Linköping Studies in Arts and Science
No. 187

The Hermeneutics of Medicine and the Phenomenology of Health: Steps towards a Philosophy of Medical Practice

Fredrik Svenaeus

Akademisk avhandling

som för avläggande av filosofie doktorsexamen vid Linköpings universitet kommer att offentligen försvaras i sal Planck, Fysikhuset, Universitetsområdet Valla, fredagen den 30 april, 1999, kl. 10. 15

ABSTRACT

This study is an attempt to develop an ontology and epistemology of medicine with the aid of the philosophical theories of phenomenology and hermeneutics. Medicine, in this work, is considered to be a particular form of practice with a certain intersubjective structure, rather than an assembly of scientific theories and technologies applied in the clinic. To be more precise, medicine is suggested to be an interpretive, helping meeting between two persons - doctor or other health-care professional and patient - the goal of which is health for the ill, help-seeking party. Phenomenology and hermeneutics, mainly in the forms developed by Martin Heidegger and Hans-Georg Gadamer, are then used to more fully understand what is meant by an interpretive, helping meeting and by its goal - health.

Health is characterized with the aid of the phenomenology of Heidegger, developed in his main work Sein und Zeit, as homelike being-in-the-world. Its opposite, illness, is explicated as an attunement (Befindlichkeit) of unhomelikeness, lived through every aspect of the being-in-the-world of Dasein, from body to language, and thus penetrating the entire understanding of the ill person. Medical practice, having the goal of establishing homelikeness in the patient's being-in-the-world, is then laid out, with the help of a reading of Gadamer's Wahrbeit und Methode, as a dialogic, interpretive coming together of the two different lifeworld horizons of doctor and patient. The two parties of the meeting must through this process of gradual fusion of horizons ultimately reach a to some extent shared understanding, which results in a therapeutic decision. The hermeneutics of medicine is thus, to speak with Gadamer, an applicative hermeneutics - a kind of understanding and interpretation put to work in a certain setting with a specific goal. This attentive, dialogic, goal-directed hermeneutics of medicine is shown, not to exclude, but to envelop the explanations, predictions and therapies of modern medical science.

The philosophical analysis in this study is carried out through the illustrative use of clinical examples. Through choosing common types of illnesses and medical encounters, strategically placed in different paradigmatic corners of the clinical territory - streptococcal infection, chronic fatigue syndrome, prostate cancer, diabetes and stroke - the author has attempted to encompass as much as possible of the vast and diverse area of clinical practice.

Keywords: attunement, clinical encounter, Gadamer, Heidegger, hermeneutics of medicine, phenomenology of illness, philosophy of medical practice, theory of health, understanding, unhomelikeness

The Tema Institute - Department of Health and Society
Linköping University, S-581 83 Linköping, Sweden
Linköping 1999

ISBN 91-7219-431-6      ISSN 0282-9800