we have to ask ourselves where did these commentators get these ideas? And how do we know which commentator to listen to? Ultimately it comes down to an inner compass. Somewhere within myself, I have a compass that can point me to what’s true and what’s false. One could go wild with this idea, and say that “man is the measure of all things,” like Protagoras, the Greek philosopher, did. I personally choose to keep it a little reined in. But then, of course, the question becomes which compass do we use? Descartes liked using the rational self alone. He figured that only through thinking can we make our way around, and know what’s true and what’s not. Some people like using their emotional self as their compass. They think the best movies are the ones that make them sad, or perhaps, depending on the person, the ones that make them happy. They think that the best medicine is the one that makes them happy. They think that the best experience of God is one that’s exciting, and makes you laugh and brings you to tears, and shocks you and all that. Some people think that the best compass is something else entirely, they use the idea of “nous” which is a Greek word that could be translated as intellect, or maybe even intuition. The idea of nous is that somewhere between thinking and feeling, and definitely outside of both of these, there’s this organ that we have where we can witness ourselves doing those other things. We can watch ourselves think, we can watch ourselves feel. And I don’t mean thinking about thinking, which is a very Cartesian thing to do. There’s this quiet and meditative state that people are always trying to get into with their spiritual and meditative practices. People call it watchfulness, mindfulness. Intuition. That’s the nous, hard at work.

Of course, for most people, especially when we start out trying to figure things out, our nous, our intuition isn’t any good. It needs to be refined, it needs to be trained, and it needs to be guided. So, in order to do this, we sit down to read the classics, we sit and read a bunch of commentators, we think a bunch of things, we form our own opinions about these things using our mind. We take these thoughts, and we take them out into the real world. We go out to the clinic to see patients. To engage with life and with disease and suffering. And then all of a sudden, with your new thoughts rattling around in your mind, and your patient in front of you, something deep inside of you clicks. There’s like this deep chord of TRUTH that just resonates through your whole body. Whereas the thoughts were bouncing around in your mind, your head, and didn’t really feel like very much, when you’re looking at this patient, the thing you experience is like this full body experience, like WHOOSH. Like, it’s so intense and so physical that you can almost hear a dramatic movie sound effect in the background when it happens. It’s like that thing you read comes alive when you look at the patient. Not because, when you look at the patient, you have some additional thought, some rational sequence of words that happens to explain something better than the words you had before. It’s because you have this direct immanent experience of something, some truth. It’s right in front of you, and it’s awesome and it’s meaningful and it’s new (at least to you). The scripture, those commentators, and all that cogitating you did, all of those things have come together and they have opened your eyes to seeing the world in a way that you never saw before. And then, afterwards, you can’t unsee it. Once you experience that truth with your nous, that truth is part of you in a way that thoughts and words never could be.

At that point, since your realization, your new knowledge, didn’t come in the form of a neat rational thought, you now have a project in front of you. Your goal is now to try to squeeze that profound, transcendent realization into a tidy, conveyable rational thought. Because what good is the realization if you can’t share it with other people? In the process of trying to wrap this new realization in a sentence, you’re trying to capture something dynamic and alive. Sometimes as you wrangle with it, you actually end up killing the realization. You lose it, and you forget what the realization was. Other times, you manage to capture a part of it, even if it’s just a small part. And, since you captured it using your words, you can then tell it to someone else, and then they get a glimmer of it. And the process repeats from there. It’s this ongoing dynamic process. It’s fascinating, and it’s thrilling. It’s the basis of human connection, and in Chinese medicine, it’s actually the true meaning behind the “heart.” Reaching out, experiencing, and trying to process it all, so that we can share it with others, only to reach out again, and experience again, and go through it all over and over and over. That’s life, and that’s part of why the heart is at the center of life.

SO, returning to our discussion of epistemology and the heart: why would we start to discard the theory that the heart is a pump? The main reason we would want to is that the mechanistic theory doesn’t make sense to us. Not just rationally, in terms of the phenomena and the evidence, but because there’s something in the theory that just doesn’t sit right. It doesn’t jive with our nous. Something feels wrong about it, and we can’t place exactly what, but it’s just never hit that deep chord of truth. Maybe the difficulty comes because you’ve heard a bunch of other people, both ancient and modern, talking about their emotions using the word “heart.” Like “sadness in my heart,” or “weighing heavy on my heart,” or “heartache” (In fact, in Chinese, the written characters for anger and grief actually have a little heart radical inside of them, a little picture of a heart). Or maybe the theory doesn’t sit right because you’ve heard a bunch of people, especially spiritual people, like saints, monks, gurus, and so on, people you respect because they kind of seem to know what they’re talking about, and they’re all talking about opening the heart as the path to happiness, to nirvana, to heaven, and that idea of the heart just doesn’t jive with this notion that the heart is a mechanical, soulless pump. Or maybe the pump theory doesn’t sit right with you because you have had these feelings in your chest. Because of your own personal experiences having a heart. You might get these weird pains in your chest sometimes. This cramping tight feeling when you get anxious. Or maybe a light, bubbly feeling when you get happy. You have felt so many different things in your chest and in your heart, and all of these things you’ve felt are things that anatomy has absolutely no response to. They can’t say why any of them happen. And the vast majority of these feelings have nothing to do with pumping. So, your doubt about the pump theory comes, simply, from the fact that it can’t explain your direct human experience. The real reason we seek new things and new theories is because something within us says, “there’s more out there. There’s more meaning, there’s more purpose, and there’s more to the heart.”

You might notice that all of this doesn’t sound like an epistemology that’s limited to Chinese medicine. I don’t know about you, but to me all this sounds pretty natural, and pretty ubiquitous from country to country and culture to culture. You can find it in the Far East, you can find it in the Orthodox Christian East, you can also find it in the New Age west; you can find even find it in Aristotle, despite his love of rational thought.

And, medicine is just philosophy in practice, right? It only follows, that if we think in a certain way, if we think of ourselves, our human experience, and our human bodies in a certain way, then our medicine should reflect that thinking as well. If medicine is just how we think about and treat human suffering, then it ought to be based in our definition of what it means to be human, and what it means to suffer. This is, after all, what Descartes sought to do in the 1600s, the same as Liu Wan-Su, in China, sought to do in the 1100s, and, arguably, what Carnegie and Rockefeller sought to do through Flexner in the 1900s.

It’s very important that our philosophy matches our medicine, and that they aren’t in conflict. Why? Well, let’s look at an example. One thing that’s increasingly common nowadays is biofield research. What this research aims to do is figure out how the electromagnetic field produced by people’s bodies, especially their hearts, can be used to scientifically understand things like non-contact healing and energy healing. The electromagnetic field of the human heart, for example, is usually detectable by scientific instruments from across the room from someone. There are some very cool studies on this, and a lot of these studies “prove” that non-contact healing actually works. But the problem with this approach is that pesky word, “proof.” Because when we try to take science driven, enlightenment epistemology, and we try to apply it to the intimate, the personal, the esoteric, we risk losing something important or getting confused in the process. We risk forgetting what our ground really is, and what we really believe in. What do we believe in with non-contact healing? We believe that the spirit of one human being, the immaterial part, or at least the less material part, can have a profound connection and a profound impact on the spirit of another human being. We believe that the spirit is really the foundation of health, and that the body is secondary. That it doesn’t matter how “healthy” your body is if your spirit is suffering. That human connection alone, deep, mindful human connection, is capable of healing suffering. And, most importantly, that the immaterial can overcome the material. That the miraculous is possible.

Suffice to say, I don’t think Descartes would agree with us! Just by adopting the methodology that belongs to scientific medicine, we already risk these things. When we do this kind of scientific analysis and research, especially when it’s focused on “proof”, all done using the wrong epistemology, we risk throwing out the thing that’s actually the most important to us. Namely, we risk losing sight of our own definition of what it means to be human.

So my question to you, dear listener, is: “does the way you think about your body, your soul, and your meaning of life match the way that your medicine thinks about your body and your soul and your meaning of life?” And, further, “does the way that you personally acquire knowledge and seek out truth in the world match the way that your medicine seeks out truth?” Again, does your search for truth look like your medicine’s search? If the answer is yes, then great! Keep on doing whatever you’re doing. But for most of us, the answer is “no.” And for those of you who answer “no,” my challenge to you is to figure out “if there was a medicine that thought about life and acquired knowledge in the same way that you do, what would that medicine look like?”

Maybe it’s a medicine that exists already, but maybe not. Lots of people over the ages found that their unique perspective was not totally captured within any existing medical paradigm. I gave some examples earlier, like Liu Wan-Su, or Descartes. Or perhaps Rudolf Steiner. Or maybe Andrew Still, founder of osteopathy. Or even David Palmer, founder of chiropractic. All of these people had a truth within them that they thought wasn’t being expressed in the current practice of medicine. So they tried to create that thing that they thought was missing.

But it’s not just the doctors, even though they’re the ones that go down in the history books. It’s the patients, too. After all, what’s a doctor without any patients? The patients are almost more important than the doctors in a way. Because they’re the ones that put their sickness, their health, their life on the line. And they say, for example, I don’t believe that I’m a walking bag of chemical reactions and mechanical pumps. I think that there’s something more to life, and I want my life, personally, to mean something more than that…

Epistemology, as it turns out, is more than a big word to be tossed around to impress your friends! As we heard today, it can make a big difference in our lives, and it bleeds into everything, including our medical theories and medical decision-making. Is the heart a pump? I don’t know, but I certainly hope it’s not!

And this brings us to the end of episode two of our Heart quadrilogy. We haven’t even gotten to the Chinese medicine yet! In our next installment, we will do a deep dive into the Chinese medicine — here’s a teaser: in Chinese medicine, the question of what the heart does gets even more complex. Why? Because Chinese medicine believes the body actually has two separate hearts! Have I blown your mind yet? All that and more in the next installment. However, next episode, we will be giving you a little break, a little detour, and we’ll focus on a totally different topic. Who needs hearts anyways? So be sure to tune in next time to Classic of Difficulties. As always, keep asking questions, and stay difficult!