EXISTENTIAL MEDICINE

“Before sickness came to be perceived primarily as an organic or behavioral abnormality, he who got sick could still find in the eyes of the doctor a reflection of his own anguish and some recognition of the uniqueness of his suffering. Now, what he meets is the gaze of a biological accountant engaged in input/output calculations. His sickness is taken from him and turned into the raw material for an institutional enterprise. His condition is interpreted according to a set of abstract rules in a language he cannot understand. He is taught only about alien entities that the doctor combats, but only just as much as the doctor considers necessary to gain the patient’s cooperation. Language is taken over by the doctors: the sick person is deprived of meaningful words for his anguish, which is thus further increased by linguistic mystification.”

Ivan Illich

“It is of the highest importance that there be thinking physicians, who are not of a mind to leave the field for the scientific technologists.”

Martin Heidegger

…for further quotations go to Guiding Thoughts and see also www.lifedoctoring.org.uk

Drawing on the work of figures such as Medard Boss and Martin Heidegger, Viktor von Weizsäcker, Luis Chiozza and Ivan Illich, Kurt Goldstein and Eugene Gendlin, Arnold Mindelland many others (see ‘Guiding Thoughts’) this site marks a small beginning in a process of gathering together an archive of writings and resources all of which share a common purpose – that of seeking to stimulate new research and a new, informal dialogical forum of a sort that serves the ultimate project of the site. This is the project of rethinking and transforming not just the philosophy and ‘science’ of medicine but also its practice, placing them firmly on an existential, phenomenological, hermeneutic and ‘pathosophical’ basis (Weizsäcker) rather than a purely biomedical one – and in this way reaffirming the profound medical relevance of Existential Analysis and Therapy as ‘Life Medicine’ and ’Life Doctoring’.

“The essential realm in which biology moves can never be grounded in biology as a science.”

Martin Heidegger

What biological medicine or ‘biomedicine’ can offer the patient is short or long-term relief from pain and suffering, its long-term ‘management’ or its substitution by other forms of pain and suffering (side-effects, reduced quality of life etc). What it cannot and does not even seek to offer the patient is way of managing to understand the meaning of that pain and suffering – not just as an expression of the life of their bodies or brains but as an embodiment of their life as whole – with all its life dilemmas and distress, life pain and life suffering. Physical or mental pain and suffering are not just a natural part of life - rather than something that merely interferes with or obstructs our lives. In their very essence and origin pain and suffering are an expression of our life and our existence or life world as a whole. Understood in this way, biological medicine has not begun to understand the true origin or ‘’etiology’ of illness, obsessed as it is with finding and treating its biological ‘causes’ and failing completely to explore its life meaning, life purpose and life origin. Nor has biomedicine begun to understand the very meaning of the term ‘biology’ itself, which refers, in its Greek origins, to the ‘speech’ (logos) of ‘life’ (bios). Only when the human body is understood as a living language of the human being, and illness as a form of bodily speech giving expression to the life of the human being, can “the essential realm in which biology moves” – our lives – come to life in “biology as a science”. Only in this way too, can we also learn to understand illness ‘pathosophically’, as suffering or pathos that is a pregnant source of life wisdom‘.

At the heart of this project for a new existential and ‘pathosophical’ approach to medicine is a fundamental distinction between the body as perceived ‘externally or ‘exteroceptively’ (the so-called ’physical’ body) and the body as subjectively or ’enterceptively’ felt and experienced from within – the ‘felt body’ or ‘lived body’ (German Leib). Along with this distinction (1) goes the recognition that all ‘psychic’ phenomena, far from being reducible to products of the physical body and brain, are essentially experienced dimensions of the individual’s lived body – itself an embodiment or ‘bodying forth’ of the individual’s entire existential life world and life history as a whole.

“Every feeling is an embodiment attuned in this or that way, a mood that embodies in this or that way.”

Martin Heidegger

Put in other terms, every state of consciousness or ‘psychical’ state is always and at the same time a felt bodily or ’somatic ”state – and vice versa. Or as Weizsäcker put it: “Nothing organic has no meaning; nothing psychical has no body.” From this it follows that a truly ‘phenomenological’ and ‘existential’ approach to health and illness must – in principle – challenge the entire social, cultural, economic, institutional, professional and personal separation between ‘psychotherapy’ in all its forms (including ‘Existential Psychotherapy’) and ‘somatic’ medicine. Indeed ‘Existential Medicine’ is, in its very essence, the abolition of this separation and in this sense may be described as marking ‘The End of Psychotherapy and the Rethinking of Medicine’. For to separate ‘psychological’ dis-ease and therapies from bodily dis-ease and therapy is to deny the essence of medicine – of therapy as such.

An existential ‘rethinking of medicine’ requires first of all a revelation of the root metaphysical assumptions and metaphors that shape the dominant ‘biomedical’ model of health and illness – first and foremost the mechanistic assumption that illnesses have biological ‘causes’ rather than existential meanings and secondly the basic military metaphor of ‘war’ against diseases and death – whether fought through the medium of biomedical research or the body’s own so-called immune ‘defences’.

Here it is not enough to question such metaphysical assumptions and metaphors merely within the framework of a general ‘Philosophy of Medicine’. Instead what is needed is a critical examination and rethinking of specific biological sciences and their languages (for example the languages of genetics and molecular biology, immunology, virology, oncology etc.). This in turn is impossible without knowledge of both the philosophical roots and historical evolution of the biological sciences and their languages (2).

A thorough phenomenological rethinking of medicine must also address in a new way the nature and essence, not just of bodyhood as such, but also the nature of specific organs, bodily functions and their associated organic ‘’disorders’ or ‘’diseases’, thus enabling us to understand their complex and intricate ”biology’’ in the root sense of this term – as an expression of the logos or ‘speech’ of life (bios), something in no way reducible molecular-genetic ‘alphabet and vocabulary’.

Taking a cursory ‘medical history’ of a pateint without any interest in and attention to their life history cannot lead to genuine insight in into the life of the patient’s body, let alone awaken sensitivity to their lived body, something inseparable from their life and lived world. The cultivation of Existential Medicine as a practice must therefore above all address the question of what would constitute an existential-phenomenological analysis’ of specific medical conditions in the larger context of an individual patient’s entire life world and life history – thus coming to truly know the patient as a human being from within through his or her outward life and condition (dia-gnosis). Here, careful and thoughtful existential analyses and case-studies of individuals suffering – perhaps for quite different reasons – from specific bio-medically defined and diagnosed diseases such as AIDS, diabetes or the varieties of cancer, are called for. For the task of the purely biomedical physician is precisely not to think but rather to simply act - in accordance with their training and in strict conformity to a regulatory professional or institutional bureacracy. “urs is not to reason why…” is the motto of biomedical practice, particularly if this why includes the central question of illlness per se: why this particular illness and why now.

No less important for the Existential Therapist – understood as an ”Existential Physician’ or ‘Life Doctor’ – iis the question of whatwould constitute an innately therapeutic relationship with the individual patient – and how such a relational comportment can be cultivated. For this comportment must be one in which a phenomenological stance is not merely adopted as a theoretical position but can itself be actively embodied in ways that are in themselves, therapeutic (3).

Marx, contrary to what many think, specifically defined ‘communism’ as a form of social organisation in which “the free development of each is the condition for the free development of all“ - not the other way round. ‘Health’ can be bureaucratically defined as ’employability’, i.e., as the functionality and exploitability of the individual’s body and mind in a socio-economic system of capitalist wage slavery – one in which countless individual human potentials and capacities in fact remain wholly stunted and unemployed. Alternatively, it can be defined as a capactiy for creative, value fulfilment through work of a sort that is of value also to society as a whole – however little its economic ’value’ on he labour ‘market’.

In the last analysis, the health of the individual is inseparable from the health of human social and economic relations – including the physician-patient relation. For this relation can either open up or foreclose opportunities for the patient to embody their most individual values, capacities and creative potentials – the essence of ‘health’ – rather than ‘somatising’ these unfulfilled potentials in the form of ‘functional’ diseases and disorders (itself in part a form a somatic resistance to the ruling defintion of health as economic functionality rather than value fulfilment).

“How far is the truth susceptible of embodiment?
That is the question. That is the experiment.”

Nietzsche

As regards the role of this particular site in addressing in pursuing and stimulating the overall project of recalling and rethinking the existential foundations of medicine, its aim is also to ensure a reasonable balance between content that is (a) accessible and of personal value to the ‘lay’ reader and (b) of specific interest to readers familiar with fields such as phenomenology and hermeneutics, psychoanalysis and Daseinsanalysis, existential therapy and/or somatic psychotherapy, and the history and philosophy of medicine.

And since the site is still in its infancy (through growing fast!) I cordially invite contributions and comments - through its Forumpage - from all those who take interest in and share its aims.

For today more than ever there is an urgent need to recall, conserve and evolve the radical new approaches to medicine developed by such figures as Medard Boss and Viktor von Weizsäcker - whose pioneering work still finds absolutely no place in institutionalised medical research, training and practice – and is at greater risk than ever before of falling into total historical oblivion, just when it is most called for.

Peter Wilberg 19.08.10

Psychotherapists and other health professionals interested in small-group seminars and/or in individualised mentoring and supervision in Existential Medicine should contact me at peter_wilberg@tiscali.co.uk .

Please also use this address to be put on the mailing list for new articles, or to submit your own articles or links.

Notes:

1. In particular of course, the Zollikon Seminars, initiated and edited by Medard Boss, and Boss’s own work on the ‘Foundations of Existential Medicine and Psychology’.

2. Excellent example of historical studies include the history of immunology recounted in Alfred Tauber’s work ‘The Immune Self – theory or metaphor?’, Anne Harrington’s book on philosophically conflicting ‘scientific’ understandings of the human organism -‘Reenchanted Science – Holism in German Culture from Wilhelm II to Hitler’ and Lily E. Kay’s ‘History of the GeneticCode’ entitled ‘Who Wrote the Book of Life?’.

3. Embodied modes of therapeutic relating are a theme dealt with my book on Heidegger, Medicine and ‘Scientific Method’ and other works, in which I seek to show how the physician’s own body can become their principle medium of therapeutic relating, through training in highly-skilled practices that I term ‘soma-sensitivity’, ‘organismic resonance’ and ‘transformative resonation’.