Corps et Monde dans l’Autisme et la Schizophrénie: Approches ontologiques en psychopathologie
Empathy, Sociality, and Personhood: Essays on Edith Stein’s Phenomenological Investigations
Reviewed by: Davide Perrotta (Roma Tre University)
Empathy, Sociality and Personhood is a collection of essays about Edith Stein’s thought and its surrounding theoretical context edited by Elisa Magrì and Dermot Moran. Both of the editors have worked on several books about Husserl, the phenomenological tradition, and, in particular, on Edith Stein.
In the Introduction the editors carefully reconstruct the interdisciplinary debates motivated by Stein’s theoretical concepts, which are discussed at length and relevant to many different philosophical and scientific fields. The Introduction points out that there are at least 43 different definitions of the term ‘empathy’ and this circumstance strongly motivates the phenomenological research which investigates empathy as a philosophical issue. Edith Stein’s interest in the topic constitutes a key aspect of her work which has attracted much attention and study. The debate concerning an emotive account of empathy and the extent to which it is present in both humans and animals, has a long history and can be traced in the Darwinian conception of animal sociality, and within the Theodor Lipps’ thesis from the psychological side[1]. The Introduction also makes reference to Vittorio Gallese’s conception of the emphatic process, which leads us into the realm of contemporary neuroscience and cognitive debates[2]. It is part of contemporary common practice to compare scientific definitions of empathy with those from the philosophical tradition, however, the empirical approach of the natural sciences is largely missing from Stein’s phenomenological descriptions.
In contrast to the prominent empirical status of the contemporary approach, this text instead refers to the phenomenological approach. As it becomes clear within the text: only with Husserl’s epistemological turn in the investigations of conscious life are we really able to describe experience structures. The essays in the collection acknowledge Edith Stein’s assimilation of the phenomenological method in order to develop new intentional investigations. Stein’s interest in empathy as a topic stems from her recognition of the importance of this theme in Husserl’s dissertations, for Stein he did not adequately treat or fully elaborate on empathy as a specific intentional act. Stein’s investigations of empathetic psychological acts is therefore profoundly intertwined with Husserl’s account and empathy is defined as an intentional act near to perception and imagination, but different from both.
The book is divided into four parts: the first part contains several essays which treat the concept of ‘Person’. This notion shouldn’t be defined as a single unit, but integrated within a whole series of psychological acts including relational spatiality. The second part integrates this topic with the affective theme of the human experience; regarding the peculiarities of intentionality in relation to the emotional style of the subject. Related to these discussion, themes such as ‘empathy’ or ‘imagination’ are carefully introduced. In the third part, different essays discuss the topic of communal experience which is very important for integrating the description of the human experience. In the fourth part, the essays discuss the thought of some lesser known phenomenologists which nonetheless, supply us with very important descriptions of the communal experience.
The first contribution in the collection is entitled ‘Edith Stein’s Encounter with Edmund Husserl and Her Phenomenology of the Person’ and is by Dermot Moran. The essay begins with a brief introduction which covers the career of Edith Stein, Moran then explores the context in which Husserl’s first book of Ideas was received by his students. The transcendental turn in this book proved difficult to accept for those who were bound to the strong realism of Husserl’s Logical investigations. However, in contrast to his other students, Edith Stein found it easy to grasp, understand and appreciate Husserl’s turn in relation to e.g. both eidetic analysis and the embodied state of consciousness. Moran communicates how Stein conceptualizes the differences between ‘originary and non-originary experience’[3] which is an essential aspect of the phenomenological analysis of consciousness. Within these theoretical features Stein conducted careful examination of the description of the empathetic act essence, and used this to develop her own conception of the subjective and inter-subjective ‘living body’. Moran then describes the way in which she worked on the affective account of subjectivity beginning with psycho-physical conditionality and moving towards the spiritual peculiarities of the emotional life. He then goes on to explain the peculiarity of Stein’s studies on the essence of the ‘individual person’; he adequately communicates the complex relation between the metaphysical influences on her thought and the phenomenological method. In spite of the complex relation between the two, Moran concludes that Stein proposes a very deep phenomenological description of the person that is strongly philosophical with theological influences.
The second essay is by Hans Rainer Sepp and it explores ‘Edith Stein’s Conception of the Person within the Context of the Phenomenological Movement’.Sepp discusses the concept of personhood in Stein’s phenomenological investigations, in which the structural conception of individuality emerges. He explores the way in which personhood is analyzed by Stein with a focus on descriptions of the intentional structures of conscience life. In the same way in which consciousness organizes our own experience of the world, for Stein personhood is constructed through a multi-stratum ontology, where the deeper found the higher ones. Fort example: we must define the sensorial psychological dimensions as an integrating part of the more complex spiritual values. Sepp explains this important definition with reference to Stein’s distinction between soul and spirit; soul relates to contemporary psychological themes, spirit concerns the values sphere, where social values emerge as the ‘responsibility’.
Sepp then compares Stein’s concept of ‘person’ with that of Max Scheler. Scheler had similar notions about personhood as Stein, but he also presents differences concerning the relation between the person and their own acts; the person is defined by Scheler as not comparable with their own acts, however, these acts continuously modify their personality. The last part of the text returns to Stein’s concept of personhood, this time focusing on Husserl’s notions of ‘ego’. Stein points out that the Greek notion of oikos, with which she spoke about an oikological conceptuality, in relation to the human spatiality. This interesting topic is well presented by Sepp as, by revealing Stein’s interest in the phenomenological spatiality among peoples the concept is not only defined by her as functional, but as essential in order to define personhood[4]. The topic concerning the spatiality of the own experience is an important prerogative for understanding the concept of ‘person’. The environment is an integral feature for understanding our relational habits, and this concept shouldn’t be avoided in the psychological understanding of the human life.
The second part of the book is entitled ‘Empathy, Subjectivity, and Affectivity’. The first contribution is by Ingrid Vendrell Ferran and is entitled ‘Intentionality, Value Disclosure, and Constitution: Stein’s Model’. Ferran retraces the debate on the relation among values and emotion from Brentano to the phenomenological context. Her brief but efficient introduction is useful for understanding the distinctness of Stein’s model of affectivity and she presents Stein’s account of the ‘ontology of person’ which is explained with care in its peculiarity. The various elements of affectivity are explained with an accurate relation to the intentional aspect of them. In this way, the author discloses these essential notions to explain the role of emotionality in the perception of values. In contrast to perception and other theoretical acts, the role of the emotional act in the constitution of values is explained coherently. Values are defined not only in the sense of ‘material objects’ but also as formal and it becomes clear how emotions have their own intentionality. In the last part of the essay Ferran uses the drafted instruments for connecting to the discussion of axiology in Stein’s thought. The topic of intentionality in relation to the affective style is an important prerogative for understanding the contrast with Scheler’s realism. Relating to the latter peculiarity, Ferran describes an affinity between Stein and Husserl’s thesis. Even though the theme of the ‘discovery’ of values seems to speak about a realism, she conceives support for the thesis of a ‘constitution’ of values in both in Husserl and in Stein. The constitution of intentional structures allows us to avoid a strong realism about values, paying greater attention to the relation between the consciousness and the world.
The contribution by Michela Summa concerns two main topics: the multiple-level structure of intentionality in Stein’s work and the presentation of various proposals in relation to the complex theme of ‘simulation’ in the emphatic intentional act. Hereafter, the essay contemplates the thought of Peter Goldie, a lesser known philosopher who makes an interesting contribution to how Stein’s work relates to these areas. Summa carefully explains the relation among understanding and imagination in Goldie’s thought overall in relation to the empathetic grasping of individual narration. Goldie shows the role of the imagination in the understanding of the other’s lived events. So, Summa shows how, in Goldie’s thought it is not only the single mental act that is to be grasped, but an entire event of the other’s individual narration. Goldie’s phenomenological description of empathy is classified with several steps, from the more cognitive level toward the most affective attitude of sympathy. The importance of the intentional directivity toward the other’s narration is described with different levels of complexity; from the essential pre-cognitive backgrounds, with which important aspects of the personality are grasped, towards the cultural features or higher motivational states.
‘Stein’s understanding of Mental Health and Mental Illness’ is the contribution by Mette Lebech, in which the topics concerning Stein’s treatment of the empirical psychological tradition are discussed. Lebech describes an interesting difference between the natural stance of the illness and the individual story. Nature intervenes in the individual story, but it doesn’t coincide with individual motivations. In Lebech’s reconstruction, the spirit is presented as the most important dimension of the person which is not only influenced by natural causes. Lebech uses a metaphor of the battery to speak about the psychological process to show how the spiritual attitude of the person lies outside of mechanical dynamics. As with Stein’s reference to God, the latter activity motivates consciousness without a strong requirement of the psychological energetic dimension. Lebech also writes about the group dynamics of the psychological affection and even in the latter case, the passive processes, like imitation, are defined differently to the higher ones – such as the sharing of common values in the community – as mere natural processes.
The third part of the book is entitled ‘Empathy, Sociality, and Medical Ethics’. The first article of this section is ‘From I to you to We: Empathy and Community in Edith Stein’s Phenomenology’. The first contribution in this part is written by Timothy A. Burns and he begins by speaking about Stein’s dissertation in which the intentional act of empathy is deeply analyzed. Burns shows the necessity of distinguishing between ‘primordial’ and ‘non primordial’ acts. The primordial part of the empathetic act belongs to the perception of the other’s physical body, while the other’s experience is defined as the ‘non-primordial’ content. Empathy, as distinct from memory, fantasy or expectation, is defined as an act that transcends the ego. Empathy doesn’t regard the ‘I’ as a subject of its acts, but instead allows us to represent the other’s experience. For this reason, Burns notices, that in empathy an ‘apperception’ is not established, because I don’t apperceive myself as subject of the act. Burns reveals two different levels of empathy: the first is defined as ‘sensual’ and concerns the bodily experience of others, the second is reiterated empathy with which we may grasp the acts by which the other experiences us. Burns uses Stein’s account of empathy in relation to the topic of the community; despite the inalienable aloneness of each individual subject, we can join each other in one community through empathetic acts. Burns explains that, through the possibility of a communal experience, the ego remains ontologically separated from the others because our own experience relates first of all to the subject to whom it belongs. So, the communal intentional structure is not independent of the subjectivities, but is a product of them, and this peculiarity is coherently treated by the author as an essential ‘noetic’ sense of communal experience, belonging to a multiplicity of subjects.
Antonio Calcagno’s contribution is entitled: ‘The Role of Identification in Experiencing Community: Edith Stein, Empathy, and Max Scheler’. Calcagno contemplates the topic of ‘shared experience’ by debating the ideas of Edith Stein and Max Scheler together. Although they use different terms, Scheler and Stein both speak about a ‘we’ experience, or GemeineschaftErlebnisse to use Stein’s terms. In Stein’s first work we find the tension between ‘individuation’ and ‘identification’ and, in contrast to Scheler, Stein ascribes greater importance to personal individuation and argues that it shouldn’t become lost when the person lives within one community. The community itself is described as an intentional structure, stratified like the other form of intentional objects. Calcagno explains how the community is constituted by categorical acts other than by the psychological process of imitation. Indeed, the logical-linguistic dimension is an important aspect which defines a spiritual community and is different from one guided by a ‘psychical infection’[5]. On the other hand, the author reconstructs Scheler’s discussion about values in strict opposition with skeptic theories of morality. Scheler claims the possibility of discovering an eidetic structure of values that characterizes his strong realism about this theme. The author correctly shows the propensity of Scheler concerning a more communal ethical thought in comparison to Stein. Scheler, indeed, speaks about the importance of the spiritual values, with which we can become a ‘collective person’, rather than a community of single individuals organized by each other.
In ‘Edith Stein’s Phenomenology of Empathy and Medical Ethics’ Fredrik Svenaeus speaks about the relation between the concepts of ‘person’ and ‘patient’. In the first part of the text, Svenaeus explains the multi-level status of the empathetic act. The most elementary phase depends on the perception of the other’s body; the second step concerns the role of the imagination, with which the other’s experience can be simulated. At the last step, the cognitive elaboration returns to the first person perspective, with an enriched intentionality. Stein speaks about the lack of this capacity for the most part in medics who work on the ‘medical body’ rather than on the ‘lived’ one. Empathy must not necessarily become ‘sympathy’, but it is an essential step we must take to grasp the other’s world, through meaningful events relating to their existence.
In the fourth part of the book is discussed the topic of ‘Edith Stein and her Contemporaries’. The first essay is entitled ‘Kurt Stavenhangen on the Phenomenology of the We’ and is written by Alessandro Salice. Salice examines the thought of Kurt Stavenhangen; a less famous phenomenologist whose work is interesting nonetheless. Stavenhangen worked on the thesis of shared intentionality, and, in line with his thinking, Salice observes that the plural pronoun ‘we’ is not merely a simple function of grammar; it is a change in the intentional structure of experience. The shared experience is characterized by the phenomenologist as a reference to the selfsame intentional object, like a general ‘we like G’. This abstract sentence is shown to explain the structural property of the communal experience. We are not describing a specific cultural expression, but the universal structure of the shared experience. So, being aware of the selfsame object, whatever it was, is not only a theoretical act, but, as Salice explains, it concerns the establishment of shared preferences within the community. What follows is a debate concerning the intentional classification of the ‘we experience’ as examined by Stavenhangen with two peculiar, different intentional forms.
‘A Philosophical Resonance: Hedwig Conrad-Martius versus Edith Stein’ is the final essay in the book and it is written by Ronny Miron. The essay focuses on the relationship between the two phenomenologists quoted in the title and how they have influenced one another. Hedwig Conrad-Martius had strong relationship with Edith Stein, and in such a way there are conspicuous theoretical resonances between them. Hedwig Conrad-Martius based her thought on several critics of Husserl, since she claimed that his thought was flawed by a lack of reality. Indeed, she did not appreciate Husserl’s turn to the transcendental ego and judged that this theoretical move concerned only a ‘pure’ investigation. She remained, for this reason, strongly bound to Husserl’s Logical investigations. Even Hedwig Conrad-Martius, as Edith Stein, spoke about theology as an essential philosophical theme, in which can be applied the phenomenological method. Indeed, the description of the eidetic structure of intentionality could be applied to ‘faith’. For both phenomenologists faith is an essential step for the construction of our own world of meaning, and for this reason it concerns an intentional act considered important for philosophical conceptualization.
In summary, this book makes an important contribution to discussions regarding the definition of empathy not only in respect to traditional philosophical approaches which concern ethical peculiarities on the topic, but also in respect to other theoretical features. The latter characteristic is important, not only to obtain a theoretical understanding of the topic, but also in respect to the experimental practice of modern psychology. ‘Empathy’ is a complex concept which warrants philosophical investigation if we are to better understand an essential feature of human beings.
[i] Husserl, E., Logische Untersuchungen (1900); Husserl, E., Logical Investigations, 2 vols, Trans, J.N. Findlay, New York, Humanities Press, 1970.
[ii] Husserl, E., Ideen zu einer reinen phänomenologie und phänomenologischen philosophie (1912-1928); Husserl, E., Ideas Pertaining to a Pure Phenomenology and a Phenomenological Philosophy, First Book, Dodrecht, Kluwer, 1989.
[iii] Husserl, E., Ideen zu einer reinen phänomenologie und phänomenologischen philosophie (1912-1928); Husserl, E., Ideas Pertaining to a Pure Phenomenology and a Phenomenological Philosophy, Second Book, Dodrecht, Kluwer, 1989.
[iv] Husserl, E., Erfarhung und Urteil: Untersuchungen zur Genealogie der Logik; Husserl, E., Experience and Judgment: Investigations in a Genealogy of Logic. Northwestern University Press, 1973.
Der Philosoph Georg Simmel
Internationale Konferenz an der Bergischen Universität Wuppertal, 25-27 September 2018
Georg Simmel is one of those thinkers whose intellectual activity cannot be confined to a single disciplinary field. His interests, which touched upon numerous areas of knowledge, allowed him to make multiple contributions to the development of the human sciences of the twentieth century. His vast influence on the younger generations of philosophers, his penetrating analyses of society, and his peculiar style of writing made him a classic of contemporary thought. On the occasion of the centenary of his death, an international conference was organised in Wuppertal by Gerald Hartung (Professor of Cultural Philosophy and Aesthetics), Heike Koenig and Tim-Florian Goslar (Research Associates).
In the opening speech, Hartung clarified that the main aim of the convention was to «(re)discover the philosopher Georg Simmel beyond the many research areas and disciplinary identities which he was attributed». These words dismiss the trend towards specialisation that prevails among the current studies on Simmel. Because of such trend, Hartung noted, Simmel’s thought has been fragmented in single facets (e.g. his sociology, aesthetics, ethics), which are studied separately as if Simmel’s theoretical interests were incompatible with each other. In contrast, the speakers were asked to adopt an interdisciplinary approach and consider if – and in which terms – it is possible to talk about Simmel’s systematic legacy. Thus, the conference brought together scholars from various geographical and disciplinary backgrounds, who offered different perspectives to shed light on the overall significance of his work.
Many speakers underlined Simmel’s confrontation with the contradictions intrinsic to modern culture. For instance, Hartung pointed out that Simmel assigned to philosophy the task to address the main tension of modernity – namely the tension between individual and universal, i.e. between the subjective need of giving meaning to one’s own existence and the impersonal objectivity of socio-cultural institutions. Along the same lines, Denis Thouard (CNRS-Paris) investigated «Simmel’s philosophical intention», and suggested that Simmel primarily aimed at renewing contemporary philosophy. In Simmel’s view, German academic philosophers had become unable to cope with the problem of modern life. According to Thouard, Simmel followed two directions in his effort towards renewal: first, he criticised the academic language for being too abstract and restrictive, and instead, promoted a heuristic use of analogies; second, he adopted a relativistic point of view as a more suitable perspective to face the complexity of societies at the turn of the century.
Following Thouard’s contribution, questions were raised on how Simmel’s relativism should be interpreted, particularly as regards its ethical consequences. According to Georg Lohmann (University of Magdeburg), Simmel’s radical individualism is inevitably incompatible with moral philosophy. On the other hand, Gregor Fitzi (University of Potsdam) and Austin Harrington (University of Leeds) argued that Simmel’s social theory entails an ambitious redefinition of personal responsibility in an ethical framework grounded on the «individual law» [individuelles Gesetz] instead of dogmatic impositions. While the contributions of Lohmann, Fitzi and Harrington focused on the social and ethical implications of Simmel’s relativism, Johannes Steizinger (University of Vienna) investigated its epistemological meaning. According to Steizinger, Simmel’s relativistic position was a consistent response to the value crisis perceived in the late nineteenth century’s philosophy: in contrast with conservative solutions to this crisis (e.g. Windelband’s construction of a system of absolute values), Simmel tried to show how our communal understanding of the world and of society relies on historically originated and culturally limited values. History and culture are the main forces that shape our experience, and—as Tim-Florian Goslar (University of Wuppertal) noted—Simmel consistently explored their meaning through a transcendental investigation. In this respect Simmel was inspired by Kant, although his notion of historical apriori exceeded the Kantian system.
In his paper Goslar also suggested that Simmel’s effort to investigate history and culture is what granted thematic unity to his work. Likewise, in order to appreciate Simmel’s unitary intent, other contributions focused on his appeal to a «philosophical culture» [philosophische Kultur]. Elizabeth Goodstein (Emory College, Atlanta) identified this concept as a form of interdisciplinarity which does not imply competition between different sets of knowledge, but aims at their cooperation under the guidance of philosophy. Heike Koenig (University of Wuppertal) stressed the relevance of Simmel’s philosophical culture for pedagogy: Simmel considered culture as a unitary picture enriched by multiple perspectives, and presented it as an instrument to reinforce our personal identity despite the societal fragmentation. Antonio Calcagno (King’s University College, London – Canada) similarly delved into Simmel’s concept of personal identity. By comparing Simmel’s view on this topic with social theories of the early phenomenological school (in particular with Edith Stein’s), Calcagno tried to show how Simmel’s account of the self as a dynamic and “unfinished” entity offers a more convincing explanation of the relation between the individual and society.
A last group of contributions shed light on some ways that Simmel influenced European philosophy and human sciences. Gérard Raulet (University of Paris-Sorbonne) reconstructed Walter Benjamin’s reading of Simmel’s concept of «Nervosität» as characteristic of modern cities. Nicole C. Karafyllis (University of Braunschweig), instead, started by pointing out that Simmel’s troubled academic career prevented him from creating a stable circle of disciples. But despite this fact—Karafyllis claimed—Simmel’s notoriety extended beyond the classrooms to wider intellectual circles. This allowed Karafyllis to identify Simmel’s influence in the work of the sociologist Hermann Schmalenbach and the pedagogue Willy Moog, although they never actually studied under Simmel’s tutorship. Olivier Agard (University of Paris-Sorbonne) examined the early reception of Simmel in France both in philosophy and sociology, and showed that the relationship between Simmel and French intellectuals, such as Émile Durkheim and Henri Bergson, was one of mutual influence.
The primary outcome of the conference was the reassessment of Simmel’s relevance both for a historical perspective and for present-day philosophy. On this basis, Hartung suggested that the end of the convention should be seen more as the starting point of a communal research program, rather than as its conclusion.
The papers that were presented during the conference—not all of which were included in this report—will be published in the Fall 2019 issue of the series Kulturphilosophische Studien by the Karl Alber Verlag (Freiburg).
Report by: Andrea Mina (PhD Student in Philosophy at the FINO Consortium, Italy)
The Language of Touch: Philosophical Examinations in Linguistics and Haptic Studies
La résolution des problèmes
Reviewed by: Pierluca D'Amato (Durham University)
In an age in which psychic and social spheres are heavily influenced by means of pervasive and inscrutable technologies, Gilbert Simondon’s ideas are progressively being recognised as crucial for the comprehension of the current relation between humans and technics.
Situated at the crossroad between philosophy of science, phenomenology and the study of social and developmental psychology, Simondon’s thought matured under the guidance of teachers of the calibre of Georges Canguilhem, Jean Hyppolite and Maurice Merleau-Ponty, and deals with two main themes: the reflexion on the notion of individual, and the development of a theory of technics. With the publication of his doctoral theses L’Individu et sa Genèse Physico-Biologique[1] (1964) and Du Mode d’Existence des Objets Techniques (1958), Simondon’s work on these topics influenced central names of the philosophical landscape of our epoch, such as Gilles Deleuze and Bernard Stiegler, and keeps fuelling the new generations of thinkers involved in a quest for the comprehension of times thanks to the generous quantity of essays and lectures that are in the process of being published for the first time, and slowly starting to be translated from French.
The processual account that Simondon develops for the notion of individual, indeed, sets off form a critique of the hylomorphic model, the Aristotelian account of beings as composed by a form and a matter, that is defined by Simondon as a technological schema derived from a cursory consideration of technics, and whose application has significant social implications. In this framework, his theory of technics, that he calls mechanology, represents an experiment at the same time theoretical and pedagogical, that is meant to fight a double problem: the general alienation of technics from the cultural debate, and the consequent unawareness regarding the material foundation of social systems, whose status and potentialities for change are always grounded on and constrained by technical forms of mediation.
Except for the article titled La perception de longue durée, appeared in the Journal de Psychologie normale et patologique in 1969, the essays collected in La Résolution des problémes were prepared as support material for psychology courses that Simondon gave between the 1974 and 1976, in the late stage of his philosophical production, and appear for the first time published in a collection.
Ranking among the many that the philosopher has produced during his intense life of work, these essays share the same emancipatory motivation underlying the thesis on the technical object, namely that the knowledge of the technician has to become the support for a theory of machines and tools, in order to shed light on the ways in which individuals relate to the world and on the relations of which social fabrics are woven. The four essays collected in this book, in fact, can be thought of as being linked by the notion of relation, declined as the one between the individual and the object, and the one between a movement and an obstacle. These two types of relations are based on the definitions of two main concepts, namely the one of object and the one of problem.
The first essay, L’homme et l’objet, is dedicated to the relations between the individual and different types of objects, and the last one, La perception de longue durée, to the character of the objet quelconque, the any-object-whatever. The remaining two essays explore the notion of problem, one from the point of view of its possible solutions (La résolution des problémes), and the other from the point of view of the intellectual resources at work behind these operations (Invention et créativité).
This book connects the concepts of object and problem through the notion of instrumentality, by which Simondon explains how, under certain circumstances, objects can become means to solve problems, and problems, in turn, represent a way for objects and techniques to evolve.
This review will focus on addressing this set of interactions, proposing a way to read the collection through a line that crosses three major relations: the one between individuals and objects, the one between oriented movements and the obstacles to their completion, and the relation established through the instrumental mediation between objects and problems. We will then conclude by addressing the definition of philosophy that can be modelled on the latter relation.
Objects
In the first essay of the collection, the concept of object is defined in relation to the individual that perceives it. Simondon’s idea of this phenomenological relation can be summarised as follows: ‘For there to be an object, motricity is not enough, a differentiated sensorium and the combination of the data of the different senses are also necessary’ (23). For the author, objects are given as results of the integration of different perceptions, that can be carried out by individuals equipped with the appropriate cognitive system, as the one developed in adults and generally present in animals provided with complex nervous systems. On this basis, Simondon claims that ‘the object is an already complex and elevated construction, which… characterizes a defined level of the structure or of the development of the living being’ (23).
The relation between individuals and objects varies then according to the age of the individuals and to their place in space and society and is configured on a case-by-case basis according to the relative size of the object, i.e., its order of magnitude. According to Simondon, it is precisely ‘according to orders of magnitude of the object that this relation has to be studied’ (12).
Infants, for example, intervene clumsily on what surrounds them because they relate to an object that is perceived as greater than them, a “complex and constant”, enduring world of objects that is somehow difficult to handle. With the growth of individuals, their relationships with people and objects change, and the world appears gradually smaller. During their growth, in fact, a new psycho-social “situation” (20), that Simondon defines as the instance of the acquisition of a system of objects (21), comes to describe the novel point of view assumed by individuals in relation to the world. From this more mature point of view, objects appear richer, as consisting of multiple dimensions and offering different possible uses. Occupying a new psycho-social situation as a novel point of view, individuals assume a new perspective on the material world and re-situate themselves in relation to it.
The development that leads to this change in perspective causes somatic and mental changes. The latter are produced not only by the individual’s biological growth, but also by the culture-induced classification of objects. The individual doesn’t change point of view and perspective exclusively because of its status of development then, but also because of the web of relations of which he is part, as an object among other objects. Once the individual reaches the psychosocial situation of the adult, the world of objects doesn’t appear as a unicum anymore, nor as a “fixed system”, but as a system composed by interconnected and mobile parts whose alteration can disclose useful energy (24).
When the individual reaches the psychosocial situation that corresponds to a renewed point of view, he assumes a new perspective over this world of objects, and the latter appears as composed of a series of objects culturally classified among which he can orient himself and on which he can intervene. The possibility of acting on the world is dependent on the proportions between the individual and the objects that surround him, that ‘varies according to the distance that separates them’ (12). The distance of which Simondon is speaking can be shortened by technology, whose mediatory character allows to access “distant” magnitudes and to intervene on the infinitesimally small or big. For this reason, the first essay will conclude by establishing the importance of technical mediation in the discourse on the relation between men and the object.
Simondon’s world of objects is then characterised a system of related magnitudes, whose relation to individuals is disciplined by cultural frameworks and alterable by the use of instruments. In his perspective, the greater the difference between the sizes of the individual and of the object, the greater is the role of tools that support the observation or the manipulation of the latter. The individual himself is an object among others whose perspective is influenced by the status of the system of relations of which it is part.
The second half of L’homme et l’objet is devoted to the consideration of the principal types of objects and to the perceptive relation with the extremely small or extremely big ones. In his classification, Simondon reserves a special place to tools, defined here as objects related to the definite actions that they allow, included the acquisition of information. With this characterization on the background, the author specifies that ‘technics are not necessarily a reconstruction of the natural through materials or different assemblages [and that] they can consist in an interweaving of natural objects of different categories’ (23). The possibility to encounter or produce couplings among different types of objects is connected to an interesting rethinking of the primacy of the solid in the general reflection on matter. On this topic, Simondon claims that objects can comport different states of matter and even include voids. Indeed, he explains, objects are not always “full”, and ‘an object may not be everywhere materialized and have real or apparent voids. The real void is a space without function in the object. The apparent void is a medium of transmission’ (23).
The discourse on transmission media and apparent voids brings about the notion of milieu, characterised as an object of a special class. According to Simondon, what he defines as “enveloping objects” have the property to influence the reciprocal relations of the objects that they contain, and can easily go unnoticed, “become invisible”, despite the importance of their effect on what they contain. The author specifies that the milieu is an object too, specifically because ‘it intervenes in the phenomenon. The position of the object is part of the object because it designates its potential energy’ (24). According to this view, the surroundings of an object not only act on the individual, influencing his perspective, but determine the state of the object itself, that “appears” because of the stability of its conditions. It is this stability, although relative because ‘situated between two orders of magnitude unstable or metastable’ (24), that makes possible to speak about objects in general. In Simondon’s account then, the milieu represents one of the most relevant parts of the coordinate reference system that shapes the relation between individuals and objects, and determines various effects of constancy, but also clichés and stereotypes, which influence the perception of objects.
Objects can appear to be near or far, and be perceived as familiar, rare or extraneous. According to the author, the “proximity” of a type of object grows proportionally to its degree of circulation among individuals and causes variations in society (29-32). For Simondon, the “extraneity” of an object is directly connected to the ideology on which a society is shaped and reflects the consequence of the division of work. Indeed, the degrees of extraneity of a type of object correspond to specific modes of production and to the distance between the figures of the user, the producer and the designer. The various relations between these figures produce three cultural models, that Simondon shapes on “different degrees of extraneity”: style and tradition are the ones in which the user has a relationship only with the designer or with the producer, while consumerism is the pole of the relation in which the user doesn’t have any relation with the other two figures. The last model, representing the opposite pole on the scale, is designated as the anthropological one, in which the three figures are all related.
On the basis of this classification, Simondon describes the current situation of technology, in which the arrangement of the relations between objects is such that things are submitted to a process of premature obsolescence, and in which the possibility to intervene on the configuration of objects is being denied by design choices that favour disposables and their endless production and consumption (32-34).
Beyond all the possible configurations of this network of relations, and all the kinds of particular objects that he classifies, Simondon posits what he calls the any-object-whatever. This notion describes the most generic object, that however has a peculiar characteristic: ‘Th[is] object is, first of all and existentially, supposed to be another organism or product or announcement of an organism, or even a group of organisms’ (57).
This idea is considered more in depth in the last essay, that consists in a detailed exposition of experiments with vision that should provide evidence for this thesis through an illustration of what Simondon calls the organism-effect. Such conception is grounded on the claim that ‘the perception of the object bears on a functional real enhanced and pre-marked by a signage’ (58). This means that objects appear because the perceiver, as agent, has a functional relation with its surrounding, and that the objects that appear to him are already filtered by his own physiological needs.
Because of this filtering function, the object is perceived on a background that Simondon describes as continuous and unlimited, because not fractioned by the selective attention of the perceiver. This background, he adds, ‘has an ecological sense, it is a texture’ (58), and ‘the texture is a characteristic of the milieu… [or better still] it is the support, the milieu’ (59).
Since the triple relation between the perceiver, the morphology of the object and this texture allows the object to be grasped, Simondon defines the milieu as a “perceptive mediator” between subject and object. This texture is defined as a microstructure, a multilevel code whose internal differences provide the basis for the action that is taking place on them and exert a regulatory function on it. According to the author, form and texture are two extreme orders of magnitude coexisting on the same perceptive field, the middle term of which is the structure. Different microstructures can produce the exact same form, so that a form is said to be the global result of a texture, i.e., a level of perceptual approximation.
With the series of experiments illustrated in the last essay of the collection, La perception de longue durée, Simondon argues that perception is always biased, and that this bias characterizes the any-object-whatever as an organism.
The experiments illustrated in the article concern prolonged observations of objects and rotating surfaces projected on a screen. According to Simondon, the optic effects generated by long periods of fixation should testify that perception is modelled on organisms, be them friends, partners, prays, food or foes.
This essay, however, has at least two problems: the first is that the study focuses only on the sense of sight, when, as shown, Simondon believed that to have an object is necessary to integrate data from different senses. Moreover, this research does not appear to be scientifically rigorous because, by admission of the author himself: ‘it would be advisable to multiply the observations, to operate with the participation of various subjects, and … by involving subjects that ignore the true nature and the real movement of the object’ (289). This issue is connected to the second problem of the essay: Simondon’s formula tends to project the quality of being an organism onto the object, while the organism-effect takes place not because the any-object-whatever is an organism, but because the perceiver is. Long durations entail the prolongation of the natural intersaccadic periods of fixation, and the effects Simondon describes can be the result of ocular drift and microtremors: it is not the object that moves then, but the eye, and because of its constitution.
Besides of these issues, the idea underlying the series of tests conducted by Simondon can be summarised as follows: ‘It may be thought that, just as there are stimuli-signals, studied by ethology, there exist archetypes and types providing to perception in critical condition its hypotheses’ (334). According to Simondon then, the illusory movement of the images resulting from long periods of fixation is a manifestation of the archetypes that orient perception. As a consequence, the idea that the any-object-whatever is an organism, means that there is an inclination of perception to expect to find organisms, and this because perception serves action, as in the case of the search for food or in the attempt to avoid predators, facilitating the survival of the living being.
Problems and Solutions
Survival is the result of a constant practice of problem-solving.
In the essay that gives the name to the collection, Simondon defines problems as follows: ‘a problem exists as soon as a finalized conduct encounters an obstacle to its realization’ (61), and problems can be classified on the basis of the kind of operations required to overcome these obstacles or avoid harmful stimuli. These operations are the result of a “change of strategy” of sorts, that can be performed as the result of blind attempts in different directions, in view of a plan and recurring to some sort of mediation, be it material or symbolic.
The easiest example of the first modality of problem-solving involves a change in the original direction of a movement. The new direction can be found accidentally and chosen after a random series of unsuccessful trials that increase the chance of not encountering the obstacle again. Simondon shows that this type of conduct is already observable in organisms that are not able to perceive stimuli at a distance, that don’t possess a spatial memory, and in which the motor function is predominant on the sensory one (67).
A more complex way to solve a problem involves the production of a “plan” and requires memory and the capacity to perceive from a distance. Differentiated from the previous by the neurophysiological capacities of the individuals, the presence of acquired habits and hereditary behavioural schemes (77), this kind of conduct presupposes the perception of an actual object instead of isolated uncomfortable sensations (69). The solution of labyrinths by laboratory mice represents a good example of this second type of strategy because mice possess both the capacity to perform a cognitive synthesis of stimuli coming from different senses and the ability to memorise simple information.
The learning process of the subjects of these tests is defined as the gradual limitation of errors, which is complemented by the memorisation of specific spatial relations, and their characterisation as either useful or unattractive. What the mice learn is therefore a new pattern of relations. At this level of complexity, the “plan” is nothing more than the memory of this pattern: ‘”what the rat learns is the labyrinth itself”, that is to say spatial relationships, a topography that had to be sought … learning is not about movements, but about spatial relationships’ (79).
Other problems ‘involve the preparation of instruments’ (88), and necessitate a more complex nervous system, as it is the case of monkeys and humans.
The usage of complex tools is crucially related to their preparation and improvement, and implies the identification of non-urgent needs. Conservation and reparation of the tools derive from this capability of the users, whose activities include the search for materials and the use of other tools in order to produce the ones desired. The conservation of the means of production represents another practice that has direct social implications, because it generates what Simondon describes as the social filters that new inventions must overcome in order to see the light. This highlights the fact that the conditions of the birth of technical objects are not only environmental, but also socio-economical.
La résolution des problèmes focuses then on the consideration of the process of invention, the analysis of which can be found, with more details, also in the third essay of the collection, Invention et créativité.
An invention can be defined as the creation of a group whose elements are in a functional relation, and the sum of which results in a function or a number of functions available to the user (105). The elements of this functional unity, the “organs” of an invention, are arranged and chosen so that ‘there is not necessarily one organ per function or one function per organ’ (105), and their assemblage derives from the articulation of a ‘plurality of tensions towards the fulfilment of functions thanks to the state created by their simultaneous fulfilment’ (100).
The equilibrium between these tensions is reached through a process constituted by three phases: a syncretic phase, an analytic one and a synthetic one. The scheme theorised by Simondon applies to the most complex objects, and is exemplifiable by the invention of industrial machines, which ‘is characterised by … a syncretism, that consist in the act of amalgamating, of blending functional parts, an analysis of the functions and of the structure of the objects, and a synthesis acting as a multifunctional combination of the structures’ (160).
Indeed, the syncretic phase can be described as the act of putting together elements that may lack functional and structural separation, and whose defective assembly makes the object impossible to be industrialised and difficult to automatize. In order to overcome the drawbacks of the initial configuration of the machine, to improve its effects, and/or to produce a new effect, the device must go through an analytic phase, in which the functions of the object are considered separately, and their functions dissociated. This leads to a reshuffle of structures and functions (147) that can be performed also to solve problems belonging to the internal milieu of the object. Problems of this sort can be risen by the fact that one of the components has been transformed by evolution, and because ‘The introduction of a new element affects the way of being of the totality, but must conform to the new laws of the totality resulting’ (105).
Leaving behind ‘a new arrangement of objects or the production of a movement that wasn’t existing before’ (131), the solution of a problem trough instrumental mediation brings about something new, qualifying as a not completely reversible activity that entails a genuine progress.
Philosophy
Theoretical problems or obstacles that cannot be solved by resorting to a material basis to manipulate can be approached through a different “strategy”, that involves the use of symbols.
Very interestingly, part of Invention et créativité is dedicated to the consideration of the process of invention in Greek philosophy. In Simondon’s view, the monism of the primordial element selected by Thales, Anaximander and Anaximenes represents the syncretic phase of the early western philosophical invention, whilst the dualistic doctrine of Plato assumes the character of an analytic phase. The synthetic moment of invention in Greek philosophy is instead represented by Aristotle’s philosophy, who, in Simondon’s view, ‘replaced the Platonic opposition between the Idea and the object with the asymmetrical coupling of form and matter, which constitutes the whole universe’ (201). According to the author then, it is possible to apply these schemes to the rest of the history of philosophy, parsing it in a dialectic taxonomy that echoes the Hegelian one.
Even more interesting than this classificatory exercise, however, is the fact that philosophy is considered as ‘a mode of thought capable of real inventions, in the manner of technical thought’ (203), and therefore essentially as a way to solve problems. This definition of the nature of philosophy can be shared or not: what is perhaps more important, is to consider it in relation to what Simondon omits. Among all the possible strategies considered by the author, in fact, solving problems through the creation of new problems has been remarkably left out. Thinking of hungry rats and mazes, for example, makes evident that all sorts of traps have been designed to solve the problem of infestation through the production of a new problem, a very difficult one to solve for the rat.
The nature of these kinds of solutions, that at the same time are also problems, forces us to re-consider Simondon’s conception of philosophy: the idea that the discipline is an inventive one is definitely acceptable, even though the condition of this invention should be debated, but the qualification of philosophy as a problem-solving technique can be quite limiting.
Unlike Simondon, Gilles Deleuze was well aware of this issue: he believed that philosophy is the art of fabricating concepts, but also that these can be created only as ‘a function of problems’ (1991, 2). According to Deleuze, problems are not simply found, they have to be posed, and raised in order to allow the invention of concepts. From this point of view, the creation of problems assumes a certain kind of primacy over their solution. This conception is explicit in a passage of Deleuze’s Bergsonism (1988), in which the philosopher quotes Bergson’s La Pensée et le Mouvant (1934), and with which is probably appropriate to conclude this review of La Résolution des Problèmes:
True Freedom lies in a power to decide, to constitute problems themselves. And this “semi-divine” power entails the disappearance of false problems as much as the creative upsurge of true ones. “The truth is that in philosophy and even elsewhere it is a question of finding the problem and consequently of positing it, even more than of solving it … its solution may remain hidden and, so to speak, covered up; The only thing left to do is to uncover it. But stating the problem is not simply uncovering, it is inventing (1988, 15).
[1] First part of the major theses, later published in its entirety as L’individuation à la Lumière des Notions de Forme et d’Iinformation (1989).
Anton Marty and Contemporary Philosophy
Existential Medicine: Essays on Health and Illness
Reviewed by: Helene Scott-Fordsmand (University of Copenhagen)
In contemporary debates in philosophy of medicine medical humanities are gaining ground in a discipline that was for many years dominated by bioethics. Phenomenology, with its focus on human experience, and a long history of interest in illness as boundary cases of human existence, turns up as a tradition with a lot to offer in this context. In their introduction to the Edinburgh Companion in Critical Medical Humanities Whitehead & Woods thus mention phenomenology as one of two key traditions within what can be called second wave medical humanities (Whitehead & Woods 2016, 11). In this spirit, the collection of essays in Kevin Aho’s inspiring publication is an invitation to join the exploration of phenomenology and existential medicine and find new potentials for philosophy of medicine within these traditions.
Existential Medicine is a well-balanced but also composite collection of essays, a rhizome of Heidegger-medicine-hybrids that cover a remarkable amount of ground within the medical sphere. We join the many skilful thinkers who have contributed to the volume in an exploration of the possibilities for phenomenology—and particularly Heideggerian thought—to contribute in manifold ways and in a variety of debates within philosophy of medicine. Readers should not expect the book to give them a clear and stringent definition of the field, nor a coherent “existential view” to use in opposition to other approaches in philosophy of medicine. The individual essays do of course present clear positions and proposals, but as a collection, they invite scholars to explore, broaden and discuss the concepts and methods offered by the phenomenological and existential tradition in light of the revived interest in meaningful lives and human relations.
To set the scene for the exploration, Aho introduces the collection of essays with a brief outline of key concepts in phenomenology that make it particularly relevant for medical debates: embodiment, space and time, affectivity and existence as hermeneutic. Given this introduction it is clear that the ambition of the book is not just to speak within phenomenological circles, but rather the book reaches out to novices in the existential/phenomenological tradition. However, even if the book may aim at the community of philosophers within medical humanities or philosophy of medicine, who have yet to learn the insights and wonders of phenomenology, it has something to offer to a wide range of people, Heidegger scholars included. As a sign of quality in interdisciplinary work, anyone working somewhere in-between the fields of phenomenology and medicine will find valuable insights within the pages of this book, from practising doctors in need of a little food for thought, to experienced phenomenology scholars looking for new perspectives.
The main character in the book is (of course) Heidegger. A key inspiration for taking the subject of medicine up in a Heidegger publishing series is the Zollikon seminars (Heidegger 2001)– a row of seminars held between 1959-1969 on an invitation from Medard Boss. The invitation was motivated by an aspiration to think about medicine outside of the biomedical-technical regime which Boss thought was too dominant at the time, and Boss’ conviction that Heidegger’s work proved valuable for this task. Many of the contributors in the volume agree that it is still the case that medicine is dominated by biomedical-technological regimen, and hence that there is a continued relevance of Heidegger’s work.
The heavy emphasis on Heidegger can seem frustrating to a non-Heideggerian at first, particularly given that some of the key concepts outlined by Aho in the introduction are also well-established as Merleau-Pontian notions. However, the particular focus serves as a helpful unifying principle throughout the essays, whose subjects and approaches may seem otherwise to be philosophical worlds apart. The use of Heidegger thus lets us return to the same concept over the course of many essays.
Surprisingly only a few of the essays in Existential Medicine reference the Zollikon seminars, and if you are not already familiar with them, it remains vague throughout the book—perhaps with the exception of some remarks in Frederik Svenaeus’ and Carolyn Culbertson’s essays—what precisely the Zollikon seminars have to offer. Other of Heidegger’s works and many of his well-known concepts, however, feature prominently in the essays as harbouring important notions for philosophy of medicine. Among these, his works Being and Time (Heidegger 1993) and The question concerning technology (Heidegger 1977) are particularly noteworthy, with notions such as being-towards-death, anxiety, being-with(-others), the they (das Man), and being-at-home recurring in several essays and forming a connecting thread throughout the book. Further, other philosophers from the phenomenological and existential tradition such as Maurice Merleau-Ponty and Hans-Georg Gadamer play a central role in many of the discussions, and a whole range of philosophers, theoreticians, and writers such as Husserl, Binswanger, Sartre, Foucault, Freud, and many more are drawn on in the varying topics treated throughout the book. This multiplicity of voices serves to highlight the ambition of the book to explore the many potentials offered by the phenomenological and existential tradition, rather than merely applying Heideggerian thought to yet another field.
Rather than venture into the individual essays of the volume, I will attempt to give an impression of the content of the essay collection by drawing up some noteworthy or common themes worked upon in the book. Not every essay touches directly upon either one of these themes, and many of them include more themes than I will be able to mention here. I have chosen to focus on three trajectories that seem to be of general importance to the area of existential medicine and the crossing of Heideggerian thought and medical practice. First, existential medicine has an important task in its critical engagement with the biomedical model of healthcare and the relation between lived human life and medical science. Second, existential medicine can tell us something about suffering, relief, health, and the role of authenticity in illness. Interestingly, this is treated mainly through issues of sociality in many of the essays. And third, existential medicine can help us understand the relation between possibilities in biotechnological development and the limits of being human.
Human Life ⇋ Medical Science
One of the strong motivations for the growing interest in existential medicine, and medical humanities in general, is a growing awareness of a dissatisfaction with the biomedical model of healthcare. The ultimate promise of biomedical discovery explaining all diseases through the genomics project did not succeed, and suffering is still abundant. Introducing her essay “Losing the Measure of Health”, Culbertson writes of this dissatisfaction as an ironic clash between the amount of success-stories of modern medicine, and the ever more common criticisms and complaints as well as the estranging effects of modern healthcare systems (179).
A strong conviction in medical humanities is that medicine and medical practice has lost something by focusing on generalisable results and universal diagnostic manuals and treatments. This critique of modern medicine is specifically thematised by both Svenaeus and Culbertson in their essays on medicine as a techno-science, i.e. as taken over by technology in ways that Heidegger warned about in The question concerning technology, and later applied to medicine in the Zollikon seminars. In “Heidegger’s Philosophy of Technology and the Perils of Medicalization” Svenaeus develops this critique through Gadamer and quotes from The enigma of health:
“In medical science we encounter the dissolution of personhood when the patient is objectified in terms of a mere multiplicity of data. […] the question is nevertheless whether the unique value of the individual (Eigenwert) is properly recognized in this process” (Svenaeus’ modified translation of Gadamer 1996). (133)
The proposal in medical humanities is for medical personal to turn towards and learn from the humanities as a “science of the particular” (a term I borrow, though slightly modified, from Carlo Ginzburg (Ginzburg & Davin 1980)). Something similar is claimed in existential medicine, where it is held that a turn of awareness towards existential elements of life will re-individualise patients. This idea is expressed throughout the essays in Existential Medicine as a strong reservation toward the reductionist character of modern biomedicine, and the assumption that health is a matter of physiological restauration.
Biomedical Reductionism
Various essays thematise the biomedical model in various ways. In line with ideas from medical humanities Svenaeus distinguishes existential medicine from biomedicine by assigning illness experience to the phenomenological or existential realm, that is, subjective experience, as something the biomedical sense of disease cannot inspect or measure (139). Tina Williams & Havi Carel use the term phenomenological exploration in their essay “Breathlessness” (156) as something similar to Svenaeus’ description of the role of phenomenology (as focused on illness experience) to emphasise phenomenology as a hidden resource for medicine, and criticise the lack of attention paid to this element of illness. They argue that the narrowed vision of biomedicine does not only speak against “medicine’s stated commitment to patient-centred care” (157), but also often result in injustices committed against the patient. In “Emotional Disturbance, Trauma, and Authenticity” Robert D. Stolorow criticises the decontextualization of human existence in modern medicine. Particularly in diagnostic manuals, and—referring to Wittgenstein’s notion of family resemblance—argues that the DSM-system reduces complex existential alterations for the individual to non-substantiated essences of pathology (19) (Svenaeus makes a similar remark when discussing the implicit technologisation in diagnostic manuals (144)). Kristin Zeiler, likewise—in her essay “On the Autós of Autonomous Decision Making”, on parental kidney donation—talks of issues around reductionism and decontextualization in the medical idea of autonomy, as a concept based on disembodied subjects who make rational choices expressed in forms of informed consent (97). Drew Leder briefly touches the subject in “What is it to ‘Age Well’?”, in terms of reducing successful aging to an absence of biological change (or at least a minimisation of change) (224). And John Russon & Kirsten Jacobson argue in “Existential Medicine and the Intersubjective Body” that biomedicine overlooks some of the most important issues in treatment of IBD (inflammatory bowel diseases) and HIV. Biomedicine is blind to the element of stigma that is part of living with these diseases, and which entails a range of existential issues. They argue this to the extent where they even seem to be suggesting that biomedical treatment is of lesser importance (identifying existential issues as “the real problem” in HIV and IBD (201)).
By turning critically towards biomedicine, the idea in existential medicine is not (at least in most cases) that medicine as biomedical science should be stopped. In fact—as Aho states in the introduction of the book—one compelling aspects of approaching medicine through Heidegger is that he acknowledges that medical science (i.e. biomedicine) is important, but simultaneously works to problematise assumptions and aspects of medicine as science. Rather than to do away with the scientific aspects of medicine, the idea is, writes Svenaeus, that the techno-scientific side of medicine – often exemplified in biomedical sciences – recognises its limitations, and does not become the dictating force within the discipline (136).
Psyche / Soma
Another related reservation evident throughout the essays, is toward the reified body conception in modern medicine as well as the dualistic subject-object divide—or rather, the psyche / soma—that underpins it. This is not the existential view of the body, as is made clear by Aho in his introduction of the notion of embodiment. Existential medicine does not mean psychiatry, its role is not to care for the psyche while biomedicine cares for the soma. With roots in phenomenology, existential medicine involves the whole existence of a human, life, body, moods, and so on.
In the essays several authors use the well-known phenomenological notion of the body as an “I can” usually associated with the healthy body. Some refer to the Leib / Körper distinction as an approximation of the two views on the body in biomedicine and existential medicine respectively. However, two particular essays in the volume challenge the dualism more directly, namely Slatman and Williams & Carel. In “Reclaiming Embodiment in Medically Unexplained Physical Symptoms”, Slatman argues from the case of MUPS (medically unexplained physical symptoms, such as chronic fatigue) that some diseases cannot be dealt with if we do not find a way to un-rigify the concept of body in our medical language (102 and throughout). The body in cases of MUPS is neither a smoothly lived body, an “I can”, nor a reified biological apparatus, whereby attempts to give meaning to the symptoms fail insofar as there is no proper language. Williams & Carel argue from the case of breathlessness that there are some cases where we have no way of distinguishing physiological and psychological symptoms from each other, as for breathlessness in respiratory illnesses and in anxiety disorders. The two can work interchangeably, simultaneously, they can cause one another, and thus appear as inseparable (150 and throughout). Looking only at the physiological side to understand the symptom (biomedicine) is insufficient, but so is the attempt to divide the symptoms between differing specialities even if including non-biomedical views. Breathlessness is a suspension of conservative medical categories, forcing us to come to terms with a material productivity of cultural aspects in our lives as well as a cultural productivity of the material aspects (formulation taken from Kristeva, Moro, Ødemark et al. 2018).
These attempts to dissolve the distinction between psyche and soma touch upon an interesting meta-discussion: whether existential medicine and biomedicine are and should be thought of as separate elements that work on separate issues, or if not, how the two are connected or integrated. Insisting that the two are completely differentiable categories, seem strange given the acceptance of the concept of embodiment. Arguing that either existential health should be more important than biomedical health or vice versa, as some of the essays in the volume flirt with, seems to uphold a divide between body and self. If we are to take the notion of embodiment as well as the points made by Slatman and Williams & Carel seriously, neither meaning nor bodily function can take preference over the other. The issue at hand is to look for ways to understand the individual life of and meaning of this life for the patient (in order to properly recognise the Eigenwert of the patient), while finding ways to make both existential medicine and biomedicine co-contributors to human health.
Positively surprising after many essays that thematise the faults of modern biomedicine, Culbertson makes the interesting observation that despite all the faults and despite a strong inclination towards the biomedical model in research and education, this is not what goes on in medical practice (186). Doctors have to engage with patients, and even if there is a lot of room for improvement, we already (or still) see existential care being practised.
Anxiety, Sustainable Authenticity, and Sociality
Illness as the Cure
One basic phenomenological observation on the experience of becoming ill, is that the suffering is often connected to a disruption of habitual ways of living, and with that a break of trust in some or many elements of existence (our body, the world, the future, etc.) that would normally be a pre-reflective part of our life. In efforts to understand this break, scholars use the Heideggerian coupling between the mode of being according to the they (das Man)—i.e. a pre-reflectively dominated, normal life before illness—and anxiety as developed by Heidegger in Being and Time. Several of the essays in Existential Medicine engage with the relation between these notions. Anxiety is not—as obvious from its identification with illness—a desired mode of being. However, for Heidegger it gives us the possibility of authenticity, of freeing ourselves through having truly acknowledged our own finitude. In existential medicine then, authenticity – because of its link with a positive way out of illness – becomes linked with existential health.
Essays by Shaun Gallagher, Martin Kusch & Matthew Ratcliffe, Slatman, Williams & Carel, Russon & Jacobson, and Nicole Piemonte & Ramsey Eric Ramsey all touch upon illness as something that breaks with habitual living. Russon & Jacobson bring out authenticity through anxiety as a positive potential in becoming ill, as a moment for patients to “own up to the realities of their own lives” (201). Likewise, Williams & Carel talk about anxiety as an opportunity to reclaim existence as one’s own (154). In both cases, the inclination is that existential health is something that can be separated from or even opposed to physiological health, that is, the idea that serious illness can be seen as a potential to reclaim an authentic life, so that patients can get existentially better even in cases where there are no biomedical cures available.
In “Health Like a Broken Hammer or the Strange Wish to make Health disappear” Piemonte & Ramsey, rightly—I think—approach the somewhat romantic idea of illness as an existential cure for mediocracy from a more sceptical perspective. They write: “it may be the case that one is simply ‘not up for it.’ Illness—and the fatigue, nausea, pain, and weakness that can accompany it—is onerous, and adding to that the expectation that one ought to honestly confront my finitude and allow it to transform me can simply be too much” (213). In their essay (on existential notions of health) they critically investigate the heroic ideal of breaking with the “they-self” (the self embedded in the they) through serious illness to obtain solitary authenticity. They suggest that solitude in illness is not necessarily something to strive for, and the tale of “finding one-self” in hardship can itself, become a symbolic figure that bears resemblance of a they (an inauthentic role, lived by outer expectations more than self-determination) (214). Emphasising Heidegger’s remark that authenticity is not a break with, but a modification of the they (215), Piemonte & Ramsey show the centrality of a they rather than its inauthenticity, in interpreting, making decisions or even understanding the world which we are thrown into. They argue that (existential) health is not a matter of breaking with the they, or not, but a rebuilding of a more authentic belonging in a they, that is not only tied up in illness.
Mitsein, Existential Individualism and Second-Person Phenomenology
In recent years the notion of intersubjectivity and “we” has gained philosophical, or at least phenomenological, influence. Interestingly, despite the prior mentioned importance of re-individualising the patient, a re-occurring theme in the volume is the notion of intersubjectivity, the importance of relations, and the effects of illness on sociality. At times this even amounts to direct criticism of the individualistic traits discernible in the Heideggerian idea of becoming authentic through isolating anxiety (what Gallagher calls existential individualism (10)).
I his essay on inauthenticity, “The Cure for Existential Inauthenticity”, Gallagher notes that the Heideggerian notion of being-with (Mitsein) is underdeveloped. He therefore draws on Merleau-Ponty, Werner Marx, and a range of Heidegger scholars to develop a more full-fletched idea of Mitsein as a relational authenticity, obtainable through shared mortality (rather than solitary confrontation with death). In the subsequent essay Robert D. Stolorow talks about something similar, and calls it “our existential kinship-in-finitude” (24). He develops a notion of relational authenticity based on the idea of a relational home arising through shared “emotional dwelling” (23). In cases of trauma – for which he develops the concept – emotional dwelling means for one to lean into the other’s emotional pain and participate in it, thus, through the relation, helping the other to bear the weight of the trauma enough to find room and time for healing. In this way, Stolorow opens up the idea of sharing anxiety and becoming authentic through communality.
However, what is importantly different between relational authenticity as described by Gallagher and Stolorow, and the they as described earlier is that relational authenticity is bound up in a sharing between individuals recognised as such. The phenomenological we may contain many forms of relations, but the idea of the second person perspective seems to offer something of importance here, although not explicitly used in the volume. A “second person phenomenology” can tell us something about how we relate to others while keeping their individuality in mind. What risks becoming a solitary individualism—authenticity in illness as a confrontation of the I with its own finitude—finds a way through the second-person-relation towards authentic recognition of individuality in a relation, insofar as the you—the other-in-front-of-us—is always a specific you. As such, it seems that even if existentialism has a reputation for freedom through solitude, there is an interest within existential medicine in finding other, perhaps more sustainable ways of authenticity, and existential health.
Slatman also emphasises being-with as a fundamental concept in understanding illness. Turning to Jean-Luc Nancy she goes as far as to reject the individual as a point of origin for sense-making (although not rejecting the idea that medicine should be more sensitive to the sense-making around the individual patient). She builds upon the idea that any meaningful self-conception—and as such any form of authentic selfhood (Jemeinigkeit)—is derived from a fundamental être-avec (Mitsein) or being-together (108), and as such, a medicine that cares for the existence of the individual must care for the relations between individuals. Much the same is touched upon by Zeiler with the notion of “intercorporeality” (83), i.e. being bodies that engage and interact, our bodily selves as always co-constituted by others. Even if we support an idea of bodily autonomy among patients (or donors, as in Zeiler’s essay), it cannot be thought about in isolation from others.
Negative Social Dimensions
Other than relational authenticity and the problem of the they, some of the essays in the volume focus on social problems in illness. Russon & Jacobson argue from a Merleau-Pontian perspective that the body is that through which we come to relate to others, but also that through which others come to relate to us. Changes to our bodies (such as illness) are thus essentially changes in our relation to others (192). They then emphasis the consequences of stigma and problematic social values in relation to illness (much like Drew Leder does in his essay on aging), and argue that an important aspect of existential medicine is to work with changing social values around disease (202). In “The world of Chronic Pain” Kusch & Ratcliffe bring focus on the potential negative social synergy that can arise from the loss of future in cases of serious or all-consuming illness (such as chronic pain). This loss of future, and the loss of the usual trust in the world which follows from serious illness, does – according to them – not only lead to a change in relations, but to a loss of agency in relations, a “self-infantilization” that leaves the patient in an incapacitating downward spiral (65).
The volume thus offers several—at times disagreeing—perspectives on the ways of regaining (or obtaining) existential health, the relation between sociality and illness and the importance of this.
New Technologies and Being-Towards-Death
The relation between medicine and technology comes up in several essays. As already touched upon, it is specifically prominent in the criticism of medicine as techno-science. Beyond Svenaeus and Culbertson, who discuss the notion of technologisation, technology comes up in the form of biotechnology and related to ethical debates. Tara Kennedy developpes an intriguing Heideggerian theory of bioethics in order to evaluate new medical technologies in “Heideggerian Ethics and the Permissibility of Bio- and Nano-Medicine”. She bases her ethics proposal on the notion of dwelling, as an opposition to the technological enframing and drive to mastery. She importantly adds that it is not an anti-technology ethics (165): as with biomedicine, Heidegger was not against technology, but rather cautious with the modes of operation it brings about and its effects on humanity. The ethics of dwelling is an ethics of care, humility and openness towards disclosures of being. Although the theory—like many other ethical theories—turns out to be somewhat vague and ambiguous when applied to actual cases, it reveals something important about the techno-scientific approach to medicine, and also manages—I think—to deepen the understanding of some common intuitions around bioethics without turning to naturalism.
Biotechnology also comes up in Adam Buben’s essay “Heidegger, Curing Aging, and the Desirability of Immortality” on the promise of immortality. Here the Heideggerian notion of being-towards-death—that features in relation to anxiety throughout the volume—is a central phrase of discussion. Buben re-interprets the notion as unrelated to actual death but rather dependent on human temporality as restricted. He writes “one does not so much fear death as feel anxious in the face of one’s limited, but still significant, capacity for choice and action” (125). Thus, we should not fear immortality as a threat to our humanity, at least not for the sake of losing our being as being-towards-death.
As the notion of being-towards-death figures in many of the other essays in light of illness as something that makes actual death more acutely present, Buben’s reinterpretation is intriguing for its unspoken consequences for the common coupling between illness, being-towards-death and authenticity. Unfortunately, the volume does not allow the various essays to relate to each other. Although many authors reference each other’s prior work, there is no direct interaction between them. I am curious as to what consequences the Buben reading would have for Williams & Carel, for instance, and if these consequences are something that Buben will want to accept in order to stick to his proposal. Several other papers would have been intriguing to hear comment on each other, Kusch & Ratcliffe and Slatman for instance, or Leder and Svenaeus, and reactions and discussions between them will be something to look forward to.
Final Remarks
In my attempt to summarise some broader trajectories, I have neglected to mention the essays of Anthony Vincent Fernandez and Dylan Trigg. These are the two most abstract essays in the volume, and also the two that speak most directly to scholars already within the field. Fernandez’ essay, “Beyond the Ontological Difference”, gives a very thorough analysis of the misunderstanding of the ontological difference in Binswanger’s Daseinsanalysis, and the consequences this misconception still has in current phenomenological discussions of psychiatry. Trigg’s essay, “From Anxiety to Nostalgia”, treats the difference in temporality of anxiety and nostalgia, and despite that, their interconnectedness. These phenomena have some relevance in psychiatry, but the most interesting aspect—I think—of the analysis is its insights on human inclination towards conservativism in times of existential challenge, and the connection one can make—and in fact Trigg does make—to current western politics.
For the essay collection Aho has managed to curate a book that touches upon an impressive range of philosophical and medical fields. Particularly it is enjoyable that the collection has such a strong emphasis on illnesses that are typically considered somatic, thus succeeding in moving existential medicine beyond the psychiatric realm within which the use of philosophy—and particularly the use of existential philosophy—in medicine is sometimes stuck. The book is divided into four parts: (1) New currents in existential psychiatry, (2) Phenomenologies of anxiety, pain, and death, (3) Ethics, medicalization, and technology, and (4) Existential health. If you are reading the book for a specific purpose or with a particular focus, take care with staying too strictly within parts. Many of the essays might as well have been placed under different part-headings, with some of their key-points relating clearly to essays in other parts of the book. If you are on a tight timeline use the outline of the volume at the end of the introduction to select relevant essays rather than chose by title. Valuable insights, thoughts and dilemmas on a variety of topics and concepts, however, pop up here and there, so reading the entire volume is definitely recommendable.
Bibliography:
Ginzburg, C. & Davin, A. 1980. “Morelli, Freud and Sherlock Holmes: Clues and Scientific Method”. History Workshop, (9), 5–36.
Kristeva, J., Moro, M. R., Ødemark, J., & Engebretsen, E. 2018. ”Cultural Crossings of Care: An Appeal to the Medical Humanities”. Medical Humanities, 44 (1), 55–58.
Whitehead, A. & Woods, A. 2016. “Introduction” in The Edinburgh Companion to the Critical Medical Humanities. Edinburgh: Edinburgh University Press, 1-31.
Heidegger, M. 2001. Zollikon Seminars: Protocols-Conversations-Letters. F Mayr & R Askey (trans.) Evanston, IL: Northwestern University Press.
Heidegger, M. 1993. Being and Time (Reprint. ed.). J Macquarrie & E Robinson (trans.) Oxford: Blackwell.
Heidegger, M. 1977. The Question Concerning Technology, and Other Essays. W Lovitt (trans) New York: Garland Pub.
Gadamer, H.-G. 1996. The Enigma of Health. J. Gaiger & N. Walker (trans.) Stanford, CT: Stanford University Press (quoted in Aho, K. (Ed.) 2018. Existential Medicine: Essays on Health and Illness. Lanham: Rowman & Littlefield International)
