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The Hermeneutics of Medicine and the Phenomenology of Health – Steps towards a Philosophy of Medical Practice
  1. Søren Holm
  1. Reader in Bioethics, University of Manchester

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    Fredrik Svenaeus, Linköping, Linköping University Press, 1999, 314 pages, 250 SEK/£20.

    Martin Heidegger is known as a notoriously difficult philosopher to understand and explicate, and it seems almost foolhardy to try to use Heidegger's philosophy as the foundation for a philosophy of medicine, but that is the task the Swedish Philosopher Fredrik Svenaeus sets himself in this very interesting book.

    The author first argues that medicine should not primarily be conceived as an assembly of scientific theories and technologies applied in the clinical situation. Medicine should instead be conceived as a practice of healing, with a central structure which is the meeting between two persons, the doctor and the patient. This line of argument is obviously not new, but it is very well substantiated in the book. It entails that the main concern of the philosophy of medicine ought to be the analysis of health and illness and not the analysis of disease.

    In the book's second section the author then presents a phenomenology of the lived experience of disease, based on several case descriptions. The main new contribution is an analysis of health as homelikeness and ill health as unhomelikeness. According to Heidegger man is thrown into the world. He has to find an attunement to the world, because the world can never be entirely my world. There are always other people in the world with me, and the world in itself will always remain in otherness and resist my understanding. But by finding the attunement of homelikeness I can live in the world in a way that keeps the not-being-totally-at-home-in-the-world from becoming apparent. Svenaeus argues that it is this attunement of homelikeness that breaks down when a person becomes ill and becomes transformed into an unhomelike attunement. In this new state of unhomelikeness the normal taken-for-grantedness of the world disappears and the transparency of the patient's normal activities is changed into an “effortful striving”. It is pointed out that for unhomelikeness to qualify as illness it has to be more than just a transient mood. We sometimes feel momentarily disoriented in the world without being ill (for instance when we are lost in the literal sense) but this is not a lasting state.

    This analysis of illness has implications for the doctor-patient relationship and these are spelled out in the third part of the book, where the medical meeting is analysed as a specific clinical hermeneutics. This part of the book moves beyond Heidegger and utilises the hermeneutic philosophy of Hans-Georg Gadamer to show that unless the doctor and patient reach a common interpretation of the clinical problem, and thereby a form of togetherness, it will be very difficult for the patient ever to attain the altered self understanding which may be necessary to achieve again homelike being-in-the-world.

    At the end of the book Svenaeus has thus not only managed to give a thorough and eminently readable explication of some central concepts in Heidegger's philosophy, he has also constructively used these concepts in a valuable rethinking of the most basic concepts of the philosophy of medicine, health and illness. This is undoubtedly the most important work using a phenomenological and hermeneutic approach to the philosophy of medicine to be written in many years. It deserves a very wide readership.

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