Naturalism, normativism and Havi Carel's phenomenological approach to health and illness (original) (raw)

A Defence of the Phenomenological Account of Health and Illness

Journal of Medicine and Philosophy, 2019

A large slice of contemporary phenomenology of medicine has been devoted to developing an account of health and illness that pro- ceeds from the first-person perspective when attempting to under- stand the ill person in contrast and connection to the third-person perspective on his/her diseased body. A proof that this phenom- enological account of health and illness, represented by philo- sophers, such as Drew Leder, Kay Toombs, Havi Carel, Hans-Georg Gadamer, Kevin Aho, and Fredrik Svenaeus, is becoming increas- ingly influential in philosophy of medicine and medical ethics is the criticism of it that has been voiced in some recent studies. In this article, two such critical contributions, proceeding from radic- ally different premises and backgrounds, are discussed: Jonathan Sholl’s naturalistic critique and Talia Welsh’s Nietzschean critique. The aim is to defend the phenomenological account and clear up misunderstandings about what it amounts to and what we should be able to expect from it.

Phenomenology of Illness H.Carel, 2016 Oxford, Oxford University Press xi + 248 pp, $50.00 (hb)

Journal of Applied Philosophy, 2018

Havi Carel's new book is the culmination of over a decade of thinking about illness. Her engagement with the subject is both academic and personal. After being diagnosed with a life-limiting lung disease, Carel published a powerful reflection of her own experiences of illness in Illness: The Cry of the Flesh (Durham: Acumen Publishing, 2008), and has written a number of academic articles developing a phenomenology of illness since. The Phenomenology of Illness contains the best of both these approaches, blending together personal anecdote and rigorous philosophical analysis to deepen our understanding of what it means to be ill. Written for an academic audience, the book has two aims: 'to contribute to the understanding of illness through the use of philosophy, and to demonstrate the importance of illness for philosophy' (p. 2). What motivates a phenomenological approach to illness? Carel offers three rationales: as the study of lived experience, phenomenology is a natural approach to understanding the variety of illness experiences; it provides a non-prescriptive framework free of conceptual restrictions; and it underscores the centrality of the body to understanding human experience (p. 7). The structure of the book can be divided into roughly two sections. The first five chapters develop the general framework for a phenomenology of illness, with the final chapter in this half applying the framework to respiratory illness. The second section of the book explores the relationship between illness and other key philosophical topics, namely, wellbeing, death, and epistemic injustice. Thus, the structure aptly mirrors the two-part aim of her project, leveraging the conceptual tools of phenomenology to examine illness, and conversely, exploring how illness may illuminate traditional debates in philosophy. A brief note: many of our thoughts in this review developed during a term-long seminar on Carel's book. This was attended by philosophers (both analytic and continental), social scientists and clinical practitioners, among others. The value of Carel's project was evident throughout the discussions. The book not only reframed issues traditionally viewed under the scope of Anglo-American philosophy; it also offered a shared language and perspective for engagement between the social sciences, humanities, and the medical sciences. Carel's approach is based on a definition of illness as 'serious, chronic, and lifechanging ill health, as opposed to a cold or a bout of tonsillitis' (p. 2). Illness is something which changes the subject's way of being, in a way that a simple cold does not. Following others, Carel contrasts this with disease, whereby disease is seen as physiological dysfunction. The book makes great use of this distinction and it no doubt

Naturalistic and Phenomenological Theories of Health: Distinctions and Connections

Human Experience and Nature: Examining the Relationship between Phenomenology and Naturalism

In this paper I present and compare the ideas behind naturalistic theories of health on the one hand and phenomenological theories of health on the other. The basic difference between the two sets of theories is no doubt that whereas naturalistic theories claim to rest on value neutral concepts, such as normal biological function, the phe-nomenological suggestions for theories of health take their starting point in what is often named intentionality: meaningful stances taken by the embodied person in experiencing and understanding her situation and taking action in the world. Although naturalism and phenomenology are fundamentally different in their approach to health, they are not necessarily opposed when it comes to understanding the predicament of ill persons. The starting point of medical investigations is what the patient feels and says about her illness and the phenomenological investigation should include the way diagnoses of different diseases are interpreted by the person experiencing the diseases as an embodied being. Furthermore, the two theories display similarities in their emphasis of embodiment as the central element of health theory and in their stress on the alien nature of the body displayed in illness. Theories of biology and phenomenology are, indeed, compatible and in many cases also mutually supportive in the realm of health and illness.

Illness and two meanings of phenomenology

Journal of Evaluation in Clinical Practice, 2020

Background: When approaching medicine, phenomenology has at least two meanings that need to be distinguished in order to become relevant in its application to medical practice. Up to now, these two meanings have been overlapped by most of the scholarly literature. Therefore, the purpose of the article is to differentiate between them, thus endorsing their potential use in medical practice. Methods: The first meaning was instituted by Edmund Husserl and views phenomenology as transcendental, ie, as a transcendental rigorous science based on the unravelling of transcendental subjectivity/intersubjectivity. The second takes it more as a narrative enterprise, ie, as a description of personal subjective experience, thus seeming closer to other approaches to disease which can be found both in philosophy and other fields. Nevertheless, both provide advantages and disadvantages when it comes to approaching illness. Results: Neither of the two meanings can supersede the other and, consequently, neither of the two analogue forms of phenomenology can impose itself as the phenomenology of medicine. Conclusion: It is important to clarify the consequences of applying each of the two understandings of phenomenology to medicine in the context of its current development. Our present inquiry concerns not merely the disentanglement of the status of what today's scholarly literature calls phenomenology of medicine in relation to meanings of phenomenology, but also the limits of applying phenomenology to the field of medicine.

What a Naturalist Theory of Illness Should Be

History, Philosophy and Theory of the Life Sciences, 2016

Christopher Boorse, the leading naturalist philosopher of medicine, used to interpret illness as a practical concept that involves normative or evaluative elements, which have to do with the undesirability of medical conditions. Later he changed his mind and has since regarded illness as a value-neutral concept, just like disease. An illness, according to his most recent point of view, is a "systemic disease, affecting the organism as a whole". Yet, his account of illness is still fairly undeveloped. In my contribution I want to scrutinize the notion of illness from a naturalist point of view. I will first draw on Boorse's theory and point out problems with it. I will then discuss the crucial question about the logical relation between the concepts of disease and illness, especially by discussing Bill Fulford's "reverse view". A naturalist account of illness holds that the extension of the concept of illness is restricted by the scope of the concept of disease, hence that a condition qualifies as a putative illness only if it is a disease. I do agree with normativists, though, in claiming that the concept of illness is evaluative; it refers to pathological conditions that are bad for the affected person. Finally, I hint at a way as to how a distinctively naturalist theory of illness can draw on a naturalist theory of disease. We seem to gain knowledge about the basic elements of a good human life in virtue of developing a theory of basic biological functions. Hence, there is an interplay between value-neutral and evaluative points of view.