의학 현상학은 질병의 원인을 단순하게 환자의 신체 밖에 존재하는 병원체에서만 찾는 것이 아니라 신체 내부의 환경에서도 찾으려고 시도한다. 의학 현상학은 현상학적 세계 고찰을 통해서 환자의 내면적 체험을 중시하게 되었다. 최근 의학과 간호학에서 현상학적 연구 방법에 기초해서 이러한 환자의 체험에 대한 분석을 담은 연구들을 진행하고 있다. 그러나 전통 현상학 자체에 대한 이해 부족으로 연구 명칭은 현상학적 방법론이지만 그 내용은 형식적인 틀에 머물고 있는 연구물들이 많이 등장하고 있다. 이에 현상학자들의 텍스트 분석을 통해서 현상학의 기본 개념들이 어떻게 의학 현상학에서 응용될 수 있는지에 대한 (...) 기초 작업이 요구된다. 실재로 국내에는 현상학자들의 텍스트에 기초해서 의학 현상학을 소개하는 전문적인 논문들이 매우 적은 편이다. 이런 기초 작업을 위해서 연구자는 이 논문에서 하이데거의 『시간과 존재』에 기술된 ‘내집에 없음’(Unheimlichkeit)이란 개념과 질환 체험과 건강 체험의 유사성에 대해서 고찰하고 있다. 하이데거의 현상학적 존재론의 몇 가지 중요한 개념들을 분석하면서 이것들이 어떻게 의학 현상학에서 응용될 수 있는지를 밝히는 것이 이 논문의 최종 목표이다. (shrink)

A large slice of contemporary phenomenology of medicine has been devoted to developing an account of health and illness that proceeds from the first-person perspective when attempting to understand the ill person in contrast and connection to the third-person perspective on his/her diseased body. A proof that this phenomenological account of health and illness, represented by philosophers, such as Drew Leder, Kay Toombs, Havi Carel, Hans-Georg Gadamer, Kevin Aho, and Fredrik Svenaeus, is becoming increasingly 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 radically 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. (shrink)

This book offers cutting edge research on the modifications and disruptions of bodily experience in the context of anxiety, depression, trauma, chronic illness, pain, and aging. It presents original contributions in applied phenomenology, biomedical ethics, and the use of medical technologies.

The categories of health and disease/illness are conceptualized from the perspective of the philosophy of medicine. Philosophical contradictions are revealed, which, fueling the debate between naturalism and normativism, prevent biomedicine from developing a single satisfactory understanding of these categories. The theoretical and practical consequences of such biomedicine features as pathocentrism, identification of health with complete well-being, dichotomy of health and disease in the absence of a clear criterion for their differentiation are analyzed. The role of humanistic (...) approaches to the medicine rehumanization is investigated with a focus on their balanced view of health and disease/illness, attentive to the fundamental vulnerability of human nature. (shrink)

While there has been a vast amount of research on breast cancer in recent years, areas within this domain remain unexplored. For instance, there have been few attempts to marry an understanding of the social context in which breast cancer occurs with an understanding of subjective experiences of this condition. The purpose of this study was to explore women's experiences of embodiment after breast cancer, utilizing a phenomenological approach rooted in a feminist perspective. The focus of this article is upon (...) the changes to embodiment that are long‐term. Twelve women were interviewed on two occasions each and were asked to talk about changes to their bodies that occurred as a result of breast cancer. Three key themes were identified: (1) how it feels (e.g. sensation and breast loss); (2) managing appearances (e.g. wearing prostheses); and (3) treatments without end (e.g. menopause). The findings of this study show that women with breast cancer are a diverse group and that survivorship is a dynamic, life‐long process, which suggests that health professionals can play an important role in establishing interdisciplinary approaches to caring, beyond the conclusion of acute treatment. (shrink)

Starting from a phenomenological understanding of the body, this article discusses the understanding of body awareness in health and illness. I question the common way to understand our relationship to our bodies in terms of subjective and objective perspectives on it, and furthermore, how this opposition has been used in the phenomenological literature to outline an understanding of health and illness as states where the body stays unnoticed versus resurfaces to our attention as dysfunctional. Using examples (...) from an ongoing interview study, I argue for an understanding of the dialectical interplay between body and world in our awareness, and how it can be understood as an approaching or distancing movement to body and world. I furthermore describe how the interplay between body and world effects and is effected by our existence in health and illness. Finally, I suggest what implications this new way of understanding the lived body has for health care practice in general, and for the development of a person‐centred care in particular. I suggest that we leave the dichotomous understanding of subjective and objective perspectives behind, and start to investigate how we move between different kinds of body awareness in health and illness. Illness, as a situation where that which has been taken for granted becomes questioned, can be said to be characterized by mistrust, and by a distancing from world and body. It is thus of importance for caregivers to provide the time, space and trusting atmosphere needed in order to make the approaching movement possible. (shrink)

This paper takes a phenomenological hermeneutic orientation to explicate and explore the notion of the grey zone of health and illness and seeks to develop the concept through an examination of the case of alcohol consumption. The grey zone is an interpretive area referring to the irremediable zone of ambiguity that haunts even the most apparently resolute discourse. This idea points to an ontological indeterminacy, in the face of which decisions have to be made with regard to the (...) health of a person (e.g., an alcoholic), a system (e.g., the health system), or a society. The fundamental character of this notion will be developed in relation to the discourse on health and the limitations of different disciplinary practices. The case of alcohol consumption will be used to tease out the grey zone embedded in the different kinds of knowledge made available through the disciplinary traditions of medical science, with its emphasis on somatic well-being, and anthropology, with its focus on communal well-being. This tension or grey zone embedded in different knowledge outcomes will be shown to have a discursive parallel with the dialogue between the Athenian, the Spartan, and the Cretan in Plato’s Laws. Making use of the dialogical approach as described by Gadamer, the Athenian’s particular resolution of the tension will be explored as a case study to demonstrate the necessarily particular analysis involved in a grey zone resolution. (shrink)

In this paper I explore health and illness through the lens of enactivism, which is understood and developed as a bodily-based worldly-engaged phenomenology. Various health theories – biomedical, ability-based, biopsychosocial – are introduced and scrutinized from the point of view of enactivism and phenomenology. Health is ultimately argued to consist in a central world-disclosing aspect of what is called existential feelings, experienced by way of transparency and ease in carrying out important life projects. (...) class='Hi'>Health, in such a phenomenologically enacted understanding, is an important and in many cases necessary part of leading a good life. Illness, on the other hand, by such a phenomenological view, consist in finding oneself at mercy of unhomelike existential feelings, such as bodily pains, nausea, extreme unmotivated tiredness, depression, chronic anxiety and delusion, which make it harder and, in some cases, impossible to flourish. In illness suffering the lived body hurts, resists, or, in other ways, alienates the activities of the ill person. (shrink)

This article is focused on the notions of health and illness, as they appear in the context of philosophical reflections on finitude and contingency of human existence. Criticizing Heidegger's approach to health and illness which is based on the Aristotelian concept of privation, the author tries to find an alternative to the privative concept of illness with the help of Schelling's treatise on human freedom which explicates Evil not as a privation of Good, but as (...) a sort of illness that has its own phenomenal positivity. Even Schelling's philosophical investigation of the nature of Evil, however, doesn't seem to provide a solid ground for a non-privative and non-normative approach to pathological phenomena. Only when Schelling's treatise on human freedom is de-contextualized and radicalized in a way suggested, for instance, by Deleuze in his Difference and Repetition, does it seem possible to elucidate pathological, and especially psychopathological phenomena, as they show themselves from themselves, and not from the perspective given by the normative ideal of health. (shrink)

This paper considers phenomenological descriptions of health in Gadamer, Heidegger, Merleau-Ponty, and Svenaeus. In these phenomenologies of health, health is understood as a tacit, background state that permits not only normal functioning but also philosophical reflection. Nietzsche’s model of health as a state of intensity that is intimately connected to illness and suffering is then offered as a rejoinder. Nietzsche’s model includes a more complex view of suffering and pain as integrally tied to health, (...) and its language opens up the possibility of many ‘healths,’ providing important theoretical support to phenomenological accounts of the diversity and complexity of health and illness. (shrink)

“You need to listen better to your body!” is a common prescription in contemporary health discourse. From a phenomenological perspective, we can say that the ability to hear your body implies body awareness. In this paper, I will provide a phenomenological analysis of the different ways in which the “audible body” can appear, and how this is related to health, drawing on the work of Merleau-Ponty, Shusterman, Leder, and Nancy. In Merleau-Ponty’s early work, so I explain, the “lived (...) body” emerges as an “audible” body, but it is only faintly audible and only so on the surface. Moreover, we find no explicit clues in his work for the injunction to learn to listen to the audible body. Shusterman, on the other hand, claims that we should train and increase somatic attention, and thus better listen to our bodies in order to cure bad bodily habits such as poor bodily posture. Subsequently, I describe how Leder argues that phenomenological analyses of the body should not only involve the surface body and its motor-sensory capacities. They should also involve the recessive, inner body. According to him it is healthy to increase one’s capacity for introception in order to increase “inside insights.” In the final part of this paper, I explain, on the basis of Nancy’s work, that listening to one’s body might become unhealthy when this listening goes hand in hand with amplifying the strangeness of one’s own body. (shrink)

In recent years limitations in the biomedical conceptualisation of health and illness have been well documented and a variety of alternative explanations produced to replace or supplement it. One such is Fredrik Svenaeus’s philosophy of medical practice, which is a development of Hans-Georg Gadamer and Martin Heideggers’ phenomenological and hermeneutical writings. This paper explores two texts, a short story by H. G. Wells, The Country of the Blind, and a poem by William Carlos Williams, Danse Russe to add (...) further insight into the ideas proposed by Svenaeus. Both texts were written before either Gadamer or Heidegger published their work. Analysis of the texts reveal examples of Heidegger’s understanding of ‘da-sein’, human-being, as the fundamental of human existence—how we relate to our ‘life-world’—together with its conditions including the tools we use to engage with and the moods that interpret the world. Emerging from this core relationship of being are the phenomena of health and illness, which are conceptualised as home-like (Heimischkeit) and un-home-like (Unheimlichkeit) being-in-the-world. In the texts the sense of home-like (and un-home-like) being is an ontological ‘web of significance’, to use Heidegger’s phrase, that creates, rather than results from a person’s psychological state. One factor that is not fully explicated in the philosophical accounts is the role that behaviour (as the physical-relating of a person) plays as a pre-requisite for agency, the ability to act in taken-for-granted ways. A person’s sense of authenticity, the extent to which someone makes their own choices rather than being led by what ‘others’ say, is linked with their ability to physically engage with and relate to their ‘life-world’. Finally, similarities between the ontological wholeness of poetry—the meaning structure of poetry—and of Dasein are noted. (shrink)

In this paper I develop a phenomenology of falling ill by presenting, interpreting and developing the basic model we find in Jean-Paul Sartre's Being and Nothingness. The three steps identified by Sartre in this process are analysed, developed further and brought to a five- step model: pre-reflective experience of discomfort, lived, bodily discomfort, suffered illness, disease pondering, and disease state. To fall ill is to fall victim to a gradual process of alienation, and with each step this alienating (...) process is taken to a new qualitative level. Consequently, the five steps of falling ill have not only a contingent chronological order but also a kind of logical order, in that they typically presuppose each other. I adopt Sartre's focus on embodiment as the core ground of the alienation process, but point out that the alienation of the body in illness is not only the experience of a psychic object, but an experience of the independent life of one's own body. This facticity of the body is the result neither of the gaze of the other person, nor of a reflection adopting the outer perspective of the other in an indirect way, but is a result of the very otherness of one's own body, which addresses and plagues us when we fall ill. I use examples of falling ill and being a patient to show how a phenomenology of falling ill can be helpful in educating health-care personnel about the ways of the lived body. (shrink)

A consideration of current debates in the philosophy of medicine and health care regarding the nature of health and health promotion, concepts and measurements of mental health problems, phenomenological conceptions of health and illness, allocation of health care resources and medical ethics.

Written in a jargon-free way, Body Matters provides a clear and accessible phenomenological critique of core assumptions in mainstream biomedicine and explores ways in which health and illness are experienced and interpreted differently in various socio-historical situations. By drawing on the disciplines of literature, cultural anthropology, sociology, medical history, and philosophy, the authors attempt to dismantle common presuppositions we have about human afflictions and examine how the methods of phenomenology open up new ways to interpret the body (...) and to re-envision therapy. (shrink)

In this paper, an attempt is made to develop an understanding of the essence of illness based on a reading of Martin Heidegger’s pivotal work Being and Time. The hypothesis put forward is that a phenomenology of illness can be carried out through highlighting the concept of otherness in relation to meaningfulness. Otherness is to be understood here as a foreignness that permeates the ill life when the lived body takes on alien qualities. A further specification of (...) this kind of otherness can be found with the concept of unhomelike being-in-the-world. Health, in contrast to this frustrating unhomelikeness, is a homelike being-in-the-world in which the lived body in most cases has a transparent quality as the point of access to the world in understanding activities. The paper then proposes that the temporal structure of illness can be conceptualised as an alienation of past and future, whereby one’s past and future appear alien, compared with what was the case before the onset of illness. The remainder of the paper follows two paths as regards the temporality of illness. The first path explores the temporality of the body in relation to the temporality of the being-in-the-world of the self. One way of understanding the alienating character of illness is that nature, as the temporality of our bodies, ceases to obey our attempts to make sense of phenomena: the time of the body no longer fits into the time of the self. The second path explored in the paper is that of narrativity. When we make sense of the present, in relation to our future and past, we do so in a special manner, namely, by structuring our experiences in the form of stories. Illness breaks in on us as a rift in these stories, necessitating a retelling of the past and a re-envisioning of the future in an effort to address and change their alienated character. These stories, however, never allow us to leave the silent otherness of our bodies behind. They are stories nurtured by the time of nature at the heart of our existence. It is then claimed that the idea of life’s being a story must be understood in a metaphorical sense, and an exploration of how phenomenology addresses the metaphoric quality of its conceptuality is ushered in. It is pointed out that metaphors can be systematically related to each other and that they always have a founding ground in the orientation and basic activities of the lived body. Therefore, if the concepts used in working out a phenomenological theory of health and illness are, to a certain extent, metaphorical, one could, nevertheless, claim that the metaphoric qualities of the phenomenological concepts are primary in referring back to the lived body and the way it inhabits the world. (shrink)

Phenomenology informs a number of contemporary attempts to give more weight to the lived experience of patients and overcome the limitations of a one-sidedly biomedical understanding of illness. Susan Bredlau has recently presented a reading of Plato’s dialogue Charmides, which portrays Socrates as a pioneer of the phenomenological approach to illness. I use a critical discussion of Bredlau’s interpretation of the Charmides to show that the phenomenology of illness also has its shortcomings and needs to (...) be complemented by still other approaches. While Bredlau does make a number of highly apt and relevant suggestions as to how a narrow biomedical approach to illness may be corrected, some of which are related to phenomenology, the attribution to Plato’s Socrates of a phenomenological approach is mistaken. Characteristically, Socrates shows little interest in the personal experience of a patient. He is more concerned with the patient’s lifestyle and conduct and so suggests an alternative or complementary perspective, stressing the importance of education and prevention to health care. (shrink)

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)

In this paper I develop a phenomenology of falling ill by presenting, interpreting and developing the basic model we find in Jean-Paul Sartre’s Being and Nothingness ( 1956 ). The three steps identified by Sartre in this process are analysed, developed further and brought to a five-step model: (1) pre-reflective experience of discomfort, (2) lived, bodily discomfort, (3) suffered illness, (4) disease pondering, and (5) disease state. To fall ill is to fall victim to a gradual process of (...) alienation, and with each step this alienating process is taken to a new qualitative level. Consequently, the five steps of falling ill have not only a contingent chronological order but also a kind of logical order, in that they typically presuppose each other. I adopt Sartre’s focus on embodiment as the core ground of the alienation process, but point out that the alienation of the body in illness is not only the experience of a psychic object, but an experience of the independent life of one’s own body. This facticity of the body is the result neither of the gaze of the other person, nor of a reflection adopting the outer perspective of the other in an indirect way, but is a result of the very otherness of one’s own body, which addresses and plagues us when we fall ill. I use examples of falling ill and being a patient to show how a phenomenology of falling ill can be helpful in educating health-care personnel (and perhaps also patients) about the ways of the lived body. (shrink)

What is it like to be a bat? What is it like to be sick? These two questions are much closer to one another than has hitherto been acknowledged. Indeed, both raise a number of related, albeit very complex, philosophical problems. In recent years, the phenomenology of health and disease has become a major topic in bioethics and the philosophy of medicine, owing much to the work of Havi Carel (2007, 2011, 2018). Surprisingly little attention, however, has been (...) given to the phenomenology of animal health and suffering. This omission shall be remedied here, laying the groundwork for the phenomenological evaluation of animal health and suffering. (shrink)

This book exploits the power of phenomenological methods to access and describe lived moral experiences of pain and suffering for patients, their families and the wider community. Creating new fields of communication for patients, their family members and health professionals in shared decision making processes, this book builds on knowledge about suffering to help and guide correct action in preventing and relieving chronic pain and improving systems of care. It offers a new phenomenology for understanding moral experience in (...) serious illness and suffering, and its implication for policy, practice and research. A series of applied chapters, looking at individual experiences of suffering and care experiences, present some areas of ethical inquiry, including: pain and suffering maternal care ethics evaluation and moral deliberation about treatment options decision-making and moral agency end-of-life experiences of care. Exploring how moral phenomenology could provide fruitful alternatives to traditional frameworks in bioethics, this is an important addition to the literature. It will be of interest to scholars and students of bioethics and phenomenological methods in the health and human services. (shrink)

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 phenomenological 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. (shrink)

Phenomenology has contributed to healthcare by providing resources for understanding the lived experience of the patient and their situation. But within a burgeoning literature on the characteristic features of illness, there has not yet been an account appropriate to describe congenital illnesses: conditions which are present from birth and cause suffering or medical threat to their bearers. Congenital illness sits uncomfortably with standard accounts in phenomenology of illness, in which concepts such as loss, doubt, alienation (...) and unhomelikeness presuppose prior health. These accounts reflect, in different ways, Maurice Merleau-Ponty’s assumption that the ways of living of the ill contain allusions to fundamental, healthy functions. The originality of congenital illness complicates this assumption and demands its own original phenomenology. In this paper, I sketch my personal experience living with a single-ventricle heart condition. While some of this story may reflect my own idiosyncratic experience, I hope that much of it will resonate with the congenital illness experience. I argue that the phenomenological literature on illness, grounded in the notion of loss, does not describe the congenital illness experience. I show how a number of other patient-centred theories of health and illness which have been influential on phenomenology can and cannot elucidate congenital illness. In particular, I consider Georges Canguilhem’s account of the normal and the pathological; debates in disability; and the notion of illness as biographical disruption. I show that congenital illness results in the preadmission of its patients to a paradoxical logic of medical palliation, one product of which is existential maturity. (shrink)

In this article I aim at developing a phenomenology ofillness through a critical interpretation of the worksof Sigmund Freud and Martin Heidegger. The phenomenonof ``Unheimlichkeit'' – uncanniness and unhomelikeness– is demonstrated not only to play a key role in thetheories of Freud and Heidegger, but also toconstitute the essence of the experience of illness.Two different modes of unhomelikeness – ``The minduncanny'' and ``The world uncanny'' – are in thisconnection explored as constitutive parts of thephenomenon of illness. The (...) consequence I draw fromthis analysis is that the mission of health careprofessionals must be not only to cure diseases, butactually, through devoting attention to thebeing-in-the-world of the patient, also to open uppossible paths back to homelikeness. This mission canonly be carried out if medicine acknowledges the basicimportance of the meaning-realm of the patient's life– his or her life-world characteristics. (shrink)

This article is an attempt to analyse the experience of embodiment in illness. Drawing upon Heidegger' sphenomenology and the suggestion that illness can be understood as unhomelike being-in-the-world, I try to show how the way we live our own bodies in illness is experienced precisely as unhomelike. The body is alien, yet, at the same time, myself. It involves biological processes beyond my control, but these processes still belong to me as lived by me. This a priori (...) otherness of the body presents itself in illness in an uncanny and merciless way. The unhomelike breakdown of our everyday being-in-the-world suffered in illness is explored through Heidegger's notion of the world being a “totality of relevance”, a pattern of meaning played out between different “tools”. The lived body is compared to a broken tool that alters and obstruct sour way of being “thrown” and “projecting” ourselves in the meaning patterns of the world through feelings,thoughts and actions. The similarities and differences between this unhomelikeness of illness and the specific unhomelikeness of authentic understanding,reached according to Heidegger in existential anxiety,are discussed. In order to illustrate how the lived body can present itself as “broken” and “other” to its owner, and in what way this unhomelike experience calls for help from health-care professionals, I make use of a clinical example of a severe and common disease: stroke. (shrink)

Contemporary philosophy of health has been quite focused on the problem of determining the nature of the concepts of health, illness and disease from a scientific point of view. Some theorists claim and argue that these concepts are value-free and descriptive in the same sense as the concepts of atom, metal and rain are value-free and descriptive. To say that a person has a certain disease or that he or she is unhealthy is thus to objectively describe (...) this person. On the other hand it certainly does not preclude an additional evaluation of the state of affairs as undesirable or bad. The basic scientific description and the evaluation are, however, two independent matters, according to this kind of theory. Other philosophers claim that the concept of health, together with the other medical concepts, is essentially value-laden. To establish that a person is healthy does not just entail some objective inspection and measurement. It presupposes also an evaluation of the general state of the person. A statement that he or she is healthy does not merely imply certain scientific facts regarding the person’s body or mind but implies also a (positive) evaluation of the person’s bodily and mental state. My task in this paper will be, first, to present the two principal rival types of theories and present what I take to be the main kind of reasoning by which we could assess these theories, and second, to present a deeper characterization of the principal rival theories of health and illness. (shrink)

Advances in neuroscience have enabled the transition of transcranial direct current stimulation (tDCS) from research and clinical settings to public use. For this primarily home-based context, tDCS has been popularized as a do-it-yourself (DIY) approach to improved cognition and wellness. The line between wellness and health is blurry, however, and little is known about how engagement with therapeutic tDCS impacts users’ interactions with other interventions such as clinical consultations, pharmacotherapy, complementary medicine, and even other neurotechnology. To close this gap, (...) we collected data from the online content aggregator Reddit and analyzed posts pertaining to tDCS. Findings indicate that most users turn to Reddit to request information about tDCS as an adjunct, but not as a bypass, to ongoing or prior approaches. Posts suggest that mainstream medical care is viewed as necessary but not sufficient to address conditions such as depression and anxiety. Users discuss a mix of benefits and harms. This discourse provides valuable insights into the health practices, concerns and priorities of users, and new knowledge for informing applications of neurotechnology both inside and outside the therapeutic setting. (shrink)

Recent advances in the brain sciences have dramatically improved our understanding of brain function. As we find out more and more about what makes us tick, we must stop and consider the ethical implications of this new found knowledge. Will having a new biology of the brain through imaging make us less responsible for our behavior and lose our free will? Should certain brain scan studies be disallowed on the basis of moral grounds? Why is the media so interested in (...) reporting results of brain imaging studies? What ethical lessons from the past can best inform the future of brain imaging? These compelling questions and many more are tackled by a distinguished group of contributors to this volume on neuroethics. The wide range of disciplinary backgrounds that the authors represent, from neuroscience, bioethics and philosophy, to law, social and health care policy, education, religion and film, allow for profoundly insightful and provocative answers to these questions, and open up the door to a host of new ones. The contributions highlight the timeliness of modern neuroethics today, and assure the longevity and importance of neuroethics for generations to come. (shrink)

Phenomenological analyses of ageing and old age have examined themes such as alterity, finitude, and time, not seldom from the perspective of “healthy” aging. Phenomenologists have also offered detailed analyses of lived experiences of illness including lived experiences of dementia. This article offers a phenomenological account of what we label as entering the grey zone of aging between “healthy” aging and aging with a disease. This account is developed through a qualitative phenomenological philosophy analysis of elderly persons’ lived experiences (...) of being tested for dementia through primary care in Sweden, i.e., within a cultural context where dementia commonly is understood as a frightening a loss of self even though this understanding also is questioned. To enter this grey zone of aging, we argue, does not dissolve dynamic self-becoming but can involve an experience of oneself as being old. Further, in the grey zone, the self experiences itself as neither fully healthy nor as having a disease, and as needing to negotiate and live this ambiguity. To enter this grey zone is to enter an affectively charged, sociocultural and medicalized zone, and while the self can still act in different ways within it, staying in the grey zone can result in a re-orientation in the self’s mode of being, in ways that are thoroughly beyond its control. To stay in the grey zone can have detrimental effects on the self, even though the self does not have a disease: the self can become “stuck” in a reflective mode of attending to embodiment, aging, health, and disease. (shrink)

This book explores patient safety themes in developed, developing and transitioning countries. A foundation premise is the concept of 'reverse innovation' as mutual learning from the chapters challenges traditional assumptions about the construction and location of knowledge. This edited collection can be seen to facilitate global learning. This book will, hopefully, form a bridge for those countries seeking to enhance their patient safety policies. Contributors to this book challenge many supposed generalisations about human societies, including consideration of how medical care (...) is mediated within those societies and how patient safety is assured or compromised. By introducing major theories from the developing world in the book, readers are encouraged to reflect on their impact on the patient safety and the health quality debate. The development of practical patient safety policies for wider use is also encouraged. The volume presents a ground breaking perspective by exploring fundamental issues relating to patient safety through different academic disciplines. It develops the possibility of a new patient safety and health quality synthesis and discourse relevant to all concerned with patient safety and health quality in a global context. (shrink)

Phenomenology of illness has grown increasingly popular in recent times. However, the most prominent phenomenologists of illness defend a psychologizing notion of phenomenology, which argues that illness is primarily constituted by embodied experiences, feelings, and emotions of suffering, alienation etc. The article argues that this gives rise to three issues that need to be addressed. (1) How is the theory of embodiment compatible with the strong distinction between disease and illness? (2) What is the (...) difference between problematic embodiment and illness? (3) How is existential edification, that illness can give rise to according to the phenomenologists, to be understood? The article then engages in an analysis of Heidegger’s and Waldenfels’ phenomenology with the ambition of developing a notion of existence, which can transgress the psychologization of illness. Rather than arguing that illness is constituted by experiences of suffering and alienation, it emphasizes that broaches upon conatively guided activities constitute illness. (shrink)

Abstract:Knock ou Le Triomphe de la Médicine [Knock, or the Triumph of Medicine] (1923) is a satirical play by Jules Romains parodying the hierarchical power relationship between patient and doctor and the supposed infallibility of science in the early twentieth century. Drawing on the phenomenological work of German physician Herbert Plügge (1970), I argue that the play exploits the physical interconnections between the healthy body and the sick body to present health as a deceptive state of hidden or imminent (...) illness. By anticipating illness, the play shatters the illusion of health in ways that are ethically, psychosocially, and biomedically salient. (shrink)

Deep brain stimulation (DBS) represents a promising new frontier in medicine and neuroscience for managing disorders of mental health that represent an enormous burden of disease on our societies. The caution and significant restraint of leaders in the evolution of DBS today stand in sharp and refreshing contrast to previous episodes in history. In embracing the anticipatory and pragmatic problem-solving approach of neuroethics to clinical neuroscience, four significant paradoxes for DBS today come to the fore: caution and innovation, capacity (...) and allocation of resources, notions of wellness and disease, and the high-stakes/high-benefit imperative of communicating about science. Tackling these paradoxes is the focus of this article. (shrink)

Phenomenology has been adapted for use in qualitative health research, where it’s often used as a method for conducting interviews and analyzing interview data. But how can phenomenologists study subjects who cannot accurately reflect upon or report their own experiences, for instance, because of a psychiatric or neurological disorder? For conditions like these, qualitative researchers may gain more insight by conducting observational studies in lieu of, or in conjunction with, interviews. In this article, we introduce a phenomenological approach (...) to conducting this kind of observational research. The approach relies on conceptual grounding to focus a study on specific aspects of the participants’ experiences. Moreover, the approach maintains the openness to novel discoveries that qualitative research requires while also providing a structured framework for data collection and analysis. To illustrate its practical application, we use examples of hemispatial neglect—a neurologic disorder in which patients characteristically lack awareness of their own illness and bodily capacities. However, the approach that we describe can be applied more broadly to the study of complex illness experiences and other experiential alterations. (shrink)

In proportion to other serious illnesses, diseases of the brain and mind represent the greatest—and still increasing—public health burden that Western societies are facing. Consequently, scientists, governments, advocacy groups, and public health authorities are committed to research to tackle the causes and consequences of neurological and psychiatric diseases and to find cures for them. As neuroscience research progresses, ethicists and neuroscientists face numerous ethical challenges to the integration of frontier application of research—neurotechnology—with the delivery of high-quality healthcare. In (...) this special neuroethics issue, we have invited distinguished scholars with diverse disciplinary backgrounds to present their reflections and research on the ethical dimensions of this crucial integration. (shrink)

Aims and Objectives. This article uses the concept of embodiment to demonstrate a conceptual approach to applied phenomenology. -/- Background. Traditionally, qualitative researchers and healthcare professionals have been taught phenomenological methods, such as the epoché, reduction, or bracketing. These methods are typically construed as a way of avoiding biases so that one may attend to the phenomena in an open and unprejudiced way. However, it has also been argued that qualitative researchers and healthcare professionals can benefit from phenomenology’s (...) well-articulated theoretical framework, which consists of core concepts, such as selfhood, empathy, temporality, spatiality, affectivity, and embodiment. -/- Design. This is a discursive article that demonstrates a conceptual approach to applied phenomenology. -/- Method. To outline and explain this approach to applied phenomenology, the Discussion section walks the reader through four stages of phenomenology, which progress incrementally from the most theoretical to the most practical. -/- Discussion. Part one introduces the philosophical concept of embodiment, which can be applied broadly to any human subject. Part two shows how philosophically trained phenomenologists use the concept of embodiment to describe general features of illness and disability. Part three illustrates how the phenomenological concept of embodiment can inform empirical qualitative studies and reflects on the challenges of integrating philosophy and qualitative research. Part four turns to phenomenology’s application in clinical practice and outlines a workshop model that guides clinicians through the process of using phenomenological concepts to better understand patient experience. -/- Conclusion and Relevance to Clinical Practice. A conceptual approach to applied phenomenology provides a valuable alternative to traditional methodological approaches. Phenomenological concepts provide a foundation for better understanding patient experience in both qualitative health research and clinical practice, and therefore provide resources for enhancing patient care. (shrink)

ABSTRACT The assumptions underlying the traditional biomedical model of health and illness and criticisms of it are described. An examination of the historical development of ideas concerning cot (crib) deaths shows how early explanations, which were congruent with this model, came to be discredited. Because subsequent explanations have also been considered unsatisfactory, cot deaths have come to be regarded as medically problematic. The relationship of models of health and illness to cot deaths has therefore been exposed (...) to an unusual degree of scrutiny. Two possible contending models, social epidemiological and socio‐economic are identified, and their status vis‐à‐vis the biomedical model is considered. The choice as to which of these models is applied to cot deaths is shown to be not only of theoretical interest but also to have ethical implications for health care policy and medical practice. (shrink)

Scientific medicine has been successful by ways of an ever more detailed understanding and mastering of bodily functions and dysfunctions. Biomedical research promises new triumphs, but discontent with medical practice is all around. Since several decades this has been acknowledged and discussed. The philosophical traditions of phenomenology and hermeneutics have been proposed as promising ways to approach medical practice, by ways of a richer understanding of the meaning structures of health and illness. In 2000, Swedish philosopher Fredrik (...) Svenaeus published a book where he proposes that the phenomenological hermeneutics of Martin Heidegger and also the reflections on health and illness of Hans-Georg Gadamer offer important ways to approach the nature of medicine. In particular, Svenaeus argues that the goal of medicine is to promote and restore health, and that health ought to be seen as “homelike being-in-the-world”. Unhealth, illness, consequently should be understood as a situation where a person’s “being-in-the-world” in characterized by that lack of the rhythm, balance and “tune” of everyday living that characterizes not “being at home”. In this article, Svenaeus’ position is briefly outlined. Questions are raised whether “unhomelikeness” is to be seen as a metaphor, and, if so, if it is a fruitful such. Furthermore, I discuss whether or not a discourse on health and illness in these terms may be misleading in a situation where the ontological presuppositions of Heidegger are lost out of sight and the popular understanding of health psychology predominates. I also approach the question whether Svenaeus’ assumptions may inadvertently lead us to an unjustifiably broad understanding of the tasks of medicine. It is finally concluded that Svenaeus phenomenological and hermeneutical approach is both interesting and promising. There are, however, several questions that ought to be pursued further, and the step from philosophical analysis to everyday clinical discourse may be unexpectedly long and risky. (shrink)

Loneliness in medicine is a serious problem not just for patients, for whom illness is intrinsically isolating, but also for physicians in the contemporary condition of medicine. We explore this problem by investigating the ideal physician-patient relationship, whose analogy with friendship has held enduring normative appeal. Drawing from Talbot Brewer and Nir Ben-Moshe, we argue that this appeal lies in a dynamic form of companionship incompatible with static models of friendship-like physician-patient relationships: a mutual refinement of embodied virtue that (...) draws both persons together. The ideal physician-patient relationship has a dialectical character that fosters each member's improvement of phenomenologically recognizing and embodying moral virtues. A key component of this dynamic is a commitment to the common goal of the patient's health, realized through joint interactivities and conversations over time. The physician's presence to the patient's suffering—understood best as an alienating phenomenological condition for the patient—orients and discloses possibilities for virtuous caregiving by structuring the meanings of the goals, conversations, and joint narrative constitutive of their relationship. Presence to suffering, paradoxically, is perhaps an important prerequisite for this dynamic partnership. These activities dialectically build an interpretive horizon of understanding through which moral goods and character refinement—in and for the other—may become revealed for both persons in their shared being-in-the-world. This analysis of suffering, mood, and revealing of (possible) moral goods has implications for addressing the modern problem of loneliness for patients and physicians, who are increasingly inhibited from building flourishing relationships with each other. (shrink)

Environmental ethicists and experts in human health have raised concerns about the effects of hydraulic fracking to access natural oil and gas resources found deep in shale rock formations on surrounding ecosystems and communities. In this study, we analyzed the prevalence of discourse on brain and mental health, and ethics, in the peer-reviewed and grey literature in the five-year period between 2016 and 2022. A total of 84 articles met inclusion criteria for analysis. Seventy-six percent (76%) mentioned impacts (...) on brain (e.g., neural tube defects, neurological symptoms), and mental health (e.g., negative psychological effects, stress, depression) briefly; 11 reports dedicated substantive discourse to either or both together. References to safety (77%) dominated the ethics context. Discussion of environmental injustices as fracking sites disproportionately affect vulnerable communities appeared in 38% of the papers. We examine the findings through the lens of environmental neuroethics that brings human-made changes to the environment, brain and mental health, and ethics together into three interwoven lines of inquiry. (shrink)

Medicine's crucial concern with health is perennial, but its reflection, concepts, means change with the advance of science and social life. We present here a fascinating panorama of current medical discussions with their philosophical underpinnings, and queries as they have evolved from the past. The role of Tymieniecka's phenomenology of life is brought forth as the system of philosophical reference.

The movement of peoples across linguistic boundaries means the existence of individuals who speak, to a greater or lesser extent, more than one language. How such individuals have in the past and can in the present serve as mediators within the health care system is described and the need for closer attention to such resources stressed.