thovardarson-ba essay

UNIVERSITY OF SKÖVDE

School of Humanities and Informatics

Theoretical Philosophy, C-course

Spring Term 2005

The Enigma of Health and Ill-Health An Investigation into the Hermeneutic Phenomenological Theory of

Homelikeness

Thesis in Theoretical Philosophy

Haukur Thor Thorvardarson

Spring Term 2005

Supervisor: Anna-Karin Selberg

The Enigma of Health and Ill-Health

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Abstract

The aim of this project is to introduce and criticize the phenomenological theories of

health and ill-health as they are described in Fredrik Svenaeus’s PhD thesis, The

Hermeneutics of Medicine and the Phenomenology of Health: Steps Towards a

Philosophy of Medical Practices. Svenaeus was born in 1966, and is an associate

professor in the Department for Health and Society at Linköping University. This

criticism is twofold. Firstly Svenaeus tries to give a detailed phenomenological

description of what it like to suffer from illness. I will attempt to argue that the actual

relationship between the patient and the world is also crucial in a phenomenological

description of illness. Secondly I will attempt to criticise Svenaeus generalization that

illness can only be seen as an obstruction, not for the view point that health is

imperceptible and illness is perceptible. I will try to argue that illness is a way of life,

a way which reveals to us that we are living towards death.


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Contents

1. 1. Introduction _________________________________________________ 4 1.1. The Problem Area _________________________________________________ 12

1.2. Differences between Svenaeus and Gadamer __________________________________ 16 1.3. Summary ______________________________________________________________ 19

2. 2. Heidegger’s Phenomenology of Everydayness ____________________ 21 2.1. What is Understanding? ____________________________________________ 23 2.2. What is Attunement? ______________________________________________ 24 2.3. What is the Correlation between Heidegger and Svenaeus? _______________ 26

3. 3. Svenaeus’s Holistic Phenomenological Theory of Health ___________ 28

4. 4. Conclusion: Summary and Discussion __________________________ 31 4.1. Summary ________________________________________________________ 32 4.2. Closing Comments _________________________________________________ 35

5. 5. References _________________________________________________ 35 6. Acknowledgements _______________________________________________ 37


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1. Introduction “…The years preceding and immediately following the Revolution saw the birth of two great myths with opposing themes and polarities: the myth of a nationalized medical profession, organized like the clergy, and invested, at the level of man's bodily health, with powers similar to those exercised by the clergy over men's souls; and the myth of a total disappearance of disease in an untroubled, dispassionate society restored to its original state of health.” (Foucault, 1975, p.31/32.)

The patient-doctor relationship is often called the central process of medical

science. It is called the central process of medical science for it is within that medical

encounter that the medical doctor obtains further information about the patient’s

symptoms, previous state of health, living conditions and then formulates a diagnosis

and enlists the patient’s agreement to a treatment plan. The patient-doctor relationship

has, according to Svenaeus, been under attack by two problems; the first is medical

technologies and the second is medical specialization. Svenaeus writes on the first

problem, “…Medical technologies, built on the theory of medical science and applied

increasingly in modern medical practice, tend to objectify the patient. The physician

no longer has direct contact with the patient but examines him as a biological

organism, objectifiable in graphical, chemical and numerical illustrations. Why ask

the patient if you are not interested in his opinion but in his patho-psychology?”

(Svenaeus, 1999, 70.)

So what is Svenaeus describing here? I think that the technological

development in the clinic has created a distance in the doctor-patient relationship in

the sense that the relationship has become more impersonal. This distance is a

distance in communication – the actual dialogue – between the doctor and patient;

Svenaeus is describing a state where the actual data produced, such as an x-ray image,

has more value than the personal opinion of the patient. The actual dialogue, the face-

to-face communication between a doctor and a patient is slowly being replaced by

medical technology,1 which produces medical data that has more value than the actual

1 Svenaeus is criticizing the notion that the patient-doctor relationship has suffered in the process of medical specialization and more mechanical practices. The gap between the patient and physicians is widened when physicians become enslaved to technology. Jasper writes, “…Physicians become functions. Technology certainly helps physicians in their work as physicians. However, when individual physicians become enslaved to medical technology, technology turns itself against the very being of the physicians” (Jasper, 1989, 257.)


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dialogue with the patient. This in turn could be a threat to the aim of the patient-

doctor relationship, which is a mutual understanding that leads to a consensus on

which a treatment plan will be applied in the given case.

The second problem that has weakened the dialogue in the patient-doctor

relationship is medical specialization. Svenaeus writes, “…Scientists are forced to

specialize in their studies, and this has led to a reinforcement of a tendency present

since the birth of modern medicine: medical specialization. The general practitioner –

the family doctor – has been on the retreat since the 1880s, if one compares the

number of generalists to the number of specialists. This specialization of medicine

was firmly established as the only alternative in the 1950s. The patient is thus

partitioned between different medical specialists, who take care of the different parts

and aspects of the organism” (Svenaeus, 1999, 70.) So what is Svenaeus actually

saying here? Medical specialization has created a gap of communication between the

physicians and the patients; it is no longer the case that a patient goes to one general

physician his whole life. A patient meets with different medical experts his whole life.

This situation puts a strain on the patient-doctor relationship because it is not a

discourse with one friendly family doctor but with many different medical specialists,

and this puts the overall goal of the patient-doctor relationship at risk, that is, common

understanding, an understanding that is based on a common trust between a physician

and a patient.

But what is this leading to? The patient-doctor relationship is the central

process of the Hippocratic medical tradition,2 which is the basis from which Western

2 The Hippocratic tradition is a personal relationship between the physician and the patient, where the overall aim of the relationship is the restoration of health based on a common understanding. Ann Ellis Hanson gives this explanation of Hippocratic physicians, “…Hippocratics find it important to absorb all human diseases within their medical technê, including the very difficult sicknesses of sudden seizures and premenarchic madness, and to this end they not only assign mechanical causes that interact with the anatomy and physiology they endorse, but they also employ therapies that reverse a diseased condition in accordance with the same mechanical principles. ‘Opposites cure opposites’ is a deliberate intellectual stance in opposition to the ‘like cures like’ of sympathetic magic. Hippocratics know how to speak the language of science, and they are certainly the first in the Western tradition to write medical science in a form that has survived to our time. They formulate questions that the West has continued to ask: What makes this person sick? Do women get sick in the same way as men? We can object that neither a descent of phlegm from the head as an etiology for epilepsy, nor a fantasy membrane at the mouth of the uterus in the young girl, is an empirically visible phenomenon; and we can dismiss the medical content of their science” (Hanson, http://www.medicinaantiqua.org.uk/sa_hippint.html)


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medicine is derived along with the Ayurvedic medical tradition of India and

traditional Chinese medicine. So what is actually happening here? The cornerstone of

Svenaeus’s and also Gadamer’s critique is that the Western tradition has broken away

from the very pillars upon which it is built, namely on the Hippocratic notion of

medicine. The supporting evidence of this is the imminent breakdown of the patient-

doctor relationship and new innovations in medical technology that are resulting in a

gap in and a lack of communication and discourse between the physicians and the

patients.

Svenaeus writes, “…The Hippocratic physician considered his patient as

placed in a world order – a cosmos – which was essentially mirrored in the make-up

of the individual. Illness was due to imbalance between the elements that compose the

body. Once one knew wherein this imbalance consisted – for instance, in the excess

or lack of certain fluids in the body, such as blood, bile or phlegm – one could pre-

scribe a diet which aimed at re-establishing balance” (Svenaeus, 1999, 30.) The

central process of Hippocratic medicine was the dialectic patient-doctor relationship,

the Hippocratic medical doctor of antiquity used discourse (rhetoric) to obtain

information about the patient’s symptoms, previous state of health, living conditions

and then formulated a diagnosis3. The Hippocratic medical doctor used rhetoric to

heal the patient’s soul and applied medical practices to the patient’s body. The

Hippocratic medical doctor was therefore not a medical specialist as we know them

today but a multi-purpose and multi-talented medical doctor who sought to establish a

dialectic relationship with his patients. The Hippocratic medical doctor sought to heal

the totality of the patient’s illnesses and physical ailments, psychological ailments,

psychical ailments or otherwise. This is described in Plato’s4 Phaedrus. Gadamer

writes, “…In light of these reflections there is a beautiful and much discussed passage

in Plato’s Phaedrus (270b ff.) which acquires a special interest for us since it

illuminates the predicament of the physician who possesses this ‘science’. Plato

speaks here about the true art of rhetoric and draws a parallel with the art of healing.

3 For more information see Temkin (1997) 4 Stempsey writes in correlation to what is written in Phaedrus, “…Plato has shown us that health is more than a healthy body; it is a vision of the good life itself. This has important implications for medical practices. The cure of the body without the cure of the soul is not a whole cure. There is no technology that ultimately soothes the soul. Thus medicine can never be a narrow technological practice. What Plato has shown us is that medicine and philosophy are inextricably linked. Holistic health involves the integration of body and soul” (Stempsey, 2001, 209.)


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For in both cases it is a question of understanding nature, either the nature of the soul

or the nature of the body, at least if we are hoping to act on grounds of genuine

knowledge rather than merely of routine and every day experience. In as much as we

must know which remedies and what sustenance should be administrated to the body

if it is to become healthy and virtuous. Then once again so too one must know which

laws and ordinances and which kinds of discourse should be introduced to the soul if

it is to acquire the proper convictions and to attain its authentic being or virtue (arête).

Socrates turns to his young friend who is so inspired by the feats of rhetoric and asks:

‘Do you believe that one can understand the nature of the soul without understanding

the nature of the whole?’ And his friend replies: ‘If we are to believe Hippocrates and

Asclepiad, then one cannot even understand anything of the body without this

procedure’ (Phdr. 270c)” (Gadamer, 1996, 39-40.) The Hippocratic medical doctor

sought to understand the nature of the whole patient in order to help the patient to

reach equilibrium in the patient’s life. But what does Gadamer mean by equilibrium?

If we think of ill-health as an imbalance, or of losing one’s balance we can

think of health as a having balance. Let’s for example imagine how a child learns to

ride a bicycle. In the beginning like any child the child has no balance on the bicycle

and therefore uses training wheels to help him or her learn to ride the bicycle. Slowly

as the child continues to strive to learn to ride the bicycle s/he learns how to gain

his/her balance on the bicycle and then learns to ride the bicycle without the need for

the training wheels. The child has now learned how to ride the bicycle; s/he

understands how to bicycle; s/he can actually do it and finds her/himself actually

doing it. What has this got to do with anything? When we are riding our bicycle we

are not actively conscious of being balanced or unbalanced. We are just riding our

bicycle, just doing it without reflecting on the way we are doing it actively. However,

when the front tire of my bicycle hits a curb I lose my balance, and suddenly the

contrast between balance and imbalance comes into focus. The same goes for health

and ill-health: we are not actively reflecting on our state of health; it just is, as

something in the background. When we fall ill the contrast between health and ill-

health becomes very much apparent to us and, like a child who has lost his/her

balance on a bicycle, we seek to do the same. The equilibrium is a life rhythm, like a

heartbeat – something that is always in the background but when it comes to the


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foreground it calls immediate attention to itself.5 Gadamer refers to a similar example

of an acrobat when he describes the loss of equilibrium. Gadamer writes: “…What we

encounter here, by contrast is the experience of balance, ‘where the pure too little

incomprehensibly transforms itself, springs over into the empty too much.’ That is

how Rilke expresses the phenomenon of balance as experienced by the acrobatic

artist. What he is describing is just this: the concentrated effort involved in producing

and maintaining equilibrium suddenly proves itself, at the very moment when balance

is attained, to be the opposite of what it seems to be. For if the balancing act were to

go wrong, it would not be because physical force or power was lacking or too little

was exerted, but rather because there was actually too much force in play. But when

the act works everything seems to happen spontaneously, lightly and effortlessly”

(Gadamer, 1996, 37.)

The thesis introduced by Svenaeus in The Hermeneutics of Medicine and the

Phenomenology of Health is that “…Clinical medicine is not a theory, but a practice.

This practice, I will claim, can best be understood as an interpretive meeting between

healthcare personnel and patient with the aim of healing the ill person seeking help.

Hermeneutics will in this work be used to further explicate what is understood by an

interpretive meeting, and phenomenology6 will be put to work to better understand the

meaning of health and illness”(Svenaeus, 1999, 15.) Svenaeus’s essay is divided into

two parts; in the first part of his essay Svenaeus is trying to craft a phenomenological

definition of health and ill-health. He divides these two into homelikeness (health),

5 Gadamer describes equilibrium in a similar way in the The Enigma of Health, writing, “…I should like to interpret the relationship at issue by resource to the concept of equilibrium and the way in which we experience it. This concept already plays a major role in the Hippocratic writings. And in fact it is not merely the phenomenon of human health which almost cries out to be understood in terms of the natural conditions of equilibrium. The concept of equilibrium also readily offers itself for our understanding of nature in general. The Greek concept of nature consisted in the discovery that the totality is an ordered structure which allows all the processes of nature to repeat themselves and to pass away in determinate configurations. Nature is therefore something which as it were holds to its own course, and does so in and of itself. This is the fundamental idea of Ionian cosmology in which all the original cosmogonic conceptions came to fulfillment: in the end the whole mighty harmonious balance of interacting events determines things as a form of natural justice” (Gadamer, 1996, 37.) 6 “The Greek word phainomenon means ‘the manifest, the self-showing’. Heidegger defines the basic meaning of phenomenon as ‘what shows itself in itself.’ The Greeks occasionally identified the phainomena with ta onta, things’ beings. There are, however, various ways in which things can show themselves: it is even possible that they show themselves as they are not, but only seem to be. Seeming is a self-showing in which things look as if they were such and such, but only seem to be. Seeming is a self-showing in which things look as if they were such and such, but are not truly so. Seeming is thus a privative modification of phenomenon. Only the positive and original meaning of phenomenon, however, is to be admitted into its definition: that which shows itself in itself”(King, 2001, 110.)


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and unhomelikeness (ill-health), which are two ideas heavily based on Heidegger’s

hermeneutic7 phenomenology. In the second part of the essay Svenaeus describes the

hermeneutic meeting between doctor and patient, which in short is the practical

application of the theories of homelikeness (health), and unhomelikeness (ill-health).

This investigation is based on Gadamer’s work The Enigma of Health.

It is my intention to focus on the first part of his thesis, and explain the

theories8 of homelikeness and unhomelikeness. What I intend to show with my

research is that it is necessary to consider several questions, if a phenomenological

theory of health and illness is to be applied to medical practices. The central question

for Svenaeus seems to be to find out the contrast between health and ill ways of being

in the world in order to be able to single out the correlation between health and

illness. Therefore it follows that the underlying questions are what it is really like to

experience these two phenomena: health and illness. Svenaeus writes, “...In many

ways the phenomenon of illness seems to be far more concrete and easy to get hold of

than the phenomenon of health. When we are ill, feelings of meaninglessness,

helplessness, pain, nausea, fear, dizziness, or disability often penetrate life. Health, in

contrast, effaces itself in an enigmatic way. It seems to be the absence of every such

feeling of illness, the state or process which we are in when everything is flowing

smoothly, running as usual without hindrance” (Svenaeus, 1999, 134.)

Coming to my criticism, I feel that it would be much easier to contrast the

correlation between health and illness. If our actual relationship with the world was

7 “...The Greek word hermeios referred to the priest at the Delphi oracle. This word and the more common verb hermeneuein and noun hermeneia point back to the wing-footed messenger-god Hermes, from whose name the words are apparently derived (or vice versa?). Significantly, Hermes is associated with the function of transmutin, which moves what is beyond human understanding into a form that human intelligence can grasp. The various forms of the word suggest the process of bringing a thing or a situation from unintelligibility to understanding. The Greek credited Hermes with the discovery of language and writing – the tools which human understanding employs to grasp meaning and convey it to others” (Palmer, 1969, 13.) 8 “...Theory, Heidegger explains in the lecture “Wissenschaft und Besinnung,” (Science and Reflection) comes from the Greek theôreô and originally means a reverential gazing upon the pure aspect in which a thing shows itself. “Aspect,” in this connection, is to be understood in the Greek sense of the eido, idea, the form in which something shows what it is – its essential being. Theory in the highest philosophical sense means a gazing upon the truth into its keeping and guards it” (King, 2001, 66.) Bohm explains theory as follows, “…the word ‘theory’ derives from the Greek ‘theoria’, which has the same root as ‘theater,’ in a verb meaning ‘to view’ or ‘to make a spectacle’. This suggests that the theory is to be regarded primarily as a way of looking at the world through the mind, so that it is a form of insight (and not a form of knowledge of what the world is)” (Bohm, 1996, 53.)


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taken into account, it is not enough only to focus on the actual phenomenon; the

patient’s whole life has to be taken into account when we want to contrast healthy and

ill ways of being in the world. In other words the patient’s relationship to the world

plays an intrinsic role in the contrast between health and illness, for it is within the

actual breakdown of the patient’s relationship of the world, where the phenomena of

illness are also mirrored. The phenomena of illness can therefore be seen as a double

mirror, where one side of the mirror reflects the actual effects of the illness in our life

and the other reflects the actual symptoms of the illness. 9

These shortcomings are evident when Svenaeus tries to answer the question:

how is it to really suffer from an illness? He describes this as unhomelike phenomena

where the subject feels alienated from the world. What I feel is lacking in this

description is a more detailed idea of how illness affects the way in which we interact

with the world. How does our relation to our being in the world change when we are

suffering from an illness? It is akin to the child who sees riding a bike as normal and

rides the bike as normal, but is then suddenly hit with the abnormal when the child

loses his/her balance on the bike and falls off. Can there be a correlation between

losing one’s balance on a bike and ill-health? Yes, when we are skilled in riding a

bicycle we generally take our balance for certain. Our act of riding the bicycle has

become attuned and embodied in the world. In other words it is not something that we

attend to; it is just running in the background because we know how to ride the

bicycle and understand how to do it and therefore we just ride the bicycle and keep

our balance like there was nothing to it.

When we were learning to use the bicycle we may have been uncertain how to

keep our balance, but slowly we learned how to gain and keep our balance when we

were riding the bicycle. Then with time and practice we actually became more skilled

in keeping our balance without needing introspection or thought about the fact of

whether or not we are keeping our balance; balance is just assumed, and we are

actually maintaining this balance riding the bicycle. To struggle with ill-health is in

9 To avoid any misunderstanding the point here is not to criticize phenomenology, the basis of Svenaeus’s work. The starting point of phenomenology is that there is a world to be perceived. There is also the danger here of falling into Cartesian dualism, which is something I want to avoid. The aim here is simply to try to think and conceive about health and illness in new ways.


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correlation with losing one’s balance on a bicycle because it sets us off course. When

we lose our balance on a bike we usually fall down, but then shortly after we get back

on the bicycle and keep riding it like we were doing before. In the same sense, when

we fall ill, we try to regain our health, and there is a certain longing to go back to

things as they were before, for example, in the cases of severe and long-term

illnesses.10

The starting point of phenomenology is that there is a world, but it seems to me

that the question “how it is for a patient to suffer from ill-health?” is a rather limiting

question because it is unable to answer questions such as “how does a patient’s ill

health affect his or her life-world?” This is perhaps not an unknown problem to

Svenaeus, but I feel that it is not emphasized in The Hermeneutics of Medicine and

the Phenomenology of Health. For example when a patient suffers from ill-health how

does it affect what he does? For example a medical doctor who is diagnosed with the

HIV virus can no longer work as a medical doctor since there exists a potential

contamination risk. The medical doctor is what he does, and he is known for what he

does by being with others [In the everyday world, the others (other beings in our

existence) meet us as what they are in their makings and doings within their own

understanding existence. “They are what they do” (Heidegger, 1953, 126.)] That is,

the medical doctor understands his being as a medical doctor and he understands his

being in the world when being with other medical doctors. So when a medical doctor

needs to quit his profession because of a disease, it is like abandoning a home that is

known and stepping into the unknown –the unhomelike. It is a terrifying experience,

perhaps even more terrifying than the disease itself, to have a major change in one’s

life-world. It is like falling out of things, to fall out of a social pattern, to fall out of a

life pattern and also to deal with a terrifying disease. For example if I have been

working as a medical doctor all my life and I am forced to retire, the HIV disease has

had a huge impact on my life. And that is what ill-health does: it affects our whole

10 Gadamer refers to a similar example of how an acrobat learns to keep his balance, for further reference, see page 37 in The Enigma of Health. Also Svenaeus writes, “…If you fall off the bicycle or get ill, however, you will notice. When your balance is challenged – when you ride over a stone. For example – you will make efforts to regain your balance in order not to fall down, but eventually will not succeed and will fall over. The moods of illness, in contrast to healthy attunement, seem to manifest themselves in obstructive ways, coloring our whole existence and understanding. This is not always an immediate experience like falling off a bicycle – but sometimes a gradual process, during which, however in the same way as in the example of riding a bicycle, one strives constantly to ‘stay upright,’ to keep one’s balance but finally has to give in to illness” (Svenaeus, 1999, 161.)


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being – the totality of our existence – and therefore those who adjust the equilibrium

between health and ill-health must understand the whole of being. It is time to see the

disorder of the body not only as the disorder of the body that needs medical attention

but the disorder of the patient’s whole being that is calling out for attention.

1.1. The Problem Area

My criticism of Svenaeus is perhaps slight, but I think it is nevertheless

significant. That is, Svenaeus is trying to create a holistic phenomenological theory on

health, trying to answer the question of what it is like from the patient’s perspective to

suffer from an illness?11 The question is if that question, what it is like from the

patient’s perspective to suffer from illness, does answer the question about how a

disease colours every aspect of the patient’s life. Is the question about how our

relation to the world changes when we are suffering from disease relevant? The

starting point of phenomenology, which is the basic ingredient of Svenaeus’s holistic

phenomenological theory on health, is that there is a world to be perceived. Svenaeus

writes, “…Diseases would no longer be disease without the persons who suffer from

them and experience them as changed meaning-patterns in their everyday life – as for

example, pain, paralysis, nausea, dizziness, weakness, anxiety, memory loss or

impaired speech or thinking. This is the way we identify ‘dis-ease’ as the word itself

indicates. The scientific investigation of biological, functional, disorders is carried out

against the horizon of an illness world of symptoms that afflict persons” (Svenaeus,

1999, 83.)

I agree with Svenaeus here, that disease would not be disease without people

suffering from disease. Disease is the actual phenomenon, the actual experience of

experiencing the disease in itself. The natural sciences are carried on in the

background of that meaning-pattern, a meaning world that interprets the actual 11 This question of what it is really like from the patient’s perspective to suffer from illness seems to be the underlying research question in Svenaeus’s thesis. I base this on the following quote where Svenaeus is actually inferring which moods a patient can go through. Svenaeus writes, “… In many ways the phenomenon of illness seems to be far more concrete and easy to get hold of than the phenomenon of health. When we are ill, feelings of meaninglessness, helplessness, pain, nausea, fear dizziness, or disability often penetrate life. Health, in contrast, effaces itself in an enigmatic way. It seems to be the absence of every such feeling of illness, the state or process which we are in when everything is flowing smoothly, running as usual without hindrance” (Svenaeus, 1999, 134.)


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phenomenon of disease. The distinction between the two is that the natural sciences

cannot tell me anything of what it is really like to have leukaemia, and in a similar

way the natural sciences cannot determine how a leukaemia patient’s being in the

world will be affected. The Hippocratic physician, according to Gadamer’s and

Svenaeus’s critique of Western medicine, was interested in these questions.

This is the core of Svenaeus’s and Gadamer’s criticism that medical specialization

has moved away from its origins: the Hippocratic tradition, the all-in-one medical

doctor to the medical expert who has demarcated himself to a specialized area of

medicine. The risk in this is that medicine may forget that illness cannot be described

with the language of medicine alone. Medicine needs to listen and understand the life-

world of the patient in order to understand illness. And Svenaeus and Gadamer feel

that this form of listening and of trying to understand the patient within the patient-

doctor relationship has been removed in the ongoing specialization within medical

science. The solution is trying to go back to the notion of the Hippocratic physician,

in which the physician would try to understand the patient’s life-world, where the

phenomenon of disease meets between the horizons of the doctor’s life-world and the

patient’s life-world.

Coming to my criticism, Svenaeus writes, “…Organisms have diseases, and these

are certainly, in most cases, the cause of ill-health, but only human beings living in

the world are ill or healthy. Health and illness are consequently not phenomena

analyzable exclusively in the terms of science, but are evaluative concepts referring to

the experiences, ambitions and abilities of human beings situated in certain contexts –

life-worlds. I will now turn to an attempt to formulate a theory of health in holistic

terms referring to the person as a whole, in constant interaction with his environment”

(Svenaeus, 1999, 117.) I agree that one of the fundamentals of phenomenology is that

there is a world, and I also agree that Svenaeus seems to emphasize that he wants to

formulate a theory of health in which holistic terms refer to the whole person, which

is in constant interaction with the environment. Svenaeus does not use our interactions

with the world to contrast health and illness, which is a weakness in his theory. It is

my sentiment that our interactions with the world play an intrinsic role in the contrast

between health and illness. It is within that relationship between the patient and the

world where the actual illness is also mirrored. It is not only the phenomenon of


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illness that echoes within the patient, it echoes all around the patient in his overall

engagement with the world.

I feel that Svenaeus’s attempt to formulate a theory on health and illness that

refers to the person as a whole does not adhere to the person as a whole if the main

thesis question posed is “what it is like for a patient to suffer from illness?” Why? I

feel that this question is not all encompassing, if the aim is to formulate a health

theory on holistic pretences. If that is the true aim, then it would be more sensible to

include the patient’s all encompassing existence. Not just what the patient is feeling

here and now while suffering from his illness, but also the patient’s background,

which would give a more holistic picture of the patient’s illness. The reason for this is

that there is often a correlation with a patient’s life and the illnesses that afflict him or

her. For example a coal miner is often exposed to coal dust, which enters the lungs

and cannot be broken down by the body. The dust, therefore, builds up in the lungs,

and causes inflammation and scarring (fibrosis). This condition will ultimately lead to

shortness of breath, which can then lead to heart failure. This is a work-related

disease, which is known as Black Lung disease or pneumoconiosis. In this example

the disease is correlated with the patient’s employment as a coal miner, but the point I

am trying to make is that the physician needs in the patient-doctor dialogue to take

into account the totality of the patient’s life-world as it will perhaps help in forming

the common understanding needed between the physician and the patient in order to

find an appropriate cure for the patient. It is not sufficient for the physician only to

look at the patient’s physical problems; the physician needs to take the whole

patient’s life into consideration because it will give him a better understanding of the

background of the illness and give him a better idea of what is the best treatment plan

to choose in order to combat the disease.

It is in this dialogue between the medical doctor and the patient that the patient

and the medical doctor seek to establish a patient-doctor relationship, which is the

central process in medicine. What I intend to show is that it is necessary for such a

theory to not only focus on the question of how it is for the patient to suffer from a

disease, but also that it is equally important to focus on the question of how the

patient’s relation to the world changes when s/he is suffering from disease? The

physician needs to take the whole patient’s life into account when formulating a


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treatment for the patient. The goal of holistic medical practices is to help the patient to

re-enter his former life, before s/he started his/her battle with the disease and therefore

to seek to give the patient the optimal solution that affects the patient’s life and person

as a whole. And it is these holistic medical practices (or the Hippocratic medical

tradition) that have been under siege by medical specialization and innovative medical

technologies, and it is this tradition that Gadamer and Svenaeus are advocating.

But what is the relation between Svenaeus’s work The Hermeneutics of Medicine

and Gadamer’s work The Enigma of Health? In short, Svenaeus wants to improve

Gadamer’s own work and wants to make an attempt to create a phenomenological

theory on health. And in many ways Svenaeus’s work can be seen as a continuation of

Gadamer’s magnum opus (The Enigma of Health). Gadamer even states that this

theory could be a possibility in The Enigma of Health, writing, “…So what

possibilities do we really have when it comes to the question of health? Without doubt

it is part of our nature as living beings that the conscious awareness of health conceals

itself. Despite its hidden character, health nonetheless manifests itself in a kind of

feeling of well-being. It shows itself above all where such feelings of well-being

mean that we are open to new things, ready to embark on new enterprises and

forgetful of ourselves, scarcely noticed the demands and strains which are put upon

us. Health is not a condition that one introspectively feels in oneself. Rather it is a

condition of being there (Da-sein), of being-in-the-world (In-der-welt-sein), of being

together with other people (Mit-den-Menschen-sein), of being taken in by an active

and rewarding engagement with the things that matter in life… It is the rhythm of life,

a permanent process in which equilibrium re-establishes itself” (Gadamer, 1996, 143-

144.)

I would say that Svenaeus’s view on health is rather similar to what Gadamer

states: health is a condition of being there, being-in-the-world, being-with-other-

people and by being able to live a good life and towards one’s life goals. Svenaeus

describes illness as follows, “Illness is obviously an obstruction to health and its

transparency; everything that goes on without us paying explicit attention to it when

we are healthy – walking, thinking, talking now offers resistance. The body our

thinking, the world, everything is now ‘out of tune,’ colored by feelings of pain,

weakness and helplessness” (Svenaeus, 1999, 138.) Again this is closely intertwined


16

with Gadamer’s notion of equilibrium, which was described earlier in the thesis with

the metaphor on how we keep our balance when riding a bicycle. But it is perhaps

better described as a total natural balance, that is, a nature that is in the constant mode

of re-establishing its natural balance. 12

1.2. Differences between Svenaeus and Gadamer

What are then the differences between Svenaeus and Gadamer? I feel that

Svenaeus does not give any concrete examples on how our state of health affects our

being with other people and our being in the world. It is peculiar that even though

Svenaeus sees his work as a continuation of Gadamer’s work, he does not follow

Gadamer’s definition of health, that is, “Health is not a condition that one

introspectively feels in oneself. Rather it is a condition of being there (Da-sein), of

being-in-the-world (In-der-welt-sein), of being together with other people (Mit-den-

Menschen-sein), of being taken in by an active and rewarding engagement with the

things that matter in life… It is the rhythm of life, a permanent process in which

equilibrium re-establishes itself” (Gadamer, 1996, 143-144.) This is the core of my

criticism towards Svenaeus: I feel that he does not emphasize the question “how does

one’s relation to the world change when s/he is suffering from an illness?” What

Svenaeus does is write patient example stories such as, “…When Peter woke up that

Monday morning he felt really bad. The few hours of sleep he had been able to get

had not done him much good. His throat was sore and aching, it hurt to swallow and

his head felt like it had been stuffed with cotton…” (Svenaeus, 1999, 137.)

12 Gadamer describes equilibrium in the following section of The Enigma of Health, “…I should

like to interpret the relationship at issue by recourse to the concept of equilibrium and the way in which we experience it. This concept already plays a major role in the Hippocratic writings. And in fact it is not merely the phenomenon of human health, which almost cries out to be understood in terms of the natural conditions of equilibrium. The concept of equilibrium also readily offers itself for our understanding of nature in general. The Greek concept of nature consisted in the discovery that the totality is an ordered structure which allows all the processes of configuration. Nature is therefore something which as it were holds to its own course. And does so in and of itself. This is the cosmogonic conceptions came to fulfillment: in the end the whole mighty harmonious balance of interacting events determines all the something which as it where holds to its own course. And does so in and of itself. This is the cosmogonic conceptions came to fulfillment: in the end the whole mighty harmonious balance of interacting events determines all things as a form of natural justices.” (Gadamer, 1996, 36.)


17

What is it that I don’t agree with the way that Svenaeus presents illness in his

patient stories? I don’t agree with Svenaeus’ assertion that illness is something that

we live through. Or in other words, by writing patient stories in terms of the patients’

physical manifestations he is de-personifying the patient. But how is this connected to

my criticism that it would be easier to contrast the correlation between health and

illness if our actual relationship with the world were taken into account? To clarify

this confusing issue, there is a correlation between the several points of critique I have

mentioned and my objection that illness is something that we live through. Now just

to review, what were the points of critique?

Firstly, it is much easier to contrast the correlation between health and illness. If

our actual relationship with the world were taken into account, it is not enough to only

focus on the actual illness itself; the whole life of the patient needs to be taken into

account. Secondly I object to the notion that illness is an obstruction to health and its

transparency to the world. What is the correlation between these two points of

critique? The correlation between the two is found in the patient’s relationship to the

world, which is where the actual illness is also mirrored. Illness is not only a

phenomenon that echoes within the patient, it echoes all around him, it echoes in his

overall engagement with the world.

What is questionable, however, is if that actual echo is an obstruction to health

and illness? That is, if health is imperceptive (non-perceivable) and illness is

perceptive (perceivable), in what way is it an obstruction? Certainly it is an

obstruction in the sense that it is something that stops health in its tracks and is

certainly not a pleasant experience and in most cases, an unpleasant experience that

comes to pass and one lives through. The question is also if we are actually living

through illness? It seems implausible to be able to state that in each and every case

illness is something that is lived through, as Svenaeus seems to point out, “…The

terms that Gadamer uses to characterize health in the last quotation – being there,

being in the world, being with other people, to be busy with projects in life – indicate

that health is something that we live through rather than towards” (Svenaeus, 1999,

137.) Illness is also something that stops us in our tracks. In the sense that it actually

puts us to death, illness understood in this way is something that we live towards

rather than through.


18

But what does Svenaeus mean with “we live through illness”? It seems to me that

he means that illness, by being perceptive in its nature, as opposed to the imperceptive

health, is an obstruction. In other words we are normally healthy but we never

actually feel that we are healthy until we become ill. Then the difference between

health and illness becomes all too evident. When we are ill we long to return to health

and desire to depart with the unpleasant, all-too-perceptive illness. It is through illness

that we appreciate and encounter our health (a health that otherwise goes unnoticed).

As Svenaeus writes, “Illness is obviously an obstruction to health and its

transparency; everything that goes on without us paying explicit attention to it when

we are healthy – walking, thinking, talking now offers resistance. The body, our

thinking, the world, everything is now ‘out of tune,’ colored by feelings of pain,

weakness and helplessness” (Svenaeus, 1999, 138.)

To draw up a scenario in the case of the common cold, illness is something that

we live through in the sense that in most cases it does not lead to the patient’s death.

In the case of the Ebola hemorrhagic fever, where there is no known cure, the illness

is lived towards rather than through. Another example of illness that could be

understood as a illness that is both lived through and towards is the human

immunodeficiency virus (HIV), where the patient can live through his life infected

with the HIV virus, but in many cases the patient gets an example of a disease that is

lived towards: in people who carry the human immunodeficiency virus (HIV), the

virus itself can lead to a fatal illness called Acquired Immunodeficiency Syndrome

(AIDS) where the disease becomes a disease that the patient is living towards, since

the patient is living towards his uttermost possibility. To summarize the point is that

illness can be both something that we live through and something that we live

towards. These are the two ways an illness can affect our life-world. What these two

ways have in common is that they both remind Da-sein of its own finitude, the idea

that when it is born it is old enough to die.

Illness can therefore be experienced in our life-world as an experience that is both

lived towards and an experience that we live through. These duplex ways of

experiencing, however, lead to the same realization that confronts the person who is


19

afflicted with an illness facing his/her own uttermost possibility. Heidegger writes,

“…Death is the possibility of the absolute impossibility of Da-sein. Thus death

reveals itself as the own most non-relational possibility not to be bypassed. As such, it

is an eminent imminence. Its existential possibility is grounded in the fact that Da-

sein is essentially disclosed to itself, in the way of being-ahead-of-itself. This

structural facture of care has its most primordial concretion in being-towards-death.

Being-towards-the-end becomes clearer as being toward the eminent possibility of

Da-sein which we have characterized” (Heidegger, 1953, 232.) I therefore understand

Svenaeus’ notion of obstruction as a reminder that we are living towards a non-

relation possibility that is not to be bypassed, or death. Svenaeus describes this as

follows, “…The body seems to be the very form of finitude, in the sense of referring

to our being born as well as our having to die. Our finitude is so to say incarnated in

the being of the body as our form of existence. Illness is an uncanny (unhomelike)

experience since the otherness of the body then presents itself in an obstructive way”

(Svenaeus, 1999, 1186.) The two ways that Da-sein can experience illness are illness

that is lived through and illness that is lived towards and are therefore a way in which

death presents itself through illness. Therefore illness becomes a reminder of our own

finitude. 13

1.3. Summary

The summary of my criticism towards Svenaeus is twofold. Firstly I feel it would

be easier for Svenaeus to contrast the correlation between health and illness, if he

would emphasize the actual relationship between patient and world. Svenaeus does

this to an extent by writing patient example stories where he describes the patient’s

experience of illness in a phenomenological way. For example “…I guess I was sick

for a year before I knew I had diabetes. It came when I was about 55, five years ago

and I had a classic case but it was a before I knew what was happening to me”

(Svenaeus, 1999, 161.) So one could argue that my first point of criticism is

irrelevant, since the primary point of phenomenology is that there is a world. On the

other hand the first point of criticism was necessary in developing my second point of 13 As Heidegger writes, “…In being-towards death, Da-sein is related to itself as an eminent potentiality-of-being” (Heidegger, 1953, 233-234.)


20

criticism that is mirrored in the patient’s relationship to the world. This is also

illustrated by Svenaeus, “…On the bus to work he felt isolated from the other

passengers. He was standing as in a soap bubble of dizzy shivering and still he felt

isolated from the other passengers. He was standing as in a soap-bubble of dizzy

shivering and still he felt like the noise from the traffic and the rolling movements of

the bus were about to burst the bubble at any time and expose him to a world of

threatening, stinging stimuli” (Svenaeus, 1999, 137.) The first point of critique is,

however, not irrelevant, for it was necessary as a starting point towards explaining my

second point of criticism.

Secondly I critique Svenaeus’s view of illness as an obstruction. I object to that

view because I feel that an illness is just another mode of being that opens up other

possibilities for our being. I would suspect that to think of illness as an obstruction,

that is obstructing a being from the good life, is tied into a hedonistic need to clutch

life with two cold hands. Svenaeus writes, “…Illness is thus always to be understood

in terms of a certain form of lack of meaning, a breakdown of meaning in the ill

person’s being-in-the-world. The difference existentials, as projective, inter-nested

powers of the self and the tool-structures of the world guiding transcendence, help us

conceptualize what this lack of meaning as unhomelikeness consists in” (Svenaeus,

1999, 196.) I disagree with Svenaeus here. I don’t see why illness should be

understood in the terms of lack of meaning, a breakdown of meaning of the ill

person’s being in the world. Why should illness be something that makes life

meaningless? Illness is an embedded part of our lives; it is unavoidable; one day we

are bound to get sick and even die. Therefore illness and in this case death are

intrinsic parts of our lives and give life a meaning, a part of the life struggle of being.

Illness and death are a condition of our life; illness like death should not be seen as an

obstruction. “…There is life in death, and there is death in life…This is not contrived

by man wilfully but acted by Dharma [cosmic law naturally]… Although we have not

left life, we already see death. Although we have not yet discarded death, we already

meet life. Life does not obstruct death, death does not obstruct life” (Kim, 1975, 226.)

Nietzsche does not consider our finitude as an obstruction but a celebration!

Nietzsche writes, “…The ‘dead’ world! Eternally in motion without erring, force

against force! It is a festival to go from this world across into the dead world. Let us


21

see through this comedy [of sentient being] and thereby enjoy it! Let us not think of

the return to the inanimate as regression! Death has to be reinterpreted! We thereby

reconcile ourselves with what is actual, with the dead world” (Nietzsche, 1974, 152.)

In all fairness to the reader I want to introduce Heidegger’s phenomenology of

everydayness, the reason being that both Svenaeus and Gadamer borrow a lot of

terminology from Heidegger. Heidegger’s terminology will be used to describe

Svenaeus’s Holistic Phenomenological Theory of Health in section three of the essay.

And it will make the overall understanding of Heidegger’s concept in the preceding

sections easier to understand.

2. Heidegger’s Phenomenology of Everydayness Illness then is in general experienced by the person who is ill as a disturbance which can no

longer be ignored. The recognition that something is lacking is connected with the idea of

balance, and this means in particular with the idea of the restoration of equilibrium out of all the

fluctuating conditions that constitute an individual’s general state of health (Gadamer, 1996,

p.55.)

The purpose of this section is to make the text more reader-friendly for those

readers who are new to Heidegger. This is needed because both Svenaeus’s theory of

health, which is a continuation of Gadamer’s conceptualization of a possible

phenomenological theory on health are both written in Heideggerian terminology,

which is found in Heidegger’s phenomenology of everyday human existence, which

is found in Division One in Being and Time. Svenaeus states that, “…The point of the

phenomenological theory would be rather to give general characteristics of health and

illness and provide a vocabulary with the aid of which one can talk about different

illnesses and different ill persons and, in each case, be able to understand why and

how this person is ill. I think that the general scheme that I (through the philosophy of

Heidegger) give, with four existentials (understanding, attunement, language, lived

body) structuring our being-in-the-world in a homelike or unhomelike way, provides

a promising ground for adequate descriptions of different illnesses with different

forms of breakdowns of meaning structures and failing transcendences” (Svenaeus,

1999, 192.) It is therefore my intention in this section to give a clear description of the


22

Heideggerian concepts that will be used throughout this essay. At the centre of

hermeneutic phenomenology14 of everyday human existence, is Da-sein (in English

“being-there”). Heidegger describes Da-sein as follows, “…Da-sein exists. Further

more, Da-sein is the being that I myself always am. Mineness belongs to existing Da-

sein as the condition of the possibility of authenticity and inauthenticity. Da-sein

exists always in one of these modes, or else in the modal indifferences to them”

(Heidegger, 1953, 49.)

Svenaeus states in his thesis The Hermeneutics of Medicine and the

Phenomenology of Health that the concept of worldliness (Weltlichkeit) constitutes an

ontological structure of the world. “…Worldliness indicates that the structure of the

world is built up by the understanding of actions. The worldliness of the world is built

upon the thoughts and feelings of human beings, which are beings-in-the-world, and

are aimed toward objects in the world. The worldliness of the world is not built upon

any properties that belong to the world, in so far as it is a collection of objects”

(Svenaeus, 1999, 143.) Svenaeus continues and states that it is therefore that

Heidegger can write that worldliness is something essential that belongs to Da-sein

but does not have any equivalent in the world itself. Heidegger writes: “...Worldliness

is an ontological concept and designates the structure of a consultative factor of

being-in-the-world as an existential determination of Da-sein. Accordingly,

worldliness is itself an existential. When we inquire ontologically about the ‘world,’

we by no means abandon the thematic field of the analytic of Da-sein. ‘World’ is

ontologically not a determination of those being which Da-sein essentially is not, but

rather characteristics of Da-sein itself” (Heidegger, 1953, 60.)

How does Da-sein constitute its world? Da-sein constitutes its world with

meaning-structures [world in Heidegger’s understanding is meaning-structures]. But

what does Svenaeus mean with meaning-structures? Svenaeus writes, “…The

meaning-structures of the world are made up of relations, not between things, but

between tools (Zeuge)” (Svenaeus, 1999, 144). As I see it, the relation and meaning 14 Heidegger describes phenomenology as follows, “…Phenomenology is the way of access to, and the demonstrative manner of determination of, what is to become the theme of ontology. Ontology is possible only as phenomenology. The phenomenological concept of phenomenon, as self-showing, means the being of beings – its meaning, medications and derivatives. This self-showing is nothing arbitrary, nor is it something like an appearing. The being of beings can least of all be something ‘behind which’ something else stands, something that ‘does not appear’” (Heidegger, 1956, 31.)


23

of the tools is determined by their situation within the totality of relevance. For

example in the shoe repair shop the shears are situated in the tool chest, the square-

point knife hangs on the hook on the wall, the wood mallet is in the right drawer on

the workbench and the leather-working hammer lies on the top of the working bench.

These tools are situated within the shoe repair shop and when I Da-sein am, in there

this equipment exists within my totality of relevance. The meaning of every tool is

defined by Da-sein. While I Da-sein am using the leather-working hammer I am

absorbed in activity, and the worldliness of Da-sein is absorbed in activity. Svenaeus

states that, “…The being-in-the-world, the ‘worldliness’ of human existence, is

conceptualized by Heidegger by stressing several different aspects of this existence.

Since these aspects belong to the only being that truly exists – Da-sein – and not to

things, they are called ‘existentials’ (Existenzialen)” (Svenaeus, 1999, 145.)

The totality of relevance is therefore also, an openness to the totality of tools. And

the openness of the totality of tools is, according to Svenaeus, a pattern of

understanding, feeling and talking. These existentials – understanding (Verstehen),

attunement (Befindlichkeit) and discourse (Rede) – are the three existentials that

Heidegger uses to illustrate Da-sein’s being-in-the-world; they are joined together

constituting the understanding of the totality of relevance. We will, however, only

focus on understanding (Verstehen) and attunement (Befindlichkeit) since they are

mostly used by Svenaeus in what he calls “…Heidegger’s analysis of the person’s

being-in-the-world as an attuned understanding played out in the meaning patterns

formed between different tools” (Svenaeus, 1999, 178.)

2.1. What is Understanding?


24

The first existential is understanding. To understand in Heidegger’s

phenomenology is to find one’s place in the meaning-structure of the world, to project

(throw) oneself toward possible goals. To project oneself towards possible goals is

something that a man already is or has. Heidegger states, “…Speaking ontologically,

we sometimes use the expression ‘to understand something’ to mean ‘being able to

handle things,’ ’being up to it,’ ‘being able to do something.’ In understanding as an

existential, the thing we are able to do is not a what, but being as existing. The mode

of being of Da-sein as a potentiality of being lies existentially in understanding. Da-

sein is not something objectively present, which then has in addition the ability to do

something, but is rather primarily being-possible. Da-sein is always what it can be

and how it is its possibility” (Heidegger, 1953, 134.) Da-sein understands itself in

terms of its possibilities. That is Da-sein understands what its possibilities are here

and now, and furthermore Da-sein is able to transcend itself towards possible

possibilities in the future. In order that Da-sein can realize its possibilities it must

transcend itself towards its possibilities and go beyond itself, it must strive for its

uttermost possibilities. What I mean by going beyond itself is to project itself into the

future where it foresees a future self. For example if I set out to do something it

becomes a possibility; I set myself an aim, the aim being to ride a bicycle from

Jerusalem to Stockholm. Therefore I conceive of it as a possibility that I may or may

not be successful in completing in the future. However the aim I have set before

myself determines the steps I am taking here and now. That is, in order to undertake

this rigorous task, I need to undergo training, to plan the trip, to buy the equipment

and so forth. There is an amount of training, skill and effort needed in order that I may

achieve my goal. What is remarkable here according to Heidegger is that I am able to

throw myself into the future. What I need to do is to transcend myself beyond my

possibilities as they are here and now and project myself to a possible self in the

future.

2.2. What is Attunement?


25

The second existential is attunement (Befindlichkeit); the word cannot be

expressed using any single English word. A common German phrase that uses the

word is “Was befinden sich?,” which in English would equate to the phrase “how do

you feel?” The English term that I will use for Befindlichkeit is Attunement.

Heidegger describes Befindlichkeit as follows in the Zollikoner Seminars, “…the

condition Befinden which we allude to when we ask someone “How are you?” – That

is how is it going with you? The question can be meant as an inquiry into the very

factual [factisch] situation of the other. However such a condition is to be

distinguished from what is interpreted as an ontological disposition [Befindlichkeit] in

Being and Time”(Heidegger, 2001, 139.)

What Heidegger is saying is that there is no correlation between Befinden and

Befindlichkeit, or what is often translated into English as attunement. Heidegger

writes, “…The first essential ontological characteristic of attunement is: Attunement

discloses Da-sein in its throwness and for the most part in the mode of an evasive

turning away” (Heidegger, 1953, 128.) For example let’s say that I have thrown

myself at the possibility of bicycling form Jerusalem to Stockholm. And if I am

bicycling on the road from Jerusalem, then I am in full concentration on what I am

doing. I am holding the steering wheel; I am keeping my balance on the bike and I

can tell that my feet are positioned securely on the pedals. My attention is fully on the

road, and I do not pay any attention to the plastic bag that is flying in the air beside

the road. In a sense I am occupied with the ways of the world, and that occupation

(the fact that I am so occupied in my very activity) takes me away from my very self.

In a sense I am lost within myself, I somehow am so involved with the world that I

am beyond myself until I am called to. Heidegger describes this as follows,

“…Attunement discloses Da-sein not only in its throwness and dependence on the

world already disclosed with its being, it is itself the existential kind of being in which

it continually surrendered to the ‘world’ and lets itself be concerned by it in such a

way that it somehow evades its very self. The existential constitution of the evasion

becomes clear in the phenomenon of entanglement” (Heidegger, 1953, 131.)


26

2.3. What is the Correlation between Heidegger and Svenaeus?

What then is the connection between Heidegger and Svenaeus? Svenaeus states,

“…My own alternative for a phenomenological theory of health will not be based

upon authenticity, freedom or autonomy, but upon homelikeness. The reminder of this

part of my work will be devoted to developing and explaining this theory. I want to

make clear from the start that what I will present below is not an orthodox reading of

Heidegger, which merely explicates a hidden theory of health in his works, but rather

a theory inspired by his thinking, which makes use of part of his vocabulary and many

of his insights” (Svenaeus, 1999, 155.) What Svenaeus is saying is that Heidegger for

him is more of an inspiration, and that he wants to use his vocabulary.

And what he uses in particular is Heidegger’s concept of authentic anxiety, which

Svenaeus uses as a basis for his notion of unhomelikeness, which is the notion that

Svenaeus uses in order to describe ill health.

Heidegger describes this authentic anxiety as follows in Being and Time, “In

anxiety one has an ‘uncanny’ feeling (In der Angst ist einem ‘unheimlich’.) Here the

peculiar indefiniteness of that which Da-sein finds itself involved in with anxiety

initially finds expression: the nothing and the no-where. But uncanniness means at the

same time not-being-at-home. In our first phenomenal indication of the fundamental

constitution of Da-sein and the clarification of the existential meaning of being-in

contradistinction to the categorical signification of ‘insideness,’ being-in was defined

as dwelling with, being familiar with…(Heidegger, 1985, 188.) It is here that

Svenaeus makes his correlation with Heidegger’s use of the word unheimlich, which

has a double meaning in German in that it can mean ‘unhomelike’ or ‘uncanny’

(strange or mysterious). It is this unhomelikeness that Svenaeus uses in his

phenomenological theory, to describe illness as a strange and mysterious attunement

that creeps up on the patient. For example in our example of the medical doctor who

is diagnosed with HIV he is stepping into the mysterious unknown, stepping into the

realm of unhomelikeness. And it is Heidegger’s authentic anxiety that has a clear

correlation with Svenaeus’s conceptualization of unhomelikeness.


27

Svenaeus states, “…What authentic anxiety makes evident is essentially the

same phenomenon that is brought to attention, not in healthy, but in ill forms of life –

the not being home in the world. Unhomelikeness which is taken to an extreme in the

authentic mood, is, even in our everyday modes of being-the-world a basic aspect of

our existence, but there it is hidden by dominating being at home in the world and is

therefore covered up” (Svenaeus, 1999, 157.) And it is on this background that

Svenaeus bases his definition of health, which states, “…Health is to be understood as

a being at home that keeps the not being at home in the world from becoming

apparent. The not being at home, which is a basic and necessary condition of human

existence related to our finitude and dependence upon others and otherness, is, in

illness brought to attention and transformed into a pervasive homelessness. One of

two a priori structures of existence –not being at home and being at home – wins out

over the other: unhomelikeness takes control of our being-in-the-world. The basic

alien ness of my being-in-the-world, which in health is always in the process or

receding into the background, breaks forth in illness to pervade existence” (Svenaeus,

1999, 157.)

What is interesting here is that Svenaeus states that illness or, what he calls the

not being at home, is a necessary condition of human finitude, which is related to our

mortality and our dependence on being with others. What does Svenaeus mean by

saying that illness is a necessary condition of human finitude? And how does that

relate to the Svenaeus view, that I presented earlier that illness is obviously an

obstruction of health and its transparency? What is the relation between our own

mortality and being with others? Heidegger writes, “…Only on the ground of the

original revelation of the nothing can human existence approach and penetrate beings.

But since existence in its essence relates itself to beings – those which it is not and

that which it is – it emerges as such existence in each case from the nothing already

revealed. Da-sein means: being held out into the nothing [Da-sein heisst:

Hineingehaltenheit in das Nichts]” (Heidegger, 2000, 105.) Could it be that the rope

tow between the homelike and the unhomelike, where the unhomelike takes control of

my being in the world, is somewhat connected to what Heidegger is stating when he

states that Da-sein means being held out into the nothing? Is it a possibility that the

outcome of the struggle between the unhomelike and the homelike is that Da-sein


28

realizes that it is being held out into the nothing?15 Where the outcome of illness or

unhomelikeness would be a confrontation with the nothingness? Where Da-sein is

confronted with its own finitude and where it perhaps comes in terms with its

finitude? 16

I hope that this section has given you, the reader, a better idea about

Heidegger’s phenomenology, which Svenaeus uses to construct his own

phenomenological theory that was introduced in section one in this essay. The

purpose of this section was to introduce Heidegger’s terminology, which is

extensively used in section three. Section three is a deepening discussion on

Svenaeus’s Holistic Phenomenological Theory of Health.

3. Svenaeus’s Holistic Phenomenological Theory of Health

In this section I intend to continue and deepen the discussion on Svenaeus’s

Holistic Phenomenological Theory of Health, which began in section one of this

essay. This includes a deeper continued discussion on the problem of obstruction,

which was introduced in section one.

The central concepts within Svenaeus’s theory are Homelikeness and

Unhomelikeness. Svenaeus writes, “…We can now, in the context of the

phenomenology of Heidegger, understand this interaction between the individual and

15 Peter Kraus writes in his essay Death and Metaphysics, “…By saying that Da-sein is ‘held out into the nothing’, he means that Da-sein persists as existence even in confrontation with nothingness; that is, unlike things that are nihilated in connection with nothingness, Da-sein persists and retains its meaning as a self-defining meaning. ‘Being held out into the nothing’ means that Da-sein as well as being a being among other beings, is also standing out from an ocean of nothingness” (Solomon, 1998, 104.) 16 But why is Da-sein finite? Heidegger writes, “…Man is finite because he has a relationship to being and, therefore, because he is not being itself, but rather because he is of his unfolding essence. Thereby, finite must be understood in the Greek sense of [περαζ], that is, limit, as what completes a thing as what it is, provides a limit to its essence, and thus lets it come forth. The [ontological] difference between [Sein] and beings [Seinende] belongs to the [the human being’s] relationship to being; and to experience this difference means to experience what is not a being. The not experience of what is “not-a-being” is the experience of nothing[ness] Nichts, and this experience of this “not-a-being” is the experience of this “not-a-being” is manifest in the relationship to death – to mortality- since death is the leave-taking from [Abschied] beings” (Heidegger, 2001, 184.)


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the environment as placement of the individual within a meaning-structure-a totality

of relevance, or what we earlier referred to as Da-sein’s Geworfenheit, its being

thrown into the world. The throwness of human existence is characterized by the

existential of Befindlichkeit – attunement. To be delivered to the world of inter-

subjective meaning – a language, culture, history, etc. – is to find oneself in the world

(sich befinden), and this finding oneself appears in the form of an attuned

understanding of finding oneself in a mood. Our attuned understanding, in the form of

finding oneself in a mood. Our attunement colors and determines our understanding

of the world. Every understanding consequently has a mood; this certainly applies for

the ill forms of understanding” (Svenaeus, 1999, 156.) As we can see from this quote

Heidegger’s concept of attunement, which I introduced earlier, plays an intrinsic part

in Svenaeus’s theory. Svenaeus even states, “…The attunement of our being-in-the-

world seems to be the phenomenon to focus upon, when we try to get hold of the

difference between healthy and ill ways of being-in-the-world” (Svenaeus, 1999,

158.) But how does Svenaeus interpret Heidegger’s concept of attunement? Svenaeus

states, “…Attunement is not the quality of a thing – of an isolated human – subject –

but rather as stated above, a being delivered to the world as an understanding

existence” (Svenaeus, 1999, 158.) What does Svenaeus mean by stating that being is

delivered into the world as an understanding existence?

Perhaps Svenaeus’s point is that Da-sein has to find its understanding in the

world. By finding its understanding it has made a part of the world its own; however,

it can never make the whole world its own for Da-sein is finite. The world reveals

itself to Da-sein in its totality of relevance. If for example I find myself as a carpenter

I will understand that my totalities of relevance are my tools, my materials and my

workshed. I am attuned to my understanding of the world as a carpenter, I have a

certain attitude towards the world and this attitude or mood affects the way in which I

understand the world that I Da-sein have made my own. I Da-sein have made my

dwelling in the world my home by being a carpenter. What is Da-sein’s familiarity

with the world? Heidegger writes: “The being-at-home of human being-there (Da-

sein) –‘dwelling’ with, being familiar with’ – is consequently, at the same time, a

being not quite at home in this world. The familiarity of our life-world the world of

human actions, projects and communications – is also always pervaded by

homelessness: this is my world but at the same time not entirely mine, I do not fully


30

know it or control it. This is not a deficit, but a necessary phenomenon: I am delivered

to the world (geworfen) with other people, and being together with them (Mitda-sein)

is a part of my own being” (Heidegger, 1953, 177.) What does Svenaeus think that

Heidegger means when he states that this world is Da-sein’s own world but at the

same time not? Perhaps it is that the attuned understanding of Da-sein being a

carpenter is limiting, in the sense that it does not give a window into the world of the

attuned understanding of the bus driver. I Da-sein am settled in and feel at home in

my being a carpenter, it is what I know, it is what I do and it is my calling. Yet there

is a part of my existence that is unknown to me, there is a world that does not appeal

to me and does not call to me. It is the world of the bus driver, which I Da-sein meet

every morning on my way to work.

Our attuned understanding, which colours and determines our understanding of

the world, has a mood. The mood that Svenaeus uses to describe ill forms of

understanding or unhomelikeness is authentic anxiety. Svenaeus writes, “…What

authentic anxiety makes evident is essentially the same phenomenon that is brought to

attention, not in healthy, but in ill forms of life –the not being at home in the world”

(Svenaeus, 1999, 156.) But how does unhomelikeness come about? Is there some kind

of balancing between homelike and unhomelike attuned understanding of our being in

the world? And in what sense are we to understand how the moods of homelikeness

and unhomelikeness are balanced? Svenaeus questions if the word “balance” carries

anything more than just a metaphorical meaning in the case of phenomenology. The

reason for this is that balance is often seen as a condition in which different elements

are in equal harmony or in equal proportions. What does it actually mean to talk about

balance (equilibrium) on the phenomenological level of meaning? Svenaeus’s answer

is, “...The homelikeness of health can thus obviously not be a balance between two

(or several) entities. The ‘balance of health’ must phenomenologically refer to the

way that a human being finds its place in the world as a meaning pattern – a being in

the world. Health is thus not a question of a passive state but a rather active process –

a balancing” (Svenaeus, 1999, 159.) What does Svenaeus mean by saying that health

is not a passive state but an active process, a balancing? If we use the metaphor of

riding a bicycle, then we do not contemplate our balance. And in the same way we do

not actively contemplate our being-in-the-world when we are healthy. Svenaeus

describes health, “…as a background attunement that does not offer the possibility of


31

direct attention” (Svenaeus, 1999, 161.) If we return to our metaphor of riding a

bicycle, our healthy mood is therefore taken for granted, it eludes us and effaces itself.

Health is the pure background mood of homelike attuned understanding until we fall

off the bicycle, when we lose our balance. Svenaeus writes, “…The health-mood

could be seen as a sort of borderline case of the transparency of attunement. It is there

all the time in the alternation between different more intrusive moods, sometimes left

alone as the pure background mood of homelike understanding” (Svenaeus, 1999,

161.) For example when we accidentally ride our bicycle over a rock we lose our

balance, and we will make an active effort to regain our balance, in some cases we

succeed and we continue riding our bicycle down the path we were riding, in other

cases we fail in our attempt to keep our balance and fall down. Svenaeus writes,

“…The moods of illness, contrary to healthy attunement, seem to manifest themselves

in obtrusive ways, coloring our whole existence and understanding. This is not always

an immediate experience – like falling down from a bicycle – but sometimes a

gradual process, during which, however, in the same way as in the example of riding

a bicycle, one strives constantly to ‘stay upright,’ to keep one’s balance but finally has

to give in to illness” (Svenaeus, 1999, 160-161.) What is debatable here is whether an

illness is obtrusive or even obstructive, and if so, in what way is an illness

obstructive? What is illness obstructing us from? Is illness obstructing us from our life

term goals, the good life or is illness an obstruction because illness forces us to face

our own finitude? Or perhaps illness opens up different possibilities to Da-sein,

different modes of being. Either way illness is one with life as well as death is one

with life, they are all three bound together as one within Da-sein. 17

4. Conclusion: Summary and Discussion

17 Nishitani writes, “…From the very outset life is at one with death. This means that all living things, just as they are can be seen under the Form of death…. The aspect of life and the aspect of death are equally real, and realities that which appears now as life and now as death” (Nishitani, 1982, 50,52.)


32

…Death is the condition of your creation, it is a part of you; [in being frightened by death] you are

fleeing from your own selves. This being of yours that you enjoy is equally divided between death

and life… The constant work of your life is to build death. You are in death while you are in life

… during life you are dying (Montaigne, 1958, 1:20.)

4.1. Summary

The foundation of this essay was to introduce and criticize The

Phenomenological Theory of Health and Ill-Health. The underlying reason that

Svenaeus wanted to develop this theory was a problem that is discussed within The

Enigma of Health by Gadamer. What is this problem? This problem is a

communication problem within the patient-doctor relationship, which has led to a lack

of understanding and increased distance between the patient and the physician.

The patient-doctor relationship is the central process of medicine and is a

meeting place of two different life-worlds of the patient and the doctor, where these

different life-worlds seek to understand each other to the end of finding an appropriate

treatment plan. This relationship is threatened by two developments within the field of

medicine: Firstly the gap that has been created between the patient and the physician,

because of rapid technological development in the clinic. It is threatening the actual

dialogue at the risk of no further need for the actual patient-doctor dialogue because it

will be outweighed by the data that are produced by medical technologies. Secondly it

is threatened by medical specialization, which is a risk because it ultimately will

affect the personal relationship between the patient and the doctor. We are no longer

living in an environment where the patient has one physician his during entire life

span, rather we are living in the reality that the patient’s medical problems are being

handled by different medical specialists.

This development is a problem because it is actually threatening the central

process of medicine (the patient-doctor relationship) and it presents a break away

from the foundation of clinical medicine that is Hippocratic medicine, which is based

on a dialectic method where medicine is an interpretive meeting between the

physician and the patient where the aim is to build a bridge of common understanding

in order to understand the nature of whole of the patient to the end that the physician’s


33

aim was not only to restore the patient’s health, but also to restore the equilibrium

between the patient and his world.

The underlying foundation in both Gadamer’s and Svenaeus’s different ideas of

health is the notion of equilibrium or balance. Gadamer describes health thus,

“…Health is not a condition that one introspectively feels in oneself. Rather it is a

condition of being there (Da-sein), of being-in-the-world (In-der-welt-sein), of being

together with other people (Mit-den-Menschen-sein), of being taken in by an active

and rewarding engagement with the things that matter in life… It is the rhythm of life,

a permanent process in which equilibrium re-establishes itself” (Gadamer, 1996, 143-

144.) Gadamer hints that the conditions of health and illness are conditions that the

patient cannot feel within himself, these conditions are found in Da-sein, in being-in-

the-world and being-with-other-people. According to Gadamer, health is not

obstructed by illness; they are both a part of a natural process, a process of constant

re-balancing. For example if, while we are riding our bicycle, we ride over a rock and

then lose our balance momentarily but then regain it without actually falling down,

the actual experience is not an obstruction, in the sense that Da-sein is halted, it is a

revelling experience where Da-sein comes in contact with what is incarnated within

its body, its finitude. Illness is not an obstructive party crasher that is hindering it

from its goals in life; it is a rewarding experience for it teaches Da-sein that it is living

towards its own finitude.

On the other hand, Svenaeus describes health in the following way, “Health is to

be understood as a being at home that keeps the not being at home in the world from

becoming apparent. The not being at home, which is a basic and necessary condition,

of human existence, related to our finitude and dependence upon others and otherness,

is, in illness, brought to attention and transformed into a pervasive homelessness. One

of two a priori structures of existence – not being at home and being at home – wins

out over the other: unhomelikeness takes control of our being-in-the-world. The basic

alien-ness of my being-in-the-world, which in health is always of receding into the

background, breaks forth in illness to pervade existence. This unhomelikeness will be

the central theme in our following interpretation of illness” (Svenaeus, 1999, 157.)

The difference between the two is that Svenaeus is inclined to the idea that illness is

an obstruction, even an obstruction to the life being held. Illness is something that


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puts Da-sein’s life on hold in the sense that it is withholding Da-sein from its prior

engagement. It is the party pooper that invades the healthy norm and obstructs Da-

sein in the life that it wants to lead. Svenaeus describes illness as follows, “Illness is

obviously an obstruction to health and its transparency; everything that goes on

without us paying explicit attention to it when we are healthy – walking, thinking,

talking now offers resistance. The body, our thinking, the world, everything is now

‘out of tune,’ colored by feelings of pain, weakness and helplessness” (Svenaeus,

1999, 138.) This brings me to my criticism.

The core of my criticism towards Svenaeus is twofold; firstly I wanted to argue

that it is necessary to explore the patient’s relation to the world when contrasting

healthy and ill ways of being in the world, it is not good enough only to focus on the

actual phenomenological symptoms of illness; the patient’s whole life has to be taken

into an account. In other words it would be much easier to contrast healthy and ill

ways of being in the world if we inspect how the correlation between a patient and his

life-world are affected in ill ways of being in the world.

That is what the conditions of health and illness are – conditions that the patient

not only feels within himself, they are conditions that can be felt in the patient’s

correlation with his life-world. They are felt not as an obstruction, but as a revealing

experience, the constant re-balancing between health and illness is a reminder of Da-

sein’s finitude. Health is therefore not obstructed by illness; they are just different

attuned moods of revelation, which are in the constant mode of re-balancing. I

therefore can’t concur with the idea that illness is an obstruction because it seems to

go against Gadamer’s definition of health and illness. Illness from my standpoint is a

rewarding experience because it teaches Da-sein that it is living towards its own

finitude.

Secondly, my criticism was towards an assertion made by Svenaeus that illness is

an obstruction to health and its transparency; instead I have argued that illness is a

rewarding experience because it teaches Da-sein that it is living towards its own

finitude. It is rewarding because it opens up different possibilities of being. For

example if I have high blood pressure (hypertension), it means that I have a risk of

having a heart attack or a stroke. It does not mean that a heart attack or stroke is

inevitable, but it becomes a challenge to be dealt with. And a challenge opens up new


35

possibilities. I may start exercising to combat the problem, stop smoking or stop

drinking. Hypertension is therefore not an obstruction but an event that opens up

different modes of being.

4.2. Closing Comments

The underlying enthusiasms, the underlying tone and the driving power of these

two critical stances towards Svenaeus are that I feel that disease has to be

reinterpreted. The phenomenological theory of health and illness is a good starting

point for that reinterpretation but that work is far from finished. As Svenaeus points

out in his closing statements, “…It is obvious that my analysis of health is far from

complete and call for further attention, reflection and development” (Svenaeus, 1999,

195.) It is my sentiment that this theory falls also into the problematic area that the

human body is a point of origin for disease, where using the laws of Euclidean

geometry in an anatomical atlas can then localize disease. 18 It is my hope that with

my critique, I have made an honest attempt in trying to illustrate the phenomena of

health and illness as something that is not only something that should be restricted to

the body, but also is a phenomenon that is outstretched in the totality of our lives. It is

time to shake the foundations and look for new plausible ways in which we can

reinterpret and see health and ill-health in a new light.

5. References

Bohm, David. (1996) On Creativity, Routledge Classics, New York, NY.

18 This is also mentioned in The Birth of the Clinic where Foucault writes, “…How can the flat homogeneous, homological space of classes become visible in a geographical system of masses differentiated by their volume and distance? How can a disease, defined by its place in a family, be characterized by its seat in an organism?” (Foucault, 1975, 10.)


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Foucault, Michel. (1975). The Birth of the Clinic: an Archeology of Medical

Perception, Trans. Sheridan, Smith. Vintage Books, New York.

Gadamer, Hans-Georg. (1996) The Enigma of Health, Trans. Gaiger, Jason. &

Walker, Nicholas. Stanford University Press, Stanford California.

Hanson, Ann-Ellis (Last updated: 2005, January), Hippocrates: “The Greek Miracle”

in Medicine, (Available: http://www.medicinaantiqua.org.uk/sa_hippint.html),

(Accessed: 2005, September 14).

Heidegger, Martin. (1953) Being and Time A Translation of Sein und Zeit, Trans. Joan

Stambaugh. State University of New York Press, New York.

Heidegger, Martin. (2001) Zollikon Seminars. Protocols-Conversations-Letters, Ed:

Medard Boss. Northwestern University Press. Evanston, Illinois.

Heidegger, Martin. (1975) Poetry, Language, Thought, Trans. Albert Hofstadter.

HarperCollins Publishers. New York.

Heidegger, Martin. (2000) Introduction To Metaphysics.Trans. Gregory Fried,

Richard Polt. Yale University Press. Yale.

Jaspers, Karl. (1989). The Physician in the Technological Age, Theoretical Medicine

10: 251-267.

King, Magda. (2001). A Guide to Heidegger’s Being and Time, State University of

New York Press, New York.

Montaigne, Michael De. (1958) The Complete Essays of Montaigne, Ed. and Trans.

Donald Frame, Stanford University Press, Stanford.

Nietzsche, Friedrich. (1974). The Gay Science, Trans. Walter Kaufmann, Vintage

Books, New York.


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Nishitani, Keiji. (1982). Religion and Nothingness, Trans. Jan Van Bragt, University

of California Press, Berkley.

Kim, Hin-Jee. (1975). Dogen Kigen – Mystical Realist, University of Arizona Press,

Tucson.

Palmer, Richard E. (1969). Hermeneutics: Interpretation Theory in Schleiermacher,

Dilthey, Heidegger and Gadamer. Northwestern University Press, Evanston, Illinois.

Ponty, Maurice M. (1978). Phenomenology of Perception, Trans. Colin Smith.

Routledge Taylor & Francis Group, London.

Stempsey, William H. (2001). Scientific Contributions: Plato and holistic medicine.

Medicine Health Care and Philosopy 4: 201-109.

Svenaeus, Fredrik. (1999). The Hermeneutics of Medicine and the Phenomenology of

Health (Steps towards a Philosophy of Medical Practices), Department of Health and

Society, Linköping.

Svenaeus, Fredrik. (1999). Freud’s philosophy of the uncanny. The Scandinavian

Psychoanalytic Review 22: 239-254.

Solomon, Robert. Maplas, Jeff. (1998). Death And Philosophy. Routledge Press,

London.

Temkin, Owsei (1997). The Double Face of Janus. John Hopkins University Press,

Baltimore.

Acknowledgements First and foremost I would like to thank my supervisor Anna-Karin Selberg for good

supervision and insightful comments. I would like to thank Herman B. Tripelgood for

mounting the Heidegger whip. I am indebted to Dr. Aslam for great insight and


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discussion on medical practices. Also I would like to thank the Infernal Skövde Circle

for Tea and Coffee. And first and furthermost I would like to thank Erika Wolfie for

her kindness and insightfulness.

thovardarson-ba essay

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