Abstract
Several philosophers have recently argued that phenomenology is well-suited to help understand the concepts of health, disease, and illness. The general claim is that by better analysing how illness appears to or is experienced by ill individuals—incorporating the first-person perspective—some limitations of what is seen as the currently dominant third-person or ‘naturalistic’ approaches to understand health and disease can be overcome. In this article, after discussing some of the main insights and benefits of the phenomenological approach, I develop three general critiques of it. First, I show that what is often referred to as naturalism tends to be misunderstood and/or misrepresented, resulting in straw-man arguments. Second, the concept of normality is often problematically employed such that some aspects of naturalism are actually presupposed by many phenomenologists of medicine. Third, several of the key phenomenological insights and concepts, e.g. having vs. being a body, the alienation of illness, the epistemic role of the first-person perspective, and the idea of health within illness, each bring with them new problems that limit their utility. While acknowledging the possible contributions of phenomenology, these criticisms point to some severe limitations of bringing phenomenological insights to bear on the problems facing philosophy of medicine that should be addressed if phenomenology is to add anything substantially new to its debates.
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Notes
Phenomenology is clearly a rather heterogeneous area of philosophy, and I simply cannot do justice to this in this article. Instead, my point is merely to pick out some recent ideas in the phenomenology of medicine and question their coherence and usefulness.
Tania Gergel [16] also provides some interesting critiques of phenomenology, such as that it is not as original or radical as it claims, that it is potentially solipsistic, and that while it claims to bracket and question our everyday assumptions about illness, it struggles to do so.
Svenaeus sees phenomenology as falling under the heading of ‘holistic’ approaches to health and illness, of which Lennart Nordenfelt’s is another example [9]. However, Svenaeus sees phenomenology as going further than a focus on ability or realizing vital goals by incorporating experience, perception, feeling, and thinking.
I shall set aside the issue of whether these approaches are better understood as ‘phenomenological psychology’ or ‘transcendental phenomenology’ and how this plays out in phenomenology’s troubled relationship to naturalism (see [20, 21]). It is possible that transcendental phenomenology is incompatible with a core naturalistic claim that subjectivity emerges out of and can be described in fundamentally non-subjective elements/processes. As these authors seem more interested in describing first-person experience, they come closer to some form of phenomenological psychology. The following criticisms stand regardless of this distinction. For more on these issues and recent attempts to relate phenomenology and naturalism, see Petitot et al. [22] and Carel and Meacham [23].
I use the scare quotes here since this claim is technically inaccurate. Naturalists do not claim to explain ‘illness’ scientifically, but rather ‘disease’. This confusion is already at work in the citations in this paragraph, and I will return to it below.
Boorse [19] adds that an illness is also marked by requiring special treatment and even allowing for certain behaviors associated with that illness to be excused.
While it is true that this equation could also be made by normativists, what is being incorporated here by these phenomenologists is not the view that normality reflects one’s preferences, but rather what is ultimately a naturalist claim, i.e., health is what is statistically normal or understood as normal function.
I thank one of the anonymous reviewers of an earlier draft for this qualificatory point.
This critique, that phenomenology ends up supporting positivism, can already be found in the end of Foucault’s Birth of the Clinic [56].
Gergel [16] takes this problem in a different direction, arguing that while phenomenology’s stress on bodily alienation helps to highlight how identity is challenged in illness, it does not provide a solution to overcome this problem.
I say ‘disease’ rather than ‘illness’ here since more arguments would be needed to show that ‘illness’ is a category that also applies to non-human animals.
This criticism was also raised following a 2011 lecture Svenaeus gave on phenomenological and naturalistic theories of health at UWE Bristol, a video of which can is available at https://www.youtube.com/watch?v=Brwx9A0Es9c; see Svenaeus [9] for the published version of the lecture. While it is certainly unfair to criticize impromptu responses at conferences, his response is nonetheless rather telling. He claimed that pregnancy ‘cannot be incorporated in [his] general analysis of illness and health’ and that it should be analyzed ‘on its own’. Interestingly, Boorse has this to say about any theory that pathologizes pregnancy: ‘to call pregnancy per se unhealthy would strike at the very heart of medical thought; it is the analytic equivalent of the “Game Over” sign in a video game’ [29, p. 44]. Analyzing the problem ‘on its own’ will not make it go away.
This is not universally shared, since Svenaeus does attempt to distinguish between health and happiness [9].
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Acknowledgements
I would like to thank Andreas De Block, James DiFrisco, and Jeff Sholl for their critical and ultimately helpful comments on previous drafts. I would also like to thank the anonymous reviewers of this article for their useful suggestions. This research was undertaken as part of a post-doctoral position funded by the Fonds Wetenschappelijk Onderzoek-Vlaanderen (Research Foundation-Flanders).
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Sholl, J. Putting phenomenology in its place: some limits of a phenomenology of medicine. Theor Med Bioeth 36, 391–410 (2015). https://doi.org/10.1007/s11017-015-9345-5
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DOI: https://doi.org/10.1007/s11017-015-9345-5