The neurologist Oliver Sacks has become very famous for his writings. His popularity has scattered all mass medias. In his books, he eloquently tells stories about patients suffering from extraordinary neurological diseases. Since the conceptual framework of Sacks' narratives has been widely unconsidered, this article pursues a more general and systematic approach to his work. Sacks terms his idiographic and phenomenological access to the world of science Romantical Science. With its features, he develops a concept of a Neurology of Identity, (...) that is basically concerned with the patient's personality and subjectivity. Sacks' personal approach to medicine implies another understanding of diseases: For him, diseases cannot be reduced to pathological facts, they constitute other worlds. He characteristically uses philosophical, psychological and mythical terms for interpretation and narration. But conversely to its sympathetic appearance, Sacks' approach entails some deficits: His presentation is not always realistic, his interpretations are often one-sided. The theoretical reflections on his method and attitude remain poor. Nevertheless, he puts medicine back into lifeworld to open it for many discourse universes beyond science in practice and theoretical reflection. (shrink)

Analysis of records of women at risk for abuse showed that though information about abuse was present, emergency room physicians rarely utilized it. The doctor-patient interaction tended to obscure rather than elucidate knowledge of abuse. Medicine's epistemologic model of care reconstructs abusive relationships through a medical encounter in which what is most significant is not seen. Nurses are less affected by the model but are under institutional constraints that lead to similar outcomes.

In this article I scrutinize the question whetherclinical medicine, in order to be considered ahermeneutical enterprise, must be thought of as areading of different texts. Three differentproposals for a definition of the concept of text inmedicine, suggested by other hermeneuticians, arediscussed. All three proposals are shown to beunsatisfying in various ways. Instead of attempting tofind a fourth definition of the concept of textsuitable to a hermeneutics of medicine, I then try toshow that the assumption that one needs to operatewith the (...) concept of text in order to develop ahermeneutics of medicine is false. Clinicalinterpretation can be shown to essentially consist ina dialogical hermeneutics, the pattern of which can befound in the philosophy of Hans-Georg Gadamer. Thiskind of hermeneutics is not a methodology of textreading, but an ontological, phenomenologicalhermeneutics in which understanding is a necessaryfeature of the being-together of human beings in theworld. This being-together in and through languagetakes on a peculiar form in the clinical encounter,since the medical meeting is typically characterizedby an asymmetrical enstrangement and has a specificgoal – health for the patient – absent in other formsof hermeneutics. Central issues of Gadamer''sphilosophy, e.g. fusion of horizons, are shown tofit the structure of clinical practice. (shrink)