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作为在世界中无家可归之存在的疾病:海德格尔与医学现象学

Illness as unhomelike being-in-the-world: Heidegger and the phenomenology of medicine.

作者信息

Svenaeus Fredrik

机构信息

Centre for Studies in Practical Knowledge, Department of Philosophy, Södertörn University, Huddinge, Sweden.

出版信息

Med Health Care Philos. 2011 Aug;14(3):333-43. doi: 10.1007/s11019-010-9301-0.

Abstract

In this paper, an attempt is made to develop an understanding of the essence of illness based on a reading of Martin Heidegger's pivotal work Being and Time. The hypothesis put forward is that a phenomenology of illness can be carried out through highlighting the concept of otherness in relation to meaningfulness. Otherness is to be understood here as a foreignness that permeates the ill life when the lived body takes on alien qualities. A further specification of this kind of otherness can be found with the concept of unhomelike being-in-the-world. Health, in contrast to this frustrating unhomelikeness, is a homelike being-in-the-world in which the lived body in most cases has a transparent quality as the point of access to the world in understanding activities. The paper then proposes that the temporal structure of illness can be conceptualised as an alienation of past and future, whereby one's past and future appear alien, compared with what was the case before the onset of illness. The remainder of the paper follows two paths as regards the temporality of illness. The first path explores the temporality of the body in relation to the temporality of the being-in-the-world of the self. One way of understanding the alienating character of illness is that nature, as the temporality of our bodies, ceases to obey our attempts to make sense of phenomena: the time of the body no longer fits into the time of the self. The second path explored in the paper is that of narrativity. When we make sense of the present, in relation to our future and past, we do so in a special manner, namely, by structuring our experiences in the form of stories. Illness breaks in on us as a rift in these stories, necessitating a retelling of the past and a re-envisioning of the future in an effort to address and change their alienated character. These stories, however, never allow us to leave the silent otherness of our bodies behind. They are stories nurtured by the time of nature at the heart of our existence. It is then claimed that the idea of life's being a story must be understood in a metaphorical sense, and an exploration of how phenomenology addresses the metaphoric quality of its conceptuality is ushered in. It is pointed out that metaphors can be systematically related to each other and that they always have a founding ground in the orientation and basic activities of the lived body. Therefore, if the concepts used in working out a phenomenological theory of health and illness are, to a certain extent, metaphorical, one could, nevertheless, claim that the metaphoric qualities of the phenomenological concepts are primary in referring back to the lived body and the way it inhabits the world.

摘要

在本文中,我们尝试通过研读马丁·海德格尔的关键著作《存在与时间》来深入理解疾病的本质。提出的假设是,通过突出与意义相关的他者概念,可以开展一种疾病现象学。这里的他者应被理解为一种异己性,当身体呈现出陌生特质时,这种异己性便会渗透到患病生活中。这种他者性的进一步具体阐释可以在“在世的非本真状态”这一概念中找到。与这种令人沮丧的非本真状态相反,健康是一种本真的在世状态,在其中,身体在大多数情况下具有透明特质,成为理解活动中通达世界的切入点。然后,本文提出疾病的时间结构可以被概念化为过去与未来的异化,即与疾病发作前的情况相比,一个人的过去和未来显得陌生。本文其余部分就疾病的时间性沿着两条路径展开。第一条路径探讨身体的时间性与自我在世的时间性之间的关系。理解疾病异化特征的一种方式是,作为我们身体时间性的自然不再听从我们对现象进行理解的尝试:身体的时间不再与自我的时间相契合。本文探讨的第二条路径是叙事性路径。当我们参照自己的未来和过去来理解当下时,我们是以一种特殊的方式进行的,即通过将我们的经历构建成故事的形式。疾病像这些故事中的一道裂痕闯入我们的生活,这就需要我们重新讲述过去并重新构想未来,以应对并改变它们的异化特征。然而,这些故事永远无法让我们摆脱身体的沉默他者性。它们是由我们存在核心处的自然时间孕育而成的故事。接着有人主张,必须从隐喻的意义上去理解生命是一个故事这一观点,并由此引入对现象学如何处理其概念隐喻性的探讨。有人指出,隐喻之间可以系统地相互关联,而且它们总是在身体的定向和基本活动中有其基础。因此,如果在构建健康与疾病的现象学理论时所使用的概念在一定程度上是隐喻性的,那么我们仍然可以宣称现象学概念的隐喻特质在回溯到身体及其在世方式方面是首要的。

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