In a study of 261 holy women in Italy since the year 1200, Rudolf Bell distinguishes between contemporary anorexia nervosa and what he calls “holy anorexia.” While the former is regarded as a syndrome of clinical pathology , in the latter, “the suppression of physical urges and basic feelings— fatigue, sexual drive, hunger, pain—frees the body to achieve heroic feats and the soul to commune with God” (p. 13). There are parallels between the two conditions and historical epochs. Bell suggests that the observation that the internal locus of evil as a corrupting force for women in the Middle Ages, in distinction to the external locus of sin as a response to external stimulus for men, corresponds to the Freudian model of anorexia nervosa as a food/sex oral fixation. In addition, in both, “the main theme is a struggle for control, for a sense of identity, competence, and effectiveness” (Hilde Bruch, quoted in Bell, p. 17). However, there is a critical difference, and “whether anorexia is holy or nervous depends on the culture in which a young woman strives to gain control of her life” (Bell, p. 20). Bynum (1987) warns against the assumption that these are precisely the same phenomenon, given theological meaning in one epoch and psychiatric meaning in another. She points out that even medieval writers had more than one paradigm for explaining fasting—that it could be supernaturally caused, naturally caused, or feigned—and that there was a clear distinction between choosing to renounce food and the inability to eat. In both historical cases, the behavior “is learned from a culture that has complex and longstanding traditions about women, about bodies, and about food,” including what kind of behaviors are in need of cure (p. 198). It is a profoundly cultural fact that in the patristic era miraculous fasting was attributed largely to men, while in the medieval period it was characteristic of women; likewise it is cultural that in the medieval period the illnesses of men were more likely thought of as needing to be cured, while those of women were to be endured. Furthermore, in the later Middle Ages fasting was associated with a wider array of miracles and practices of somatic spirituality, including subsistence on the Eucharist, stigmata, espousal rings, sweetsmelling bodies, bodily elongation, and incorruptibility.

Moreover, as the U.S. space program began to enjoy success, optimism grew in both scientific and government circles about the feasibility of taking on large-scale technological challenges. Many in government were impressed with the productive results being secured in the space program and the military from centrally funded, programmatic research. U.S. physicians and biomedical scientists saw themselves as being able to overcome the many technical obstacles through hard work, directed budgets, and targeted programs. The space program had as its goal putting a man on the moon before the end of the 1960s. The artificial heart program launched at the NIH in 1964 set as its goal the testing of a total artificial heart in a human being by Valentine’s Day, February 14, 1970 (Bernstein). The goal of implanting an artificial heart by the end of the 1960s was not attained. A major hurdle was the development of an energy source capable of providing long-term power to an artificial heart—while fitting inside the body. Not only was progress slow but, during the time artificial heart researchers were trying to overcome the large number of technical challenges that confronted them, an alternative to the mechanical heart appeared: cardiac transplantation. Ironically, the rationale for recent clinical trials of artificial hearts is to find a replacement for the now common cadaveric heart transplant. The increased need for organs and a stable donation rate are the main reasons why there has been renewed interest in total artificial hearts. While Denton Cooley did implant a crude mechanical heart in a human recipient at Baylor University College of Medicine in 1969, most of the device, including the power source, remained outside the body. He explicitly stated that his sole motive for using this primitive, untested device was the desperate hope that it might help an imminently dying patient live long enough for a donor heart to become available for transplant. According to Michael DeBakey, Cooley did not believe the device he implanted was a permanent replacement for his patient’s heart.

In 1964 the U.S. Congress budgeted $581,000 to establish an artificial heart program at the National Institutes of Health (NIH). This was the first large-scale effort by any nation to support systematic research into the development of an artificial heart. The effort to build a reliable, totally implantable artificial heart has yielded marginal results. But even though an effective device does not exist, the artificial heart has, since the 1960s, been at the center of a heated ethical, economic, and policy debate. The debate over the wisdom of building and testing an artificial heart has also served as a paradigm for debating the future of expensive technologies in the U.S. healthcare system. Scientists and physicians in many countries have dreamed for centuries of curing fatal heart diseases by creating a mechanical substitute. Technological advances during the 1960s in engineering fields such as metallurgy, fluid dynamics, electronics, and computer modeling made some scientists think that it might be possible to actually construct such a device. The emergence of the kidney dialysis machine, which could mimic the functions of a human kidney, created a fundamental change in attitude in medicine about the feasibility of building an artificial heart. In the late twentieth century, the quest for the Totally Implantable Artificial Heart (TAH) was once again the catalyst for other technological advances; except for the TAH, the success of the artificial heart program to date is still up for debate.

Ethics asks questions about right and wrong, and about good and evil. The notions of intrinsic goodness (that which is desirable or valuable in itself or for its own sake) and intrinsic evil (that which is undesirable and to be avoided for its own sake) are of central importance to ethical theory. In teleological theories of right and wrong, right acts result in intrinsic goodness, while wrong acts fail to do so or produce intrinsic evil. Doing good and avoiding or preventing evil are momentous moral duties even in deontological theories (except for Immanuel Kant’s). Doing one’s duty usually, if not always, involves understanding and acting in accord with moral ideals and rules—none of which even exist, according to metaphysical behaviorism. Ethicists may disagree about answers to questions like “What acts are right or wrong?” or “What things are good or evil?” There is, however, agreement that no moral obligations and no intrinsic good or evil would exist in a world without consciousness. Moral right and wrong and intrinsic good and evil exist only in and for conscious active beings. Almost all the philosophers who have considered the question agree that ethics would have no point in a world devoid of conscious beings. Yet Watsonian metaphysical behaviorism gives us just such a world—one in which all behavior is caused by external or environmental stimuli and no behavior is caused by inner conscious mental states and processes. Skinner’s radical behaviorism may allow that some activities are spontaneous rather than environmentally caused, but these behaviors are repeated only if their consequences are positively reinforcing.

The technical language that behaviorism aspired to generate was certainly not ordinary everyday language, for it never lost sight of consciousness, its complexity, and its manifold contents, purposes, and values. Since the middle of the twentieth century, more and more philosophers, psychologists, neuroscientists, and psychotherapists have acknowledged the centrality of consciousness for their own activities. Consciousness is now seen as being complex, ranging from minimal awareness devoid of conceptual representation, through symbolic awareness, to self-awareness, while a great deal of nonconscious data-processing occurs (Gazzaniga et al.). Consciousness and immediate self-awareness are indispensable for people to understand their uniqueness and their personal, ethical, professional, and therapeutic relations with each another. Initially, behaviorists aspired to explain what people do on a simple Pavlovian stimulus–response model; but the terms stimulus, response, and behavior have been used quite loosely. Muscles, glands, and organs (and who knows what else) react to external (and, they confessed later, to internal) stimuli; and no conscious processing or activities intervene. This view, however, proved to be too simple, too ambiguous, and too devoid of comprehensiveness, to be true—which does not deny that valuable lessons can be learned from the study of behavior. Gestalt psychologists recognized that empirical stimuli or data are processed internally and holistically, and that no simple stimulus–response theory could explain how humans perceive continuous motion from discontinuous and still motion-picture frames. Noam Chomsky argued effectively that psychological conditioning and associationist learning theory, according to which learning occurs solely through repeated exposures that form connecting links, are too weak to account for the genetically prestructured dispositions of human infants to learn human languages—and for the creative and rule-governed ways in which languages are employed.