Therapeutic nihilism is a contention that curing people, or societies, of their ills by treatment is impossible.
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In medicine, it was connected to the idea that many "cures" do more harm than good, and that one should instead encourage the body to heal itself. Michel de Montaigne espoused this view in his Essais in 1580. This position was later popular, among other places, in France in the 1820s and 1830s, but has mostly faded away in the modern era due to the development of provably effective medicines such as antibiotics, starting with the release of sulfonamide in 1936.
History of Therapeutic Nihilism
In the 19th century, some leading physicians started questioning the fundamentals of medical care, leading to the idea that existing drugs and medical treatments were useless. This was the start of therapeutic nihilism. Therapeutic nihilism was first considered to be a global disease that was more concentrated in English-speaking countries. It was also thought to have greater effect towards males, elders, and people dedicated in the medical field and less towards children and females. One paradoxical characteristic of therapeutic nihilism was that despite being a mental affection, it only affected 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. An unknown “germ” that disrupts the brain was thought to cause therapeutic nihilism. The germ was not considered fatal but was considered to be very difficult to observe microscopically, which limited the investigation to autopsies. Having been most prevalent among the medical profession, symptoms were very conspicuous. People with therapeutic nihilism were found to neglect all the contemporary studies, discard literature such as books, and disregard physician’s advice. Instead, they gained a sense of superiority and wisdom, thinking they knew what the public didn’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 treatment. Once the patient did not overcome the noxiousness of the disease, he was thought to fall into chronic therapeutic nihilism, never to 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. Therapeutic nihilism, however, underwent a transition and faced with different reaction from the public.
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 described that “the stream of tendency of modern medical thought was toward a therapeutic nihilism.” The most preferred treatment method was active medication. For example when cocaine was first discovered, it was described in all of medical literature to have curative properties towards diseases such as gastralgia, childbirth, and nasal hemorrhage. Some, without question or doubt, were dosing newest medication and 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 those who were taking heavy dosage of medication and receiving newest practice of medicine, the doctors were considered a “heroic” figure. If the therapeutics was successful the physician received credit, but for unsuccessful cases, patients were considered simply “unfortunate.” This naturally led to a 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 were lacking in practicality. When faced with everyday exigencies, more and more physicians were left clueless. To make things worse, the ratio of medical practitioners to the US population in 1888 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.” Therapeutic nihilism slowly faded in the 19th century as systematic reform of the medical education system took place.
Therapeutic nihilism reappeared in the 20th century, 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 the physicians 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 the regulation of bodily secretions such as extraction of blood, promotion of perspiration, or urination to regain the natural state of equilibrium. Ivan Illich was one of the ardent supporters of therapeutic nihilism. In his book Medical Nemesis, Illich 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 were excess of hospitals and doctors, performing unnecessary surgeries and over-prescription of antibiotics and drugs. Therapeutic nihilists claimed such excess often led to malpractice and increase in iatrogenic (doctor-caused) injuries, accusing the physicians of creating even more illnesses. 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.”
In society and politics
In relation to society, therapeutic nihilism was an idea, with origins in early 20th-century Germany, that nothing can be done to cure society of the problems facing it. Its main proponent was the novelist Joseph Conrad, whose writings reflect its tenets.
In politics, therapeutic nihilism is a defining principle of modern conservatism. The so-called "Father of Conservatism" Edmund Burke's imputation of "unintended consequences" – the implicitly inevitable and undesirable results of political engineering, and Peter Viereck's assertion in "But I'm A Conservative!", his also-definitive essay in the April 1940 issue of the Atlantic magazine, that socialists are naïve to believe that society can be improved, are two prime examples of conservative arguments for therapeutic nihilism.
In medicine
The phrase therapeutic nihilism is also included in a modern version of the Hippocratic Oath, traditionally taken by physicians upon graduation. The statement is "I will apply for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism."