Abstract
In the Nicomachean Ethics, Aristotle places the art of medicine alongside other examples of technē. According to Gadamer, however, medicine is different because in medicine the physician does not, properly speaking, produce anything. In The Enigma of Health, rather than introducing Aristotle’s intellectual virtue of phronēsis (practical wisdom) as a way of understanding medical practice, Gadamer focuses on how medicine is a technē “with a difference”. In this paper, I argue that, despite the richness of his insights, this focus prevents Gadamer from reaching an adequate account of health and the practice of medicine, and I demonstrate how making phronēsis central via a phenomenological description furthers our understanding of the art of healing in important ways. The paper begins with an exploration of Gadamer’s understanding of phronēsis and technē (via Heidegger) to provide a foundation for a phenomenological analysis of the art of healing. After considering the shortcomings of Gadamer’s analyses, I introduce a working definition of “health” that both captures the spirit of Gadamer’s insights and prepares the ground for a phenomenological description. Finally, I introduce concepts from Merleau-Ponty in order to establish an adequate account of the relation between technē and phronēsis and a more nuanced understanding of experience as unfolding within the expressive trajectories forged by bodies that are subject to the weight of the past and the weight of the ideal. The art of medicine, I argue, needs to be understood as expressive behavior in the context of historically and socially situated individuals, institutions, and open trajectories of sense.
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Notes
Svenaeus has published excellent work that connects Gadamer’s ideas with medical ethics, with a particular focus on the Heideggarian influences on Gadamer’s hermeneutical phenomenology. I believe the existential-phenomenological perspective (inspired by Merleau-Ponty) represented in this paper offers an alternative approach to the question of health and the art of healing.
Gadamer (1996). Phronēsis is only thematized two or three times across the thirteen essays in this collected volume. Or again, a recent summary of The Enigma of Health provides only a brief mention of phronēsis (Dallmayr 2000: 337). An alternative interpretation of the importance of phronēsis in this collection is alluded to by Dostal (2002a: 31). Svenaeus (2003) also argues for understanding Gadamer’s value for medical ethics in relation to the role of phronēsis in Gadamer’s work in general, and aims to show how this influences the approach Gadamer takes in The Enigma of Health essays. However, Svenaeus focuses mostly on Gadamer’s work elsewhere rather than on the health essays precisely because phronēsis remains tangential in The Enigma of Health.
Also, see Gadamer (1986, 1996, 2003). This is Gadamer’s own German translation of Aristotle’s Nicomachean Ethics Book VI, with introduction and commentary. This moment in Gadamer’s engagement with Aristotle, however, comes after the essays on health, which are the primary focus of the current paper. For a careful reading of Gadamer’s commentary and the developments in his reading of Aristotle represented therein, see Berti (2000). For an excellent study of how phronēsis functions in Gadamer’s hermeneutics and a suggestion of how this would work in a hermeneutics of medical practice, see Svenaeus (2003).
For a Heideggarian approach, see the essays by Svenaeus in the works cited section of this paper.
Gadamer travelled from Marburg to Freiburg in Spring of 1923 in order to study Aristotle and phenomenology with Husserl and Heidegger. The following year, Heidegger took up a position in Marburg, and Gadamer returned with him and continued to work closely with him in the following years. At the time, Heidegger was teaching quite extensively on Aristotle (Dostal 2002a). For an extended study of this connection, see Coltman (1998).
One reason for beginning a course on Plato’s Sophist with a close study of Aristotle’s “modes of disclosure” (alētheuein) is that, for Heidegger, Aristotle’s enumeration offers “an orientation regarding the possible ways open to Greek Dasein to experience and interrogate the beings of the world” (1997: 16). As Arrien (2010) has recently argued, Heidegger’s early work should not only be read as on the way to Being and Time, since the focus of Heidegger’s early work is an important contribution on the hermeneutic of factical life. Indeed, in the context of the current paper it is important to remember that Gadamer is being influenced by the young Heidegger. Arrien also stresses in this context the exemplary value of the 1924–1925 course.
The idea that there is a manifold structure of being-in-the-truth is a conviction elaborated by Gadamer in Truth and Method (2003).
I am primarily following here Bernasconi’s (1989) argument regarding the connection between phronēsis and Umsicht in Heidegger. Other interpreters, as Bernasconi notes, have located phronēsis in other key Heideggerian terms, such as Entschlossenheit (resoluteness) and Verstehen (understanding). Moreover, as I will discuss below, Heidegger also declares phronēsis to be “conscience” (1997: 39). I believe the argument in this paper serves to demonstrate the richness of phronēsis in a phenomenology of experience that would encompass all of these various approximations. For a discussion of this nexus of translation and interpretation problems, see Bernasconi (1989: 129f.) and Coltman (1998: 11–13).
The implications of Heidegger’s and Gadamer’s interpretation of Aristotle’s phronēsis over sophia for the ontological and hermeneutical project is explored with insight in Long (2002).
An extrapolation from this might lead one to ask whether such a point suggests that technē and epistēmē (scientific knowledge) are not more properly grouped together, given how we might think in the contemporary worldview of the close connection between science and technology. In Truth and Method, for instance, Gadamer argues for a direct relation between science and “method,” and aims to reveal ways in which there is an experience of understanding without a method that reduces understanding to the product of a scientific or technical process.
The idea of “piloting” the ship bears on the larger context of this paper in a few ways. For instance, traditional medical practice can be described as paternalistic and as thus assuming the physician to be the “pilot” of the ship. But this more nuanced phenomenological description of the experience of being subject to the weight of the ideal suggests that the pilot metaphor can indeed be non-paternalistic, insofar as a physician is creatively engaging and guiding the trajectory of treatment in a responsible and responsive way that recognizes the various urgencies of the situation (including the patient’s desires and needs). Such a phronetic approach to “piloting” might indeed be the soft-paternalism or beneficence that we would hope to encounter in the art of medicine.
This mirrors Gadamer’s concern in Truth and Method to undermine the presumption that truth is the domain of forms of experience that can be reduced to scientific or technological methods. On this point, see Dallmayr (2000).
In this passage, Gadamer is summarizing American sociologist Eliot Freidson.
Here I have in mind the important contribution to the phenomenology of ethical expertise as presented by Dreyfus and Dreyfus (1991).
Here I am drawing upon Merleau-Ponty’s use of the French word sens, which can be translated as “meaning,” “sense,” or “direction”.
I believe that the phenomenological descriptions here are in harmony with the hermeneutical approach to the essence of illness offered by Svenaeus (2000, 2003, 2011). Svenaeus argues that the concept of illness can be understood by exploring the notion of “unhomelike being-in-the-world” via Heidegger, so as to cast illness as a foreign “otherness” that permeates and threatens our meaningful narratives. See also this concept as developed in Svenaeus (2000: 90–113).
The notion of a “metastable” equilibrium is drawn from Simondon (2005). Unfortunately I do not have the space to elaborate here further, and must refer the reader to a fuller discussion of this reading of Merleau-Ponty and the connection to Simondon in the introduction to Landes (2013). See also, Landes (2014).
I would like to credit this formulation of “incoherent deformation” as an extension of Merleau-Ponty’s rich notion of “coherent deformations” to Sarah McLay, who developed this idea at length in her excellent Major Research Paper at Concordia University titled “Traumatized Sense-Making: On Merleau-Ponty, Traumatic Memory, and Institution” (defended in 2014).
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Landes, D.A. Phronēsis and the Art of Healing: Gadamer, Merleau-Ponty, and the Phenomenology of Equilibrium in Health. Hum Stud 38, 261–279 (2015). https://doi.org/10.1007/s10746-015-9342-8
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DOI: https://doi.org/10.1007/s10746-015-9342-8