Phenomenology of illness

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It argues that illness is the primary and fundamental phenomenon, with disease an aspect of it, abstracted from it for specific practical or theoretical purposes. Carel draws on both classical phenomenologists and also contemporary practitioners, such as Shaun Gallagher, Matthew Ratcliffe, and Dan Zahavi. This is the erosion of a stable, confident sense of embodied existence within a world receptive to agency and purpose. A loss of freedom, for instance, has multiple aspects, some bodily, some existential. Some involve a loss of freedom of bodily movement — to move, breathe, eat — but others take a different form.

Carel describes losses of freedoms to plan for the future and to live confidently in the present and of trust in the world pp.

But if and how an ill person experiences these losses will vary. Some experience all of the losses, others only some of them, and cultural context also affects the sorts of losses that might be salient for a person — not all cultures valorise Promethean virtues like autonomy and independence, for instance.

Such observations reiterate the irreducibly subjective character of experiences of illness and underscore the epistemic privilege enjoyed by an ill person. This advantage is worthy of incorporation into healthcare theory and practice. The body, world, and breathlessness.

A distinctive reason for the epistemic significance of a first-person stance on the lived experience of illness is the central role of the body. Sartre announced in Hui clos that Hell is other people; something similar could be said of illness. Pathographies are filled with testimonies — often bitter, frustrated, and angry — to the ways that the social world exacerbates the difficulties of being ill.

People stop and stare, speak brusquely, ask brutal questions, and act without empathy. The difficulties of honestly discussing illness are amplified by a tendency among philosophers to make ability central to human life. But Carel argues that this account has only limited purchase on human life. It refers mainly to adulthood, rather than vulnerable youth and aged dependence, and presupposes bodily and psychological health.

In doing so, suggests Carel, we might be better able to identify effective processes for coming to terms with the many experiences of inability that are integral to a human life.

Breathing Life into a Phenomenology of Illness, Part I

This occurs after the erosion of our typically unrecognised and taken-for-granted sense of certainty in our bodily capacities. Sitting in this coffee shop, I can make this bodily certainty a conscious object of experience. I type rapidly, reach for my coffee cup, inhale and exhale — my body does these things automatically, effortlessly. That my body can realise such possibilities, offering capacities without caveats, is a basic certainty that underlies my life. Such bodily certainty will not last forever. It will be repeatedly ruptured, as the course of my life inevitably subjects me to accidents, ageing, and acute and chronic illness.

Bodily doubt becomes the norm, whether totally or partially, and gradually or suddenly — the slow ache of ageing joints, or sudden chaos of illness. Such experiences of bodily doubt will alter how we experience ourselves as embodied beings within the world.

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Suddenly one needs to pause, plan, and to prepare in advance for actions that were once easy and automatic. Carel offers rich accounts of the shifts from bodily certainty to doubt in their practical, emotional, and existential dimensions. Her accounts will resonate with those familiar with them, but can inform those yet to experience them. The hope is that pre-emptive reflection on lived experiences of pathology can disclose aspects of our being-in-the-world that we are apt to neglect but could learn to attend to. In so doing, we may learn how to appreciate and cope with the fragility of our mode of life.

It draws on her own experiences and is valuable for drawing together themes and ideas from the earlier chapters and presenting them within the context of a specific life. This chapter illustrates the universalising and particularising potential of phenomenology. Wellbeing, death, and authenticity.

The latter half of the book — chapters six to ten — is devoted to a wider set of ethical, epistemic, and metaphilosophical issues. It shows how phenomenology of illness can inform a range of topics of wider philosophical interest.

The theme of chapter six is the question of whether wellbeing is possible within illness. A negative answer may seem obvious, but the empirical evidence surprisingly shows that many ill persons argue the opposite. Carel draws on psychological studies to offer explanations. Most healthy people have a very limited idea of what it would be like to live with illness and popular accounts of such lives are of very limited value.

Not knowing what life in illness is like, the healthy struggle to imagine how they might cope, and tend to expect the worst. The limited insight of healthy people into a life led with illness is coupled to a failure to appreciate its potentially positive fruits. As Jonathan Haidt argues, people tend to underestimate their capacity to cope with adversity. Such coping can reveal unrealised abilities, enhance relationships, and offer focus and peace of mind.

Epicureans and Stoics devised practical and spiritual exercises to enable people to achieve tranquillity and ataraxia amid the turmoil of life. Her purpose is to emphasise the too- often unrecognised or excluded possibility of such positive responses to illness. Illness and death are natural bedfellows. But propositional assertion of this certainty is, of course, quite distinct from its existential realisation. It is a possibility that is both constant and distinctive: its actualisation entails total inability to take up other possibilities.

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Once death is actualised, all other possibilities are nullified. The chapter ends with discussion of authentic and inauthentic attitudes to death, mortality, and finitude pp. Testimony, intelligibility, and epistemic injustice. Illness and death are difficult to talk about by virtue of their emotionally and personally demanding realities. Earlier chapters surveyed several of the reasons, including our pathophobic culture and the psychological constraints on our capacity to imagine the lives of the ill.

In chapter eight, Carel moves onto a set of epistemological reasons for our inabilities to properly discuss and understand illness. Fricker identified two main forms of epistemic injustice: testimonial, which affects credibility, and hermeneutical, affecting intelligibility.

Subsequent work has expanded the range of forms and sources of epistemic injustice see Kidd, Medina, and Pohlhaus Carel and I have argued that ill persons are particularly vulnerable to epistemic injustices see Carel and Kidd , Kidd and Carel Many stereotypes of illness build in features that deflate their credibility and limit their testimonial capacities. Moreover, the range of hermeneutical resources needed to make sense of the social experiences of being ill are sadly too often lacking. The claim is not that ill persons are always credible and epistemically competent, since many are not, due to the constraints caused by their conditions and treatment.

Rather, judgments about the epistemic capacities of ill persons are too often prejudicial and their intelligibility to others often a result of a lack of the necessary sense-making resources. Phenomenology requires openness to the testimonies of ill persons and aims at making sense of their distinctive experiences.. The chapter ends with positive proposals for reducing the vulnerability of ill persons to epistemic injustice. To describe the fundamental structures of meaning that underlie our experience, and our testimonies to and interpretations of them, is therefore constitutive of a deep form of epistemic justice.

But such abilities especially matter to ill persons, for two reasons. The first is that illness will often deprive a person of just those abilities; the second is that the abilities are crucial in efforts to respond to illness. The inability to engage in them — or to be thwarted when trying to - is disturbing, frustrating, and a main source of the suffering of ill persons. Epistemic justice for ill persons emerges as an integral aim of a phenomenology of illness.

Philosophy, illness, and life. Carel ends the book by identifying ways that philosophy can be enriched through a more robust engagement with illness. The enrichment lies not only in the novel means for ethical, epistemic, and axiological debate, but also in new conceptions about the aims and practices of philosophy. Carel starts by outlining a range of ways that illness can enrich philosophy. First, philosophising about illness can afford new insights into such staple topics as embodiment, agency, virtue, empathy, and the good life.

Third, illness can shape the methods, aims, and agenda of philosophical enquiry. The distinctively personal and forceful character of experiences of illness can transform our sense of the sorts of values, literatures, and cognitive styles necessary to authentic philosophising.

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