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THE CURRENT CRISIS OF MEDICINE AND SCIENCE
By Tarek Ali Hassan   
Rated "G" by the Author.
Last edited: Thursday, September 27, 2007
Posted: Thursday, September 27, 2007

THE CURRENT CRISIS OF MEDICINE AND SCIENCE

AND THE PLACE OF MUSIC

THE CURRENT CRISIS OF MEDICINE AND SCIENCE
AND THE PLACE OF MUSIC
From the original presentation at the 3rd International Conference on
Music, Medicine, Education and Therapy
Denmark 1983

INTRODUCTION
I come from Egypt, where once upon a time doctors were wise men. For many centuries the name for a doctor was "Hakeem" i.e. wise man. I will show you perhaps a little later a form of folk preventive medicine which has been operating for several years, together with a form of therapeutic body movement, music and dance and expression therapy, folk medicine which still operates to this day. Both of these music-based forms of therapy and prevention have rhythms and content which is so intense that had we had appropriate connections with loudspeakers, no member of the audience could resist responding and participating with body movement, with dance, and/or with one or more expressive channels potentially available to us. It is probable that many will find the experience relevant and valuable.
These two forms of folk music therapy and prophylaxis are dying down. They are threatened with cultural erosion, invasion and humiliation. Once tolerated by the "Hakeems" they are threatened and attacked by the now reigning all-powerful western brand of medicine which I purport to show you is a system that is very efficient in many relative ways but profoundly blinkered and hazardous in other domains.
I have not come to that belief easily. It has been a long journey. My being with you here criticising modern medicine as it is, its practice, teaching and research orientation, is the culmination of a long and difficult journey up the echelons of the medical establishment to the top. Through that journey I have acquired the authority and the right to criticise the blinkered and sometimes anti-life and anti-health postures of modern medicine and to present and advocate a vision of a life-respecting, life-saving, health enhancing, reorientation not only in medicine but in the sciences.

The Sphinx represents the ancient Egyptian wisdom that man is animal and spiritual component integrated
Man is neither one of these properties alone
The first slide I am going to show you is the sphinx. Being dedicatedly animal as well as dedicatedly human it is a reminder of dimensions lost to modern medicine. This product of old Egyptian wisdom and art, the sphinx, has an animal body and a human head. A very conscious human head. The relationship between the animal body and the human head is not an accidental relation. It is a situation of absolute insistence and affirmation of mind and.body, of left lobe and right lobe, i.e. emotion and rationality, physicality and spirituality. The conception is one of perfect balance of the mind and the body, of a totality that is made of all the parts. The parts that make the totality are non-disintegratable, non-separable and they make the whole. As though to underline this point, that many faceted sphinx is carved from one single stone. Just a miracle of artistic creation or is that a further affirmation of the holistic message? It is there! An affirmation of unity through plurality and plurality through unity.

The wisdom of integration symbolised in the sphinx is a domain where modern science has had its gravest shortcoming. Our sciences resort habitually to fixation and disintegration of the various parts to study them. Yet we have not developed the knowledge or the pitch of consciousness to re-integrate the parts into an experience of the whole; of the 'totality' that is made of the various elements. The totality that frequently is greater than the simple summation of the parts.

Reductionism has served medicine and science in certain ways but it has also manifest limitations and failures that can be disastrous unless we are deeply aware of them and correct them.
The totality that science disintegrates and fixes for study, measurement, description and observation of that totality is very elusive. It eludes the "pure" scientist who is deprived after his erudite journeys of research and learning from the ability to re-integrate the parts into the whole and is even less able to integrate the parts into a living whole. The "living whole" keeps emerging as a continuous reminder to science and scientists of limits and limitations. For wise men this totality is a continuous source of learning, admiration, respect and insight.
Tragically however, the living totality emerges as a continuous threat and humiliation to scientists who have forgotten the limitations of "science" and who refuse the humility of wisdom and insight. To them that living, creative, surprising and unpredictable totality must be disciplined and subdued then to remain within the confines of these all powerful and wonderful sciences. Very subtly sciences metamorphose from servants of life and of nature, into systems of a priori reference to which life and nature must be subdued.

Mechanisms of "fixing" creativity.

The Egyptians -and later all cultures-undergoing fixation on their initial break¬throughs so that imperceptibly the creative vision and wisdom become the new rigidity of the status quo destroyers of the new vision.

The powers endowed by the creative are used to maintain fixity and destroy the creative

A universal and recurrent disorientation
I do not want to naively transmit a romantic picture of Egypt or of the ancient civilisations from which we have so much to understand and to learn. I want to transmit to you as much as is possible a balanced picture of Egypt because in some ways we were all born in Egypt. Even if the WEST likes to deny it, we were born in Egypt, Sumer, China and India and then Greece.

We deserve, we need to understand ourselves and where and why things went wrong. The modern current civilisation, the modern cultural concepts are born in Egypt and within the great ancient river civilisations, with the great visions as well as the misconceptions. The phenomenon of the status quo using the fruits of creativity to enhance fixity and rigidity and then ingeniously rationalise the destructive metamorphosis, is a universal curse. It has been the tragic rule all over our very short history.
In Egyptian wisdom that phenomenon is symbolised in the recurrent killing and deliberate disintegration of Osiris, the benefactor and teacher of the essence of life and creativity. Not only is Osiris killed every time he is captured, he must be castrated, cut up into many separate parts which must be deliberately separated ad kept separate by law.
Please look at figure 1, and note that on a twenty four hour scale all recorded history is but a mere quarter of second at the tail end. There is no reason why we should not acknowledge that in this quarter of a second we have made conceptual mistakes. There is no need to blow up ourselves, our planet and all of life with our bizarre atomic bombs and other weapons perfected for mass impersonal destruction, for the sake of the systems, institutions, edifices, prejudices and fears etc., born out of this infinitesimally short period of development down an alley that many see now see as a path of sanctified misconceptions. These sanctified misconceptions may have served some purpose during certain phases of history and of social, political and economic evolution. They have no right to persist or to pose as perennial and inherent reality.

Osiris was born in Egypt but also Kafka was rapidly invented there !

In Egypt, parallel with the many great break-throughs we also have the subtle rise of the edifice, of the rules, the rise of the system. A vision so remarkable becomes the system. The 'system' becomes larger and larger, more powerful and more rigid. A static edifice is created, whose deep almost subconscious function is to destroy new vision and new wisdom. The human being, the very thing that gave birth to this greatness, becomes so insignificant. Look at the infinitesimally small and insignificant 'us' next to the ankles of the colossal statue of Ramses ! !
(Slide)
A fascinating depiction, perhaps prediction, of a Kafkaesque vision. A situation when human beings, by the direct violence of the whip and the sword, or the indirect violence of conditioning through upbringing and mass media -as in our times and in many of the "democracies"- are turned into machines with controlled and predictable responses and controlled predictable "free" choices.
There is an analogy with modern sciences where the system has become so huge and so enormous and so impressive and so imposing that human beings look like dwarfs; insignificant, ineffectual dwarfs.
Human beings whose creative visions gave birth to the system in the first place now risk punishment, destruction and annihilation if they attempt to modify, develop or renovate the system. Throughout our recorded history the system has failed to become human centered ; in fact human beings are centered around systems. When they suffer, it is their mistake. They are wrong. They are outcasted, tolerated, treated, punished or destroyed as the case may be.
We must all sit passively by our TV sets to watch millions of our race regularly sacrificed at the altar of the system rather than dare think that the system ought to be sacrificed at the altar of living human-beings and life. The tragedy reaches bizarre proportions when a minority of people make a system that represent to them the absolute truth, the one and only final truth for "progress" and for the "good", that is to be inflicted by force of the gun. The system is sanctioned by the gun directly as in case of the military minorities who ruled and rule millions or sanctioned by the "holy" book whether it be religious dogma or one of the dogma "isms" via the "mechanism" of the gun also .

Lessons from Akhnaton
The Pharaoh who tried to change the "system"
At this juncture I can almost see Akhnaton conjured amongst us; the much neglected, maligned Akhnaton. Akhnaton was one of the great men in history. He, the pharaoh, rebelled against the system. He was supreme privileged monarch and yet he deviated. He tried to make the system move. He wanted to make the system respond to human need and vision. The Amarna murals show that, perhaps for the first time in recorded history, he chose to put truth, the search for truth and movement before the system, before ritual and a priori symbol and a priori assumptions. He enriched us with one of the most creative journeys of ancient times whether it be in science, art or religion.
Most of his work was destroyed by the priests and generals of the system. He is insufficiently studied. His significance is insufficiently understood.
He was finally destroyed physically, probably by poisoning, some think by blinding and banishment and denial, like Oedipus. The system refused to take the challenge. Shortly after his destruction or banishment it was taboo to even mention him. We do not know for certain how he died, but we know that he was resisted, denied and later suppressed and amputated from the social and political consciousness.
When Akhnaton's faithfulness to his truth, to his life consciousness necessitated dissolution of the system, he had to be destroyed. Even though the person who perceived these new truths was the supreme head of the system. Does this echo of the JFK , the John Kennedy tragedy in our times ?

Static "enclaved" safety ? or
Dynamic, interactive safety ?

Men have subtly manoeuvred themselves to construct systems that purport to serve them when it is they who serve, it is they who serve the system and stumble over the hurdles.
Historically people who do not succumb to this subtle misorientation (education) must be destroyed. Paradoxically, after punishing to destruction the quick, the pulse, the creative vision of man (men and women), the system is quite ready to adopt certain changes, quite ready to change (ref. 8 )
It is not movement per se, it is not change per se which is the taboo. Systems do change and develop but it is the handing back of the reins of usurped power and leadership to the rightful heir; life/mother earth, through living man/woman, that must be prevented at all costs. That is the crux. It is the place of man in his world that must -at all costs and to brutal extremes- be controlled to serve the superficially easy option to safety through life rejection, by poising all human capabilities, forces and resources against life and against nature to control and subdue them for "our" safety. What safety ? The safety found in the simple, safe, static, scientific, bipolar, reductionist view of self and the world; 0 :1 according to computer language .

It is however impossible to escape the 0 :1 logical conclusions that the culmination of this road is annihilation of life at the individual and at the mass level. In the second half of the twentieth century, the tail end of the quarter of a second on the figure 1 scale, the reality of a massive failure of our culture/civilisation to nurture life, to nurture the environment and to nurture Nature is upon us .

On the shortcomings of the relation between the "System" and the Human-being in modern Medicine
I will show you in a short while how medicine, instead of becoming patient-oriented or patient-centered has for a long time been made the superior instrument to be inflicted upon patients who are 'sucked' into the machine through their real and legitimate need, or through made up needs that do not exist in reality.
Modern medicine has enormous achievements, no doubt. But where do the ordinary people of Egypt and the so-called Third World stand in the middle of all that amazing array of respirators, computers, heart-lung machines, kidney, heart and liver transplants, auto-analysers, processors and impersonal uncheckable decision makers. Where do the ordinary European people, Western and Westernised people, stand in the middle of all this growing jungle of impersonal and expensive machines. A system of knowledge, skills and a technology that achieves truly wonderful things when the interventions are calculated wisely and timed sensitively but sometimes unwise and unnecessary interventions lead to monumental blunders and lead to enormous, unnecessary and even harmful expenditure of energy and resources.
(slide of Second World War deportees into concentration camps. Each man is labelled with a colored triangle indicating: political subversive, communist, gypsy, mentally defective, Jew, homosexual etc...)

Men and Women reduced to a label. Judged and classed a priori according to their label for promotion or for condemnation

An expected outcome of succumbing to a reductionist view
of self and the World
We look at second World War scenes of men being labelled by a priori judgements, being dehumanised and reduced to number and marks as they are led off to the particular concentration camp, prison, torture, army service, deportation, expatriation, re-education or the firing squad, or promotion according to their label etc. What we have just seen is one of the many variations of the process of reducing men to non-interactive a priori judgements while the social body passively watches as "they" are subjected to the various operations that the system has prescribed for their label. On seeing the picture, we, all of you, I have no doubt, shudder at the horror and atrocity. And yet is not a similar atrocity practised amongst us, by us, in so many other domains and in medicine and in the biological and social sciences, and also in society at large?
Did we shudder at the atrocity because in this picture it was obviously the Nazis who are automatic and easy "other" baddies, that are the perpetrators ? Have we lost the capacity for critical self analysis, that we do not see how naturally we practice the same process of reducing ourselves and "other" to dehumanised labels and a priori judgements.
In medicine, people are labelled as 'diseases'. In the field of mental disorder the phenomena is more obvious.

Phenomena that are incompletely understood or that are feared –
and all 'unknowns' are feared- are labelled. The labels in such
cases are always negative, derogatory, 'bad'.
The "others", who are labelled as different, pay. Whatever they have to go through -and it is not always as clear and materialised as physical torture and abuse as in the political prisons and in the concentration camps- is equally punitive and destructive. It is even more dangerous because it is much more subtle. On the surface it is so kind-hearted, 'loving', white, pure and clinical. To label, exteriorise, dehumanise, mechanise, and directly and indirectly condemn the "other" is a continuous violence that we practice as a "norm", as a habit. Little do we realise that we are thus practising violence upon ourselves and driving ourselves farther from happiness, integration and a creative response to the challenges of life on a personal and group level.

SOME PRACTICAL EXPERIMENTAL AND EXPERIENTIAL DATA

An analysis of current curricular and establishment approaches to medical education, research and practice has been extensively performed by our team (ref. 1,2,3,4).
In my field of Medicine there is nothing more exemplary of how removed from life medicine has become, than what the medical student goes through in "normal" contemporary medical education. There he is supposed to learn how to take care of people, take care of their health, how to help them achieve a concept of health that encompasses mental and physical well-being, interaction, integration and the possibility of creation.
In their first year they are bombarded with hours and hours of didactic information, they are locked up in laboratories manipulating chemicals in bottles and test tubes. They are made to spend hours dissecting cockroaches, frogs and homing pigeons . Each of their victims -specimens-- must be killed at first before it is scientifically examined. If the "specimen" was not killed, the creature involved had to be crucified or pinned and decerebrated or anaesthetised.
In the second and the third years, they are at last introduced to human beings. Dead bodies. They are made to go into dead bodies in minute disintegrating detail.
Promoted to the fourth year, they are made to go back to test tubes, slides, jars and bottles of illnesses, parts of humans in jars and pots and on slides. By the fifth year when; for contact with human beings and the drama of their life, health, illness, death and birth, crisis and regeneration, they have instead had intensive contact with jars, bottles, test tubes, dead rats, dogs, frogs, cockroaches, corpses and mountains of didactic information. They are now deemed fit to relate to living human beings.
I deal with these students and I am very concerned that what I teach is not the didactic stuff, not the mountains of information. I am concerned that they go through a process of growth, of sensitivity towards themselves, of sensitivity towards others. I am concerned that they develop sensitivity towards the messages and needs of human beings in transition and in crisis. A primary requisite for finding and developing the ability to help in crisis situations other than acute and hyper acute life threatening emergencies where for short spates only the technical and clinical skills of the medic and his support structures are needed.
What I have demonstrated on my work with 'normal' students with the 'best' western type education is a deep lack of awareness of the importance of communication, dialogue, understanding; deep lack of awareness that many crises in life and in health are developmental crises that need resolution not suppression and amputation whether it be by drugs and surgery; lack of awareness that most illnesses are multifactorial in their generation and are also in need of a multifaceted cross disciplinary response, where there is full co-operation between various elements and forces in the "patient's" life, for their resolution .

With the best of medics and would-be medics, I have frequently demonstrated what I came to refer to as the gradual expropriation of the sensorium as well as the gradual expropriation of expression potential, the "expressorium" to coin a new word.
This situation is associated with gradual breakdown of communication with self and with outside world. Some a priori external authority permitting code becomes absolutely essential for any action.
People with this syndrome are unable to recognise or "enjoy" in this case "act the enjoyment" of great art without a priori information by some mystified "authority" that what they are experiencing is "great". They would enjoy and admire Picasso and Stranvisky when they are told to do so by an a priori "authority". They are unable to differentiate either experience from color stains or from noise. They are unable to generate the recognition of an unauthorised Rembrandt or a Mozart themselves, within or without.
In the multiplying, high activity, high noise, high education, high civilisation crowd, rising isolation is taking place. Man (and woman) ceases to look to his brother for communication, but helplessly waits -playing the social games and making the social noises and climbing the social ladders- for sanctification and licence from a higher authority to do any thing unusual or to recognise and accredit anything creative and different. Expropriation achieved its goal. Vision is now absolutely focused onto 'the system', blinkered to all else awaiting the sanction of the system for any original act and blindly affirming the condemnations or praises that the system attributes to anything, everything.
Sensitivity to life is very low or nil.
When that truly frightening low is reached, this is the time to shower the expropriated "citizen, learner, grower-up, student" with laurels and graduate them as fully-fledged responsible decision makers and potential leaders in the socio¬political order and in the services in their respective fields.
In medicine, as doctors are all the time seeing people in unpredictable crisis situations -physical, emotional or both- demanding unusual, and unpredictable creative responses, their performance can be especially poor and damaging when and where they are needed most and when and where they could potentially do the most good. A multidimensional crisis situation is almost always reduced to some small component of the whole -a component that appears (or is eligible for appearance) in the text books under one of the customary labels. A good diagnosis. (ref. 4, 5, 12, 14 )
Contemporary scientists and doctors see this gross and glaring anomaly obvious to an outside "philosopher/observer" as an anomaly, as perfectly 'normal' procedure. It is the norm .


In the absence of faith and loyalty to the creative, in the absence of awareness of life cycles, there is a manifest lack of imagination concerning the potential.
From that stance the growth-giving resolution inherent in crisis and / or in transition is a "load of idealistic or poetic nonsense". The only available model is what was before i. e. crisis-suppressing resolutions are automatically adopted and encouraged, regardless of whether this resolution is justified -as is the case sometimes- or disastrous as when a crisis is a developmental crisis. The assumption is that all crisis is "bad". The assumption is also that normality is a priori determined and not to be explored or discovered or achieved and re-achieved by process.
When the a priori available model of normality cannot be achieved, and in that reigning absence of consciousness of the developmental and development potential, those who fail to achieve the model must be branded as abnormal and handicapped.
I hope to continue to work with all who care in any and all disciplines to help a larger number of 'handicapped' acquire perception of this subtle and damaging circuit and breakaway from the hold of a label which is frequently artificial and unjustified.
I will proceed to present some experimental and experiential data showing how handicapped the sensorium (input) and expressive potential, the expressorium (output) of 'normal' has become. Instead of sitting back cosily wondering how we can 'help' the handicapped we may in parallel think and act to help ourselves become less handicapped; believing in and capable of sensitive creative responses to every situation.

We should and must maintain the continuous ability to learn and
especially to learn from those in transition and in crisis. The very people who we are conditioned to dismiss, despise, reject or at best patronise are the very people we have most to learn from.
How can we make the day closer when the all-powerful doctor / god or scientist/god, shall approach the most handicapped of his / her patients and humbly ask for knowledge. Humbly seeking to know the many dimensions of a problem so as to respond creatively in its resolution. Only in this radically new and challenging posture can we hope to offer resolutions to handicapped-ness in ourselves, in others and in our society, (figure 3 )


MORE EXPERIMENTAL AND EXPERIENTIAL DATA USING ART AS DIAGNOSTIC
One of the ways I have used to explore how handicapped is 'normal' is to use arts, music, painting and drama as diagnostic vehicles .
1 have taken my students in groups, rating from 10 to 15 and explored together their ability to express themselves using various means . Certain patterns representing the major direction emerge, there are exceptions naturally :
Music : first we came across very important, very difficult barriers. The barrier of technique and 'learning' :
" I haven't learnt how."
" I was never taught to express myself at school".
" I don't know".
" I was never taught to understand music".
So we work to get over these barriers, only to discover that the barrier of technique is really a useful defence, something to hide how shy, embarrassed and crippled we really are within our normal socially OK. facade, in the simple goal of being able to express oneself in non-verbal ways.
We shift to painting :
" You are not expected to paint with great technique."
" …………………………………………"
" Use colours, use relations, spaces, rhythms, harmonies."
" …………………………………………"
" Do anything "
" …………………………………………"
" There is no a priori right or wrong ."
" …………………………………………"
" Express yourself!"
" …………………………………………"
We go through an array of responses some of which are recorded.(ref. ). If time and equipment had been available, I might have shown you some.
We go again to music . Dropping the instrument, trying to bridge the barrier of technique.
"O.K. Sing!" " cannot sing" " Intonate !"
" ………………"
" use your voice "
" ………………"
It is very illuminating to note the difficulty and sometimes the agony that some 'normal' medical, and non-medical students have to bridge, patiently, to make a sound or simply smear a canvas with anything, any colour/s.

We use drama sometimes. At one point in the drama, exploring certain primordial memory areas; birth, death, jealousy, sexuality, pocessiveness, discovery, rejection the group wanted, they needed to scream. They could not scream. We had a very long, very difficult period to achieve a scream . (ret 6 )
After the difficult initial sequences, I introduced very simple instruments that do not need technique. Varieties of percussion and pianos (used as note generators). No 'training' is needed. These are instruments that simply offer themselves as potential expressive pathways vehicles. It was most surprising to witness repeated episodes of severe suffering.
This phenomenon of "expropriation of expressive rights," and "expropriation of the sensorial rights" kept cropping up painfully in our path.
When finally the difficult inculcated expression barrier was bridged, a very interesting phenomenon emerged. It appeared that each student had become or rather been educated to become an isolated island in a state of complete non¬communication with "other". Complete inaction was at the later stages substituted with a state of extreme aggressive noise generation, in the sense that force was substituted for intensity. A very limited range of the instrument was explored. The instruments were frequently damaged physically. The person with the most powerful instrument was quite ready to overpower everybody else for the whole length of the session.
Several sessions were needed to : -
- discover awareness of others
- discover qualities and expressive ranges of instrument
- discover damage limits
- discover the possibilities of varied dynamics
- discover the ability to respond to others and create harmonies, rhythms,
counterpoints, that were not entirely solo : that were not entirely "self", locked on the amazing bipolar seesaw of complete submission / complete domination.
Painting groups frequently demonstrated the same phenomena. First the usual gulf of technique, but eventually there was demonstrated many subjective phenomena including the profound inhibition in the use of colour, the use of repetitive decoration elaborating on formulae patterns. Above all the most significant and less subjective observation , which you see clearly on the slides, is how for many sessions each member of these groups of "friends" used their chosen or allotted corner of the canvas as though other/s did not exist at all.
I suggest that these slides made from the work of the painting groups, point out to a phenomenon of breakdown of communication, breakdown of meaningful feed-in and feedback (ref. 7 ).
The results of repeated experiments and experiences continue to warn us that human beings within the education system and under the "normal" social upbringing forces we subject them to, in modern western and "westernised" societies, and certainly doctors and medical students, tend to develop into something of these modern walkman machine-men.

Men going around with two ears, symbolic sensorium, plugged, their whole body, symbolic expressorium, riveted in an autistic state refusing, unable and / or too frightened any more to communicate within and without outside the selfish, automatic, mechanistic and reductionist patterns inculcated in them. They had been conditioned and pressurised into selfish, limited and automatic postures so that inspite of "acting" socially as congenial social beings and inspite of acting "relation", they were frequently not relating and alone, even in "the crowd". So limited and expropriated -sensorium and expressorium- their real interests are reduced to the tangible material things -amass and consume-- in a very limited self centred sphere. The process by which vision, dreams, communication and imagination is generated has been avulsed from the roots.
It is rather frightening when you think that this work is with 'normals', not only with "ordinary" normals but with the "creme de la creme" of normals accepted in the privileged Universities to study top rated subjects like medicine on the basis of being the most brilliant performers in highly competitive exams. Is there something wrong with these competitive exams ? What are these exams measuring then ?
These are the people who are going to be responsible for human individual and societal health. These are future decision makers who are going to make vital decisions for families and individual patients in crisis and in transition journeying through some of the most critical, delicate and frightening passages of human existence. These are also the decision makers regarding research, education and evaluation.
It is important to point out at this juncture that as the participants in these experiences rediscover their sensory, expressive, integrative and interactive potential, their performance in all the clinical medical fields, fields having to do with living human beings, shows a highly significant improvement as assessed by patients, their families and their friends. That improvement is also shown as assessed by a humanistic life centered interactive evaluation patiently developed by some of us and deeply resisted by the forces for protection of the status quo.
Expressive / communicative arts had not only acted as diagnosis but also as therapy to the 'handicapped' therapists. A very real hope for the future. (ref. 6,7, 18).

DISCUSSION

A PLEA FOR RELATIVITY IN THE SCIENCES DEALING WITH HUMANS !

At the dawn of the twenty first century, living beings are still considered much less important than matter, atoms, electrons and neutrons. Sciences and applications dealing with life, with society and with economics doggedly refuse to enter the age of interactive-dynamic-relativity.
Scientific thought, method, concept and application in physics has had to undergo radical changes (ret. 9), while paradoxically it has remained quite intransigently rigid in biology, medicine, psychology, sociology and economics (ref. 4, 5, 9, 10, 12, 14, 15, 19). Living beings so far are treated as much weaker, much less relevant beings than gravity, radiation, time/space, atomic particles and subatomic particles, electrons, positions, neutrons and neutrinos.
Medicine, psychology, psychiatry, sociology and economics arrogantly resist the changes needed to become life centred, dynamic and interactive regardless of the rampant destruction they sometimes are seen to cause in their outdated and limited posture (ref. 5, 10, 15, 19).
In the majority of instances, their now inappropriate systems of "scientific" thought have solved the challenges and messages presented by life, by nature and by earth, not by development but by allying themselves to forces that put them higher, more important, more fundamental than life, than living man and than Nature. Rather than undergo interactive change and development in humility these sciences have opted for power. The rightful leaders and guides for science and technology -Life, Nature, Earth- are perceived as dangerous, subversive forces continuously generating an unwelcome challenge, continuous disturbers of the peace. In this arrogant posture of supremacy through "power", modern medicine has convinced almost everyone of its dramatic role in improving the health and prolonging the life of populations when on deep analysis this assumption is exposed as false (ref. 5, 12, 14). Inculcating that false assumption is very important however to convince millions to hand all, to that miraculous modem medicine that has "saved" them and their fathers and will continue to save their children, if they are good and hand "supremacy", authority and power to this mystified god, allied with the other "gods" that handle human affairs. They must acquiesce to the expropriation of health if they and their children are not to be cruelly deprived of all the great and manifest advantages of high powered all powerful modern medicine.
There is however, mounting evidence that the major advances in health and longevity occurred with the introduction of clean and running water, sewage disposal, improved nutrition, housing and environmental improvement.

I firmly believe that, in addition to the above, major health, behavioural and environmental improvements have taken place, and will continue to take place, as humans hesitantly and slowly progress along the road of accepting themselves as worthy beings, worthy of love, respect and care, worthy of joy, happiness and well being and capable of reciprocating these qualities, instead of being indoctrinated to see themselves as dirty, despicable, irrelevant, guilty and riddled with sin, original and acquired*.
The peak -or low- of that doctrine of original sin and original guilt is where men are perceived as natural canon fodder and authority slaves in a bizarre and endless struggle for power and "glory" by their patrons, carers and mentors.
The women --also dirty, sinful and deeply tainted- are to conceive in pain and shame and give birth in pain and shame till their sinful bodies are consumed. Glimpses of pleasure or joy are to be suppressed as reprehensible lust and degraded animal feelings. Dynamism, interactive orientations and integration have to be prevented at all costs to prevent the perception of pleasure as an elevating, integrating, liberating and ennobling experience**. The material must remain -by force if necessary-- separated from the spiritual.
The tragedy is that the potentially healthy reaction against these postures of abuse and guilt generation, starting in the sixties have been taken over and systematised into new inculcated reductionist and mechanised behavioural patterns pressurised by the new "liberated" society rather than internally and creatively generated. Girls and boys at puberty or even before, are almost forced by "freedom", "liberation" and with-itness" pressures to indulge in perineal sex, to "prove themselves", re-generating the fountains of guilt, fear and dynamics of inadequacy and unfulfilment leading to neuroses, insecurity and insatiability. Happiness, "self" and "other-self" love, integration still elude the "free" pressurised into role-playing "freedom". To let be, to let grow, to love, to accept, to integrate is a "process" that still eludes the social and conceptual fabric so far created by the "liberated".
The other part of the tragedy is that the millions of abused, confused and underprivileged "life-mass" in the Southern hemisphere, have so far failed to see the enormous potential of the sixties Euro-American movements for life-based, integrative values. The South is also still not aware enough of the importance of the eighties and nineties Earth, Life and Ecology movements. Yet another major potential ally for life and Earth generated evaluation and values.
*ln this context I am happy to have helped document the now established concept of Psychosocial Dwarfism and Delayed Puberty (ref. 19 )
**Something of this perception was expressed in the poem "The Apple Eater" (13)

Anticlimax!
Rather than look into the challenging data, the loud messages, modern medicine, like much of modern 'science' and application in psychology, sociology and economics, blithely goes on inflicting itself on man and nature, and if man or if nature fails to react / respond as is predicted and is desirable scientifically the fault is man's or nature's. *

AN UNTIRING CRITICAL EXAMINATION OF EDUCATION IS NEEDED
AN UNTIRING CRITICAL ANALYSIS OF WHAT EXACTLY THE EDUCATIONAL
FORCES ARE INCULCATING IN CURRENT GENERATIONS
AND IN GENERATIONS TO COME

By analysing the sort of educational system that the privileged minorities in medicine set up for students to learn medicine, and by practical demonstration (ref. 1, 2, 7 ), I have demonstrated how the inculcation of insensitivity to man as a 'whole multi-sided living being', is produced while purportedly the "process" is trying to achieve the opposite. I have demonstrated the bias towards treating labellable diseases with drugs and surgery. I have -in parallel with many other workers-demonstrated the gross imbalance and the 'Cinderella' position of preventive medicine, whole person health care and emergency medicine in relation to flashy treatment of system classified diseases. I, with several others, have attempted to document this process in other papers and publications (ref. 1, 4, 5, 11, 12, 14).
There is overwhelming evidence that the same phenomenon is recurrent in many other fields, of 'scientific' education, research and practice. I have shown how the medical student, initially full of life, love, good will and human sensitivity, is systematically 'educated' to become disintegrated, life insensitive, feelingless, mercenary and callous. This is no accident.
Much of Medicine in our age -together with other social and biological sciences - suffers the shortcoming of not being able to find the path to the acceptance of man and life as a reference point. Our recent history is one continuous tragedy of a determined attempt to make the greater, life, man, nature, subservient to the lesser; the system/power.
* An expression not infrequently used in medical circles with full seriousness "the operation was a complete success but the patient died" or according to Ernest Hemingway, shortly before his suicide in 1961, "they cured the disease but killed the man."

DEALING WITH MANIFEST DISEASES IS DEALING WITH ONLY A VERY SMALL
PART OF THE PROBLEM OF ACHIEVING, MAINTAINING AND RECOVERING
HUMAN HEALTH
I have at length demonstrated the damaging responses of non-life centered, non-man centered, non-patient-centered, non-learner centered, non-social centered, cross discipline-resistant Medicine and Medical establishment, to the challenge of educating doctors. In its response to other challenges of health care, disease prevention, emergency intervention, crisis resolution, responsiveness to transition, responsiveness to inherited or acquired subnormal or supranormal or paranormal abilities, traits and potentials, current medicine and medical education is expectedly wanting.
Most of the energies of that Medicine and of the medical establishment, are concentrated on a minute proportion the 'health' problem; the treatment of manifest, labelable diseases. We need to realise clearly that that is a minute part of the Health problem. Even in the domain of treating manifest and labellable disease, an objective analysis springs many surprises (ref. 4, 5, 11, 12, 14 ).
Allopathic medicine plays an important role. It has many achievements, especially in the fields of intervention in, accidents and in life threatening emergency situations when and were physiological homeostatic and healing mechanisms have been stretched or are likely to be stretched beyond their limits.

Rather than modestly come to terms with its inherent limitations and ally with an open heart and mind to "OTHER" systems of knowledge, prevention, intervention, catalysis and resolution, modern medicine frequently attempts to hide its fundamental failures by volleys of distracting fireworks trying to prove that it is still all-powerful
High technology and high powered life support, organ transplant and other 'wizardries' -magnificent tools and techniques as they can be when harnessed for the service of humanity and its health, happiness and well-being- are brandished to dazzle the uninformed public and blackmail the better informed critics. While it has become the fashion to shamelessly mass propagate - through mass media pictures and news of the 'dazzling' medical' achievements'- to the public all over the world (including to the starving, deprived and terrorised millions). Everybody admits that no provision whatever is made to provide these 'dazzling' possibilities to the billions who are now made to dream that their abused and unlived lives will somehow be saved and prolonged by these magnificent techniques and machines responsive only to the hands and minds of these undialoguical* semigods. Through these implicit promises, temptations and "carrots" - acknowledged by everybody to be false, and impossible to fulfil for the majority- the deluded millions are made to hand authority over their life and health and well-being to others be it the medical profession or other authorities and professions perpetuating this expropriation game.
* Borrowing the expression from Martin Buber.

This is not very out of tune with the tendency to expropriate most basic political and human rights practised crudely by brute force and by the gun or indirectly through mass media and control of input information and data.
More than 99% who - thanks to the propaganda of mass media - look upon this brand of western modern medicine, as well as many brands of brandished goods, practices and values, to save or prolong their postponed lives, will never get the flimsiest chance of sampling the benefit -or the harm - themselves. It is like some macabre lottery where hypnotised millions buy the propaganda because every now and then one wins the million dollars. The dream! That "one" in a million, is made such a 'fuss' of in the mass media that the story of the 'one' dominates consciousness while the plight of the 999, 999 is forgotten.
The majority go to their deaths --having been turned into submissive passive uncreative and unproductive waiting agents- waiting for the dream to be materialised and presented to them by the 'others' who somehow promised them they would .
Millions are still waiting. Resentment, despair and desperation mounting. Fertile breeding ground for violent eruptions within -implosions- or without -explosions- against self, against "other", against authority, against the World.

As the above dynamics operate
Health becomes a prohibitively expensive luxury
available only to the privileged few, even in the most privileged
countries
In its posture of opting for the supremacy of high technology treatment of diseases instead of opting primarily for health care and prevention, with high technology treatments of disease occupying its rightful part within the health care strategy, medicine has raised the cost of medical care and diminished its cost-effectiveness.
In its posture of neglect of prevention, of pre pathology states and causes, in its neglect of role of patient, friends, peers, in its neglect of understanding of the life cycle and cyclicality, in its disdain of the possible contributions to preventive or therapeutic goals of alternative approaches including music and the arts, in its dissociation from social or environmental commitment, in all these postures and many more modern medicine is making health an unattainably expensive dream for the majority.
As emphasis is shifted in practice, education and research from humanistic health care, multi and cross disciplinary participatory prevention with active patient and populace participation, to high technology high powered treatment of complicated diseases, the cost of medical care becomes expectedly prohibitive. The cost will continue to rise. As the cost - to individuals and to society - of medical care, education and research rockets up, its 'achievements' and 'miracles' are brandished with more vigour while, fewer people are able to benefit from it. The less politically powerful and materially powerful members of society and/or of the international order, will suffer and will fall neglected and embittered by the way side.

These groups include, within the national community, the old, the infirm, the handicapped, the poor, the unemployed, the in-transition and in-crisis, the "different" members of the community. At the international level this inappropriateness, unattainability and neglect of the existing forces of science, medicine and technology, will encompass millions of the southern hemisphere. A most amazing impasse. We are in this impasse now.
Back to my opening assertions : Medicine, as a human and humane health care system, is in crisis.

With the new concepts
new patterns of relations within the health care situation must emerge
How deeply I feel the continued perpetuation of the misorientation and the unjustified denial of medicine's real crisis when I see the shy embarrassed, hesitant, "auxiliaries" and paramedics vital "others" in the health, or handicapped care situation, when the M. D. makes his / her pronouncements.
All these; nurse, nutritionist, social worker, psychologists, physiotherapist, music therapist, art, therapist, drama therapist, story teller, assistants, students, relatives, friends, healers and the patient blush and disappear into nothingness in the classical confrontation scene with the M. D. Representative of the all powerful medical establishment.
Let this paper be a reminder to them that they must evolve the ability to work together, they need never be intimidated or purely subservient to the M. D., except in rare self evident emergencies where there is no time or space for interaction and process.
Even if modern medicine and decision making medics have yet failed to set the conceptual and behavioural lead, we must all strive in the health professions to serve the patient and patiently gain and welcome co-operation of all possible forces involved for this magnificent goal as long as the forces are harmonised by an overall vision.
To do so we must remain life aware and life sensitive within and without. This is no easy task. It is a task which needs dedicated learning -and an openness to learn continuously- it needs enormous loving and mutual support. It is a task of undramatic, forceful but gentle resistance to intimidation and/or temptation by the various 'systems'. It is a task that needs art and especially music as diagnostic, therapeutic and as supportive food.
Let this paper also be a reminder that there is a place for many approaches to a given health problem. There is a necessity for multi-disciplinary and trans-disciplinary approaches. The nature of health problems in humans is multifactorial, multi-dimensional and dynamic.
So much is opened up when we see, the patient as leader and director and are therefore obliged to listen. As we learn to listen and teach the art and love of listening then we can discover and know the music of ourselves, of others, of living beings, of Earth and of the universe and then we can serve and then we can listen more and learn anew.

CONCLUSION
In the impasse that modern medicine has taken health and in the parallel impasse that modern science has led humanity at large, one of our major hopes is to learn to listen to the music within and without. To be able to tap this music to get in touch with the life force that is our major hope. To underline this impasse we are in , let me point to the contradictions of millions of humans of all ages succumbing yearly to dire fatal or permanently destructive diseases that are preventable by simple environmental, behavioural, or nutritional measures, while mass media hypnotise us to hand all to the "magicians" who transplant hearts, livers and insert mechanical pumps instead of hearts*.
Let me also point out to the contradictions of the fact that modern sciences have provided for each living man, woman or child enough explosive power to tear them to smithereens -overkill as they technically call it - but has failed to provide millions of men, women and children with clean water or with the handful of rice or wheat that they need not to spend the next night starving under the same skies.
We are all together on spaceship earth. Inescapably responsible, and inescapably interconnected. We need to be able to listen to each other to tap forces and knowledge for integration, resolution and survival. We need to understand, learn, teach and modify our behaviour and the posture of our institution in the direction of life and Earth reverence and support, or we sink together (ret. 10,15,16).
From a scientific point of view what we see all over the world is perhaps no contradiction at all. There are no receptors in all-powerful science for 'petty human consideration'. Science is quickly creating a world with no place for 'petty human1 considerations in it. Inhuman economics reign where recession, unemployment, death destruction and ruination for millions and more life shattering actions in the domain of health are decided and undecided according to theory by erudite "economists" and theoreticians. It is an era that has seen a rampant arms trade, unprecedented impersonal killing, rampant drugs trade, dire threats to environment, mounting extinction of animal and plant species, unprecedented pollution of air, seas and waterways. It is an era where the drug and arms trade represent the biggest international trade activity while horrendous statistics tell us of how many children are dying per day from preventable causes, and how many millions are dispossessed and displace because of unnecessary "modernised" warfare sold and exported to "non-modernised" societies.
* I am of course speaking of a strategic posture and of a choice about the most effective distribution of resources and of the educational and learning orientation necessary to serve the goal of health the most effective way in a National and International context. In the individual case, a high powered liver transplant supported by the most sophisticated machinery may be the only remaining solution. This is a fact that had to be accepted and integrated in the wider scheme for health, without allowing these extreme cases, that in themselves frequently represent failure of preventative and predictive approaches, to dominate the strategy orientation of health care.

The struggle is now frantic between America and Japan to build super and supra-super computers to support the systems that control our lives and expropriate our sensory input and motor output.

I suggest that out of this conference of remarkable men and women aware of the depth of the crisis of modern medicine and modern science there should develop an international cross-disciplinary group and network. As I have outlined there is so much that can be done and needs to be done. Amongst the early goals there should be amplification and support of the positive aspects of modern medicine especially in the fields of patient centred health care (ref. 17, 18, 19, 2), prevention and high quality emergency management.
There should be included amongst the goals the enormous task of humanising medicine, biological and social sciences. We should undertake to do to these sciences what atomic and subatomic particles are forcing physicists to do, namely, re-introducing relativity, interactive and dynamic, re-introducing music into their world.

References:
1) Hassan, Tarek H. A.," Education in sickbed" (Abridgement of" on the urgent need for research regarding education in general and medical education in
particular in Egypt and parallel third world countries").
2) Hassan, Tarek H. A., Shalaby, T., Medani, A., et al., "Goals of Medical
Education. The dissociation between medical curricula and the disease patterns in
society", Presented to the Fayoum Conference on Medical Education, 1978 (in
Arabic)
3) Hassan, Tarek H. A., "The University teaching Hospital in Egypt, a critical study
and proposals for development", El Ghad publications, Cairo, 1974 (in Arabic with
English summary of contents)
4) Sabbour, M.S., Hassan, T. H. A., Shaalan, M., "The sickness of modern
medicine", E.S.G.T. publications, Cairo, 1983 (in Arabic)
5) Illich, Ivan, "Limits to Medicine", Penguin, 1977
6) Hassan, T.H.A., Bergman, S., Simpson, M., and Avery, P., "The contratype
Experiment", Unpublished data about group evolution drama, first presentations
Edinburgh International Festival of Music and Drama, August 1967
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experiments in Expression, Paint series", unpublished.
8) Hassan, T. H. A., "The Prison", drama recurrentis, a drama, first performed ULU
London, 1968.
9) Capra, Fritjof, "The Turning Point", Wildwood House, London, 1982

10) Schumacher, E.F., "Small is Beautiful" a study of economics as if people
mattered, Harper & Row, N .Y. 1975
11) Sabbour, M.S., "The other side of medicine" Presidential address to the annual
meeting of the Egyptian Society for culture and Sciences, Cairo, 1980
12) Mckeown, Thomas, "The Modern Rise of Population", (chapter on : The medical
contribution), Arnold, London, 1976
13) Hassan Tarek H. A.," The Rape of Man" Vol. II of collected poems, Stanton
publications, London, 1969
14) Kennedy, Ian, "The Unmasking of Medicine" Granada publishing, 1983
15) Dammann Erik, "The Future in our Hands", Pergamon Press, 1979
16) ………., "Doctors and the bomb", Editorial, B.M.J., March, 13, 1983
17) Balint, M., "The doctor's therapeutic function", Lancet, 1:1177- 80, June, 1965.

18) Balint, M., Ball H. D. & Hare L.M., "Training Medical Students in Patient-
centered Medicine," Comprehensive Psychiatry, Vol. 10, No. 4, July, 1969
19) Hassan, Tarek H. A., " A Guide to Medical Endocrinology", MACMILLAN Ltd,
1985
20) Hassan T. H. A. and Shaalan, M., "The problem of psychosocial dwarfism and
delayed puberty with an illustrative case report", Endocrine Society Conference,Cairo, 1980.