Patient support tools have drawn on a variety of disciplines, including psychotherapy, social psychology, and social care. One discipline that has not so far been used to support patients is philosophy. This paper proposes that a particular philosophical approach, phenomenology, could prove useful for patients, giving them tools to reflect on and expand their understanding of their illness. I present a framework for a resource that could help patients to philosophically examine their illness, its impact on their life, and its (...) meaning. I explain the need for such a resource, provide philosophical grounding for it, and outline the epistemic and existential gains philosophy offers. Illness often begins as an intrusion on one’s life but with time becomes a way of being. I argue that this transition impacts on core human features such as the experience of space and time, human abilities, and adaptability. It therefore requires philosophical analysis and response. The paper uses ideas from Husserl and Merleau-Ponty to present such a response in the form of a phenomenological toolkit for patients. The toolkit includes viewing illness as a form of phenomenological reduction, thematizing illness, and examining illness as altering the ill person’s being in the world. I suggest that this toolkit could be offered to patients as a workshop, using phenomenological concepts, texts, and film clips to reflect on illness. I conclude by arguing that examining illness as a limit case of embodied existence deepens our understanding of phenomenology. (shrink)

Many interpretations of David Cronenberg’s 1986 film The Fly read it as a film about monstrosity. Within this framework, the protagonist Seth Brundle’s progressive illness and decay are subsumed under his metamorphosis into a monster. Illness is taken to be a metaphor for the changes in Seth, changes that continuously turn him away from the human and towards the monstrous. Seth’s monstrosity, in turn, arises from the fusion of human and non-human, in this case the fusion of a man with (...) an insect. I suggest an opposite interpretation: instead of seeing Seth’s illness as a metaphor for monstrosity, I suggest that monstrosity is a metaphor for illness. Seth’s physical corruption as he becomes more and more monstrous is, in fact, a depiction of illness, and elicits disgust in the viewer that is identical to the disgust elicited by physical corruption brought about by illness. The external deformation of Seth as he becomes more and more fly-like, shown so spectacularly in the film, is a representation of the internal destruction and physiological chaos caused by disease. I argue that the notion of the monstrous that is so central to the film in fact supports the health/ illness dichotomy, in which the two states – health and illness, or human and monster – are posited as mutually exclusive. Instead of accepting the dichotomy and focusing on the dialecticbetween human and monstrous, as many interpretations have, I claim that the film in fact demonstrates the fallacy of this dichotomous view, showing that ultimately we all have ‘the disease of being finite’. I propose to understand the film as a tragedy portraying the terminal illness of a decent man. As such, the film dupes the viewer into accepting the human/ monster and healthy/ diseased dichotomies, only to grasp their illusoriness by the end of the film. (shrink)

(No abstract is available for this citation).

ABSTRACT This paper offers an account of institutional testimonial justice and describes one way that it breaks down, which we call institutional opacity. An institution is opaque when it becomes resistant to epistemic evaluation and understanding by its agents and users. When one cannot understand the inner workings of an institution, it becomes difficult to know how to comport oneself testimonially. We offer an account of an institutional ethos to explain what it means for an institution to be testimonially just; (...) we then describe how an ethos of institutional testimonial justice can break down when the institution becomes opaque. An opaque institution is especially problematic for individuals and groups already rendered epistemically vulnerable during their interactions with that institution, which we call epistemically vulnerabilised individuals. We articulate the features of an encounter between an epistemically vulnerabilised individual and an opaque institution. We end by tracing ameliorative strategies that could help repair a deteriorated institutional ethos of testimonial justice. (shrink)

What is the relationship between phenomenology and naturalism? Are they mutually exclusive or is a rapprochement possible between their approaches to consciousness and the natural world? Can phenomenology be naturalised and ought it to be? Or is naturalism fundamentally unable to accommodate phenomenological insights? How can phenomenological method be used within a naturalistic research programme? This cutting-edge collection of original essays contains brilliant contributions from leading phenomenologists across the world. The collection presents a wide range of fascinating and carefully argued (...) answers to these questions. (shrink)

Health research initiatives worldwide are growing in scope and complexity, particularly as they move into the developing world. Expanding health research activity in low- and middle-income countries has resulted in a commensurate rise in the need for sound ethical review structures and functions in the form of Research Ethics Committees (RECs). Yet these seem to be lagging behind as a result of the enormous challenges facing these countries, including poor resource availability and lack of capacity. There is thus an urgent (...) need for ongoing capacity and resource development in these regions in general, and in Africa in particular. Similarly, there is a need for research and initiatives that can identify existing capacity and funding and indicate the areas where this needs to be developed.This discussion paper argues that the Mapping African Research Ethics Capacity (MARC) project is a timely initiative aimed at identifying existing capacity. MARC provides a platform and tool on the Council on Health Research for Development's (COHRED) Health Research website (HRWeb), which can be used by RECs and key stakeholders in health research in Africa to identify capacity, constraints and development needs. MARC intends to provide the first comprehensive interactive database of RECs in Africa, which will allow for the identification of key relationships and analyses of capacity. The potential of MARC lies in the mapping of current ethical review activity onto capacity needs. This paper serves as a starting point by providing a descriptive illustration of the current state of RECs in Africa. (shrink)

Epistemic injustice is a harm done to a person in their capacity as an epistemic subject by undermining her capacity to engage in epistemic practices such as giving knowledge to others or making sense of one’s experiences. It has been argued that those who suffer from medical conditions are more vulnerable to epistemic injustice than the healthy. This paper claims that people with mental disorders are even more vulnerable to epistemic injustice than those with somatic illnesses. Two kinds of contributory (...) factors for epistemic injustice in psychiatric patients are outlined: global and specific. Some suggestions are made to counteract the effects of these contributory factors, for instance we suggest that physicians should participate in groups where the subjective experience of patients is explored, and learn to become more aware of their own unconscious prejudices towards psychiatric patients. (shrink)

O que queremos dizer atualmente quando falamos sobre filosofia? Como a filosofia se relaciona com a ciência, com a política e a literatura? Que métodos o filósofo moderno utiliza, e como a filosofia progride? A filosofia é diferente de um lugar para outro? O que a filosofia pode fazer por nós? E o que não pode fazer? Este livro diz o que a filosofia é e também nos mostra a filosofia contemporânea em ação.

Health research initiatives worldwide are growing in scope and complexity, particularly as they move into the developing world. Expanding health research activity in low- and middle-income countries has resulted in a commensurate rise in the need for sound ethical review structures and functions in the form of Research Ethics Committees. The urgent need for continued capacity development in Africa has necessitated research initiatives to identify existing capacity. This discussion paper describes the mapping of RECs in Africa through MARC project, second (...) phase and discusses the findings. MARC provides a platform and tool on COHRED's Health Research HRWeb, which can be used by RECs and key stakeholders in health research in Africa to identify capacity, constraints and development needs. (shrink)

Havi Carel uses phenomenology to explore how illness modifies the ill person's body, values, and world. Carel argues that illness has received little philosophical attention. Phenomenology of Illness develops a phenomenological framework for illness and a systematic understanding of illness as a philosophical tool.

Propositions of law are based upon normative judgement. The interpretation and application of legal provisions rest upon a judgement that determines which weight must be attributed to some point of view or perspective. In this respect, legal theory has a normative character. Its normative character does not preclude legal theory from being a scientific discipline. The scientific character of legal theory is not located in the possibility of testing the correctness of its theories. Rather, legal theory owes it scientific character (...) to the shared standards of production and evaluation of legal arguments: the grammar of justice. (shrink)

The maxim to understand the law literally resembles Holmes ' Plain Meaning Approach. But these approaches should not be considered as the expression of a naïve legal epistemology. They rather stress that the law ought to be interpreted as it is understood by the prudent citizen. In this way, the ideal of the rule of law is best guaranteed.

What is illness? Is it a physiological dysfunction, a social label, or a way of experiencing the world? How do the physical, social and emotional worlds of a person change when they become ill? And can there be well-being within illness? In this remarkable and thought-provoking book, Havi Carel explores these questions by weaving together the personal story of her own serious illness with insights and reflections drawn from her work as a philosopher. Carel's fresh approach to illness (...) raises some uncomfortable questions about how we all - whether healthcare professionals or not - view the ill and challenges us to become more thoughtful. 'Illness' unravels the tension between the universality of illness and its intensely private, often lonely, nature. It offers a new way of looking at a matter that affects every one of us. (shrink)

What is illness? Is it a physiological dysfunction, a social label, or a way of experiencing the world? How do the physical, social and emotional worlds of a person change when they become ill? And can there be well-being within illness? In this remarkable and thought-provoking book, Havi Carel explores these questions by weaving together the personal story of her own serious illness with insights and reflections drawn from her work as a philosopher. Carel shows how the concepts (...) and language used to describe illness today are inappropriate and misleading. Too often illness is viewed as a localised biological dysfunction while ignoring the actual experience of the ill person, their fears, their hopes, the way they interact with others and, ultimately, experience life. By focusing on the impact of illness on the ill person's life and reflecting on the experience of illness as lived from within, Carel shows how illness is a life-changing process rather than a limited physiological problem. Carel's fresh approach to illness raises some uncomfortable questions about how we all - whether healthcare professionals or not - view the ill and challenges us to become more thoughtful. "Illness" unravels the tension between the universality of illness and its intensely private, often lonely, nature. It offers a new way of looking at a matter that affects every one of us. For those who are ill, it offers insights on our ability to remain happy within the constraints of illness. (shrink)

Bundel besprekingen van ideeënromans met filosofische thema's.

Chronic fatigue syndrome or myalgic encephalomyelitis remains a controversial illness category. This paper surveys the state of knowledge and attitudes about this illness and proposes that epistemic concerns about the testimonial credibility of patients can be articulated using Miranda Fricker’s concept of epistemic injustice. While there is consensus within mainstream medical guidelines that there is no known cause of CFS/ME, there is continued debate about how best to conceive of CFS/ME, including disagreement about how to interpret clinical studies of treatments. (...) Against this background, robust qualitative and quantitative research from a range of countries has found that many doctors display uncertainty about whether CFS/ME is real, which may result in delays in diagnosis and treatment for patients. Strikingly, qualitative research evinces that patients with CFS/ME often experience suspicion by health professionals, and many patients vocally oppose the effectiveness, and the conceptualization, of their illness as psychologically treatable. We address the intersection of these issues and healthcare ethics, and claim that this state of affairs can be explained as a case of epistemic injustice. We find evidence that healthcare consultations are fora where patients with CFS/ME may be particularly vulnerable to epistemic injustice. We argue that the marginalization of many patients is a professional failure that may lead to further ethical and practical consequences both for progressive research into CFS/ME, and for ethical care and delivery of current treatments among individuals suffering from this debilitating illness. (shrink)

We develop a broader, more fine-grained taxonomy of forms of ‘transformative experience’ inspired by the work of L.A. Paul. Our vulnerability to such experiences arises, we argue, due to the vulnerability, dependence, and affliction intrinsic to the human condition. We use this trio to distinguish a variety of positively, negatively, and ambivalently valenced forms of epistemically and/or personally transformative experiences. Moreover, we argue that many transformative experiences can arise gradually and cumulatively, unfolding over the course of longer periods of time.

This article develops the concept of wrongful depathologization, in which a psychiatric disorder is simultaneously stigmatized and trivialized. We use OCD as a case study to argue that cumulatively these two effects generate a profound epistemic injustice to OCD sufferers, and possibly to those with other mental disorders. We show that even seemingly positive stereotypes attached to mental disorders give rise to both testimonial injustice and wilful hermeneutical ignorance. We thus expose an insidious form of epistemic harm that has been (...) overlooked in the literature. (shrink)

We propose that certain forms of chronic illness can be transformative experiences, in the sense described by L.A. Paul.

This article analyses the phenomenon of epistemic injustice within contemporary healthcare. We begin by detailing the persistent complaints patients make about their testimonial frustration and hermeneutical marginalization, and the negative impact this has on their care. We offer an epistemic analysis of this problem using Miranda Fricker's account of epistemic injustice. We detail two types of epistemic injustice, testimonial and hermeneutical, and identify the negative stereotypes and structural features of modern healthcare practices that generate them. We claim that these stereotypes (...) and structural features render ill persons especially vulnerable to these two types of epistemic injustice. We end by proposing five avenues for further work on epistemic injustice in healthcare. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Ubiquity of MoodsMatthew R. Broome (bio) and Havi Carel (bio)Keywordsphenomenology, Heidegger, moods, affects, meaning, self, philosophyPhilosophy is often caricatured as one of the most disconnected and anemic academic enterprises. Yet in philosophers’ own accounts of what drew them to the problems they have sought to address they answer, typically, in two broad, passionate, ways: wonder or anxiety. As such, philosophy, and philosophers’ self-understanding of themselves and their (...) enterprise, can serve as a way to address some of the important topics raised by Rosfort and Stanghellini. Even for philosophers, the emotional experience of moods and affects is employed in narrativity, or at least, employed when one is called to give an account of oneself. One could envisage a party conversation along these lines:So why did you become a philosopher?Well, I wanted to go to university but wasn’t interested in science or in the humanities and I’ve always been dreadful at languages.(Laugh) But you must like something about it as you wouldn’t have become a professor?You know how it is... you drift into things. I did well as an undergraduate, my tutor suggested I should do a PhD. Found an excellent supervisor, and got a few papers published and then a teaching post....You must be very committed to the subject.Ummm—I guess so. I thought about joining the civil service after my PhD, but always managed to find work and the hours are much more flexible at universities!Well I think it is amazing: to think and teach about such important things.Do you?There is something slightly baffling here that may simply be part of the inherent irony and self-deprecation of some academics. The philosopher's interlocutor is asking about what philosophy means to the philosopher: why he has given his life to it. As such, she is alluding to a deeper, philosophical question that, after decades of falling out of favor, is returning to the attention of philosophers: namely, how has philosophy given your life meaning? The philosopher responds with possible irony, banality, or superficiality and invokes luck rather than meaning in his narrative. He serves as Nietzsche's feared nihilist. The account offered also seems to fail to meet normative standards, and depending on how the philosopher carries it off, this gap between expectation and reality in the conversation may generate humor.However, the greater likelihood is that the conversation engenders perplexity and disappointment in the interviewer. Rather like the characters in Evelyn Waugh's early novels, the philosopher is buffeted passively by life and luck and eschews agency or meaning. In Waugh's skilled hands this becomes tragic comedy; for the philosopher and his interlocutor we have disconnection and sadness. The crucial reason for this is that we need to use terms referring to moods, affects, meaning, and emotion when we offer an account of ourselves and when we try to understand ourselves. [End Page 267] Otherwise, something is missing and the reason a person gives for their actions either look like poor reasons or not reasons at all (Bortolotti and Broome 2008). Further, agency, rationality, and self-knowledge may themselves be dependent upon reason-giving.In invoking moods and affects in one's narrative the practical understanding (or ‘affordances’) of the world one inhabits are laid open in clear view. Hence Aristotle's account of wonder as the stimulus for philosophy. Aristotle says: ‘For it is owing to their wonder that men both now begin and at first began to philosophize; they wondered originally at the obvious difficulties, then advanced little by little and stated difficulties about the greater matters’ (1984, 1554). Conversely, given the experience of transcendence, of ambiguity, of finitude rather than wondrous awe, the philosopher may be motivated by anxiety (Kant's awakening from his dogmatic slumbers, Heidegger's battles with ‘Crisis’ and the flight of the gods). Either manner of accounting for one's interest seems to work normatively in the giving of reasons and in generating a narrative, and, moreover, a philosophical narrative.Our fictional dialogue and discussion aims to reinforce the important link between narrative, reason-giving and moods and affects argued for by Rosfort... (shrink)

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. (shrink)

In this paper we argue that ill persons are particularly vulnerable to epistemic injustice in the sense articulated by Fricker. Ill persons are vulnerable to testimonial injustice through the presumptive attribution of characteristics like cognitive unreliability and emotional instability that downgrade the credibility of their testimonies. Ill persons are also vulnerable to hermeneutical injustice because many aspects of the experience of illness are difficult to understand and communicate and this often owes to gaps in collective hermeneutical resources. We then argue (...) that epistemic injustice arises in part owing to the epistemic privilege enjoyed by the practitioners and institutions of contemporary healthcare services—the former owing to their training, expertise, and third-person psychology, and the latter owing to their implicit privileging of certain styles of articulating and evidencing testimonies in ways that marginalise ill persons. We suggest that a phenomenological toolkit may be part of an effort to ameliorate epistemic injustice. (shrink)

In this paper I explore the tacit underlying sense of bodily certainty that characterizes normal everyday embodied experience. I then propose illness as one instance in which this certainty breaks down and is replaced by bodily doubt. I characterize bodily doubt as radically modifying our experience in three ways: loss of continuity, loss of transparency, and loss of faith in one's body. I then discuss the philosophical insights that arise from the experience of bodily doubt. The paper uses a Humean (...) framework with regards to bodily certainty, treating it as a taken for granted tacit aspect of normal experience. I argue that although bodily certainty is not rationally justifiable, we are nonetheless unable to reject it. Bodily certainty is thus revealed to be part of our brute animal nature. I conclude by suggesting that the study of pathology is a philosophical method useful for illuminating tacit aspects of experience. (shrink)

Can one be ill and happy? I use a phenomenological approach to provide an answer to this question, using Merleau-Ponty’s distinction between the biological and the lived body. I begin by discussing the rift between the biological body and the ill person’s lived experience, which occurs in illness. The transparent and taken for granted biological body is problematised by illness, which exposes it as different from the lived experience of this body. I argue that because of this rift, the experience (...) of illness cannot be captured within a naturalistic view and propose to supplant this view with a phenomenological approach. The latter approach accounts for changes in the ill person’s relationship to her social and physical world. These changes, I argue, cannot be captured by a naturalistic perspective. I then propose the notion of health within illness as a useful concept for capturing the experience of well-being reported by some ill people. I present empirical evidence for this phenomenon and assess its philosophical significance. Finally, I suggest that adaptability and creativity are two common positive responses to illness, demonstrating that health within illness is possible. The three elements combined – the transformed body, health within illness and adaptability and creativity – serve as the basis for a positive answer to the question posed above. (shrink)

Mueller et al. discuss the role of acoustic cues in detecting language structure more generally. Across languages, there are clear links between acoustic cues and syntactic structure. They show that AGL experiments implementing analogous links demonstrate that prosodic cues, as well as various auditory biases, facilitate the learning of structural rules. Some of these biases, e.g. for auditory grouping, are also present in other species.

In August 2021, Froese et al. published survey data collected from 2,543 respondents on their subjective experiences living under imposed social distancing measures during COVID-19 (1). The questionnaire was issued to respondents in the UK, Japan, and Mexico. By combining the authors’ expertise in phenomenological philosophy, phenomenological psychopathology, and enactive cognitive science, the questions were carefully phrased to prompt reports that would be useful to phenomenological investigation and theorizing (2–4). These questions reflected the various author’s research interests (e.g., technology, grief, (...) time). Between April 7th and July 31st, 2021, a second questionnaire with the same question set was issued to respondents of the original who had agreed to do a follow-up. This was intended to capture subjective reports of life under social distancing measures a year after the initial survey. By this time–depending on their country of residence and health status–respondents had potentially lived with repeated and prolonged lockdowns and a variety of other restrictions on their social lives. When taken together, Survey I and Survey II provide a cross-cultural and longitudinal dataset that allows for analysis of longer-term impacts of imposed social distancing measures on people’s experiences. For researchers working in diverse disciplines, this dataset offers a rich resource that reflects people’s reactions to the imposition of different social restrictions in different countries and over different time periods. (shrink)

Ill persons suffer from a variety of epistemically-inflected harms and wrongs. Many of these are interpretable as specific forms of what we dub pathocentric epistemic injustices, these being ones that target and track ill persons. We sketch the general forms of pathocentric testimonial and hermeneutical injustice, each of which are pervasive within the experiences of ill persons during their encounters in healthcare contexts and the social world. What’s epistemically unjust might not be only agents, communities and institutions, but the theoretical (...) conceptions of health that structure our responses to illness. Thus, we suggest that although such pathocentric epistemic injustices have a variety of interpersonal and structural causes, they are also sustained by a deeper naturalistic conception of the nature of illness. (shrink)

In this article, I propose that illness is philosophically revealing and can be used to explore human experience. I suggest that illness is a limit case of embodied experience. By pushing embodied experience to its limit, illness sheds light on normal experience, revealing its ordinary and thus overlooked structure. Illness produces a distancing effect, which allows us to observe normal human behavior and cognition via their pathological counterpart. I suggest that these characteristics warrant illness a philosophical role that has not (...) been articulated. Illness can be used as a philosophical tool for the study of normally tacit aspects of human existence. I argue that illness itself can be integral to philosophical method, insofar as it facilitates a distancing from everyday practices. This method relies on pathological or limit cases to illuminate normally overlooked aspects of human perception and action. I offer Merleau-Ponty’s analysis of the case of Schneider as an example of this method. (shrink)

L’article interroge, à travers une vignette clinique, le désir d’enfant et l’infertilité secondaire en étant à l’écoute des enjeux inconscients et des représentations socioculturelles gabonaises. Il repère comment le recours à l’ amp n’exclut pas l’adhésion aux croyances traditionnelles de la malédiction. La recherche s’appuie sur une méthodologie qualitative et intègre la libre réalisation de l’arbre généalogique. L’utilisation de la médiation projective permet d’investiguer les liens familiaux, conjugaux et la place fantasmatique de l’enfant dans l’espace généalogique. L’analyse souligne, sur le (...) plan intrapsychique, une conflictualité œdipienne non résolue. Elle pointe le passage obligé par la maternité pour accéder à un statut social valorisé soutien de l’identité féminine. (shrink)