Review by Niclas Hundahl.
When we think about the human body, what role does illness play? Should it be awarded only minor attention, given that it can be considered an “irregular” state, something that is out of the ordinary? No, argues Havi Carel in Phenomenology of Illness (Oxford University Press, 2016), we must study illness and the particular embodied experience it brings to those who fall ill. For “the experience of illness is a universal and substantial part of human existence” (1). She makes a distinction between disease, the scientific understanding of physiological dysfunction, and illness, how disease is experienced by the individual.
Havi Carel is professor of Philosophy at the University of Bristol. Having examined illness in much of her previous research, she wanted to bring the full force of phenomenology to bear on the concept, because scientific inquiry is not enough. To fully understand illness, we must see and examine it as lived experience. And what better method to use than phenomenology, the philosophy method most specialized in studying lived experience. Carel focuses on severe, chronic and life-changing ill health, because these have the ability to permanently change how we experience the world, and therefore can reveal much about how we experience the world before illness.
Phenomenology of Illness can be split roughly into two parts. The first part examines the phenomenological tradition, how embodied experience is understood within this tradition, and how illness can be understood from this view of the body. Using Martin Heidegger’s famous analysis of malfunctioning tools, and how we only really notice objects once they cease to function, she creates an analogy to the body in illness: When we experience the failure of bodily functions, the experience is similar to that of a broken tool. However, because our bodies are our way of inhabiting our world, this breakdown is experienced much more severely than a broken pen: “My head with a headache is not a malfunctioning tool, but a way of being” (62). When our body breaks down, it can severely change our experience of the world, and of ourselves.
In the second half of the book, Carel works within the framework she builds in the first. She examines a particular type of illness, breathlessness, and later goes about working a taboo in Western Society: Is a good and fulfilling life possible in illness? Largely the answer is yes, most people suffering from chronic or severe illness report similar levels of happiness to unafflicted people. She explains this in part with a process called hedonic adaptation: “We adapt to – and therefore cease to feel the impact of – changes to things that affect our hedonic state” (135). The primary reason illness is heavily stigmatised is because human beings, despite being highly capable at adaptation, have very poor imagination. This is why we need phenomenology of illness, to: “account for the richness and diversity of the illness experience, and thus also to articulate the positive, often unexpected consequences of illness” (126).
Throughout the book Carel also occasionally brings in her own experience of illness. Being diagnostic lymphangioleiomyomatosis, or LAM, a lung condition severely limiting her ability to breathe and requiring her to always bring oxygen canisters with her. Her passages describing both the physical feeling of her condition as well as how she worked through it, are hard to read. But they work. They work insofar as they make us challenge how little we understand about the life in illness.
Phenomenology of Illness provides both a great introduction to phenomenology and creates a highly useful framework for studying both particular cases of illness, as well as reflecting on shared features of all types of illness. Anybody interested in phenomenology, medicinal humanities and applied philosophy will find that Phenomenology of Illness provides a thought provoking and enlightening take on a common experience, and show how important philosophy can be for medicine.
Niclas N. Hundahl is an independent researcher, trying to make sense of the human in a world of technology, nature and fiction.