Phenomenology and its application in medicine
Tóm tắt
Phenomenology is a useful methodology for describing and ordering experience. As such, phenomenology can be specifically applied to the first person experience of illness in order to illuminate this experience and enable health care providers to enhance their understanding of it. However, this approach has been underutilized in the philosophy of medicine as well as in medical training and practice. This paper demonstrates the usefulness of phenomenology to clinical medicine. In order to describe the experience of illness, we need a phenomenological approach that gives the body a central role and acknowledges the primacy of perception. I present such a phenomenological method and show how it could usefully illuminate the experience of illness through a set of concepts taken from Merleau-Ponty. His distinction between the biological body and the body as lived, analysis of the habitual body, and the notions of motor intentionality and intentional arc are used to capture the experience of illness. I then discuss the applications this approach could have in medicine. These include narrowing the gap between objective assessments of well-being in illness and subjective experiences which are varied and diverse; developing a more attuned dialogue between physicians and patients based on a thick understanding of illness; developing research methods that are informed by phenomenology and thus go beyond existing qualitative methods; and providing medical staff with a concrete understanding of the impact of illness on the life-world of patients.
Tài liệu tham khảo
Moran, D. 2000. Introduction to phenomenology. London: Routledge.
Kant, I. 1999 [1781]. Critique of pure reason. Cambridge: Cambridge University Press.
Gardner, S. 1999. Kant and the critique of pure reason. New York: Routledge.
Husserl, E. 1988 [1931]. Cartesian meditations. Dordrecht: Kluwer.
Merleau-Ponty, M. 1962 [1945]. Phenomenology of perception. New York: Routledge.
Heiddeger, M. 1962 [1927]. Being and time. London: Blackwell.
Heidgger, M. 1993. The origin of the work of art. In Basic writings, ed. D.F. Krell, 143–212. New York: Routledge.
Merleau-Ponty, M. 1964. Cezanne’s doubt. In Sense and nonsense, trans. P.A. Dreyfus and H.L. Dreyfus, 9–25. Evanston, IL: Northwestern University Press.
Husserl, E. 1990 [1928]. On the phenomenology of the consciousness of internal time. Dordrecht: Kluwer.
MacKinnon, C. 1993. Only words. Boston: Harvard University Press.
Gallagher, S., and D. Zahavi. 2008. The phenomenological mind. New York: Routledge.
Toombs, S.K. 1988. Illness and the paradigm of lived body. Theoretical Medicine 9: 201–226.
Zaner, R.M. 1981. The context of self. Athens, OH: Ohio University Press.
Zaner, R.M. 2005. A work in progress. Theoretical Medicine 26: 89–104.
Wiggins, O.P., and J.Z. Sadler, eds. 2005. Clinical ethics of Richard M. Zaner. Special issue. Theoretical Medicine and Bioethics 26 (1): 1–104.
Wiggins, O.P., and M.A. Schwartz. 2005. Richard Zaner’s phenomenology of the clinical encounter. Theoretical Medicine 26: 73–87.
Toombs, S.K. 1987. The meaning of illness: A phenomenological approach to the patient–physician relationship. Journal of Medicine and Philosophy 12: 219–240.
Toombs, S.K. 2001. The role of empathy in clinical practice. Journal of Consciousness Studies 8(5–7): 247–258.
Svenaeus, F. 2000. Das Unheimliche—Towards a phenomenology of illness. Medicine, Health Care and Philosophy 3: 3–16.
Svenaeus, F. 2000. The body uncanny—Further steps towards a phenomenology of illness. Medicine, Health Care and Philosophy 3: 125–137.
Svenaeus, F. 2001. The hermeneutics of medicine and the phenomenology of health. Linköping: Springer.
Kirkengen, A.L. 2007. Heavy burdens and complex disease—An integrated perspective. Journal of the Norwegian Medical Association 127: 3228–3231.
Merleau-Ponty, M. 1964. The primacy of perception and its philosophical consequences. In The primacy of perception, trans. W. Cobb, 12–42. Evanston, IL: Northwestern University Press.
Clark, A. 1997. Being there. Cambridge, MA: MIT Press.
Clark, A. 2008. Supersizing the mind. Oxford: Oxford University Press.
Wheeler, M. 2005. Reconstructing the cognitive world. Cambridge, MA: MIT Press.
Petitot, J., F. Varela, B. Pachoud, and J.M. Roy. 1999. Naturalising phenomenology. Stanford: Stanford University Press.
Calvo, P., and T. Gomila. 2008. Handbook of cognitive science: An embodied approach. Oxford: Elsevier.
Lakoff, G., and M. Johnson. 1999. Philosophy in the flesh. New York: Basic Books.
Gallagher, S. 2005. How the body shapes the mind. Oxford: Oxford University Press.
Noë, A. 2004. Action in perception. London: MIT Press.
Young, I.M. 2005.Throwing like a girl: A phenomenology of feminine body comportment, motility and spatiality. In On female body experience, 27–45. Oxford: Oxford University Press.
Ratcliffe, M. 2008. Touch and situatedness. International Journal of Philosophical Studies 16(3): 299–322.
Boorse, C. 1977. Health as a theoretical concept. Philosophy of Science 44(4): 542–573.
Boorse, C. 1997. A rebuttal on health. In What is disease?, ed. J. Humber, and R. Almeder, 3–134. New Jersey: Humana Press.
Carel, H. 2008. Illness. Stockfield: Acumen.
Baron, R.J. 1985. An introduction to medical phenomenology. Annals of Internal Medicine 103: 606–611.
Carel, H. 2010. The lived experience of illness: Developing a phenomenological toolkit for patients. Working paper, University of the West of England, Bristol.
Ratcliffe, M. 2008. Feelings of being: Phenomenology, psychiatry and the sense of reality. Oxford: Oxford University Press.
Matthews, E. 2007. Body-subjects and disordered minds. Oxford: Oxford University Press.
Stanghellini, G. 2004. Disembodied spirits and deanimated bodies. Oxford: Oxford University Press.
Carel, H. 2009. ‘I am well, apart from the fact that I have cancer’: Explaining wellbeing within illness. In The philosophy of happiness, ed. L. Bortolloti, 82–99. Basingstoke: Palgrave.
Carel, H. 2007. Can I be ill and happy? Philosophia 35(2): 95–110.
Angner, E., M. Ray, K. Saag, and J. Allison. 2009. Health and happiness among older adults: A community-based study. Journal of Health Psychology 14(4): 503–512.
Malpass, A., M. Bowden, J. Calvert, H. Carel, D. Kessler, D. Sharp, and A. Shaw. Currently underway. Mindfulness based cognitive therapy for patients with COPD or asthma and anxiety or depression. A NIHR funded feasibility study being conducted at the Academic Unit of Primary Health Care, University of Bristol.
Fulford, K.W.M., S. Ersser, and T. Hope. 1996. Essential practice in patient-centred care. London: Blackwell.
Little, P., H. Everitt, I. Williamson, et al. 2001. Preferences of patients for patient centred approach to consultation in primary care: Observational study. British Medical Journal 322(7284): 468.
Sitzia, J., and N. Wood. 1997. Patient satisfaction: A review of issues and concepts. Social Science and Medicine 45(12): 1829–1843.
McClimans, L. 2011. Choosing a patient-reported outcome measure. Theoretical Medicine and Bioethics 32(1). doi:10.1007/s11017-010-9163-8.
Paterson, M. 2009. Haptic geographies: Ethnography, haptic knowledges and sensuous dispositions. Progress in Human Geography 33(6): 766–788.
Mulhall, S. 2005. Routledge philosophy guidebook to Heidegger and Being and time. New York and London: Routledge.
Carel, H. 2008. What is illness? Philosophical perspectives. Continuing professional development workshop for health care practitioners held at the University of the West of England, Bristol, on April 17.
Jonas, H. 1985. The imperative of responsibility. Chicago: Chicago University Press.
Levinas, E. 1969. Totality and infinity. The Hague: Martinus Nijhoff.