Phenomenology of Illness by Havi Carel, Oxford: Oxford University Press, 2016
Reviewed by James Rakoczi
Havi Carel’s Phenomenology of Illness is a rich and tightly-structured book with two principle aims. First, ‘to provide a comprehensive and coherent phenomenology of illness’ (38). Second, to travel in the ‘opposite direction’ and give an account of ‘what illness can do for philosophy’ (11). This review concerns itself chiefly with the ways in which these aims are mutually enriching.
Carel establishes the relevance of her first aim by noting how phenomenology, a ‘method aimed at providing a philosophical description of consciousness and its engagement with the world’ (20), quickly came to pivot upon embodiment. Both Husserl and Merleau-Ponty developed an account of the body as the condition of possibility for all experience. It is from this claim of the body as the locus of being, our means of participating in the world both experientially and materially, that Carel argues illness can benefit. When our body changes, our whole world changes. Modern medicine, though concise in its conceptualisation of the body as mechanistic working parts, fails to acknowledge phenomenology’s discovery of the body as interconnected totality.
Drawing from the concepts of several phenomenological thinkers, Carel then develops her own framework of the themes and dimensions of illness as it is lived in the embodied first-person. These include S. Kay Toomb’s characterisation of illness as five losses: loss of wholeness, certainty, control, freedom to act and familiarity, the transparency of bodily certainty in health against the opacity of bodily doubt in illness and a compelling extension of Heidegger’s characterisation of human existence as ‘being able to be’ to incorporate ‘being unable to be’ – but a ‘being unable to be’ which is not coded towards death.
In the fifth chapter, ‘A Phenomenology of Breathlessness,’ Carel applies her framework to an account of her own illness experiences. I would suggest this chapter forms the thematic and intellectual heart of the book. It brings together, in concrete and useful ways, the multivalent strands of phenomenological theory about somatic illness and does so by skilfully interweaving these theories into Carel’s own powerful testimony. Breathlessness, argues Carel, entails the limiting self-knowledge that bodily stability is an illusion:
I feel more alone now because others cannot understand the contours of my world. I no longer … share their freedom, take for granted the commonality of health, its hegemony, its normalizing force. (118)
The book’s second aim is addressed most explicitly in the final chapter which, in a thrilling and convincing formulation, imagines illness as ‘a radical, violent philosophical motivation’ (208). Carel describes this chapter as her book coming ‘full circle’ (204).
In fact, Carel’s bi-directional aims occur in tandem throughout. Her claim that illness aids philosophy relies upon her account of philosophy aiding illness, and vice versa. Illness requires the prescription of phenomenological philosophy before it can become philosophically, and clinically, useful. Chapter 7, for example, suggests that through phenomenological examination, illness is re-described as relational rather than individuating, and this can resolve interpretational difficulties of Heidegger’s concept of being-towards-death. Elsewhere Carel proposes and outlines a phenomenological toolkit, to be delivered in workshops for patients and staff, which could ‘ameliorate epistemic injustice by giving patients the ability to interpret and articulate their illness experiences’ (198).
What gateways must experience pass through in order to achieve such fidelity? In other words, I am wondering if there is a tension between the philosophical accuracy and therapeutic imperative of phenomenological description. Carel writes that ‘initially chaotic and confusing’ experiences ‘can, once phenomenologically articulated and ordered, lend new structure and order to the ill person’s experience’ (127). But if the act of description is, albeit beneficially, distorting the initial what-it-is-like-ness of the experience, how can we be sure that the phenomenological method is successfully representing the reality of lived illness?
Carel alludes to this problem. She cites Merleau-Ponty’s claim that pathological cases are not examples of deficiency per se but instead revelations of fundamental functions ‘striving to make good’ (Phenomenology of Perception, 110) and in Chapter 6 she hypothesises that these inherent adaptations which occur in illness are what makes well-being in illness possible. Nevertheless, in this insistence of therapeutic order, is there not also a rejection of a philosophy and a politics of inchoateness (a chaotics) which illness, without phenomenological intervention, might otherwise instantiate?
Phenomenology of Illness is an immense piece of scholarship, a distillation of years of sophisticated thinking about illness and a worthy successor to Carel’s innovative Illness (2008). Its oscillating aims instil a very kind pragmaticism: an ambition to increase clinical smoothness and improve the experiences of patients embroiled within, yet routinely ignored by, healthcare institutions. The questions it raises are vital for any researcher positioned between theory and praxis and it deserves to become a centre of research gravity in medical humanities and philosophy alike.
Bibliography
Havi Carel, Illness (Durham: Acumen Publishing, 2008)
Havi Carel, Phenomenology of Illness (Oxford University Press, 2016)
Maurice Merleau-Ponty, Phenomenology of Perception, trans. by Donald A. Landes (New York: Routledge, 2012)