Today we are facing many articles & thesis about basing medicine on evidence which is adopted by many health institutions for different reasons. Here I am intending to show the pivotal role of Husserlian phenomenology for dermatological practice.
Dermatologist & physician in general used to give significance to only one type of researches which satisfying their statistical model (quantitative).
This mathematization of medical research made the lived body absent from the picture; Quantitative way of thinking made us not ready to hear the patient attitude of his experience of illness & the way the disease changing their life quality. This subordination of the subjective aspect of the medical experience stimulates me to highlight the importance of subjectivity in medical career for both doctor/nurse & the patient through using Husserlian phenomenology.
Phenomenology is the study of phenomena, the way things appear to us in genuine experience or consciousness. Kant already used the term to distinguish between the study of objects and events (phenomena) as they appear in our experience and objects and events as they are in themselves (noumena). Hegel used the term "phenomenology" to describe the science in which we come to know mind as it is in itself through the study of the ways in which it appears to us. However,only with Husserl phenomenology became a full-fledged descriptive method as well as a human science movement based on modes of reflection at the heart of philosophic and human science thought.
For Husserl phenomenology is a discipline that endeavors to describe how the world is constituted and experienced through conscious acts. His phrase Zu den Sachen means both "to the things themselves" and "let's get down to what matters!" Phenomenology must describe what is given to us in immediate experience without being obstructed (mediated) by pre-conceptions and theoretical notions. Husserl developed a transcendental or constitutive phenomenology. But in his last major work The Crisis of European Sciences and Transcendental Phenomenology, he formulated the notion of the Lebenswelt, the lifeworld, the everyday world in which we live in the natural, taken-for-granted attitude. This notion of the lifeworld has become programmatic in the development of a more existentially oriented phenomenology. Existential phenomenology (not to be confused with the life philosophy of existentialism) aims at describing how phenomena present themselves in lived experience, in human existence. Thus, for Heidegger phenomenology is ontology--a study of the modes of "being in the world" of human being. Heidegger's professed aim is to let the things of the world speak for themselves. He asks: What is the nature (Being) of this being? What lets this being be what it is?
Phenomenology differs from the various human science approaches such as ethnography, symbolic interactionism, and ethnomethodology in that phenomenology makes a distinction between appearance and essence. "Phenomenology is the study of essences," says Merleau-Ponty. This means that phenomenology always asks the question of what is the nature or meaning of something. In the "Preface" to his Phenomenology of Perception Merleau-Ponty points out that the work of phenomenology is as painstaking as the work of artists such as Balzac, Proust, Valery, or Cezanne. Phenomenology demands of us re-learning to look at the world as we meet it in immediate experience. And it requires of us "the same demand for awareness and the same will to seize the meaning of the world as that meaning comes into being." In other words, phenomenology does not produce empirical or theoretical observations or accounts. Instead, it offers accounts of experienced space, time, body, and human relation as we live them. In the various disciplines phenomenology has been mobilized to produce a phenomenological sociology (Schutz), phenomenological psycho-therapy or psychiatry (Van den Berg), phenomenological psychology (Merleau-Ponty), etc. In education, phenomenology has been especially productive in the phenomenological pedagogy of Langeveld, Beets, Beekman in the Netherlands, and in the more philosophy of education oriented writings of Greene and Vandenberg in North America. (1)
How does phenomenology contribute to Dermatology?
Phenomenology contributes to dermatology through giving holistic approach to the dermatological patient, which entail diagnostic, therapeutic &pedagogical dimension.
Phenomenology work in all these fields through providing awareness of what it is implicit, what it is taken for granted &trying to make it explicit.
For example patient with atopic dermatitis is in need to more than medical prescription;because they are not having only atopic skin but their world become atopic. Approach to such people must be directed to the whole aspect of disease.
Skin is an intersubjective organ, through it we communicate with other; our embodiment is fulfilled through skin.The other is the mirror through which we see our skin,Dialogue with other conditioned most of the time through skin.
So those with chronic disease need empathetic approach which is just one dimension of the phenomenological method.
We must read empathy in the phenomenological context rather than everyday context which has a limited meaning of pitiness & kindness (emotional aspect of empathy).
Empathy in Husserlian phenomenology is epistemiological, it is a condition for the experience to be intersubjective (objective),that is ,can be verified & reproduced by other .So our understanding of empathy is the window through which we can see the great contribution of Husserlian phenomenology to the human sciences in general & Dermatology in particular.
What is empathy? In Phenomenology, empathy is understood to be a unique kind of direct experience, distinct from other kinds of direct experience such as sense perception (Stein 1964). Empathy and sense perception are distinct because they have different objects and these objects are given to us in different ways. In sense perception we grasp the things of the world, whereas in empathy we grasp experiences other than our own. A person smiles, for example, and we become aware of his joy. The joy is not a perceptual thing, such as a tree in the courtyard or a bird flying across the sky, nor do we experience it as a perceptual thing: "Perception has its object before it in embodied givenness; empathy does not" .We see the face of another; it stands before us in embodied givenness. But the joy of another cannot stand before us in this way; we can be aware of it only in its expression. Nonetheless, empathy, like perception, is a form of direct experience: just as sense perception gives us the worldly thing itself, not a representation of the thing, so empathy gives us the experience of another, not a representation of it. The person’s smile is not a representation of his joy; the joy shows itself in his smile, and we directly grasp the smile as the visible expression or manifestation of his joy.
In sum, empathy is that kind of direct experience in which we directly grasp the experience of another, without undergoing that experience ourselves.
For this reason we are in crucial need for basing not only our dermatology career on phenomenology but also our whole life.
According to Edith Stein’s (1964) important analysis, empathy unfolds as the feeling of being led by another’s experience, and it takes place in three steps. First, the experience emerges before us: "it arises before me all at once; it faces me as an object (such as the sadness I ‘read in another’s face’)." Second, we can inquire into the content of the experience, delving into it in an effort to comprehend it from the person’s point of view. The experience then ceases to face us as an object, for we have become immersed in the effort to clarify and understand its content. Finally, when this clarification is complete, the experience stands before us again, but now in a clarified or explicated way. Thus empathy is not one-dimensional, for "there are various grades of accomplishment possible.(2)
One of the most important reasons that human consciousness is not a private subjective sphere enclosed within the head is that one’s consciousness of oneself as an embodied individual is accomplished in reiterated empathy with another.
This fundamental point is one of the major contributions of Phenomenology to the understanding of human consciousness. Its full explication, however, will take several steps.
To begin we need to go back to the notion of the lived body. When we see another person, we do not perceive his body as a mere physical thing; rather, we grasp it immediately as a lived body like our own. Thus empathy is not simply the grasping of another’s particular experiences (sadness, joy, and so on); on a more fundamental level, it is the experience of another as a being like oneself. This kind of empathy, moreover, is not layered on top of sense perception; it is woven into the fabric of sense perception from the start.(3)
The problem with medical career is reduction of patient to physical being &trying ti identify his problem within this physical world
Husserl revolutionary motto is to go back to the things themselves, which in this case we must be listenting to anything appear to us without trying to classify it conceptually into objective (sign/physical) & subjective (symptom)
The problem here is the superiority of the objective over subjective as that the subjective dimension is elusive, cannot be reproduced.
Meicine must be liberated from such ideology especially that we are living in the postmodern era.
Our approach to the skin disease can be modified phenomenologically through using it as a qualitative research which aimed at revealing the lived experience of the patient to his illness.
There is features characterized qualitatative research:
Qualitative approaches to research are based on a "world view" which is holistic and has the following beliefs:
1. There is not a single reality.
2. Reality based upon perceptions that are different for each person and change over time.
3. What we know has meaning only within a given situation or context.
The reasoning process used in qualitative research involves perceptually putting pieces together to make wholes. From this process meaning is produced. However, because perception varies with the individual, many different meanings are possible(4) .
The broad question that phenomenologists want answered is "What is the meaning of one’s lived experience?" The only reliable source of information to answer this question is the person.
Understanding, human behaviour or experience requires that the person interpret the action or experience for the researcher, and then the researcher must interpret the explanation provided by the person.
Phenomenological reduction & Bracketing (Epoche)
The phenomenological method developed by Edmund Husserl involved an attempt to suspend pre-conceptions. What is most characteristic of the phenomenological approach is the attempt to refrain from pidgeon-holing things. It is an attempt at greater innocence of perception. This means allowing things to, as it were, speak for themselves. This method of inquiry is initially descriptive. It requires a willingness to enter into view-points other than one's own. It requires a suspension of judgement.(5)
Bracketing, also called phenomenological reduction or the epoché, is the other side of the coin. Bracketing means setting aside all our usual, "natural" assumptions about the phenomena. You can't hear it if you are loudly telling it what it is!
Practically speaking, this means we must put aside our biases, prejudices, theories, philosophies, religions, even common sense, and accept the phenomenon for what it is. If therapists brought all their prejudices into the therapy situation with them, they would never be able to understand their clients in all their frustrating uniqueness. The same is true for any phenomenon.
This seems obvious. But the most common bias for psychology students is one actually encouraged by mainstream psychology: that knowledge means measurement, cause-and-effect, and reductionism! So psychologists and their students say that anger is "really" sympathetic nervous system activation, or that blue is "really" certain wavelengths of electromagnetic energy, or that thoughts are "really" just neural activity. Yet these explanations are nowhere to be found in experience!
So bracketing ultimately means a suspension of belief in the existence or non-existence of the phenomenon: We must not be concerned with explanations of what the phenomenon "really" might be.(5)
When the researcher gets ready to attend to his/ her data, the first task is to bracket or in other words suspend his/ her own preconceived ideas of the phenomenon under study. This bracketing helps him/ her to enter as much as possible into the world of the informants.
Traditional methods -- e.g. experimentation -- begin long before they seem to: You derive a hypothesis from your favorite theory and expect it to hold up; you define your variables operationally, i.e. in terms of what you intend to manipulate and measure; you control other variables, either physically in the lab, or statistically with a nice big "n"; you choose a statistical device to decide the significance of the results for you.... It's sort of like declaring war on your topic!
This is in contrast to phenomenology, which instructs us to allow the phenomenon to reveal itself in its fullness. You "look" at it from all perspectives, using all your senses, even attending to your thoughts and feelings. Phenomenologist say that phenomena are apodictic, which means the "speak for themselves" -- which means in turn that we should be prepared to listen! (5)
Phenomenological reduction is our door to phenomenal world of others (how things is given to him) so it is logically proceeds emergence of the empathetic ego (attitude).
We can understand why patient with acne thinking in committing suicide, why they are anger, why they are not compliant ,we can know how make them be confident in our approach to their condition if the fell that we not just external observer ,we are sharing them their phenomenal world (their perception of their illness).
This lead us to the science of interpretation &understanding which is called hermeneutic which deals with the patient as atext .
Hermeneutics is traditionally defined as the practice and theory of interpretation. With this rather general definition it is understandable that the practice of hermeneutics can be applied to a variety of fields -- ranging from biblical and legal fields to medicine and economics. Examining interpretations of medicine one can see at work many hermeneutical concepts that are traditionally applied to classical hermeneutical subjects. Leder views medicine as a subjective, practical science. In order to stress the fact that medicine is subjective, Leder goes as far as to say that medicine is subjective whether or not it is seen as a natural or a practical science. Leder feels that all science is subjective because all interpretation is subjective. The so-called objective facts that scientists collect are not objective at all, but rather they are "preshaped" by the theories that scientists have, and the theories themselves are preshaped by the values, cultural, and societal aspects that the scientist is exposed to. So, even though there is debate about whether medicine is a natural or a practical science, there should be no debate about the fact that it is a subjective science. (Leder, 1990, p. 9). Through a hermeneutical description of the clinical interaction between a patient and a doctor, Leder demonstrates the subjectivity of medicine. There are several texts to be interpreted in the medical process. The primary text is the patient, not the disease or the set of organs, but the whole of the patient, including personality, life history, and concerns (see the notion of holistic interpretation, below). It is the primary text that determines the ultimate treatment. There are also several secondary texts that further expand upon the primary text. The secondary texts are included in the clinical examination. They are the experiential text, the narrative text, the physical text, and the instrumental text. (Leder, 1990, p. 11). Leder summarizes what Husserl intended to say through his phenomenological work.
Partial and Holistic Interpretations
The purpose of medicine is to achieve an understanding of human well-being, and through that understanding to be able to distinguish between states of illness and health (Gatens-Robinson, 1986, p. 171). Modern medicine, however, seems to focus on treatment of the disease rather than treatment of the person who has the disease. Through a hermeneutical approach to medicine, viewing the disease as only a part of a more complex whole, one can hope to create a situation in which the physician can understand the individual person, what it means for them to be healthy, and what it means for them to be sick, and therefore focus on treatment of the person. Through treatment of the person, one can ideally return the person back to their prior state of health.
For a physician to be able to diagnose each particular manifestation of illness that he is faced with every day, he must have at his disposal basic scientific knowledge of the way the body functions, and what it means to be sick. He must also have prior exposure to similar scenarios that he can use as a basis for interpretation of each new scenario. In other words, the background that the physician must have in order to accurately interpret a patient includes medical education and experience. (Gatens-Robinson, 1986, 1986, p. 174) If the physician is to interpret the patient as he or she would a text, the physician must recognize that just as words have particular meaning within a particular context, the patient's symptoms have a particular meaning within the framework of the patient's lifestyle, history, and situation. In addition to the patient's symptoms, the physician has several tools at his disposal in order to properly diagnose and treat a patient. Through the use of a physical exam, and several diagnostic tools such as blood tests, x-rays, EKG, etc, the physician is able to gather a store of information that he must interpret with the patient's particular background in mind.
Such a hermeneutical approach to medicine is particularly useful given the fact that each disease state has a wide range of symptoms, and no patient will exhibit all symptoms, or exhibit symptoms to the same degree. Two patients with the same disease may exhibit completely different symptoms, which may make diagnosis very difficult. A good physician, however, knows that there is more to a disease then merely the symptoms. Through a careful study of all of the symptoms, as well as the situation, lifestyle, and history of the patients, a good physician will be able to accurately diagnose both patients. He can do so not only because he carefully listened to and communicated with each patient, but also because he has knowledge and experience.
The relationship between a physician and a patient should be one in which there is mutual communication. The model for patient/physician communication is very similar to Gadamer's Dialogical Model. Gadamer believes that just as the interpreter imposes meaning onto the text, the text imposes its meaning onto the interpreter, and in this way, the truth is discovered. He also believes that the interpreter is influenced by his background, including culture, traditions, language, and practical interests, and that the text is influenced by its historical context and by the author. Similarly, the doctor must impose meaning on the patient's symptoms and prescribe treatment based on his diagnosis. The patient then provides feedback to the physician either by getting better or worse. The physician must then respond, either by continuing with a treatment that is working, or trying a different treatment if the original is found to be ineffective. The treatment may be ineffective simply because it is not suitable to the particular patient, or because the diagnosis is incorrect, and the patient does not have the disease that he is being treated for. If this is the case, the physician must re-assess the situation. It may take more then one try, but it is in this process that the physician discovers what particular disease the patient has. At the same time, the physicians background (education, experience) and the patients background (history, lifestyle, situation) influence the physician and the patient respectively. So a complete understanding of the patient is not discovered immediately upon diagnosis, but understanding grows out of the process of treatment as the disease state of the patient is eventually confirmed. (6)
Phenomenology makes listening & dialogue possible in any domain of our life.This article is just highlighting the importance of phenomenology rather being an exhaustive analysis of its application which need an encyclopedic work.
References
1- Max van Manen.www.phenomenology online.com.
2- Stein, E. 1964. On the Problem of Empathy. trans. Waltraut Stein. The Hague: Martinus Nijhoff
3-Varela, F.J., Thompson, E. & Rosch, E. 1991. The Embodied Mind: Cognitive Science and Human Experience. Cambridge, MA: The MIT Press.
4- Burns & Grove (1993) The Practice of Nursing Research: Conduct, Critique & Utilization 2nd Edition
5- C.George Boeree. http://www.ship.edu/~cgboeree/qualmeth.html
6- http://www.philosophy.ucf.edu/ahmed.html#patient
Dermatologist & physician in general used to give significance to only one type of researches which satisfying their statistical model (quantitative).
This mathematization of medical research made the lived body absent from the picture; Quantitative way of thinking made us not ready to hear the patient attitude of his experience of illness & the way the disease changing their life quality. This subordination of the subjective aspect of the medical experience stimulates me to highlight the importance of subjectivity in medical career for both doctor/nurse & the patient through using Husserlian phenomenology.
Phenomenology is the study of phenomena, the way things appear to us in genuine experience or consciousness. Kant already used the term to distinguish between the study of objects and events (phenomena) as they appear in our experience and objects and events as they are in themselves (noumena). Hegel used the term "phenomenology" to describe the science in which we come to know mind as it is in itself through the study of the ways in which it appears to us. However,only with Husserl phenomenology became a full-fledged descriptive method as well as a human science movement based on modes of reflection at the heart of philosophic and human science thought.
For Husserl phenomenology is a discipline that endeavors to describe how the world is constituted and experienced through conscious acts. His phrase Zu den Sachen means both "to the things themselves" and "let's get down to what matters!" Phenomenology must describe what is given to us in immediate experience without being obstructed (mediated) by pre-conceptions and theoretical notions. Husserl developed a transcendental or constitutive phenomenology. But in his last major work The Crisis of European Sciences and Transcendental Phenomenology, he formulated the notion of the Lebenswelt, the lifeworld, the everyday world in which we live in the natural, taken-for-granted attitude. This notion of the lifeworld has become programmatic in the development of a more existentially oriented phenomenology. Existential phenomenology (not to be confused with the life philosophy of existentialism) aims at describing how phenomena present themselves in lived experience, in human existence. Thus, for Heidegger phenomenology is ontology--a study of the modes of "being in the world" of human being. Heidegger's professed aim is to let the things of the world speak for themselves. He asks: What is the nature (Being) of this being? What lets this being be what it is?
Phenomenology differs from the various human science approaches such as ethnography, symbolic interactionism, and ethnomethodology in that phenomenology makes a distinction between appearance and essence. "Phenomenology is the study of essences," says Merleau-Ponty. This means that phenomenology always asks the question of what is the nature or meaning of something. In the "Preface" to his Phenomenology of Perception Merleau-Ponty points out that the work of phenomenology is as painstaking as the work of artists such as Balzac, Proust, Valery, or Cezanne. Phenomenology demands of us re-learning to look at the world as we meet it in immediate experience. And it requires of us "the same demand for awareness and the same will to seize the meaning of the world as that meaning comes into being." In other words, phenomenology does not produce empirical or theoretical observations or accounts. Instead, it offers accounts of experienced space, time, body, and human relation as we live them. In the various disciplines phenomenology has been mobilized to produce a phenomenological sociology (Schutz), phenomenological psycho-therapy or psychiatry (Van den Berg), phenomenological psychology (Merleau-Ponty), etc. In education, phenomenology has been especially productive in the phenomenological pedagogy of Langeveld, Beets, Beekman in the Netherlands, and in the more philosophy of education oriented writings of Greene and Vandenberg in North America. (1)
How does phenomenology contribute to Dermatology?
Phenomenology contributes to dermatology through giving holistic approach to the dermatological patient, which entail diagnostic, therapeutic &pedagogical dimension.
Phenomenology work in all these fields through providing awareness of what it is implicit, what it is taken for granted &trying to make it explicit.
For example patient with atopic dermatitis is in need to more than medical prescription;because they are not having only atopic skin but their world become atopic. Approach to such people must be directed to the whole aspect of disease.
Skin is an intersubjective organ, through it we communicate with other; our embodiment is fulfilled through skin.The other is the mirror through which we see our skin,Dialogue with other conditioned most of the time through skin.
So those with chronic disease need empathetic approach which is just one dimension of the phenomenological method.
We must read empathy in the phenomenological context rather than everyday context which has a limited meaning of pitiness & kindness (emotional aspect of empathy).
Empathy in Husserlian phenomenology is epistemiological, it is a condition for the experience to be intersubjective (objective),that is ,can be verified & reproduced by other .So our understanding of empathy is the window through which we can see the great contribution of Husserlian phenomenology to the human sciences in general & Dermatology in particular.
What is empathy? In Phenomenology, empathy is understood to be a unique kind of direct experience, distinct from other kinds of direct experience such as sense perception (Stein 1964). Empathy and sense perception are distinct because they have different objects and these objects are given to us in different ways. In sense perception we grasp the things of the world, whereas in empathy we grasp experiences other than our own. A person smiles, for example, and we become aware of his joy. The joy is not a perceptual thing, such as a tree in the courtyard or a bird flying across the sky, nor do we experience it as a perceptual thing: "Perception has its object before it in embodied givenness; empathy does not" .We see the face of another; it stands before us in embodied givenness. But the joy of another cannot stand before us in this way; we can be aware of it only in its expression. Nonetheless, empathy, like perception, is a form of direct experience: just as sense perception gives us the worldly thing itself, not a representation of the thing, so empathy gives us the experience of another, not a representation of it. The person’s smile is not a representation of his joy; the joy shows itself in his smile, and we directly grasp the smile as the visible expression or manifestation of his joy.
In sum, empathy is that kind of direct experience in which we directly grasp the experience of another, without undergoing that experience ourselves.
For this reason we are in crucial need for basing not only our dermatology career on phenomenology but also our whole life.
According to Edith Stein’s (1964) important analysis, empathy unfolds as the feeling of being led by another’s experience, and it takes place in three steps. First, the experience emerges before us: "it arises before me all at once; it faces me as an object (such as the sadness I ‘read in another’s face’)." Second, we can inquire into the content of the experience, delving into it in an effort to comprehend it from the person’s point of view. The experience then ceases to face us as an object, for we have become immersed in the effort to clarify and understand its content. Finally, when this clarification is complete, the experience stands before us again, but now in a clarified or explicated way. Thus empathy is not one-dimensional, for "there are various grades of accomplishment possible.(2)
One of the most important reasons that human consciousness is not a private subjective sphere enclosed within the head is that one’s consciousness of oneself as an embodied individual is accomplished in reiterated empathy with another.
This fundamental point is one of the major contributions of Phenomenology to the understanding of human consciousness. Its full explication, however, will take several steps.
To begin we need to go back to the notion of the lived body. When we see another person, we do not perceive his body as a mere physical thing; rather, we grasp it immediately as a lived body like our own. Thus empathy is not simply the grasping of another’s particular experiences (sadness, joy, and so on); on a more fundamental level, it is the experience of another as a being like oneself. This kind of empathy, moreover, is not layered on top of sense perception; it is woven into the fabric of sense perception from the start.(3)
The problem with medical career is reduction of patient to physical being &trying ti identify his problem within this physical world
Husserl revolutionary motto is to go back to the things themselves, which in this case we must be listenting to anything appear to us without trying to classify it conceptually into objective (sign/physical) & subjective (symptom)
The problem here is the superiority of the objective over subjective as that the subjective dimension is elusive, cannot be reproduced.
Meicine must be liberated from such ideology especially that we are living in the postmodern era.
Our approach to the skin disease can be modified phenomenologically through using it as a qualitative research which aimed at revealing the lived experience of the patient to his illness.
There is features characterized qualitatative research:
Qualitative approaches to research are based on a "world view" which is holistic and has the following beliefs:
1. There is not a single reality.
2. Reality based upon perceptions that are different for each person and change over time.
3. What we know has meaning only within a given situation or context.
The reasoning process used in qualitative research involves perceptually putting pieces together to make wholes. From this process meaning is produced. However, because perception varies with the individual, many different meanings are possible(4) .
The broad question that phenomenologists want answered is "What is the meaning of one’s lived experience?" The only reliable source of information to answer this question is the person.
Understanding, human behaviour or experience requires that the person interpret the action or experience for the researcher, and then the researcher must interpret the explanation provided by the person.
Phenomenological reduction & Bracketing (Epoche)
The phenomenological method developed by Edmund Husserl involved an attempt to suspend pre-conceptions. What is most characteristic of the phenomenological approach is the attempt to refrain from pidgeon-holing things. It is an attempt at greater innocence of perception. This means allowing things to, as it were, speak for themselves. This method of inquiry is initially descriptive. It requires a willingness to enter into view-points other than one's own. It requires a suspension of judgement.(5)
Bracketing, also called phenomenological reduction or the epoché, is the other side of the coin. Bracketing means setting aside all our usual, "natural" assumptions about the phenomena. You can't hear it if you are loudly telling it what it is!
Practically speaking, this means we must put aside our biases, prejudices, theories, philosophies, religions, even common sense, and accept the phenomenon for what it is. If therapists brought all their prejudices into the therapy situation with them, they would never be able to understand their clients in all their frustrating uniqueness. The same is true for any phenomenon.
This seems obvious. But the most common bias for psychology students is one actually encouraged by mainstream psychology: that knowledge means measurement, cause-and-effect, and reductionism! So psychologists and their students say that anger is "really" sympathetic nervous system activation, or that blue is "really" certain wavelengths of electromagnetic energy, or that thoughts are "really" just neural activity. Yet these explanations are nowhere to be found in experience!
So bracketing ultimately means a suspension of belief in the existence or non-existence of the phenomenon: We must not be concerned with explanations of what the phenomenon "really" might be.(5)
When the researcher gets ready to attend to his/ her data, the first task is to bracket or in other words suspend his/ her own preconceived ideas of the phenomenon under study. This bracketing helps him/ her to enter as much as possible into the world of the informants.
Traditional methods -- e.g. experimentation -- begin long before they seem to: You derive a hypothesis from your favorite theory and expect it to hold up; you define your variables operationally, i.e. in terms of what you intend to manipulate and measure; you control other variables, either physically in the lab, or statistically with a nice big "n"; you choose a statistical device to decide the significance of the results for you.... It's sort of like declaring war on your topic!
This is in contrast to phenomenology, which instructs us to allow the phenomenon to reveal itself in its fullness. You "look" at it from all perspectives, using all your senses, even attending to your thoughts and feelings. Phenomenologist say that phenomena are apodictic, which means the "speak for themselves" -- which means in turn that we should be prepared to listen! (5)
Phenomenological reduction is our door to phenomenal world of others (how things is given to him) so it is logically proceeds emergence of the empathetic ego (attitude).
We can understand why patient with acne thinking in committing suicide, why they are anger, why they are not compliant ,we can know how make them be confident in our approach to their condition if the fell that we not just external observer ,we are sharing them their phenomenal world (their perception of their illness).
This lead us to the science of interpretation &understanding which is called hermeneutic which deals with the patient as atext .
Hermeneutics is traditionally defined as the practice and theory of interpretation. With this rather general definition it is understandable that the practice of hermeneutics can be applied to a variety of fields -- ranging from biblical and legal fields to medicine and economics. Examining interpretations of medicine one can see at work many hermeneutical concepts that are traditionally applied to classical hermeneutical subjects. Leder views medicine as a subjective, practical science. In order to stress the fact that medicine is subjective, Leder goes as far as to say that medicine is subjective whether or not it is seen as a natural or a practical science. Leder feels that all science is subjective because all interpretation is subjective. The so-called objective facts that scientists collect are not objective at all, but rather they are "preshaped" by the theories that scientists have, and the theories themselves are preshaped by the values, cultural, and societal aspects that the scientist is exposed to. So, even though there is debate about whether medicine is a natural or a practical science, there should be no debate about the fact that it is a subjective science. (Leder, 1990, p. 9). Through a hermeneutical description of the clinical interaction between a patient and a doctor, Leder demonstrates the subjectivity of medicine. There are several texts to be interpreted in the medical process. The primary text is the patient, not the disease or the set of organs, but the whole of the patient, including personality, life history, and concerns (see the notion of holistic interpretation, below). It is the primary text that determines the ultimate treatment. There are also several secondary texts that further expand upon the primary text. The secondary texts are included in the clinical examination. They are the experiential text, the narrative text, the physical text, and the instrumental text. (Leder, 1990, p. 11). Leder summarizes what Husserl intended to say through his phenomenological work.
Partial and Holistic Interpretations
The purpose of medicine is to achieve an understanding of human well-being, and through that understanding to be able to distinguish between states of illness and health (Gatens-Robinson, 1986, p. 171). Modern medicine, however, seems to focus on treatment of the disease rather than treatment of the person who has the disease. Through a hermeneutical approach to medicine, viewing the disease as only a part of a more complex whole, one can hope to create a situation in which the physician can understand the individual person, what it means for them to be healthy, and what it means for them to be sick, and therefore focus on treatment of the person. Through treatment of the person, one can ideally return the person back to their prior state of health.
For a physician to be able to diagnose each particular manifestation of illness that he is faced with every day, he must have at his disposal basic scientific knowledge of the way the body functions, and what it means to be sick. He must also have prior exposure to similar scenarios that he can use as a basis for interpretation of each new scenario. In other words, the background that the physician must have in order to accurately interpret a patient includes medical education and experience. (Gatens-Robinson, 1986, 1986, p. 174) If the physician is to interpret the patient as he or she would a text, the physician must recognize that just as words have particular meaning within a particular context, the patient's symptoms have a particular meaning within the framework of the patient's lifestyle, history, and situation. In addition to the patient's symptoms, the physician has several tools at his disposal in order to properly diagnose and treat a patient. Through the use of a physical exam, and several diagnostic tools such as blood tests, x-rays, EKG, etc, the physician is able to gather a store of information that he must interpret with the patient's particular background in mind.
Such a hermeneutical approach to medicine is particularly useful given the fact that each disease state has a wide range of symptoms, and no patient will exhibit all symptoms, or exhibit symptoms to the same degree. Two patients with the same disease may exhibit completely different symptoms, which may make diagnosis very difficult. A good physician, however, knows that there is more to a disease then merely the symptoms. Through a careful study of all of the symptoms, as well as the situation, lifestyle, and history of the patients, a good physician will be able to accurately diagnose both patients. He can do so not only because he carefully listened to and communicated with each patient, but also because he has knowledge and experience.
The relationship between a physician and a patient should be one in which there is mutual communication. The model for patient/physician communication is very similar to Gadamer's Dialogical Model. Gadamer believes that just as the interpreter imposes meaning onto the text, the text imposes its meaning onto the interpreter, and in this way, the truth is discovered. He also believes that the interpreter is influenced by his background, including culture, traditions, language, and practical interests, and that the text is influenced by its historical context and by the author. Similarly, the doctor must impose meaning on the patient's symptoms and prescribe treatment based on his diagnosis. The patient then provides feedback to the physician either by getting better or worse. The physician must then respond, either by continuing with a treatment that is working, or trying a different treatment if the original is found to be ineffective. The treatment may be ineffective simply because it is not suitable to the particular patient, or because the diagnosis is incorrect, and the patient does not have the disease that he is being treated for. If this is the case, the physician must re-assess the situation. It may take more then one try, but it is in this process that the physician discovers what particular disease the patient has. At the same time, the physicians background (education, experience) and the patients background (history, lifestyle, situation) influence the physician and the patient respectively. So a complete understanding of the patient is not discovered immediately upon diagnosis, but understanding grows out of the process of treatment as the disease state of the patient is eventually confirmed. (6)
Phenomenology makes listening & dialogue possible in any domain of our life.This article is just highlighting the importance of phenomenology rather being an exhaustive analysis of its application which need an encyclopedic work.
References
1- Max van Manen.www.phenomenology online.com.
2- Stein, E. 1964. On the Problem of Empathy. trans. Waltraut Stein. The Hague: Martinus Nijhoff
3-Varela, F.J., Thompson, E. & Rosch, E. 1991. The Embodied Mind: Cognitive Science and Human Experience. Cambridge, MA: The MIT Press.
4- Burns & Grove (1993) The Practice of Nursing Research: Conduct, Critique & Utilization 2nd Edition
5- C.George Boeree. http://www.ship.edu/~cgboeree/qualmeth.html
6- http://www.philosophy.ucf.edu/ahmed.html#patient
posted by Ali Tareq @ 10:16 AM
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