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 shows how the concepts and language (...) used to describe illness today are inappropriate and misleading. Too often illness is viewed as a localised biological dysfunction while ignoring the actual experience of the ill person, their fears, their hopes, the way they interact with others and, ultimately, experience life. By focusing on the impact of illness on the ill person's life and reflecting on the experience of illness as lived from within, Carel shows how illness is a life-changing process rather than a limited physiological problem. 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. For those who are ill, it offers insights on our ability to remain happy within the constraints of illness. (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)

The basic work for this book was carried out during the spring of 1989 in Edinburgh, where I had been granted a research position at The Institute for Advanced Studies in the Humanities. I should like to express here my indebtedness to the Institute for the opportunity thus afforded me. I should also like to say how very grateful I am for the stimulating conversations I had there with Professor Timothy Sprigge and Dr. Elizabeth Telfer. Dr. Telfers’s own treatise Happiness (...) has been a major influence on my view of the questions involved. The basic view of health and illness presented in this book is more fully set out in my On the Nature of Health. As in the case of my previous larger projects, I have received a great amount of support and may wise comments from Professor Ingmar Pörn, Helsinki. Three Danish experts – Anton Aggernaes, Erik Ostenfeld and Peter Sandøe – have made valuable comments. Professor Heng ten Have, Nijmegen, has improved my reading of the philosophy of Jeremy Bentham. I should also like to thank my colleagues at the Department of Health and Society, University of Linköping, for helping me to avoid a number of the pitfalls that can so easily stumble into when it comes to a treatise like this. Especially I should like to mentioned Per-Erik Liss, Ingemar Nordin and Bo Petersson, all three of whom have read and commented on the entire manuscript. A Swedish version of this book, Livskvalitet och hälsa, came out in 1991. I have been made quite a number of corrections and additions, one type of addition being replies to critical points made in reviews of the Swedish version. I should like to thank Malcolm Forbes for valuable help putting my English into publishable condition. Linköping, May 1993 Lennart Noredenfelt. (shrink)

Phenomenology is a useful methodology for describing and ordering experience. As such, phenomenology can be specifically applied to the first person experience of illness in order to illuminate this experience and enable health care providers to enhance their understanding of it. However, this approach has been underutilized in the philosophy of medicine as well as in medical training and practice. This paper demonstrates the usefulness of phenomenology to clinical medicine. In order to describe the experience of illness, we need a (...) phenomenological approach that gives the body a central role and acknowledges the primacy of perception. I present such a phenomenological method and show how it could usefully illuminate the experience of illness through a set of concepts taken from Merleau-Ponty. His distinction between the biological body and the body as lived, analysis of the habitual body, and the notions of motor intentionality and intentional arc are used to capture the experience of illness. I then discuss the applications this approach could have in medicine. These include narrowing the gap between objective assessments of well-being in illness and subjective experiences which are varied and diverse; developing a more attuned dialogue between physicians and patients based on a thick understanding of illness; developing research methods that are informed by phenomenology and thus go beyond existing qualitative methods; and providing medical staff with a concrete understanding of the impact of illness on the life-world of patients. (shrink)

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)

Emotions and bodily feelings -- Existential feelings -- The phenomenology of touch -- Body and world -- Feeling and belief in the Capgras delusion -- Feelings of deadness and depersonalization -- Existential feeling in schizophrenia -- What William James really said -- Stance, feeling, and belief -- Pathologies of existential feeling.

Here is a thoroughly updated edition of a classic in palliative medicine. Two new chapters have been added to the 1991 edition, along with a new preface summarizing where progress has been made and where it has not in the area of pain management. This book addresses the timely issue of doctor-patient relationships arguing that the patient, not the disease, should be the central focus of medicine. Included are a number of compelling patient narratives. Praise for the first edition "Well (...) written. . .should be read by everyone in medical practice or considering a career in medicine."---JAMA. "Memorable passages, important ideas, and critical analysis. This is a book that clinicians and educators should read."---New England Journal of Medicine. (shrink)

This essay argues that, while much has been gained by medicine's focus on the spatial aspects of disease in light of developments in modern pathology, too little attention has been given to the temporal experience of illness at the subjective level of the patient. In particular, it is noted that there is a radical distinction between subjective and objective time. Whereas the patient experiences his immediate illness in terms of the ongoing flux of subjective time, the physician conceptualizes the illness (...) as a disease state according to the measurements of objective time. A greater understanding of this disparity in temporal experiencing provides insights into the lived experience of illness and can preclude difficulties in communication between physician and patient. (shrink)

THE ARTICLE DEMONSTRATES FOR SOMATIC MEDICINE AS WELL AS PSYCHIATRY AND PSYCHOTHERAPY THAT THE CONCEPT OF DISEASE IS AT LEAST PARTIALLY DEPENDENT ON IDEOLOGICAL CONSIDERATIONS. THE PAPER SURVEYS REPRESENTATIVE VIEWS AND EXPLORES THE BEARING OF THE CONCEPTS OF NORMS, FUNCTIONS, VALUES ON THE SPECIFICATION OF DISEASE.

In this unique study Fulford combines the disciplines of rigorous philosophy with an intimate knowledge of psychopathology to overturn traditional hegemonies. The patient replaces the doctor at the heart of medicine. Moral theory and the logic of evaluation replace epistemology as the focus of philosophical enquiry. Ever controversial, mental illness is at the interface of philosophy and medicine. Mad or bad? Dissident or diseased? Dr Fulford shows that it is possible to achieve new insights into these traditional dilemmas, insights at (...) once practically relevant and philosophically significant. (shrink)

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)

The idea that there is such a thing as a human right to health has become pervasive. It has not only been acknowledged by a variety of international law documents and thus entered the political realm but is also defended in academic circles. Yet, despite its prominence the human right to health remains something of a mystery - especially with respect to its philosophical underpinnings. Addressing this unfortunate and intellectually dangerous insufficiency, this book critically assesses the stipulation that health is (...) a human right which - as international law holds - derives from the inherent dignity of the human person. Scrutinising the concepts underlying this stipulation, it shall conclude that such right cannot be upheld from a philosophical perspective. (shrink)

Taking as its starting point a recent statement of the Goals of Medicine published by the Hastings Centre, this paper argues against the dualistic distinction between pain and suffering. It uses an Aristotelian conception of the person to suggest that malady, pain, and disablement are objective forms of suffering not dependent upon any state of consciousness of the victim. As a result, medicine effectively relieves suffering when it cures malady and relieves pain. There is no medical mission to confront the (...) spiritual condition of the patient. (shrink)

Fredrik Svenaeus' book is a delight to read. Not only does he exhibit keen understanding of a wide range of topics and figures in both medicine and philosophy, but he manages to bring them together in an innovative manner that convincingly demonstrates how deeply these two significant fields can be and, in the end, must be mutually enlightening. Medicine, Svenaeus suggests, reveals deep but rarely explicit themes whose proper comprehension invites a careful phenomenological and hermeneutical explication. Certain philosophical approaches, on (...) the other hand - specifically, Heidegger's phenomenology and Gadamer's hermeneutics - are shown to have a hitherto unrealized potential for making sense of those themes long buried within Western medicine. Richard M. Zaner, Ann Geddes Stahlman Professor of Medical Ethics, Vanderbilt University. (shrink)

The starting point for the contemporary debate about theories of health should be the holistic theory of Lennart Nordenfelt, claims George Khushf, not the refuted theory of Christopher Boorse. The present paper is an attempt to challenge Nordenfelt and to present an alternative theory to his and other theories, including Boorse’s. The main problems with Nordenfelt’s theory are that it is relativistic, that it leads to counter-intuitive results as to what goals can count as healthy, that it focuses on the (...) wrong kind of abilities, that it makes measuring health extra difficult, and that it does not give us a sufficient account of health, at most a necessary one. The alternative theory proposed is two-dimensional. First, health is to have developed the abilities and dispositions that members of one’s culture typically develop, and be able to use them, in acceptable circumstances; and second, health is to experience positive moods and sensations, the kinds that have internal causes. The theory solves the problems attached to Nordenfelt’s theory by not being individual relativistic, by eliminating the goals in the definition, by giving an alternative interpretation of “ability,” by making health easier to measure, and by adding the dimension of well-being that, together with health as ability, not only gives us a necessary, but also a sufficient, account of health. (shrink)

Yet, the central conviction that informs this volume is that phenomenology provides extraordinary insights into many of the issues that are directly addressed ...

One INTRODUCTION 1. Background The theory of the nature of health and disease, or of the concepts of health and disease, has been central in modem ...

This book contains scholarly contributions to several current debates in the philosophy of medicine and health care regarding the nature of health and health promotion, concepts and measurements of mental illness, phenomenological conceptions of health and illness, allocation of health care resources, criteria for proper medical science, the clinical meeting, and ethical constraints in such a meeting. With one exception, the authors in this book are or have been teachers or graduate students at the interdisciplinary Department of Health and Society (...) (Tema H) at Linköping University, Sweden. While all the texts have a philosophical focus, many other disciplines have influenced the choice of specific perspectives. The university backgrounds of the authors range from medicine, psychology, sociology, and religion to philosophy. What binds the authors together is their deep interest in the theory of medicine and in the pursuit of a philosophy of humanistic medicine and health care. (shrink)

Taking as its starting point a recent statement of the Goals of Medicine published by the Hastings Centre, this paper argues against the dualistic distinction between pain and suffering. It uses an Aristotelian conception of the person to suggest that malady, pain, and disablement are objective forms of suffering not dependent upon any state of consciousness of the victim. As a result, medicine effectively relieves suffering when it cures malady and relieves pain. There is no medical mission to confront the (...) spiritual condition of the patient. (shrink)