Everything Is Just Dandy!

How can we understand illness? Phenomenology and the pillar of person-centred care

British Journal of General Practice current issue
Koki Kato
2022 03 31
https://bjgp.org/content/72/717/178

INTRODUCTION: A PHENOMENOLOGY OF ILLNESS

Understanding illness, defined as ‘a feeling, an experience of unhealth which is entirely personal, interior to the person of the patient’,1 is a central task of a physician’s life. McWhinney’s principles of family medicine state, ‘The family physician attaches importance to the subjective aspects of medicine’,2 which encompasses the understanding of illness and people. Although understanding illness is an essential task for family physicians, achieving it is challenging. The reason is that illness is a first-person experience, only available to the patient concerned.

The key to closely approaching a patient’s illness is empathy. Edith Stein, a German philosopher, describes that empathy ‘allows me to see or understand the inner life of another and the body of the other as both other and similar to my body’.3

To understand illness with empathy, there is a helpful reflective mode, phenomenology. Phenomenology itself has been developed by various philosophers such as Husserl, Heidegger, Sartre, and Merleau-Ponty.4 Among recent phenomenologists, Toombs and Carel have elaborated particularly on the phenomenology of illness. Havi Carel, a professor of philosophy at the University of Bristol, explores what patients experience when ill using phenomenological analysis in her book, Phenomenology of Illness. She introduces phenomenology as ‘a method for examining pre-reflective, subjective human experience as it is lived prior to its theorisation by science’, and it ‘enables us to direct our attention towards others in thoughtful empathy’.5

ONTOLOGY IS A STUDY OF BEING; PHENOMENOLOGY IS A STUDY OF EXPERIENCE

This idea is not familiar to us because we are deeply immersed in the world of ontology. Ontology is the study of ‘being’, and can be a way of thinking that there are invariants in reality.6 Most evidence in medicine, especially quantitative, has been founded on ontological grounds. For example, in the view of the ontological thinker, …