Havi Carel uses phenomenology to explore how illness modifies the ill person's body, values, and world. Carel argues that illness has received little philosophical attention. Phenomenology of Illness develops a phenomenological framework for illness and a systematic understanding of illness as a philosophical tool.

This article analyses the phenomenon of epistemic injustice within contemporary healthcare. We begin by detailing the persistent complaints patients make about their testimonial frustration and hermeneutical marginalization, and the negative impact this has on their care. We offer an epistemic analysis of this problem using Miranda Fricker's account of epistemic injustice. We detail two types of epistemic injustice, testimonial and hermeneutical, and identify the negative stereotypes and structural features of modern healthcare practices that generate them. We claim that these stereotypes (...) and structural features render ill persons especially vulnerable to these two types of epistemic injustice. We end by proposing five avenues for further work on epistemic injustice in healthcare. (shrink)

In this paper we argue that ill persons are particularly vulnerable to epistemic injustice in the sense articulated by Fricker. Ill persons are vulnerable to testimonial injustice through the presumptive attribution of characteristics like cognitive unreliability and emotional instability that downgrade the credibility of their testimonies. Ill persons are also vulnerable to hermeneutical injustice because many aspects of the experience of illness are difficult to understand and communicate and this often owes to gaps in collective hermeneutical resources. We then argue (...) that epistemic injustice arises in part owing to the epistemic privilege enjoyed by the practitioners and institutions of contemporary healthcare services—the former owing to their training, expertise, and third-person psychology, and the latter owing to their implicit privileging of certain styles of articulating and evidencing testimonies in ways that marginalise ill persons. We suggest that a phenomenological toolkit may be part of an effort to ameliorate epistemic injustice. (shrink)

What is illness? Is it a physiological dysfunction, a social label, or a way of experiencing the world? How do the physical, social and emotional worlds of a person change when they become ill? And can there be well-being within illness? In this remarkable and thought-provoking book, Havi Carel explores these questions by weaving together the personal story of her own serious illness with insights and reflections drawn from her work as a philosopher. Carel's fresh approach to illness raises some (...) uncomfortable questions about how we all - whether healthcare professionals or not - view the ill and challenges us to become more thoughtful. 'Illness' unravels the tension between the universality of illness and its intensely private, often lonely, nature. It offers a new way of looking at a matter that affects every one of us. (shrink)

What is illness? Is it a physiological dysfunction, a social label, or a way of experiencing the world? How do the physical, social and emotional worlds of a person change when they become ill? And can there be well-being within illness? In this remarkable and thought-provoking book, Havi Carel explores these questions by weaving together the personal story of her own serious illness with insights and reflections drawn from her work as a philosopher. Carel shows how the concepts and language (...) used to describe illness today are inappropriate and misleading. Too often illness is viewed as a localised biological dysfunction while ignoring the actual experience of the ill person, their fears, their hopes, the way they interact with others and, ultimately, experience life. By focusing on the impact of illness on the ill person's life and reflecting on the experience of illness as lived from within, Carel shows how illness is a life-changing process rather than a limited physiological problem. Carel's fresh approach to illness raises some uncomfortable questions about how we all - whether healthcare professionals or not - view the ill and challenges us to become more thoughtful. "Illness" unravels the tension between the universality of illness and its intensely private, often lonely, nature. It offers a new way of looking at a matter that affects every one of us. For those who are ill, it offers insights on our ability to remain happy within the constraints of illness. (shrink)

Epistemic injustice is a harm done to a person in their capacity as an epistemic subject by undermining her capacity to engage in epistemic practices such as giving knowledge to others or making sense of one’s experiences. It has been argued that those who suffer from medical conditions are more vulnerable to epistemic injustice than the healthy. This paper claims that people with mental disorders are even more vulnerable to epistemic injustice than those with somatic illnesses. Two kinds of contributory (...) factors for epistemic injustice in psychiatric patients are outlined: global and specific. Some suggestions are made to counteract the effects of these contributory factors, for instance we suggest that physicians should participate in groups where the subjective experience of patients is explored, and learn to become more aware of their own unconscious prejudices towards psychiatric patients. (shrink)

We develop a broader, more fine-grained taxonomy of forms of ‘transformative experience’ inspired by the work of L.A. Paul. Our vulnerability to such experiences arises, we argue, due to the vulnerability, dependence, and affliction intrinsic to the human condition. We use this trio to distinguish a variety of positively, negatively, and ambivalently valenced forms of epistemically and/or personally transformative experiences. Moreover, we argue that many transformative experiences can arise gradually and cumulatively, unfolding over the course of longer periods of time.

Chronic fatigue syndrome or myalgic encephalomyelitis remains a controversial illness category. This paper surveys the state of knowledge and attitudes about this illness and proposes that epistemic concerns about the testimonial credibility of patients can be articulated using Miranda Fricker’s concept of epistemic injustice. While there is consensus within mainstream medical guidelines that there is no known cause of CFS/ME, there is continued debate about how best to conceive of CFS/ME, including disagreement about how to interpret clinical studies of treatments. (...) Against this background, robust qualitative and quantitative research from a range of countries has found that many doctors display uncertainty about whether CFS/ME is real, which may result in delays in diagnosis and treatment for patients. Strikingly, qualitative research evinces that patients with CFS/ME often experience suspicion by health professionals, and many patients vocally oppose the effectiveness, and the conceptualization, of their illness as psychologically treatable. We address the intersection of these issues and healthcare ethics, and claim that this state of affairs can be explained as a case of epistemic injustice. We find evidence that healthcare consultations are fora where patients with CFS/ME may be particularly vulnerable to epistemic injustice. We argue that the marginalization of many patients is a professional failure that may lead to further ethical and practical consequences both for progressive research into CFS/ME, and for ethical care and delivery of current treatments among individuals suffering from this debilitating illness. (shrink)

Journal of Social Philosophy, EarlyView.

Ill persons suffer from a variety of epistemically-inflected harms and wrongs. Many of these are interpretable as specific forms of what we dub pathocentric epistemic injustices, these being ones that target and track ill persons. We sketch the general forms of pathocentric testimonial and hermeneutical injustice, each of which are pervasive within the experiences of ill persons during their encounters in healthcare contexts and the social world. What’s epistemically unjust might not be only agents, communities and institutions, but the theoretical (...) conceptions of health that structure our responses to illness. Thus, we suggest that although such pathocentric epistemic injustices have a variety of interpersonal and structural causes, they are also sustained by a deeper naturalistic conception of the nature of illness. (shrink)

Phenomenology is a useful methodology for describing and ordering experience. As such, phenomenology can be specifically applied to the first person experience of illness in order to illuminate this experience and enable health care providers to enhance their understanding of it. However, this approach has been underutilized in the philosophy of medicine as well as in medical training and practice. This paper demonstrates the usefulness of phenomenology to clinical medicine. In order to describe the experience of illness, we need a (...) phenomenological approach that gives the body a central role and acknowledges the primacy of perception. I present such a phenomenological method and show how it could usefully illuminate the experience of illness through a set of concepts taken from Merleau-Ponty. His distinction between the biological body and the body as lived, analysis of the habitual body, and the notions of motor intentionality and intentional arc are used to capture the experience of illness. I then discuss the applications this approach could have in medicine. These include narrowing the gap between objective assessments of well-being in illness and subjective experiences which are varied and diverse; developing a more attuned dialogue between physicians and patients based on a thick understanding of illness; developing research methods that are informed by phenomenology and thus go beyond existing qualitative methods; and providing medical staff with a concrete understanding of the impact of illness on the life-world of patients. (shrink)

We survey several ways in which the structures and norms of medicine and healthcare can generate epistemic injustice.

In this paper I explore the tacit underlying sense of bodily certainty that characterizes normal everyday embodied experience. I then propose illness as one instance in which this certainty breaks down and is replaced by bodily doubt. I characterize bodily doubt as radically modifying our experience in three ways: loss of continuity, loss of transparency, and loss of faith in one's body. I then discuss the philosophical insights that arise from the experience of bodily doubt. The paper uses a Humean (...) framework with regards to bodily certainty, treating it as a taken for granted tacit aspect of normal experience. I argue that although bodily certainty is not rationally justifiable, we are nonetheless unable to reject it. Bodily certainty is thus revealed to be part of our brute animal nature. I conclude by suggesting that the study of pathology is a philosophical method useful for illuminating tacit aspects of experience. (shrink)

Can one be ill and happy? I use a phenomenological approach to provide an answer to this question, using Merleau-Ponty’s distinction between the biological and the lived body. I begin by discussing the rift between the biological body and the ill person’s lived experience, which occurs in illness. The transparent and taken for granted biological body is problematised by illness, which exposes it as different from the lived experience of this body. I argue that because of this rift, the experience (...) of illness cannot be captured within a naturalistic view and propose to supplant this view with a phenomenological approach. The latter approach accounts for changes in the ill person’s relationship to her social and physical world. These changes, I argue, cannot be captured by a naturalistic perspective. I then propose the notion of health within illness as a useful concept for capturing the experience of well-being reported by some ill people. I present empirical evidence for this phenomenon and assess its philosophical significance. Finally, I suggest that adaptability and creativity are two common positive responses to illness, demonstrating that health within illness is possible. The three elements combined – the transformed body, health within illness and adaptability and creativity – serve as the basis for a positive answer to the question posed above. (shrink)

This article develops the concept of wrongful depathologization, in which a psychiatric disorder is simultaneously stigmatized and trivialized. We use OCD as a case study to argue that cumulatively these two effects generate a profound epistemic injustice to OCD sufferers, and possibly to those with other mental disorders. We show that even seemingly positive stereotypes attached to mental disorders give rise to both testimonial injustice and wilful hermeneutical ignorance. We thus expose an insidious form of epistemic harm that has been (...) overlooked in the literature. (shrink)

In this chapter we suggest that many experiences of suffering can be further illuminated as forms of transformative experience, using the term coined by L.A. Paul. Such suffering experiences arise from the vulnerability, dependence, and affliction intrinsic to the human condition. Such features can create a variety of positively, negatively, and ambivalently valanced forms of epistemically and personally transformative experiences, as we detail here. We argue that the productive element of suffering experiences can be articulated as transformative, although suffering experiences (...) are not the type mostly discussed in the transformative experience literature. We correct for this here by developing a taxonomy of negatively valenced transformative experiences. We suggest three features that make such experiences ones of suffering, following Michael Brady’s definition: intensity, novelty, and attentional focus. Finally, we suggest that one possible explanation for the edifying capacity of suffering comes from it requiring more transformation than positive experiences. (shrink)

We propose that certain forms of chronic illness can be transformative experiences, in the sense described by L.A. Paul.

In this paper we propose that our understanding of pathocentric epistemic injustices can be enriched if they are theorised in terms of predicaments. These are the wider socially scaffolded structures of epistemic challenges, dangers, needs, and threats experienced by ill persons due to their particular emplacement within material, social, and epistemic structures. In previous work we have described certain aspects of these predicaments - pathocentric epistemic injustices, pathophobia, and so on. We argue that thinking predicamentally helps us integrate the various (...) social, epistemic, and practical obstacles experienced by ill persons and also unify the many concepts available for theorising them (microaggessions, epistemic injustices, and so on). (shrink)

In this article, I propose that illness is philosophically revealing and can be used to explore human experience. I suggest that illness is a limit case of embodied experience. By pushing embodied experience to its limit, illness sheds light on normal experience, revealing its ordinary and thus overlooked structure. Illness produces a distancing effect, which allows us to observe normal human behavior and cognition via their pathological counterpart. I suggest that these characteristics warrant illness a philosophical role that has not (...) been articulated. Illness can be used as a philosophical tool for the study of normally tacit aspects of human existence. I argue that illness itself can be integral to philosophical method, insofar as it facilitates a distancing from everyday practices. This method relies on pathological or limit cases to illuminate normally overlooked aspects of human perception and action. I offer Merleau-Ponty’s analysis of the case of Schneider as an example of this method. (shrink)

This article examines the philosophical role of illness. It briefly surveys the philosophical role accorded to illness in the history of philosophy and explains why illness merits such a role. It suggests that illness modifies, and thus sheds light on, normal experience, revealing its ordinary and therefore overlooked structure. Illness also provides an opportunity for reflection by performing a kind of suspension (epoché) of previously held beliefs, including tacit beliefs. The article argues that these characteristics warrant a philosophical role for (...) illness. While the performance of most philosophical procedures is volitional and theoretical, however, illness is uninvited and threatening, throwing the ill person into anxiety and uncertainty. As such it can be viewed as a radical philosophical motivation that can profoundly alter our outlook. The article suggests that illness can change the ways in which we philosophise: it may shape philosophical methods and concerns and change one's sense of salience and conception of philosophy. (shrink)

In this paper, we argue that certain theoretical conceptions of health, particularly those described as ‘biomedical’ or ‘naturalistic’, are viciously epistemically unjust. Drawing on some recent work in vice epistemology, we identity three ways that abstract objects (such as theoretical conceptions, doctrines, or stances) can be legitimately described as epistemically vicious. If this is right, then robust reform of individuals, social systems, and institutions would not be enough to secure epistemic justice: we must reform the deeper conceptions of health that (...) underlie them. (shrink)

What counts as health or ill health? How do we deal with the fallibility of our own bodies? Should illness and disease be considered simply in biological terms, or should considerations of its emotional impact dictate our treatment of it? Our understanding of health and illness had become increasingly more complex in the modern world, as we are able to use medicine not only to fight disease but to control other aspects of our bodies, whether mood, blood pressure, or cholesterol. (...) This collection of essays foregrounds the concepts of health and illness and patient experience within the philosophy of medicine, reflecting on the relationship between the ill person and society. Mental illness is considered alongside physical disease, and the important ramifications of society's differentiation between the two are brought to light. Health, Illness and Disease is a significant contribution to shaping the parameters of the evolving field of philosophy of medicine and will be of interest to medical practitioners and policy-makers as well as philosophers of science and ethicists. (shrink)

In this paper I respond to Edward Harcourt’s suggestion that human excellences are structured in a way that allows us to see the multiplicity of life forms that can be instantiated by different groups of excellences. I accept this layered model, but suggest that Harcourt’s proposal is not pluralistic enough, and offer three critical points. First, true pluralism would need to take a life-cycle view, thus taking into account plurality within, as well as between, lives. Second, Harcourt’s pluralism still posits (...) physical health as a requirement for excellence, whereas I claim that the challenges of illness give more, not less, opportunity for excellence. Third, I make a more general claim that in certain salient cases it is precisely the absence of excellence that can facilitate virtue. (shrink)

The experience of illness is a universal and substantial part of human existence. Like death, illness raises important philosophical issues. But unlike death, illness, and in particular the experience of being ill, has received little philosophical attention. In Phenomenology of Illness Havi Carel argues that the experience of illness has been wrongly neglected by philosophers and provides a distinctively philosophical account of illness. Using phenomenology, Carel explores how illness modifies the ill person's body, values, and world. The aim of Phenomenology (...) of Illness is twofold: to contribute to the understanding of illness through the use of philosophy and to demonstrate the importance of illness for philosophy. Phenomenology of Illness develops a phenomenological framework for illness and a systematic understanding of illness as a philosophical tool. (shrink)

Life and Death in Freud and Heidegger argues that mortality is a fundamental structuring element in human life. The ordinary view of life and death regards them as dichotomous and separate. This book explains why this view is unsatisfactory and presents a new model of the relationship between life and death that sees them as interlinked. Using Heidegger's concept of being towards death and Freud's notion of the death drive, it demonstrates the extensive influence death has on everyday life and (...) gives an account of its structural and existential significance. By bringing the two perspectives together, this book presents a reading of death that establishes its significance for life, creates a meeting point for philosophical and psychoanalytical perspectives, and examines the problems and strengths of each. It then puts forth a unified view, based on the strengths of each position and overcoming the problems of each. Finally, it works out the ethical consequences of this view. This volume is of interest for philosophers, mental health practitioners and those working in the field of death studies. (shrink)

The confusion surrounding Heidegger's account of death in Being and Time has led to severe criticisms, some of which dismiss his analysis as incoherent and obtuse. I argue that Heidegger's critics err by equating Heidegger's concept of death with our ordinary concept. As I show, Heidegger's concept of death is not the same as the ordinary meaning of the term, namely, the event that ends life. But nor does this concept merely denote the finitude of Dasein's possibilities or the groundlessness (...) of existence, as William Blattner and Hubert Dreyfus have suggested. Rather, I argue, the concept of death has to be understood both as temporal finitude and as finitude of possibility. I show how this reading addresses the criticisms directed at Heidegger's death analysis as well as solving textual problems generated by more limited interpretations of the concept. (shrink)

What is the relationship between phenomenology and naturalism? Are they mutually exclusive or is a rapprochement possible between their approaches to consciousness and the natural world? Can phenomenology be naturalised and ought it to be? Or is naturalism fundamentally unable to accommodate phenomenological insights? How can phenomenological method be used within a naturalistic research programme? This cutting-edge collection of original essays contains brilliant contributions from leading phenomenologists across the world. The collection presents a wide range of fascinating and carefully argued (...) answers to these questions. (shrink)

The phenomenological method has been fruitfully used to study the experience of illness in recent years. However, the role of illness is not merely that of a passive object for phenomenological scrutiny. I propose that illness, and pathology more generally, can be developed into a phenomenological method in their own right. I claim that studying cases of pathology, breakdown, and illness offer illumination not only of these experiences, but also of normal function and the tacit background that underpins it. In (...) particular, I claim that the study of embodiment can be greatly enhanced, and indeed would be incomplete, without attending to bodily breakdown and what I term bodily doubt. I offer an analogy between illness and Husserl’s epoché, suggesting that both are a source of distancing, and therefore motivate a reflective stance. (shrink)

In this chapter we suggest that many experiences of suffering can be further illuminated as forms of transformative experience, using the term coined by L.A. Paul. Such suffering experiences arise from the vulnerability, dependence, and affliction intrinsic to the human condition. Such features can create a variety of positively, negatively, and ambivalently valanced forms of epistemically and personally transformative experiences, as we detail here. We argue that the productive element of suffering experiences can be articulated as transformative, although suffering experiences (...) are not the type mostly discussed in the transformative experience literature. We correct for this here by developing a taxonomy of negatively valenced transformative experiences. We suggest three features that make such experiences ones of suffering, following Michael Brady’s definition: intensity, novelty, and attentional focus. Finally, we suggest that one possible explanation for the edifying capacity of suffering comes from it requiring more transformation than positive experiences. (shrink)

This is the editors' introduction to an edited volume devoted to the relation between phenomenology and naturalism across several philosophical domains, including: epistemology, metaphysics, history of philosophy, and philosophy of science and ethics.

In this short commentary, I reflect on the new definition of disease proposed by Powell and Scarffe. I suggest that the method they appeal to as objective, namely, rational justification, is open to several criticisms, which I outline and discuss.

I have been breathless for a long time. I lagged behind others when walking uphill. I became breathless when dancing. I couldn’t play tennis. But I somehow convinced myself that this was normal. I was getting older—perhaps in one’s mid-30s fitness drops like this, I thought? Perhaps I have “small lungs,” my husband speculated. But we were both physically active, and as we were living in Australia at the time, we enjoyed bush-walking, bike riding, and the sunshine that permeates outdoor (...) life down under. So I masked my breathlessness as best I could, and never went to see a doctor, despite my clear and increasing respiratory difficulties.Two years went by. We returned to live in the United Kingdom—in hilly Bristol.. (shrink)

This paper offers a nexus of terms – mortality, limits, contingency and vulnerability – painting a picture of human life as marked by limitation and finitude. I suggest that limitations of possibility, capacity, and resource are deep features of human life, but not only restrict it. Limits are also the conditions of possibility for human life and as such have productive, normative, and creative powers that not only delimit life but also scaffold growth and transformation within it. The paper takes (...) a less known interpretation of the term ‘ephēmeros', to mean ‘of the day', rather than ‘short-lived' and suggests that as ephemeral, human life is contingent and mutable, subject to events beyond our control. However, virtue can still be exercised – indeed, can be exuberantly displayed – when we respond to contingent events marked by adversity. (shrink)

New Takes in Film-Philosophy offers a space for the advancement of the film-philosophy debate by some of its major figures. Fifteen leading academics from Philosophy and Film Studies develop new approaches to film-philosophy, broaden theoretical analyses of the topic and map out problems and possibilities for its future. The collection examines theoretical issues about the relationship between film and philosophy; looks at the relationships film-philosophy has to other media such as photography and literature; and applies theoretical approaches to particular films (...) and directors. Written in a clear style that assumes no previous knowledge of any particular philosopher, this collection will appeal to advanced students and scholars in philosophy, film studies, cultural studies, media studies and the arts. _. (shrink)

More people desperately require an organ than become donors themselves. When discussing organ donation, people mainly consider the question whether they want to donate, whereas empirically they are more likely to be on the receiving end. So it is rational for each of us to join the organ donor register and to agree to donate our relative’s organs, if we are ever in that situation.

We argue that pandemic and lockdown can be usefully interpreted as transformative experiences, albeit of a sort with interestingly different features to those discussed by L.A. Paul.

More people desperately require an organ than become donors themselves. When discussing organ donation, people mainly consider the question whether they want to donate, whereas empirically they are more likely to be on the receiving end. So it is rational for each of us to join the organ donor register and to agree to donate our relative’s organs, if we are ever in that situation.

Many interpretations of David Cronenberg’s 1986 film The Fly read it as a film about monstrosity. Within this framework, the protagonist Seth Brundle’s progressive illness and decay are subsumed under his metamorphosis into a monster. Illness is taken to be a metaphor for the changes in Seth, changes that continuously turn him away from the human and towards the monstrous. Seth’s monstrosity, in turn, arises from the fusion of human and non-human, in this case the fusion of a man with (...) an insect. I suggest an opposite interpretation: instead of seeing Seth’s illness as a metaphor for monstrosity, I suggest that monstrosity is a metaphor for illness. Seth’s physical corruption as he becomes more and more monstrous is, in fact, a depiction of illness, and elicits disgust in the viewer that is identical to the disgust elicited by physical corruption brought about by illness. The external deformation of Seth as he becomes more and more fly-like, shown so spectacularly in the film, is a representation of the internal destruction and physiological chaos caused by disease. I argue that the notion of the monstrous that is so central to the film in fact supports the health/ illness dichotomy, in which the two states – health and illness, or human and monster – are posited as mutually exclusive. Instead of accepting the dichotomy and focusing on the dialecticbetween human and monstrous, as many interpretations have, I claim that the film in fact demonstrates the fallacy of this dichotomous view, showing that ultimately we all have ‘the disease of being finite’. I propose to understand the film as a tragedy portraying the terminal illness of a decent man. As such, the film dupes the viewer into accepting the human/ monster and healthy/ diseased dichotomies, only to grasp their illusoriness by the end of the film. (shrink)

This paper challenges the accepted interpretation of Oedipus Rex, which takes Oedipus’ ignorance of the relevant facts to be an established matter. I argue that Oedipus’ epistemic state is ambiguous, and that this in turn generates a moral ambiguity with respect to his actions. Because ignorance serves as a moral excuse, my demonstration that Oedipus was not ignorant bears significantly on the moral meaning of the play. I next propose to anchor this ambiguity in the Freudian notion of the unconscious, (...) by presenting an interpretation that treats Oedipus’ knowledge as unconscious. I discuss the moral status of an agent acting from unconscious knowledge and find it to be genuinely indeterminate, thus supporting my claim that the play is epistemically and morally ambiguous. (shrink)

What is illness? Is it a physiological dysfunction, a social label, or a way of experiencing the world? How do the physical, social and emotional worlds of a person change when they become ill? And can there be wellbeing within illness? In this remarkable and thought-provoking book, Havi Carel explores these questions by weaving together the personal story of her own serious illness with insights and reflections drawn from her work as a philosopher. Carel’s fresh approach to illness raises some (...) uncomfortable questions about how we all – whether healthcare professionals or not – view the ill and challenges us to become more thoughtful. Illness unravels the tension between the universality of illness and its intensely private, often lonely, nature. It offers a new way of looking at a matter that affects every one of us. (shrink)