In December 2008 I was under the impression that a large proportion of my intestines weren’t going to make it through the winter. This was, to put it mildly, a fairly bleak prospect. At this point I had been diagnosed with a chronic digestive disease for over a year, and was beginning to lose interest in the standard medical script: “Your body doesn’t work? Have some drugs. The drugs don’t work? Best lose some body then…”
As my mind wandered from the path of standard treatment it had the good fortune to come across a book called Illness. The book put forward an account of illness that rang true with my own experience like nothing I had ever read. It put the patient’s highly individual and subjective experience of suffering at the centre of the picture, where of course it should be.
So why does philosophy matter? Illness is my paradigm example, because it is first and foremost a philosophy text. Written in 2008 by Havi Carel, a senior lecturer at UWE, it is a rigorous and carefully thought out approach to the phenomenology of illness. Phenomenology is a way of looking at a subject by asking questions like, ‘How is the individual actually experiencing a certain phenomenon?’, rather than the standard medical approach which asks, ‘What is happening to their body in an objective, physiological sense?’
The reason this is such a significant conceptual step to make is that in many cases of chronic disease it doesn’t matter what the doctors do, because it’s not going to work. What really matters is how the illness affects a patient’s life. This is a much richer, more complex equation than one that can be solved with the administering of drugs and the confiscation of body parts. A patient’s well being is more often than not just as closely connected to their emotional health as it is to their physical. With this realisation comes the possibility of a more holistic approach to healthcare, one that realises the significance of the individual’s own experience. As Carel has it, “being ill is not just an objective constraint imposed on a biological body part, but a systematic shift in the way the body experiences, reacts and performs tasks as a whole. The change in illness […] strikes at the heart of subjectivity.”
With this in place, Carel goes on to explore the ways in which philosophy can provide genuine solace where the medical world has come up short. The idea of phenomenology is age old, and summed up well by Thomas Nagel when he asked, “What is it like to be a bat?” The point being we have no idea. This is a problem faced by medical practitioners, who in general have little idea of what it is actually like to have the condition they are treating. Carel points to studies in which medics and nurses have been given a much deeper understanding of various conditions through accurate simulation of them. She also suggests a shift from the objectification of the patient as a medical subject to a more human approach: “Speaking to patients at eye level, showing fundamental human empathy and compassion… A phenomenological approach would introduce this missing first-person perspective on illness and would enable health professionals to understand the transformation of the world of the ill person caused by the illness.”
As well as practical advice for the medical world, Carel passes on advice from the likes of Epicurus and Heidegger. Far from being lofty philosophical sophisms, the reader is given highly practical and feasible advice. This includes some essential adjustments to one’s ambitions, and the need to live within new, more achievable ones. The finitude of life is also touched on, with some very sound answers to our at times unfounded fear of death.
Two years on and this book is very much still with me, so I decided to meet the author and get a better idea of what philosophy can do for us. Havi Carel is still working in the areas of phenomenology and the philosophy of medicine, and is currently trialling a “tool-kit” to help patients find new ways of approaching their illnesses. In her own experience she found that a lot of psychological and social services were offered, but the “huge resource” of philosophy remained largely untapped.
“I don’t know if you’ll agree, but a lot of the suffering is sort of existential. You’re driven to ask some genuine philosophical questions about justice, fairness, morality, retribution; the basic kind of question that Job asked: “Why should the good man suffer?”
Her suggestions run along similar lines to those found in her book; reappraisals of time, and the idea of health within illness.
“It’s a shame that there isn’t more done to promote this idea [of health within illness] to people who might actually find a lot of solace in it. Not because it’s some sort of false belief, on the contrary, it’s a true belief, but you have to do a bit of work to try and find the areas that have benefited. Everyone’s so afraid of becoming unhealthy, but actually once you become unhealthy, it’s a richer terrain than the one I think we’ve so far identified.”
Two years ago I read these sentiments as a confirmation that it was possible to lead a happy, if limited life. This was a psychological, or even philosophical, victory over what was from the outside deemed an untreatable physical condition. One of the resounding points about illness is that it is the mental welfare of the patient that must be kept first and foremost in the minds of everyone involved. In focusing on the ailment over the individual we risk the alienation of those we try so hard to treat. What Carel so successfully achieves is to show that a lot of this work has already been done by philosophy; we just need to take notice.