Māra Grīnfelde | University of Latvia (original) (raw)

Papers by Māra Grīnfelde

Medicine, Health Care and Philosophy , 2023

The global crisis of COVID-19 pandemic has considerably accelerated the use of teleconsultation (... more The global crisis of COVID-19 pandemic has considerably accelerated the use of teleconsultation (consultation between the patient and the doctor via video platforms). While it has some obvious benefits and drawbacks for both the patient and the doctor, it is important to consider-how teleconsultation impacts the quality of the patient-doctor relationship? I will approach this question through the lens of phenomenology of the body, focusing on the question-what happens to the patient objectification in teleconsultation? To answer this question I will adopt a phenomenological approach combining both insights drawn from the phenomenological tradition, i.e., the concepts of the lived body and the object body, and the results from the phenomenologically informed qualitative research study on the patient experience of teleconsultation. The theoretical background against which I have developed this study comprises discussions within the field of phenomenology of medicine regarding the different sources of patient objectification within clinical encounter and the arguments concerning the negative impact that objectification has on the quality of care. I will argue that a factor that has frequently been identified within phenomenology of medicine as the main source of patient objectification in clinical encounters, namely, the internalized gaze of the clinician, is diminished during teleconsultation, increasing patient's sense of agency, decreasing her sense of alienation and opening up the possibility for a closer relationship between the patient and the health care provider, all of which lead to the transformation of the hierarchical patient-health care professional relationship.

Human Studies

The global crisis of the COVID-19 pandemic has considerably accelerated the adoption of teleconsu... more The global crisis of the COVID-19 pandemic has considerably accelerated the adoption of teleconsultation—a form of consultation between patient and health care professional that occurs via videoconferencing platforms. For this reason, it is important to investigate the way in which this form of interaction modifies the nature of the clinical encounter and the extent to which this modification impacts the healing process. For this purpose, I will refer to insights into the clinical encounter as a face-to-face encounter drawn from the phenomenology of medicine (R. Zaner, K. Toombs, E. Pellegrino). I will also take into account a criticism that has been expressed by various contemporary phenomenologists (H. Dreyfus, T. Fuchs, L. Dolezal, H. Carel), namely, that due to the lack of physical proximity to the other in all types of online encounters, such encounters lack significant features that are present in face-to-face encounters, with the most important of these being the possibility ...

The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine, 2023

A key topic within the field of the phenomenology of medicine has been the relationship between b... more A key topic within the field of the phenomenology of medicine has been the relationship between body and self in illness, including discussions about the otherness and mineness of the body. The aim of this article is to distinguish between different meanings of bodily otherness and mineness in illness with reference to the interpretation of the body as “saturated phenomenon,” inspired by the phenomenology of Jean-Luc Marion. With the help of Marion’s ideas it is possible to distinguish between two meanings of bodily otherness and of mineness (objective and non-objective forms). These distinctions support and elaborate on ideas already found in the phenomenology of medicine and offer further insights into the nature of the experience of illness.

The Journal of Medicine and Philosophy, 2021

A large part of contemporary phenomenology of medicine has been devoted to accounts of health and... more A large part of contemporary phenomenology of medicine has been devoted to accounts of health and illness, arguing that they contribute to the improvement of healthcare. Less focus has been paid to the issue of prevention of disease and the associated difficulty of adhering to health-promoting behaviours, which is arguably of equal importance. This article offers a phenomenological account of this disease prevention, focusing on how we-as embodied beings-engage with health-promoting behaviours. It specifically considers how we engage with oral hygiene regimes to prevent periodontitis and why we are not good at it. The article suggests that the poor adherence to health-promoting behaviours can be explained with reference to the concept of the absent body, as prevention of disease is generally concerned with presymptomatic illness experience. The final section contains a discussion of some strategies for the improvement of disease prevention based on this viewpoint.

AVANT. Trends in Interdisciplinary Studies, 2018

In this paper I will try to systematically lay out and describe the multiple dimensions of the em... more In this paper I will try to systematically lay out and describe the multiple dimensions of the embodied experience of illness, which until recently has been the main focus within the field of the phenomenology of medicine. In order to do this, I will turn to analysis of the nature of embodiment in Husserl's phenomenology. I will argue that based on Hus⁠ serl's phenomenology of the body, one can distinguish four ways of experiencing one's body, or four dimensions of embodiment. I will distinguish between experience of one's body as 1) a bearer of sensations (the affective dimension of embodiment); 2) a seat of free movement, characterized by the faculty of " I can " (the functional dimension of embodiment); 3) a material thing in a causal relationship with the material world (the material dimension of embodiment); 4) a material thing embedded in a social context (the social dimension of embodiment). I will then apply the proposed classification of dimensions of embodiment to the experience of illness, focusing on the various ways these dimensions have been used within the phenomenology of medicine. This serves two purposes. Firstly, it provides a framework for classification of the existing interpretations of the experience of illness; secondly, it opens up a way for a comprehensive analysis of the experience of illness which includes both individual and social aspects of embodiment as well as their mutual intertwining.

Medicine, Health Care and Philosophy, 2019

During the last few decades, many thinkers have advocated for the importance of the phenomenologi... more During the last few decades, many thinkers have advocated for the importance of the phenomenological approach in developing the understanding of the lived experience of illness. In their attempts, they have referred to ideas found in the history of phenomenology, most notably, in the works of Edmund Husserl, Martin Heidegger, Maurice Merleau-Ponty and Jean-Paul Sartre. The aim of this paper is to sketch out an interpretation of illness based on a yet unexplored conceptual framework of the phenomenology of French thinker Jean-Luc Marion. Focusing on concepts of the saturated phenomenon and flesh, the paper develops an interpretation of illness as the saturated phenomenon, which highlights a variety of dimensions of illness already elaborated within the phenomenology of medicine, such as the affective dimension of illness, the disruptive dimension of illness, the transformed perception of the self in illness, mineness of flesh in illness and the inexpressible and hermeneutical dimension of illness. In addition to that, the paper explores some of the consequences the proposed interpretation of illness offers regarding the nature of illness and health. It is argued that illness in its essence is very similar to the experience of other saturated phenomena, suggesting that the difference between them does not lie within the character of the affective givenness, but rather within the dynamic relationship between the affective givenness and its conceptualization. It is also shown that the experience of health is compatible with the experience of saturation and thus is not limited to the tacit and harmonious background state.

Conference paper, 2021

In this paper I will briefly outline the context, aim, methods and provisional results of my post... more In this paper I will briefly outline the context, aim, methods and provisional results of my post-doctoral research project “Healing at a distance: phenomenological perspective on patient experience of teleconsultation”.

Religiski-filozofiski raksti, 2013

French thinker Jean-Luc Marion (Jean-Luc Marion) is probably best known for his hypothesis of the... more French thinker Jean-Luc Marion (Jean-Luc Marion) is probably best known for his hypothesis of the ‘saturated phenomenon’ (phénomène saturé) – a hypothesis of a phenomenon that is characterized through the excess of intuition over intention. Marion’s scholars have been mainly interested in this hypothesis of the saturated phenomenon without paying any attention to the distinction made by Marion himself between the saturated phenomenon and the saturated saturated phenomenon or the phenomenon of revelation. A close reading of Marion’s work Being Given (Étant donné) reveals unconditional phenomena that are not saturated with intuition – Marion calls them ‘phenomena of revelation’. Contrary to saturated phenomena, which are described as intuitive givenness, phenomena of revelation are described as givenness without intuition.
The aim of this paper is to question the phenomenological possibility of the phenomenon of revelation. This presupposes questioning the meaning of ‘givenness without intuition’ which is done in the first part of the paper ‘The meaning of the phenomenon of revelation.’ The second part of the paper ‘The phenomenon of revelation: birth, time, death and Revelation’ is devoted to the question – how does givenness without intuition (birth, death, time and Revelation) show itself? It is argued that, based both on examples of the phenomenon of revelation and on its description found in Marion’s work In Excess (De surcroît), givenness without intuition shows itself indirectly. However, the idea of ‘indirect phenomenalization’ is itself problematic. Therefore, in the third part of the paper ‘The impossibility of the phenomenon of revelation’ the following question is posed – is indirect phenomenalization a phenomenological possibility? Are there phenomena that show themselves both indirectly and unconditionally?
In the first part of the paper concepts of ‘phenomenon’, ‘givenness’ and ‘’intuition’ are analyzed. It is concluded that, according to Marion, phenomena as givens can manifest themselves at least in two different ways – 1) as intentional objects (either resulting from an adequation between signitive intention and intuition (in the case of ideal objects) or resulting from an inadequation between them due to a lack of intuition in relation to signitive intention (in the case of a perception of a thing) and 2) as saturated phenomena resulting from the inadequation between signitive intention and intuition due to the excess of intuition in relation to signitive intention. However, Marion argues for the third possibility as well – givens can manifest themselves both nonintentionally and non-intuitively. Givenness must not necessary be either that of intention or intuition; there is a third option – pure givenness or givenness that does not show itself on either the basis of intention or intuition, but on the basis of itself.
The difference between the saturated phenomenon and the phenomenon of revelation, according to Marion, lies in the fact that the former is still determined according to the relationship between intuition and signitive intention, while the latter transcends these elements and is determined based on the givenness alone. However, he also maintains that intuition (understood as givenness that shows itself in and from itself without any mediation) is free from any intention, that is, it can be given without any relation to the intention. If this is the case, in order to argue for the non-intuitive character of the phenomenon of revelation, it is not enough to show its detachment from intention. In the second part of the paper, based on Marion’s examples of the phenomenon of revelation, it is concluded that the phenomenon of revelation is indeed non-intuitive, but not because it cannot be measured against intention, but because it shows itself indirectly.
The rest of the second part of the paper is devoted to a brief analysis of the four examples of the phenomenon of revelation, in order to ascertain whether all of them can be characterized through indirect phenomenalization. It is concluded that the phenomenon of my birth, the phenomenon of the death of the other and the phenomenon of Revelation can be characterized as phenomena that show themselves indirectly. The phenomenon of time and the phenomenon of my death do not show themselves indirectly (the former shows itself directly, the latter does not show itself at all) and, therefore, are not taken into account in evaluating the possibility of non-intuitive givenness.
In the last part of the paper it is argued that, based on Marion’s examples of givenness without intuition (my birth, death of the other and Revelation), it can be equated either 1) with unfulfilled meaning-intention (something that is merely thought) or 2) with the speculative ideal. In both cases Marion is not able to maintain the characterization of non-intuitive givenness as unconditional givenness that shows itself of itself and from itself. In other words, indirect phenomenalization can be equated with either phenomenon that shows itself as intentional object within the reduced sphere of transcendental subjectivity or with the speculative ideal that exceeds the sphere of reduced experience. In the first case it loses its unconditional character, in the second case its phenomenological possibility. The phenomenon of revelation as Marion describes it – unconditional non-intuitive givenness that shows itself indirectly – is phenomenologically impossible.

Valsts pētījumu programmas “Nacionālā identitāte (valoda, Latvijas vēsture, kultūra un cilvēkdros... more Valsts pētījumu programmas “Nacionālā identitāte (valoda, Latvijas vēsture, kultūra un cilvēkdrosība)” projekts “Nacionālā un eiropeiskā identitāte”

Reports by Māra Grīnfelde

HORIZON Studies in Phenomenology, 2017

The report briefly outlines the aim, history, and future plans of the conference series dedicated... more The report briefly outlines the aim, history, and future plans of the conference series dedicated to the traditions and perspectives of the phenomenological movement in Central and Eastern Europe, provides information about the aim and structure of the conference, and gives short summaries of the keynote lectures.

Books by Māra Grīnfelde

Neredzamā pieredze. Žana Lika Mariona dotības fenomenoloģija, 2016

Summary of my book "Invisible Experience. Jean-Luc Marion’s Phenomenology of Givenness" (publishe... more Summary of my book "Invisible Experience. Jean-Luc Marion’s Phenomenology of Givenness" (published in Latvian)

Conference Presentations by Māra Grīnfelde

the The 23rd Annual Conference of the Society for Phenomenology and Media 'Being Together in the Digital Age’, 2022

The global crisis of Covid-19 pandemic has considerably accelerated the use of the teleconsultati... more The global crisis of Covid-19 pandemic has considerably accelerated the use of the teleconsultation (consultation between the patient and the doctor via video platforms). While it has some obvious benefits and drawbacks for both the patient and the doctor, it is important to understand if and how this new form of interaction modifies the clinical relationship. I will consider this question in the context of the discussions about the quality of care crisis in medicine (Marcum 2012), in which patients perceive physicians as not sufficiently empathic towards their suffering, leading to the dehumanization of medical practice. Taking into account the fact that this crisis has been said to stem from the physician’s exclusive focus on the patient’s body (Marcum 2004), leading to its objectification, it is important to find out what happens to clinical encounter when the physical body is absent. I am proposing to approach this issue from the perspective of phenomenology, including insights from both phenomenological philosophy and phenomenologically informed qualitative research study about patient experience of teleconsultation. I will use distinction between the lived body and object body. I will argue that the technological mediation in the teleconsultation transforms the asymmetrical patient-physician relationship, giving more control and responsibility to the patient and opening up the possibility for more empathetic clinical relationship. This transformation is grounded in the absence of the physical body of the patient, which forces the physician to take seriously the story of the patient and to focus on her lived experiences.

Conference paper, 2021

The global crisis of Covid-19 pandemic has considerably accelerated the use of teleconsultation (... more The global crisis of Covid-19 pandemic has considerably accelerated the use of teleconsultation (consultation between the patient and the doctor via video platforms). While it is clear that video-based online clinical encounter has certainly taken away many possibilities for action accessible to both the patient and the doctor, such as, for example, the possibility to touch the other person, it is not clear how the absence of the physical body has modified the interaction between the physician and the patient. The aim of my paper is to find out how the patient experiences being with the doctor online and what is the role of embodiment in this experience? This question is motivated by two things. Firstly, by insights expressed within phenomenology of medicine regarding the nature of clinical encounter (Edmund Pellegrino, Kay Toombs), namely, that clinical encounter contains a face-to-face relationship between the patient and the doctor, ensuring a successful healing process, which among other things presupposes patient’s experience of “intimacy, closeness, expression, emotion and contact” (Dolezal, 2020) with the doctor. Secondly, the question is motivated by the suspicion expressed by contemporary phenomenologists (Hubert Dreyfus, Tomas Fuchs, Havi Carel, Luna Dolezal) regarding the nature of online video-based interaction, namely, that it differs significantly from the embodied face-to-face contact. For example, with reference to the concepts of embodiment and intercorporeality, found in the works of Merleau-Ponty, Dolezal argues that video encounter will always fall short of the on-site encounter due to the lack of embodied proximity to the other person (Dolezal 2020). I will approach the issue from the perspective of phenomenology, including both insights from the phenomenological philosophy and the results from the phenomenologically informed qualitative research study about patient experience of teleconsultation, which I have conducted. Firstly, I will show that based on the results of the qualitative research study, patients do experience emotions, expression, closeness and contact with the doctor, which in some cases is even higher than in on-site face-to-face consultations. Secondly, I will argue, that this has less to do with the embodied nature of the interaction and more to do with 1) the lack of the clinical environment (lack of doctor’s office, waiting room, etc.); 2) the particularities of the online environment (such as the undivided attention from the doctor) and 3) the previous relationship between the patient and the doctor. Thus, I will argue that on-site embodied interaction is not a necessary condition for a successful healing process.

The global crisis of Covid-19 pandemic has considerably accelerated the use of teleconsultation (... more The global crisis of Covid-19 pandemic has considerably accelerated the use of teleconsultation (consultation between the patient and the doctor via video platforms). While it has some obvious benefits and drawbacks for both the patient and the doctor, it is important to consider how this new form of interaction impacts the nature of the clinical encounter. Based on the insights from the phenomenology of medicine about the nature of the clinical encounter as the “face-to-face encounter” (E. Pellegrino, K. Toombs), my aim is to find out if teleconsultation is also experienced as the face-to-face encounter? This research question is motivated by the suspicion expressed by contemporary phenomenologists (H. Carel, L. Dolezal) about the nature of online video-based interaction, namely, that it differs significantly from the embodied face-to-face contact. I am approaching the issue from the perspective of phenomenology, including both insights from the phenomenological philosophy regarding the concept of the “face-to-face relationship” and the results from the phenomenologically informed qualitative research study about patient experience of teleconsultation. Based on the work of phenomenological thinkers (most notably A. Schutz and E. Levinas), I have distinguish between three essential features of the “face-to-face relationship”: 1) temporal simultaneity, 2) spatial immediacy of the other’s presence and 3) the sense of the embodied risk. This conceptual differentiation provided a lens through which I have conducted qualitative research, the results of which show that teleconsultation can provide temporal simultaneity, sense of togetherness to the doctor (arguably even higher than in on-site consultations) and it does include the sense of the embodied risk. Thus, I will argue that based on both the analysis of the concept of the “face-to face relationship” and the results from the qualitative research, it is possible to meet with the doctor face-to-face online.

Iemiesotība un attālināta saskarsme: fenomenoloģiskā perspektīva Referāts nolasīts 16.03.2021. La... more Iemiesotība un attālināta saskarsme: fenomenoloģiskā perspektīva Referāts nolasīts 16.03.2021. Latvijas Universitātes 79. Starptautiskās konferences sekcijā "Filosofijas un ētikas aktualitātes pandēmijas laikā", ko organizē Latvijas Universitātes Filozofijas un Socioloģijas institūts. Referāts izstrādāts Pēcdoktorantūras pētniecības projekta (1.1.1.2/VIAA/4/20/622) "Attālināta ārstēšana: pacienta ārstnieciskās tikšanās pieredzes telemedicīnā fenomenoloģiska analīze" ietvaros. Pandēmija ir atstājusi ietekmi uz daudzu cilvēku pieredzi-gan laika pieredzi, gan miesas pieredzi, gan pasaules pieredzi, gan arī savstarpējo attiecību pieredzi. Tā kā fenomenoloģiskā filozofija ir pieredzes filozofija, (uzsverot gan to, ka pieredze ir ikviena apraksta sākumpunkts, gan arī to, ka atšķirīgas pieredzes uzrāda atšķirīgas, sev raksturīgas (bieži vien sociālās un kultūras vides noteiktas) iezīmes), mūsdienu fenomenologi ir pievērsušies šo transformēto pieredžu aplūkojumam, izmantojot virkni klasiskajā fenomenoloģijā atrodamu jēdzienu, tādu kā miesa, intencionalitāte, dzīvespasaule, atsvešinātība, u.tml. Šobrīd es īstenoju pēcdoktorantūras projektu "Attālināta ārstēšana: pacienta ārstnieciskās tikšanās pieredzes telemedicīnā fenomenoloģiska analīze", kura ietvaros es pielietoju fenomenoloģiskās filozofijas jēdzienus (apvienojumā ar kvalitatīvajām intervijām, kas sniedz materiālu "faktuālai variācijai"), lai saprastu, vai un kā telekonsultācija (video konsultācija starp ārstu un pacientu) maina pacienta ķermenisko pieredzi, attiecību ar ārstu pieredzi, telpas un laika pieredzi? Šī referāta ietvaros es vēlos īsumā iezīmēt fenomenoloģiskās filozofijas potenciālu šī jautājuma risināšanā un plašāk – ikvienas attālinātas saskarsmes kā īpaša pieredzes veida aprakstīšanā.

Presence is tied indelibly in Martin Heidegger's thinking to the human experience of being. A cen... more Presence is tied indelibly in Martin Heidegger's thinking to the human experience of being. A central concept in Being and Time is the 'clearing' (Lichtung)-a space within Dasein wherein entities come to presence. Presence here, like much of Heidegger's vocabulary, takes on a very particular meaning. It implies more than the mere occurring or coming-across of an entity-it is coming-to-be-with an entity in an entirely new way.

Medicine, Health Care and Philosophy , 2023

Human Studies

The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine, 2023

The Journal of Medicine and Philosophy, 2021

AVANT. Trends in Interdisciplinary Studies, 2018

Medicine, Health Care and Philosophy, 2019

Conference paper, 2021

Religiski-filozofiski raksti, 2013

HORIZON Studies in Phenomenology, 2017

Neredzamā pieredze. Žana Lika Mariona dotības fenomenoloģija, 2016

the The 23rd Annual Conference of the Society for Phenomenology and Media 'Being Together in the Digital Age’, 2022

Conference paper, 2021

The global crisis of Covid-19 pandemic has considerably accelerated the use of teleconsultation (... more The global crisis of Covid-19 pandemic has considerably accelerated the use of teleconsultation (consultation between the patient and the doctor via video platforms). While it has some obvious benefits and drawbacks for both the patient and the doctor, it is important to consider how this new form of interaction impacts the nature of the clinical encounter. Based on the insights from the phenomenology of medicine about the nature of the clinical encounter as the “face-to-face encounter” (E. Pellegrino, K. Toombs), my aim is to find out if teleconsultation is also experienced as the face-to-face encounter? This research question is motivated by the suspicion expressed by contemporary phenomenologists (H. Carel, L. Dolezal) about the nature of online video-based interaction, namely, that it differs significantly from the embodied face-to-face contact. I am approaching the issue from the perspective of phenomenology, including both insights from the phenomenological philosophy regarding the concept of the “face-to-face relationship” and the results from the phenomenologically informed qualitative research study about patient experience of teleconsultation. Based on the work of phenomenological thinkers (most notably A. Schutz and E. Levinas), I have distinguish between three essential features of the “face-to-face relationship”: 1) temporal simultaneity, 2) spatial immediacy of the other’s presence and 3) the sense of the embodied risk. This conceptual differentiation provided a lens through which I have conducted qualitative research, the results of which show that teleconsultation can provide temporal simultaneity, sense of togetherness to the doctor (arguably even higher than in on-site consultations) and it does include the sense of the embodied risk. Thus, I will argue that based on both the analysis of the concept of the “face-to face relationship” and the results from the qualitative research, it is possible to meet with the doctor face-to-face online.