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Article Excerpt
Abstract
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.
Keywords
health, illness, existence, finitude, contingency, phenomenological psychology
Troubles with Health and Illness
Modern medicine, including psychiatry, finds itself in a state of total anarchy. This state can be best expressed by the famous slogan of Sex Pistols: "We do not know what we want, but we know how to get it." In the area of medical treatment, this means that modern medicine disposes of innumerable means by which it can manipulate the human being, but once it tries to explain what goal this manipulation shall achieve it ends in an impasse. To avoid any misunderstanding and possible disappointment, it is good topoint out that the aim of this paper is not to stop the anarchy and put medicine finally in order by formulating a perfect, universally valid definition of health; its only aim is to reflect on the basis terminological problems that cause the anarchy in medicine and to question some seemingly promising ways out of the impasse. This seems to be the only way we can at least point in the direction of a path hitherto undiscovered.
Somebody may, however, object that anarchy in medicine is not so bad, as there is the well-known definition of health provided by the World Health Organization. According to this definition, "health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" (WHO, 1948). Health is thereby differentiated from a mere absence of objectively diagnosed disease or subjectively experienced infirmity and is identified with a total well-being that comprises not only physical and mental, but also social well being. To put this simply, health is here identified with the absence of suffering. Whether the suffering in question is caused by physical and mental discomfort, or by a small salary, it is implicitly understood as the opposite of health. The one who suffers cannot be healthy, and vice versa. But if we take such a definition literally, would it not mean that we all, or at least the vast majority of us, are sick? Do not we all, to some extent, fall behind the ideal of absolute well-being? Not because of our imperfection, but because of the finitude and contingency that is constitutive for human existence as such. Even though the finitude and contingency of the human existence may be understood as signs of imperfection, in the post-metaphysical thought, they cannot be opposed to any state of perfection that would serve as an ideal of health. Even though they express the negativity of the human existence, they do not have any positive counterpart. It is, of course, possible to imagine such counterpart as a state without suffering, a state of redemption where human being would not suffer any more, but what is the meaning and purpose of a definition of health according to which we are all sick? To make us wait for a redeemer? To put medicine into the position of redeemer? On the other hand, provided we refuse the messianic ideal of health, do we not have to give up any attempt to cure and relieve the other from suffering?
Let us therefore consider the question of health and illness once again. Even if we concede that health means not only the absence of disease or infirmity, as the definition of WHO suggests, the question remains whatthe relation is between health and illness. How shall we explicate the relation between health and illness? Can one grasp the meaning of health without any reference to illness, and can one comprehend the notion of illness without taking into consideration the notion of health? There is no doubt that these questions surpass the horizon of purely medical thought, leading us to the sphere of philosophical reflection. The question, "What is health and what is illness?," is already a philosophical question, as it aims at the very essence of these phenomena. That is not to say that we must ignore medical experience; rather, we are to stay at the border between medicine and philosophy.
Heidegger's Exposition of Health and Illness
To begin with, we can recollect what Heidegger says about the relation between health and illness in his Zollikon Seminars.(1) When explaining the basic principles of the phenomenological approach to human health and illness, he departs from a simple observation that every illness deprives the existing individual of some possibilities. With every illness, be it of primarily psychic or somatic nature, we lose some of our existential possibilities. While the agoraphobic is incapable of entering an open space, a closed room is unbearable for the claustrophobic. Other neurotics are largely limited in their relations to possibilities offered by their co-existence with others. But even a common influenza that confines us to bed prevents us from, for instance, going to the cinema. Accordingly, illness means a restriction of a free realization of possibilities provided by our open being-in-the-world. Illness condemns us to a bigger or smaller loss of our freedom and openness to the possibilities of being-in-the-world. "Each illness," claims Heidegger, "is a loss of freedom" (Heidegger, 1987/2001, p. 157).
The question is, however, how the deprivation specific to pathological states should be understood. The deprivation of freedom which characterizes all pathological states brings Heidegger to the view that both somatic and psychic disorders can be subsumed under one common denominator,the phenomenon of privation (Heidegger, 1987/2001, p. 45-6). Every pathological disorder is viewed in Zollikon Seminars as a specific lack, as a specific privation of health. To be ill basically means not to be healthy Insofar as health is understood as the ability to freely dispose with all possibilities that announce themselves in the open realm of the world, illness represents a certain negation of this ability. The phenomenological interpretation of illness is thus grounded upon the definition of health which is, in one way or another, negated by a specific illness. This negation, however, is no utter denial and exclusion of the healthy state, but rather a privative form of health which is, in this view, attributed an entirely positive sense. Since every privation encompasses the essential relatedness to the positive that is lacking, Heidegger claims that everyone dealing with an illness is "actually dealing with health in the sense that health is lacking and has to be restored" (Heidegger, 1987/2001, p. 46). To meditate on illness is thus to meditate on health, and it is understandable that the way we understand health implicitly determines our understanding of illness.
When elucidating the peculiar relation between health and illness, Heidegger refers also to Plato's dialogue Sophist, where the phenomenon of privation is revealed in the connection with the question of the relative non-being (TO ME ON). Apart from the absolute non-being that simply does not exist, the mentioned dialogue addresses, for the first time in the history of Western philosophy, the possibility of the relative non-being that still, in one way or another, is. In other words, the non-being is grasped here not only as the mere opposite to the being, but also as having its own reality. The essence of the relative non-being is found in difference, that is to say, in that by means of...
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