Why Medicine Needs Phenomenology
The primary aim of the Existential Medicine project is to challenge the detached and objectifying standpoint of mainstream medical science in an effort to deepen and broaden our understanding of health and illness and offer more sensitive and humane approaches to healthcare. To this end, Existential Medicine is not so concerned with the application of medical science to fix the biological body. Rather, the essays are focused on the body as it is lived, and the various ways in which the lived-body’s relationship to the world is modified and disrupted in illness.
It was an important collection of work to me from the start, but the volume took on a profound personal significance while I was in the midst of reviewing the page proofs in December 2017. I had decided to venture out for one of my long Saturday morning bike rides. It was unseasonably hot and humid in southwest Florida on that day, and as I was finishing the last few miles, I suffered a massive heart attack. And this was just the beginning. After having an emergency stent placed in my left anterior descending artery, I suffered a major blood clot in my right leg, followed shortly thereafter by a dangerous episode of ventricular tachycardia putting me at risk for sudden cardiac death. Within a few hours, my life and world had been radically transformed. I had gone from a healthy 48 year-old man who was seemingly in the prime of his life to a broken shell of his former self. Among other things, the experience exposed the fundamental vulnerability of my body and destroyed the illusion of my own strength and autonomy. But it has also brought into sharp focus the important role that phenomenology plays in helping us understand the experience of critical illness and the limitations of mainstream biomedicine. By attending to the first-person experience, phenomenology not only helps to illuminate the structures of meaning that constitute our subjectivity, it also reveals the ways in which these structures are modified and breakdown in the course of illness.
“Among other things, the experience exposed the fundamental vulnerability of my body and destroyed the illusion of my own strength and autonomy. But it has also brought into sharp focus the important role that phenomenology plays in helping us understand the experience of critical illness and the limitations of mainstream biomedicine.”
I experienced this kind of breakdown first hand. The structure of lived-space, for example, expansive and open before my heart attack, collapsed on me as previously effortless activities like walking, driving, or giving lectures became exhausting and sometimes frightening. The structure of lived-time no longer held open a wide range of possibilities that I could project for myself in the future. The illness shattered the temporal coherence of past and future, trapping me in a meaningless present of medical tests, hospital visits, and medications. The structure of affectivity was also transformed, disclosing a situation where I no longer felt at home or in tune with the world. After the heart attack, an atmospheric mood of anxiety revealed a world where things were affectively empty and meaningless. And this global affect made it difficult for me to engage in activities that I normally relied on to maintain a unified and coherent identity or sense of self. Finally, the intersubjective or relational structure of my existence was shattered. The illness disrupted my ability to disappear into the seamless, relational flow of public life. I stood out by being too slow, too clumsy, too anxious, and too tired. Unable to vanish into the web of social relations, I felt like a broken object under the gaze of those who were healthy and normal.
“The structure of lived-space, for example, expansive and open before my heart attack, collapsed on me as previously effortless activities like walking, driving, or giving lectures became exhausting and sometimes frightening. The structure of lived-time no longer held open a wide range of possibilities that I could project for myself in the future. The illness shattered the temporal coherence of past and future, trapping me in a meaningless present of medical tests, hospital visits, and medications.”
The heart attack exposed how poorly equipped many of the healthcare professionals I interacted with were in understanding the experience of this structural breakdown. Trapped in the objectifying discourse of biomedicine, the focus is largely on treatment rather than healing, on what is being done to the body rather than who is living or undergoing the treatments. Indeed, after two weeks in the hospital, it became clear to me that it was not always the physicians and surgeons but more often the technology itself that was making the decisions. The doctors deferred not to me, not to how I felt, but to the data transmitted on the heart monitor, the echocardiogram, or the blood test. The instrumentality was dehumanizing, resulting in profound feelings of helplessness, where I no longer saw myself as a participant in my own existence.
It was this experience that truly brought to light how important phenomenology can be in providing a corrective to the dispassionate and objectifying framework of mainstream biomedicine. Phenomenology can help remind healthcare professionals to see the patient not just as another set of data points but also as a human being who is suffering. The essays in Existential Medicine serve this purpose by expanding our understanding of what it means and what it feels like to be ill and the ways in which illness fundamentally disrupts our relationship to the world. To this end, the volume is intended as a valuable resource for philosophers, biomedical ethicists, medical humanists, policy makers, and, perhaps most importantly, healthcare practitioners themselves.
About Kevin Aho
Kevin Aho is professor and chair of the Department of Communication and Philosophy at Florida Gulf Coast University. He is the author of Existentialism: An Introduction, Heidegger’s Neglect of the Body and co-author of Body Matters: A Phenomenology of Sickness, Illness, and Disease.
His latest edited collection Existential Medicine: Essays on Health and Illness, part of Rowman and Littlefield International’s New Heidegger Research series, gathers together a group of leading figures in the philosophy of medicine such as Havi Carel, Shaun Gallagher, Drew Leder, Matthew Ratcliffe, John Russon, Jenny Slatman, Robert Stolorow, Fredrik Svenaeus, and Kristin Zeiler who draw on the methods of phenomenology to explore different aspects of the lived-experience of health and illness.