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Putting phenomenology in its place: some limits of a phenomenology of medicine

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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

  1. 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.

  2. 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.

  3. 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.

  4. 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].

  5. 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.

  6. 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.

  7. My point here is not to discuss the critiques of naturalistic views about what is ‘normal and natural’. For more on this see [5254].

  8. 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.

  9. I thank one of the anonymous reviewers of an earlier draft for this qualificatory point.

  10. This critique, that phenomenology ends up supporting positivism, can already be found in the end of Foucault’s Birth of the Clinic [56].

  11. 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.

  12. 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.

  13. 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.

  14. This is not universally shared, since Svenaeus does attempt to distinguish between health and happiness [9].

References

  1. Carel, H., and R. Cooper (eds.). 2013. Health, illness and disease: Philosophical essays. Durham: Acumen.

    Google Scholar 

  2. Ereshefsky, M. 2009. Defining ‘health’ and ‘disease’. Studies in History and Philosophy of Biological and Biomedical Sciences 40(3): 221–227.

    Article  Google Scholar 

  3. Hamilton, R.P. 2010. The concept of health: Beyond normativism and naturalism. Journal of Evaluation in Clinical Practice 16: 323–329.

    Article  Google Scholar 

  4. Aho, J., and K. Aho. 2008. Body matters: A phenomenology of sickness, disease, and illness. Lanham: Lexington Books.

    Google Scholar 

  5. Carel, H. 2008. Illness. Durham: Acumen Publishing.

    Google Scholar 

  6. Carel, H. 2011. Phenomenology and its application in medicine. Theoretical Medicine and Bioethics 32: 33–46.

    Article  Google Scholar 

  7. Ratcliffe, M. 2008. Feelings of being: Phenomenology, psychiatry and the sense of reality. Oxford: Oxford University Press.

    Book  Google Scholar 

  8. Svenaeus, F. 2001. The hermeneutics of medicine and the phenomenology of health. Linköping: Springer.

    Google Scholar 

  9. Svenaeus, F. 2013. Naturalistic and phenomenological theories of health: Distinctions and connections. In Phenomenology and naturalism: Exploring the relationship between human experience and nature, ed. H. Carel and D. Meacham, 221–238. Cambridge: Cambridge University Press.

    Google Scholar 

  10. Svenaeus, F. 2013. What is phenomenology of medicine? Embodiment, illness and being-in-the-world. In Health, illness and disease: Philosophical essays, ed. H. Carel and R. Cooper, 97–111. Durham: Acumen.

    Google Scholar 

  11. Zaner, R. 1981. The context of self: A phenomenological inquiry using medicine as a clue. Ohio: Ohio University Press.

    Google Scholar 

  12. Toombs, S.K. 1988. Illness and the paradigm of lived body. Theoretical Medicine 9: 201–226.

    Article  Google Scholar 

  13. Toombs, S.K. (ed.). 2001. Handbook of phenomenology and medicine. Dordrecht: Kluwer.

    Google Scholar 

  14. Svenaeus, F. 2000. Das unheimliche—Towards a phenomenology of illness. Medicine, Health Care and Philosophy 3: 3–16.

    Article  Google Scholar 

  15. Carel, H. 2012. Phenomenology as a resource for patients. Journal of Medicine and Philosophy 37: 96–113.

    Article  Google Scholar 

  16. Gergel, T.L. 2012. Medicine and the individual: Is phenomenology the answer? Journal of Evaluation in Clinical Practice 18: 1102–1109.

    Article  Google Scholar 

  17. Fuchs, T. 2013. Temporality and psychopathology. Phenomenology and the Cognitive Sciences 12(1): 75–104.

    Article  Google Scholar 

  18. Merleau-Ponty, M. 1962. Phenomenology of perception. Trans. C. Smith. London: Routledge & Kegan Paul.

  19. Boorse, C. 1975. On the distinction between disease and illness. Philosophy and Public Affairs 5(1): 49–68.

    Google Scholar 

  20. Husserl, E. 1977. Phenomenological psychology: Lectures, summer semester, 1925. Trans. J. Scanlon. The Hague: Martinus Nijhoff.

  21. Zahavi, D. 2013. Naturalized phenomenology: A desideratum or a category mistake? In Phenomenology and naturalism: Exploring the relationship between human experience and nature, ed. H. Carel and D. Meacham, 23–42. Cambridge: Cambridge University Press.

    Google Scholar 

  22. Petitot, J., F.J. Varela, B. Pachoud, and J.-M. Roy (eds.). 1999. Naturalising phenomenology. Stanford: Stanford University Press.

    Google Scholar 

  23. Carel, H., and D. Meacham (eds.). 2013. Phenomenology and naturalism: Exploring the relationship between human experience and nature. Cambridge: Cambridge University Press.

    Google Scholar 

  24. Papineau, D. 2007. ‘Naturalism’. Stanford Encyclopedia of Philosophy. http://plato.stanford.edu/entries/naturalism/. Accessed 20 Oct 2014.

  25. De Caro, M., and D. Macarthur (eds.). 2010. Naturalism and normativity. New York: Columbia University Press.

    Google Scholar 

  26. Dupré, J. 2010. How to be naturalistic without being simplistic in the study of human nature. In Naturalism and normativity, ed. M. De Caro and D. Macarthur, 289–303. New York: Columbia University Press.

    Google Scholar 

  27. Eisenberg, L. 1977. Disease and illness: Distinctions between professional and popular ideas of sickness. Culture, Medicine and Psychiatry 1: 9–23.

    Article  Google Scholar 

  28. Conrad, P., and K.K. Barker. 2010. The social construction of illness: Key insights and policy implications. Journal of Health and Social Behavior 51(5): S67–S79.

    Article  Google Scholar 

  29. Boorse, C. 1997. A rebuttal on health. In What is disease?, ed. J.M. Humber and R.F. Almeder, 3–134. Totowa: Humana Press.

    Google Scholar 

  30. Wakefield, J. 1992. The concept of mental disorder: On the boundary between biological facts and social values. American Psychologist 47(3): 373–388.

    Article  Google Scholar 

  31. Wakefield, J. 2011. Darwin, functional explanation, and the philosophy of psychiatry. In Maladapting minds: Philosophy, psychiatry, and evolutionary theory, ed. P.R. Adriaens and A. De Block, 143–172. Oxford: Oxford University Press.

    Chapter  Google Scholar 

  32. Kingma, E. 2014. Naturalism about health and disease: Adding nuance for progress. Journal of Medicine and Philosophy 39(6): 590–608.

    Article  Google Scholar 

  33. Boorse, C. 1976. Wright on functions. Philosophical Review 85(1): 70–86.

    Article  Google Scholar 

  34. Bateson, P., and P. Gluckman. 2011. Plasticity, robustness, development and evolution. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  35. Laland, K.N., and G.R. Brown. 2006. Niche construction, human behavior, and the adaptive-lag hypothesis. Evolutionary Anthropology 15: 95–104.

    Article  Google Scholar 

  36. Sholl, J. forthcoming. Contextualizing medical norms: Georges Canguilhem’s Surnaturalism. In Naturalism in philosophy of health: Issues, limits and implications, ed. É. Giroux. Dordrecht: Springer.

  37. Ananth, M. 2008. In defence of an evolutionary concept of health: Nature, norms, and human biology. Hampshire: Ashgate Publishing.

    Google Scholar 

  38. Schulkin, J. 2003. Rethinking homeostasis: Allostatic regulation in physiology and pathophysiology. Cambridge: MIT Press.

    Google Scholar 

  39. Richerson, P.J., and R. Boyd. 2005. Not by genes alone: How culture transformed human evolution. Chicago: University of Chicago Press.

    Google Scholar 

  40. Gilbert, S.F., and D. Epel. 2009. Ecological developmental biology: Integrating epigenetics, medicine, and evolution. Sunderland: Sinauer Associates Inc.

    Google Scholar 

  41. Jablonka, E., and M.J. Lamb. 2004. Evolution in four dimensions: Genetic, epigenetic, behavioral, and symbolic variation in the history of life. Cambridge: MIT Press.

    Google Scholar 

  42. Borsboom, D., and A.O.J. Cramer. 2013. Network analysis: An integrative approach to the structure of psychopathology. Annual Review of Clinical Psychology 9: 91–121.

    Article  Google Scholar 

  43. Barabási, A.L., N. Gulbahce, and J. Loscalzo. 2011. Network medicine: A network-based approach to human disease. Nature Reviews: Genetics 12(1): 56–68.

    Article  Google Scholar 

  44. Gross, F. 2011. What systems biology can tell us about disease. History and Philosophy of the Life Sciences 33: 389–396.

    Google Scholar 

  45. Dupré, J. 2012. Processes of life: Essays in the philosophy of biology. Oxford: Oxford University Press.

    Book  Google Scholar 

  46. Dubos, R. 1965. Man adapting. New Haven: Yale University Press.

    Google Scholar 

  47. Canguilhem, G. 1989. The normal and the pathological. Trans. C.R. Fawcett and R.S. Cohen. New York: Zone Books.

  48. Murphy, D. 2006. Psychiatry in the scientific image. Cambridge: MIT Press.

    Google Scholar 

  49. Sapolsky, R.M. 2004. Why zebras don’t get ulcers, 3rd ed. New York: St. Martin’s Griffin.

    Google Scholar 

  50. Childs, B., C. Wiener, and D. Valle. 2005. A science of the individual: Implications for a medical school curriculum. Annual Review of Genomics and Human Genetics 6: 313–330.

    Article  Google Scholar 

  51. Morange, M. 2008. Retour sur le normal et le pathologique. In Philosophie et médecine: en hommage à Georges Canguilhem, dir. A. Fagot-Largeault, C. Debru, and M. Morange, ed. H.-J. Han, 155–169. Paris: Vrin.

  52. Amundson, R. 2000. Against normal function. Studies in History and Philosophy of Biological and Biomedical Sciences 31(1): 33–53.

    Article  Google Scholar 

  53. Kingma, E. 2010. Paracetamol, poison, and polio: Why Boorse’s account of function fails to distinguish health and disease. British Journal for the Philosophy of Science 61: 241–264.

    Article  Google Scholar 

  54. Sholl, J., and A. De Block. 2015. Towards a critique of normalization: Canguilhem and Boorse. In Medicine and society: New perspectives in continental philosophy, ed. D. Meacham, 141–158. Dordrecht: Springer.

    Chapter  Google Scholar 

  55. Boorse, C. 1977. Health as a theoretical concept. Philosophy of Science 44(4): 542–573.

    Article  Google Scholar 

  56. Foucault, M. 2003. The birth of the clinic: An archaeology of medical perception. Trans. A.M. Sheridan. London: Routledge.

  57. Canguilhem, G. 2008. Knowledge of life. Trans. S. Geroulanos and D. Ginsberg. New York: Fordham University Press.

  58. Rose, N., and J.M. Abi-Rached. 2013. Neuro: The new brain sciences and the management of the mind. Princeton: Princeton University Press.

    Book  Google Scholar 

  59. Hucklenbroich, P. 2014. “Disease entity” as the key theoretical concept of medicine. Journal of Medicine and Philosophy 39(6): 609–633.

    Article  Google Scholar 

  60. Fábrega, H. 1997. Evolution of sickness and healing. Berkeley: University of California Press.

    Google Scholar 

  61. Canguilhem, G. 2012. Writings on medicine. Trans. S. Geroulanos and T. Meyers. New York: Fordham University Press.

  62. Yagoda, M. 2013. ADHD is different for women. The Atlantic. http://www.theatlantic.com/health/archive/2013/04/adhd-is-different-for-women/381158/?single_page=true. Accessed 20 Oct 2014.

  63. Kendler, K.S., P. Zachar, and C. Craver. 2011. What kinds of things are psychiatric disorders? Psychological Medicine 41: 1143–1150.

    Article  Google Scholar 

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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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