Editors' introduction to 3rd thematic issue on philosophy of medicine.

In some quarters within philosophy of medicine, more particularly in the phenomenological approaches, naturalism is looked upon with suspicion. This paper argues, first, that it is necessary to distinguish between two expressions of this attitude towards naturalism: phenomenological approaches to illness disagree with naturalism regarding various theoretical claims and they disapprove of naturalism on an ethical level. Second, this paper argues that both the disagreement with and the disapproval of naturalism are to a large extent confused. It then offers some (...) proposals to set up an agenda for future collaboration. (shrink)

Phenomenology in medicine’s main contribution is to present a first-person narrative of illness, in an effort to aid medicine in reaching an accurate disease diagnosis and establishing a personal relationship with patients whose lived experience changes dramatically when severe disease and disabling condition is confirmed. Once disease is diagnosed, the lived experience of illness is reconstructed into a living-with-disease narrative that medicine’s biological approach has widely neglected. Key concepts like health, sickness, illness, disease and the clinical encounter are being diversely (...) and ambiguously used, leading to distortions in socio-medical practices such as medicalization, pharmaceuticalization, emphasis on surveillance medicine. Current definitions of these concepts as employed in phenomenology of medicine are revised, concluding that more stringent semantics ought to reinforce an empirical phenomenological or postphenomenological approach. (shrink)

The distinction between explanation and understanding was foundational to Jaspers’ ‘phenomenological’ approach to psychiatry. It makes sense that those now calling for a phenomenological approach to psychiatry would look to Jaspers for inspiration, and that in doing so, they would take up this distinction. However, I argue that it is and was a mistake to use the distinction in work on psychiatry: adhering to the distinction now would undermine, rather than support, the goals of those advocating a phenomenological approach to (...) psychiatry; furthermore, if the distinction had been adhered to, then contemporary psychiatry and its patients would be worse off. (shrink)

Despite their shared origins, medicine and dentistry are not always two sides of the same coin. There is a long history in medical philosophy of defining disease and various medical models have come into existence. Hitherto, little philosophical and phenomenological work has been done considering dental caries and periodontitis as examples of disease and illness. A philosophical methodology is employed to explore how we might define dental caries and periodontitis using classical medical models of disease – the naturalistic and normativist. (...) We identify shared threads and highlight how the features of these highly prevalent dental diseases prevent them fitting in either definition. The article describes phenomenology and the current thought around the phenomenology of illness, exploring how and why these dental illnesses might integrate into a phenomenological model. We discover that there are some features particular to dental caries and periodontitis: ubiquity, preventability and hyper-monitorablility. Understanding the differences that these dental diseases have compared to many other classically studied diseases leads us to ethical questions concerning how we might manage those who have symptoms and seek treatment. As dental caries and periodontitis are common, preventable and hyper-monitorable, it is suggested that these features affect the phenomenology of these illnesses. For example, if we experience dental illness when we have consciously made decisions that have led to it, do we experience them differently to those rarer illnesses that we cannot expect? Other diseases share these features are discussed. This paper highlights the central differences between the classical philosophical notion of disease in medicine and the dental examples of caries and periodontitis. It suggests that a philosophical method of conceptualising medical illness - phenomenology - should not be applied to these dental illnesses without thought. A phenomenological analysis of any dental illness is yet to be done and this paper highlights why a separate strand of phenomenology should be explored, instead of employing those that are extant. The article concludes with suggestions for further research into the nascent field of the phenomenology of dental illness and aims to act as a springboard to expose the dental sphere to this philosophical method of analysis. (shrink)

Several philosophers have recently argued that phenomenology is well-suited to help understand the concepts of health, disease, and illness. The general claim is that by better analysing how illness appears to or is experienced by ill individuals—incorporating the first-person perspective—some limitations of what is seen as the currently dominant third-person or ‘naturalistic’ approaches to understand health and disease can be overcome. In this article, after discussing some of the main insights and benefits of the phenomenological approach, I develop three general (...) critiques of it. First, I show that what is often referred to as naturalism tends to be misunderstood and/or misrepresented, resulting in straw-man arguments. Second, the concept of normality is often problematically employed such that some aspects of naturalism are actually presupposed by many phenomenologists of medicine. Third, several of the key phenomenological insights and concepts, e.g. having vs. being a body, the alienation of illness, the epistemic role of the first-person perspective, and the idea of health within illness, each bring with them new problems that limit their utility. While acknowledging the possible contributions of phenomenology, these criticisms point to some severe limitations of bringing phenomenological insights to bear on the problems facing philosophy of medicine that should be addressed if phenomenology is to add anything substantially new to its debates. (shrink)

Once a marginal affair, applied phenomenology is now a vast and vibrant movement. With great success, however, comes great criticism, and critics have been harsh, accusing applied phenomenology’s practitioners of everything from spewing nonsense to assailing down-to-earth researchers with gratuitous jargon. In this article, I reconstruct the most damning criticisms as a dilemma: Either applied phenomenology merely describes experience, in which case it offers nothing distinctive, or it involves the kind of analysis characteristic of classical phenomenology, in which case it’s (...) only of interest to a small number of philosophers; either way, we should explore the experiential dimension by other means. Notwithstanding the enormous body of research in applied phenomenology, few authors have tried to explain what makes it an independent intellectual enterprise distinct from pure phenomenology, and none has defused this dilemma. Here I try my hand at both. After considering eight major approaches to applied phenomenology that fail to defuse the dilemma, I propose an approach that, I argue, does the job, one that understands applied phenomenology as a research program that brings the phenomenological method and the resources of at least one other discipline to bear on problems beyond the scope of any monodisciplinary approach. (shrink)

The ever-increasing prevalence of chronic conditions over the last half century has gradually altered the demographic of patients admitted to acute care settings; environments traditionally associated with episodic care rather than chronic and complex healthcare. In consequence, the lifeworld of the hospital medical doctor often entails healthcare for a complex, multi-morbid, patient cohort. This paper examines the experience of providing complex healthcare in the pressurised and fast-paced acute care setting. Four medical doctors from two metropolitan health services were interviewed and (...) their data were analysed using a combinatorial framework of phenomenology and complexity theory. The horizon of complex care revealed itself as dynamic, expansive, immersive, and relational, entailing a specialised kind of practice that is now common in acute care settings. Yet this practice has made inroads largely without heralding the unique nature and potential of its ground. Herein lies opportunity for complex care clinicians to expand notions of health and illness, and to shape research, practice, and system design, for a future in which care for health complexity is optimised, irrespective of care settings. (shrink)

Mental disorder (earlier entitled “illness” or “disease”) is ascribed to deviations from normal thoughts, reasoning, feelings, attitudes, and actions that are considered socially or personally dysfunctional and apt for treatment. Schizophrenia, depression, and bipolar disorder are core examples. The concept of mental disorder plays a role in many domains, including medicine, social sciences such as psychology and anthropology, and the humanities, including literature and philosophy. Philosophical discussions are the primary focus of the present entry, which differs from the entry on (...) Philosophy of Psychiatry in noting several different approaches—not only those of the philosophy of science and mind, but also those arising from phenomenology and social theory. -/- Mental disorder is a widely contested concept and there are longstanding debates on whether disorders are biological or social in nature. Even uncontroversial disorders, such as those listed above, were not always regarded as disorders in the past (Porter 2002). Moreover, the status of mental disorder has frequently indicated ethical, as much as other deficiency (Irwin 2013). Such reminders direct our attention to contemporary medical psychiatry’s sometimes uncompromisingly neurobiological, and avowedly value-free “medical model”, with its incumbent analogies and assumptions, and to the general question of how the taxa of psychiatric classifications are to be viewed as objects of natural science. This model has received intensive philosophical scrutiny, including arguments that deny these conditions are deficiencies at all. Along with issues arising from cognitive psychology and the neurosciences, such foundational matters make up much of the following entry. Because of their focus on issues central to the philosophy of mind and ethics (e.g., the mind-body problem, moral responsibility, agency and identity), analyses of mental disorder have extensive implications for those fields. As clinical phenomena, they also reflect an inescapable, everyday, social reality, giving theoretical inquiries additionally urgent practical, moral, and legal implications. (shrink)