In this paper we argue that ill persons are particularly vulnerable to epistemic injustice in the sense articulated by Fricker. Ill persons are vulnerable to testimonial injustice through the presumptive attribution of characteristics like cognitive unreliability and emotional instability that downgrade the credibility of their testimonies. Ill persons are also vulnerable to hermeneutical injustice because many aspects of the experience of illness are difficult to understand and communicate and this often owes to gaps in collective hermeneutical resources. We then argue (...) that epistemic injustice arises in part owing to the epistemic privilege enjoyed by the practitioners and institutions of contemporary healthcare services—the former owing to their training, expertise, and third-person psychology, and the latter owing to their implicit privileging of certain styles of articulating and evidencing testimonies in ways that marginalise ill persons. We suggest that a phenomenological toolkit may be part of an effort to ameliorate epistemic injustice. (shrink)

Book reviewed in this article: The Meaning of Illness. By S. Kay Toombs.

The normal and the pathological are terms used for structures, activities, individual or collective situations proper to living beings and especially to man. The relation of a fact and a norm is its positive or negative value. Can the assessment of behaviours be reduced to noting a necessity? Is a living being's disease a fact similar to universal attraction? The author maintains that diseases are not merely predetermined effects, but are revealing of a normative regulation proper to living beings and (...) man. (shrink)

Fricker shows that virtue epistemology provides a general epistemological idiom in which these issues can be forcefully discussed.

The point of departure for this article is a review of the discussion between Twaddle and Nordenfelt on the concepts of disease, illness, and sickness, and the objective is to investigate the fruitfulness of these concepts. It is argued that disease, illness, and sickness represent different perspectives on human ailment and that they can be applied to analyze both epistemic and normative challenges to modern medicine. In particular the analysis reveals epistemic and normative differences between the concepts. Furthermore, the article (...) demonstrates, against Nordenfelt's claim, that the concepts of disease, illness, and sickness can exist without a general theory of health. Additionally, the complexity of different perspectives on human ailment also explains why it is so difficult to give strict definitions of basic concepts within modern health care. (shrink)

A large slice of contemporary phenomenology of medicine has been devoted to developing an account of health and illness that proceeds from the first-person perspective when attempting to understand the ill person in contrast and connection to the third-person perspective on his/her diseased body. A proof that this phenomenological account of health and illness, represented by philosophers, such as Drew Leder, Kay Toombs, Havi Carel, Hans-Georg Gadamer, Kevin Aho, and Fredrik Svenaeus, is becoming increasingly influential in philosophy of medicine and (...) medical ethics is the criticism of it that has been voiced in some recent studies. In this article, two such critical contributions, proceeding from radically different premises and backgrounds, are discussed: Jonathan Sholl’s naturalistic critique and Talia Welsh’s Nietzschean critique. The aim is to defend the phenomenological account and clear up misunderstandings about what it amounts to and what we should be able to expect from it. (shrink)

Havi Carel uses phenomenology to explore how illness modifies the ill person's body, values, and world. Carel argues that illness has received little philosophical attention. Phenomenology of Illness develops a phenomenological framework for illness and a systematic understanding of illness as a philosophical tool.

The emerging concept of systems medicine (or ‘P4 medicine’—predictive, preventive, personalized and participatory) is at the vanguard of the post-genomic movement towards ‘precision medicine’. It is the medical application of systems biology, the biological study of wholes. Of particular interest, P4 systems medicine is currently promised as a revolutionary new biomedical approach that is holistic rather than reductionist. This article analyzes its concept of holism, both with regard to methods and conceptualization of health and disease. Rather than representing a medical (...) holism associated with basic humanistic ideas, we find a technoscientific holism resulting from altered technological and theoretical circumstances in biology. We argue that this holism, which is aimed at disease prevention and health optimization, points towards an expanded form of medicalization, which we call ‘holistic medicalization’: Each person’s whole life process is defined in biomedical, technoscientific terms as quantifiable and controllable and underlain a regime of medical control that is holistic in that it is all-encompassing. It is directed at all levels of functioning, from the molecular to the social, continual throughout life and aimed at managing the whole continuum from cure of disease to optimization of health. We argue that this medicalization is a very concrete materialization of a broader trend in medicine and society, which we call ‘the medicalization of health and life itself’. We explicate this holistic medicalization, discuss potential harms and conclude by calling for preventive measures aimed at avoiding eventual harmful effects of overmedicalization in systems medicine (quaternary prevention). (shrink)

What is illness? Is it a physiological dysfunction, a social label, or a way of experiencing the world? How do the physical, social and emotional worlds of a person change when they become ill? And can there be well-being within illness? In this remarkable and thought-provoking book, Havi Carel explores these questions by weaving together the personal story of her own serious illness with insights and reflections drawn from her work as a philosopher. Carel's fresh approach to illness raises some (...) uncomfortable questions about how we all - whether healthcare professionals or not - view the ill and challenges us to become more thoughtful. 'Illness' unravels the tension between the universality of illness and its intensely private, often lonely, nature. It offers a new way of looking at a matter that affects every one of us. (shrink)

This article is an attempt to analyse the experience of embodiment in illness. Drawing upon Heidegger' sphenomenology and the suggestion that illness can be understood as unhomelike being-in-the-world, I try to show how the way we live our own bodies in illness is experienced precisely as unhomelike. The body is alien, yet, at the same time, myself. It involves biological processes beyond my control, but these processes still belong to me as lived by me. This a priori otherness of the (...) body presents itself in illness in an uncanny and merciless way. The unhomelike breakdown of our everyday being-in-the-world suffered in illness is explored through Heidegger's notion of the world being a “totality of relevance”, a pattern of meaning played out between different “tools”. The lived body is compared to a broken tool that alters and obstruct sour way of being “thrown” and “projecting” ourselves in the meaning patterns of the world through feelings,thoughts and actions. The similarities and differences between this unhomelikeness of illness and the specific unhomelikeness of authentic understanding,reached according to Heidegger in existential anxiety,are discussed. In order to illustrate how the lived body can present itself as “broken” and “other” to its owner, and in what way this unhomelike experience calls for help from health-care professionals, I make use of a clinical example of a severe and common disease: stroke. (shrink)

This book, Goldstein's magnum opus and widely regarded as a modern classic in psychology and biology, grew out of his dissatisfaction with traditional natural science techniques for analyzing living beings.

In this essay I discuss Edith Stein's analysis of empathy and note its application in the field of clinical medicine. In identifying empathy as the basic mode of cognition in which one grasps the experiences of others, Stein notes, 'I grasp the Other as a living body and not merely as a physical body'. The living body is given in terms of five distinctive characteristics - characteristics that disclose important facets of the illness experience. Empathy plays an important role in (...) clinical practice in aiding physicians to grasp the content of first-person reports of bodily disorder, and to comprehend the meaning of illness-as-lived. I suggest that an important task for medical education should be that of developing students' capacity for empathic understanding and I note several ways in which this task might be accomplished. (shrink)