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Nietzsche, Illness and the Body’s Quest for Narrative

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Abstract

This paper explores Nietzsche’s approach to the question of illness. It develops an account of Nietzsche’s ideas in the wake of Arthur W. Frank’s discussion of the shortcomings of modern medicine and narrative theory. Nietzsche’s approach to illness is then explored in the context of On the Genealogy of Morality and his conception of the human being as “the sick animal”. This account, it is argued, allows for Nietzsche to develop a conception of suffering that refuses to reduce it to modernist restitutive conceptions of well-being. Instead, Nietzsche advocates a more nuanced conception of varying degrees of health. This, it is argued, can be developed into a model that allows for a more satisfying conception of the relation between medical practitioner and patient.

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Notes

  1. Nietzsche [13], Preface for the second edition, section 2.

  2. Kaufmann [6], p. 23.

  3. Kaufmann also notes that during military training in the late 1860s Nietzsche sustained injuries from a fall from a horse that were sufficiently serious to oblige him to cut short his training. He also served as a medical orderly in the Franco-Prussian war, where he managed to contract dysentery and typhoid (ibid., p. 26).

  4. Nietzsche [17], “Human, All Too Human, with two continuations”, section 5.

  5. Ecce Homo, “Why I Am So Wise”, section 1.

  6. Nietzsche [13], Preface, section 3.

  7. viele Gesundheiten”.

  8. Human, All Too Human, the work illness forces Nietzsche to conclude by dictation, marks the beginning of his naturalistically inspired reconsideration of any philosophy which refuses to acknowledge the primacy of embodied existence. The text is most strongly characterised by its rejection of metaphysics. As opposed to “metaphysical philosophy”, Nietzsche tells us, one must embrace “historical philosophy”, a mode of thought which affirms the insight that all that exists is in a continual state of “becoming”. Such an approach seeks to overturn the traditional philosophical notion (epitomised by Platonism) that pure thought is the gateway to discussion of reality. Nietzsche’s whole text rests on the contention that no such access to reality is possible. All thought is embodied and hence prey to the vicissitudes of history. See, Nietzsche [11], sections 1–3.

  9. The Gay Science, op. cit., section 312.

  10. Frank [2], p. 180.

  11. The Wounded Storyteller, ibid.

  12. The Wounded Storyteller, ibid.

  13. Frank, The Wounded Storyteller, p. 5.

  14. As now, the worst case scenario in the past for the average person might have been a lonely, uncared for death on the street.

  15. The Wounded Storyteller, ibid.

  16. The Wounded Storyteller. ibid.

  17. The Wounded Storyteller, p. 15.

  18. The Wounded Storyteller, p. 11.

  19. Frank offers an example of this: “I met a man who had cancer of the mouth […]. His treatment had been sufficiently extraordinary for his surgeon to have published a medical article about it, complete with picture […] showing the reconstructive process. […] I imagined the article might actually be about him: his suffering throughout this mutilating, if life-saving, ordeal. As I looked at the article I realised his name was not mentioned. […] Thus, in ‘his’ article he was systematically ignored as anyone—actually anything—other than a body” (The Wounded Storyteller, p. 12).

  20. The restitution narrative is the “culturally preferred” one (The Wounded Storyteller, p. 83).

  21. The modern world, Frank notes, “seeks to turn mysteries into puzzles, which is both its heroism and its limit” (The Wounded Storyteller, p. 81).

  22. Witness the tendency to treat death as a brute “fact of life”. The recoiling from death in this way is analysed by Martin Heidgger in Being and Time in terms of the dictatorship of “the They”. The “They” is a realm of unconscious normative regulation which is a constitutive condition of human self-understanding: I tend to judge myself in terms of a world composed of impersonal others; in terms of how “They” do things, what “They” desire, what “They” are horrified by, etc. Death, Heidegger notes, is thereby neutralised in its disturbing potential: it is a mere fact that “one” encounters as casually as any other mere fact, rather than something which each of us must ultimately face as our own. See, [4], pp. 164ff. For Heidegger’s discussion of death see pp. 279ff.

  23. The Wounded Storyteller, pp. 115ff.

  24. Although he only mentions him once in passing, Frank’s approach has strong parallels with Jean-François Lyotard’s conception of the ethical demands opened up by postmodern discourse. This is most forcefully expressed in Lyotard’s The Differend [8]. Lyotard’s view is, however, more succinctly expressed in a short, early essay entitled “Dead Letter”: “Culture is lending an ear to what strives to be said, culture is giving a voice to those who do not have a voice and seek one” (see, “Dead Letter”, [9], p. 21). See also, Lyotard [7], “Answering the Question: ‘What is Postmodernism?’”. For some discussion of this see, Sedgwick [18], pp. 267ff.

  25. The Wounded Storyteller, p. 17.

  26. Frank instead emphasises an approach suggested by the ethics of Emmanuel Levinas.

  27. Nietzsche [10], p. 42. The essay was written in 1872, when Nietzsche was in his late twenties.

  28. Nietzsche, one should note, is no crude empiricist. He does not accept the view that the body is the passive receptor of sensory impressions. See, in connection, Daybreak [12], section 117, which argues that the body is constituted not merely in terms of a series of physical facts, but in terms of social and historical factors. The body is a bundle of culturally regulated habits, and this includes the habits wherein we engage with the world as a sensory phenomenon: “The habits of our senses have woven into us lies and deception of sensation: these again are the basis of all our judgements and ‘knowledge’—there is absolutely no escape, no backway or bypath into the real world!”. See also, Beyond Good and Evil, section 20, which offers a much more complex conception of the relation between sensory experience and world than empiricism could dream of.

  29. Friedrich Nietzsche, Human, All Too Human, op. cit., section 101.

  30. Nietzsche [16], essay II, sections 1–2.

  31. Amongst such inclinations the drives to sustenance, procreation and survival are presumably foremost.

  32. On the Genealogy of Morality, essay II, section 3.

  33. On the Genealogy of Morality, ibid.

  34. Such self-fashioning is, for Nietzsche, unconscious. It does not presuppose an agent endowed with self-reflexivity prior to the social realm. The latter’s policing of the biological individual is for him a consequence of the power relations which constitute the mechanisms governing even the most primitive social forms.

  35. The primary feature of this circumstance is survival. Like other apes, the primitive proto-human is envisaged as lacking especially sharp teeth and claws. Communal life offers a solution to such vulnerability, but introduces new conditions of sociality that must be negotiated. There are, of course, many possible ways in which the demands of sociality may be negotiated, as the example of a bee hive readily suggests.

  36. Nietzsche notes that the ancient practices of flaying, boiling in oil, “coating the wrong-doer with honey and leaving him to the flies in the scorching sun”, etc., all served this purpose (ibid.).

  37. Ibid.

  38. This is done primarily through what Nietzsche calls the creditor-debtor relationship. This is the most ancient and “most primitive personal relationship there is […]: here person met person for the first time, and measured himself person against person” (Genealogy, essay II, section 8). For a detailed discussion of the creditor-debtor relationship in the Genealogy see, Sedgwick [19].

  39. On the Genealogy of Morality, ibid.

  40. “[H]ow much blood and horror lies at the basis of all ‘good things’!…” (On the Genealogy of Morality, ibid.).

  41. The most telling example of this is the violent formation of the state and with it the violent imposition of disciplinary power over the primitive communal subject (see, Genealogy, essay II, section 13).

  42. Consider a more or less solitary natural being like a tiger. This is a creature well adapted to engaging with its natural surroundings. Such a being is a more or less perfect fit with its environment. It does not need to ponder questions concerning what it will do and consequently who it might be, since living according to the condition of anything other than “tigerishness” is not an option for it. To be human, in contrast, involves lacking such a fit with one’s environment, since our “natural” environment is culture rather than nature. We remain creatures of the drives, but such drives are situated in a sometimes uncomfortable relationship with our social roles. As such, we lack a determinate or given “nature”.

  43. See Nietzsche’s comment in [15], section 62. The human being, he argues, is “the animal whose nature has not yet been fixed, the rare exception”. One of the main consequences of this is that humanity is so fragile that it is more prone than any other animal to spiritual sickness.

  44. On the Genealogy of Morality, essay III, section 13.

  45. One response to this is to reject the body in favour of faith in a realm of pure intellectuality. For Nietzsche, metaphysics exemplifies this response (specifically, the metaphysics associated with Platonism).

  46. Such onslaughts can range from the minor injury to a finger to the diagnosis of a painful and debilitating cancer or the anguish of mental illness. Each is, in its happening, a contingent feature of embodied experience: there is, for example, no necessity that dictates from having fingers that one will cut this finger in this way on this day at that time. What is a necessary feature of embodied experience, however, is that one is continually open to the threat of such pain and anguish: that contingent perils will ultimately strike one in some way or other.

  47. On the Genealogy of Morality, ibid.

  48. Thus, essay III of the Genealogy argues that the entire history of asceticism springs from the desire to ameliorate suffering by supplying a narrative that explains it. For the ascetic priest, the sufferer suffers because he or she has sinned. Pain is overcome by faith in a “higher” world in which the self can dwell as pure “spirit” immune from the threat of bodily travails. The human animal, Nietzsche in turn notes, would thus rather “will nothing than not will at all” (Genealogy, III, sections 1, 28). In other words, we are beings who need to feel that our lives are endowed with meaning and will endure any form of suffering so long as we can believe that this is the case. The alternative is destruction.

  49. Nietzsche’s term for the kind of person who typifies this modernist tendency is “the last man”, see, Nietzsche [14], op. cit. For the “last man” all that is important is the promise of a pain-free existence: “‘We have invented happiness,’ say the last men and they blink […] One still works, for work is a form of entertainment. But one is careful lest the entertainment be too harrowing. One no longer becomes poor or rich: both require too much exertion” (Thus Spoke Zarathustra, Part I, “Prologue”, section 5). The “last man” craves peaceful resignation and relief from suffering in all its forms, be they bodily or spiritual.

  50. Bearing witness in this sense is not, for Nietzsche, the same as pitying. Nietzsche’s contempt for pity is well known. See, for example, his caustic discussion of the “morality of pity” it in the Genealogy, Preface sections 5–6 and the treatment of the ascetic priest’s attitude to suffering in essay III, section 17. The priest, Nietzsche argues, does not offer a genuine remedy to suffering but merely its temporary amelioration by way of a narrative of restitution.

  51. Nietzsche, The Gay Science, op. cit., section 120.

  52. Ibid.

  53. Ibid.

  54. Book V was added to the first four parts of the original 1882 text in 1887.

  55. The Gay Science, section 382.

  56. See the quotation from The Gay Science at the beginning of this essay.

  57. See, Descartes [1], Meditation 6, p. 102. The mind, Descartes claims, is different in kind from the body: the one is an indivisible unity, the other a corporeal thing that can be subject to division (a finger can be severed, an eye gouged out). The self, in other words, is, in its very essence, immune to the sickness and trauma of embodiment—its health is already pre-given. Nietzsche’s approach, unsurprisingly, has a greater (if nevertheless limited) kinship with the social empiricism of David Hume. See, Hume [5], Book II, section 8: since “health and sickness vary incessantly to all men […] there is none […] solely or certainly fixed in either”.

  58. The Daily Telegraph [20], p. 10, “Marr: give carers more time off”. It is worth noting here that the image of a “time bomb”, i.e. of something impersonal and machine-like waiting to “go off”, implicitly invites an instrumental response—it goes without saying that such a response alone is, from the standpoint advocated here, chronically insufficient.

  59. This dwindling is recounted eloquently by Jonathan Franzen in the essay “My Father’s Brain”. See, Franzen [3], pp. 7–38.

  60. Franzen, How to be Alone, op. cit., p. 30.

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Sedgwick, P.R. Nietzsche, Illness and the Body’s Quest for Narrative. Health Care Anal 21, 306–322 (2013). https://doi.org/10.1007/s10728-013-0264-1

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