‘Existential Medicine: Essays on Health and Illness’: Book Review

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Avril Tynan considers how the insights in Aho’s edited collection Existential Medicine can help us think through the disruption to our sense of ‘being-at-home in the world’ caused by the pandemic. 

In a presentation delivered in November 2020, Kevin Aho suggests that in this time of pandemic we are living in an “affective atmosphere of uncanniness” (2021: 6). Borrowing from Heidegger’s concept of das Unheimliche, Aho argues that the Coronavirus pandemic has “thrown us into a liminal state of strangeness and uncertainty” (2021: 5). In other words – and despite public health messages to “stay at home” – the pandemic has profoundly disrupted our sense of being-at-home in the world. Although his edited collection, Existential Medicine: Essays on Health and Illness was published in 2018, nearly two years before the world would first learn of Covid-19, Aho’s observations bring home – no pun intended – the significance and timeliness of Heideggerian thought for contemporary humanistic approaches to medicine and healthcare.

In a time of pandemic, the principles of Existential Medicine are profoundly valuable for scholars of phenomenology and existential philosophy and for those interested in bioethics, narrative medicine and applied hermeneutics more broadly. The unhomelikeness of illness, a phrase now commonly associated with Fredrik Svenaeus (2000), relates to the physical and psychological effects wrought by a particular illness or incapacity; if I break my right arm, for example, the thought of picking up a pen to write is radically transformed from a habitual action to a clumsy challenge. But this unhomelikeness also concerns the ontological reorientation of a subject to their world when health becomes visible by its absence (Gadamer 1996). Today, however, this paradigm has shifted, and we are increasingly aware of both health and illness as lived experiences on a global and local scale. Think about the last time you heard someone cough or sneeze in public: have we ever been so acutely aware of not being ill? A sore throat is no longer a sign of a cold but a symptom necessitating rigorous testing to re-establish a state of unhomelike health. In other words, we no longer notice our bodies only when they fail to function as anticipated – as the Heideggerian hammer which passes unnoticed so long as it fulfils its expected duty – but increasingly we have become conscious of our health as it too becomes unhomelike. In these times of uncertainty, phenomenological hermeneutics supplies tools that help us to orient ourselves in the world with others in spite of our increasing dis-ease. Aho’s collection of essays delivers a worthy contribution to the field in ways that are particularly important for our contemporary lived experiences of illness and health.

Existential Medicine is framed by Heideggerian existentialism and particularly by his Zollikon Seminars (1959-1969) which identified “how the naturalistic standpoint in medicine invariably overlooks more fundamental questions about what it means ‘to be’ human” (Aho 2018: xii). Expanding on the phenomenological roots of existential medicine, Aho underlines that healthcare and medicine have often relied upon mechanistic and objectifying practices that ascertain illness as the result of clinical testing – an X-ray showing a broken bone, for example. Attempting to unravel this dualism between psyche and soma, phenomenological approaches to illness and health draw attention to the situatedness and affectivity of the subject who experiences ill health in dialogue with – but not purely as the object of – quantitative science.

Briefly introducing phenomenology, Aho offers a concise overview of the main themes that recur in the book and more broadly in the philosophy of medicine and health: embodiment, space and time, affectivity, and existence as hermeneutic. As he shows, these key concepts make phenomenology a particularly relevant approach in advocating for a humanistic reorientation of naturalistic medicine. A renowned figure in the philosophy of health and illness, Aho’s expertise translates into an introduction that is accessible for those who are new to the topic and enriching for those already familiar with phenomenology, Heideggerian existentialism or applied hermeneutics more generally, and it paves the way for the collection of essays that follows. Bringing together a range of established and emerging voices from across the academic fields of bioethics, philosophy and psychology to demonstrate the theoretical and practical applications of existentialism for understanding health and illness and creating more humanistic healthcare services, this collection offers insights for researchers and practitioners in the medical humanities, existential philosophy and the natural sciences.

Split into four parts, the book delivers an overview of some of the major directions and applications for existential medicine. Part I, New Currents in Existential Psychiatry, begins with a chapter by Shaun Gallagher on the relationality of human existence in the context of grief as it enters the DSM-V as a medical condition potentially conflated with depression. Robert D. Stolorow’s chapter on the decontextualisation of psychiatric states similarly argues for relational authenticity through a therapeutic sharing of emotional trauma that would acknowledge, rather than pathologise, the other’s distress. Anthony Vincent Fernandez’s chapter on the “ontological difference” in Heideggerian phenomenology is particularly useful in understanding the perceptual challenges of depression as a “loss of feeling, rather than a kind of feeling” (38, emphasis mine) that pertains not only to a disruption in the ontic modes of an individual but to the breakdown in ontological structures that shape what it means to be human. The final chapter of this section returns to the Heideggerian analysis of anxiety and the what if of the future to look backwards towards the time of nostalgia. Dylan Trigg argues that when it is falsely conceived as a homecoming, the “protracted homelessness” of nostalgia may be weaponised in political arenas to champion an erstwhile “safe-space” that never truly existed (57).

Part II, Phenomenologies of Anxiety, Pain, and Death begins with a fascinating discursive account between chronic-pain patient and philosopher Martin Kusch and phenomenological philosopher Matthew Ratcliffe on the ways in which pain – and particularly long-term pain – shatters habitual conceptualisations of trust in interpersonal relationships, time and space. Heidegger is not the only phenomenologist to receive attention in this collection and Kristin Zeiler’s chapter makes particular use of Maurice Merleau-Ponty’s philosophy of the lived body and the sedimentation of experience in understanding intercorporeality and parental decision making in cases of organ transplantation. Jenny Slatman’s chapter on Medically Unexplained Physical Symptoms (MUPS) – such as Chronic Fatigue Syndrome (CFS) but also, I would suggest, “long Covid”– returns to the psyche/soma distinction with which Aho began, arguing that MUPS demonstrates the persistence of this dualism in medical and public discourses when doctors, faced with the absence of any obvious somatic cause, assume the patient’s symptoms to be “all in the mind.” In the final chapter of part II, Adam Buben enters into dialogue with Samuel Scheffler’s Tanner lectures on the afterlife and Heidegger’s notion of Being-towards-death to explore how it is not death but rather life itself that gives life meaning.

Part III, Ethics, Medicalization, and Technology begins by returning to Heidegger’s Zollikon Seminars. Svenaeus’ account of bioethics and medical technology asserts that illness may be the contextual basis of an individual’s lived experience and that mood enhancing drugs, for example, “may separate the person from his or her true self” (143). Like Gallagher and Stolorow, Svenaeus finds the instrumentalisation of diagnosis in psychiatry problematic and urges us to consider the ethical precarity of medical practices that seek to assert standard definitions of health. Tina Williams and Havi Carel’s chapter on breathlessness returns to the psyche/soma debate and the symbiosis of experiences such as breathlessness that may be both the cause and the consequence of tangential conditions, outlining the need to distinguish between “different types of breathlessness” (149). Like Kusch and Ratcliffe, they call on the importance of attending to the patient’s experience in order to understand the subjective implications of illness. The final chapter in this section neatly rounds off the discussion begun by Svenaeus and provides an intriguing counterpoint to the earlier debate raised by Buben. Here, Tara Kennedy interrogates the ethics of contemporary bio- and nanotechnologies in human experience through Heidegger’s normative phenomenology, asking how medical advances have the potential to enhance or detract from what it means to be human.

In the collection’s final part, Existential Health, Carolyn Culbertson picks up once more the threads of the Zollikon Seminars but continues their discussion through the work of Heidegger’s student, Hans-Georg Gadamer. Although the increasing reliance upon technology in clinical settings is, she argues, “inevitably alienating” (186), Culbertson acknowledges the existing humanism in modern medicine that “does not produce health” (188) but works to re-establish a patient’s equilibrium. John Russon and Kirsten Jacobson’s chapter provides an accessible analysis of the “existential realities” (196) of illness when the condition in question is shadowed by particularly visceral taboos and stigmas. In the cases of IBD (inflammatory bowel disease) and HIV-AIDS, the authors argue that the intersubjective determination of the disease as “dirty” (199) shapes the lived experience beyond the organic condition itself. In the following chapter by Nicole Piemonte and Ramsey Eric Ramsey, the intersubjective space of illness remains central as the authors discuss how the patient’s sense of belonging to the healthy community of the – or a – “they” is irrevocably disrupted in illness. A restorative sense of belonging cannot be found in any one “they” – whether a “they” of health or a “they” of illness – but in “blurring the line between the healthy and the ill” (218) to exploit our common vulnerabilities. Finally, Drew Leder’s chapter draws positive conclusions to the work of existential medicine by exploring an optimistic phenomenological approach to “ageing well” that moves away from reductive, ageist paradigms of measurable biological change and looks to “expand our sense of successful aging” (226) in any number of existential ways.

Kevin Aho’s Existential Medicine offers an impressive diversity of approaches, applications and arguments that intersect and intertwine in surprising ways that are not always clearly delineated by the section headings. With that in mind, the chapter titles themselves may often seem daunting – particularly to readers less familiar with Heidegger – but the authors provide readable introductions and accessible overviews complemented by concise and practical examples. As I hope to have shown here, a number of different pathways for reading can be found in this book that supplement and challenge pre-existing knowledge and aims. This is a key reference text for those working in or approaching the fields of bioethics and philosophy of illness and health.

Works cited

Aho, Kevin (ed.). 2018. Existential Medicine: Essays on Health and Illness. London and New York: Rowman and Littlefield.

Aho, Kevin. 2021. The uncanny in the time of pandemics: Heideggerian reflections on the Coronavirus. Existential Analysis, 32(1): 5–20.

Gadamer, Hans-Georg. 1996. The enigma of health: The art of healing in a scientific age. Translated by Jason Gaiger and Nicholas Walker. Stanford: Stanford UP.

Svenaeus, Fredrik. 2000. The body uncanny – Further steps towards a phenomenology of illness. Medicine, Health Care and Philosophy, 3: 125–137.

Existential Medicine: Essays on Health and Illness, edited by Kevin Aho was published in 2018 by Rowman and Littlefield.

Avril Tynan is a postdoctoral researcher in comparative literature at the Turku Institute for Advanced Studies in Finland. Her work examines the roles of narrative and ethics in the representation of ageing, illness and death. She is co-organiser of the SELMA Medical Humanities Seminar Series. Twitter: @avitynan

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