Download Karin Dahlberg

Paper to be presented at 5th Central and Eastern European Conference on
Phenomenology “Corporeity and affectivity”, in celebration of
Merleau-Ponty’s 100th birthday
Prague September 28th - October 2nd, 2008
The relevance of Merleau-Ponty's philosophy for the understanding of
health and health science methodology
by
Karin Dahlberg, professor
and
Martina Summer Meranius, doctoral student
School of Health Sciences
Växjö University, Sweden
The lifeworld – a phenomenal field
Merleau-Ponty took seriously upon the oft-repeated idea and Husserlian
motto in phenomenological philosophy to go to the things themselves. For
him, and for phenomenology, things are things of experience. The idea of
going to the things themselves means to do full justice to the lived
experience, e.g. the everyday experience (Husserl, 1970; Merleau-Ponty,
1995). This idea includes the aim to approach the world as it is experienced
in all its variety, without avoiding the complexities.
Husserl’s lifeworld theory came into full blooming by Merleau-Ponty and
became a lifeworld phenomenology. He expresses the idea of lifeworld as
our being to the world, and the lifeworld is a world of perception.
Accordingly, for Merleau-Ponty, the awareness and understanding of the
lifeworld is a necessary condition for knowledge. In his famous preface he
says that the lifeworld precedes knowledge.
Perception is not a science of the world, it is not even an act,
a deliberate taking up of position; it is the background from
which all acts stand out, and is presupposed by them. (1995, x)
It is clear, that for Merleau-Ponty we can never escape the lifeworld, the
complex, qualitative and lived reality that is there for us whatever we do. We
live in and through a “phenomenal field”, a phrase that suggests how the
world we investigate has two faces: we judge the world in relation to our
experience of it, and at the same time the world or an object of the world is
present, even if we are not aware of it at the moment. It is there whether or
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not we experience it. And it is present, as lifeworld, already when
researchers or other professionals start to think and to carry out their work.
The lifeworld is thus pre-scientific, pre-theoretical and pre-reflective.
This is of crucial importance for the health sciences. The notions of the
phenomenal field and lifeworld add something vital to this scientific arena,
which for so many years has been dominated by medicine. The apt for
mathematics and statistical measurements has urged medicine to divide and
categorise the living human existence into separate entities such as body and
soul, outer and inner, physical treatments and psychological ones. All the
complexity of human suffering is neatly organised in diagnoses, mostly
accompanied by drug prescriptions. This in combination with the
technological approach of medicine has clearly divided the people in health
care in two groups: the experts who are the professionals and the patients
who are the passive receivers of care.
In the health science research that is based in phenomenological ontology,
epistemology and methodology we can see that the briefly described medical
understanding of human existence and its health care consequences are
neither true nor good. Human existence is much more complex, not least
when people are ill, than any diagnosis can cover. In our project we
interviewed old patients who are labelled “multi-morbidity” by medicine. In
our preliminary results we have found that it is not the many diagnoses or the
many illnesses and their inherent order that is their problem. The core of
their suffering is their struggle not to let illness take over and dominating
their everyday life. This struggle seems to be more sever due to the doctors’
approach. Our interviewees explain how doctors give them advices that are
related to each diagnosis, with the results that their patients get contradictory
advices. One example is a woman with heart problems as well as
rheumatism. The cardiologist told her to rest but the rheumatologist said she
had to be active. As a result she felt abandoned, her health situation became
unsure and unsafe, and she didn’t know how to deal with her life when she
felt tired and stiff.
This leads us over to the next section.
The lived body
A main contribution by Merleau-Ponty to the lifeworld theory was his
notions of the body as lived. In phenomenology we don’t have to deny that
we are of biology, but without understanding that the body is lived, health
sciences fall short.
The lifeworld is for Merleau-Ponty the lived world. It is the world we have
access to through our bodies. As he expresses it (1995), “I am to the world as
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body”. Referring back to the woman we just heard of one can say that a tired
and stiff body likely gives access to a tired and stiff life.
It would be difficult to overstate the centrality of the subjective and lived
body in Merleau-Ponty’s understanding of the human world. The human
body can never be understood merely as an object that can be moved around
the room in the same way as furniture and other things1. The body as lived is
distinguishable from other objects in that we can turn away from the latter
whereas we can never turn away from the body2.
Instead, the body is constantly perceived and constantly perceiving. It is
through the body and the bodily experiences that the surrounding world
becomes meaningful for us. It is the body that gives us a world in the first
place, being “our means of communication with it” (1995, p. 92). We can
never free ourselves from this embodiment, never come away from or stand
outside ourselves as subjective bodies, but constantly let the body root us in
the world. The bodily connection is generally both meaningful and coherent.
In Merleau-Ponty’s words, our body is “a nexus of living meanings” (p.
151).
In short, the “body is our anchorage” (p. 144) in the world. As long as we
live we have a world and the reason for that is the fact that we are subjective
bodies. The lived body provides one with a home in the world and in its
existence it emphasizes the mutuality between humans and the world. This
mutuality is very concrete in the embrace (Smith, 2006). One can embrace
another person, and “one can embrace an idea, a religion, some change,
literature, a new way of living, and so on, and one can in turn be embraced
by events and spaces that, for some, carry sacred value” (p. 2). MerleauPonty would have said that when you embrace the world, the world
embraces you back. Through the embrace, and the touch, there is a sense of
connection, with the world, with everything that is.
As lived bodies and through our lifeworlds we belong to the world of
“flesh”3, which means an ontological connectedness and mutuality. All of us,
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“If my arm is resting on the table I should never think of saying that it
is beside the ash-tray in the way in which the ash-tray is beside the
telephone” (Merleau-Ponty, 1995, p. 98).
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“To say that it [the body] is always near me, always there for me, is
to say that it is never really in front of me, that I can not array
it before my eyes, that it remains marginal to all my perceptions,
that it is with me” (Merleau-Ponty, 1995, p. 90).
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[W]hen I reflect on the essence of subjectivity, I find it
bound up with that of the body and that of the world, this is
because my existence as subjectivity is merely one with my
existence as a body and with the existence of the world, and
because the subject that I am, when taken concretely, is
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all our experiences, all my thoughts, your thoughts “and the thoughts of
others are caught up in the fabric of one sole being”, Merleau-Ponty (1968, p
110) states. Because we belong to the same world, Merleau-Ponty seems to
suggest that we are in one way or another connected with everything and
everyone. Our very own behaviour, our personal actions and our individual
ways of being are all a result of our own personal room in the world, which
can be described as one’s own entry to a common and shared world. This
being, the flesh of the world, which underlies and sustains the differences
represented by individual beings, is as a background very much present in
what is and what happens, but at the same time it is “silent” and “invisible”.
These ontological insights cannot be neglected if we want to understand how
it is to be old and ill in some ways. These people, as we all, want to embrace
the world and be embraced back, but their illnesses, and not least the
treatments, alienate them from others’ vibrating world of existence. To be
given this bunch of diagnoses tells the world that one is different and does
not belong. The modern health care adds weight to the burden.
One characteristic meaning of suffering in this context is to find oneself
being reduced to a body-object. One example from our research can illustrate
this: A woman with chronic heart failure has been advised not to lift her
arms above the head level. However, once coming home from grocery
shopping she wants to put her articles into the kitchen cupboards and fridge,
and she cannot wait until the home care personnel shows up, for one thing
she never knows for sure what time they come. What she does is that she
lifts and carries and stows her things in to the right places – but without
saying anything. She plays a game with the unknowing carers, covering up
her real existence with a show-up. This is the worst part of her being ill, she
says, it is worse than being ill in the first place. This acting is called noncompliance by medicine. In fact, it is her way to master her existence. In
particular, the cheating is her response to the health care approach, which
makes a split between her body as object and body as subject. It is her
response to a form of health care that tries to separate her out from a living
existence.
Health science methodology
This project is part of the research carried out at the Centre for Lifeworld
Research, the School of Health Sciences at Växjö University, in the south of
Sweden. Our research and research education is epistemologically built upon
inseparable from this body and this world. The ontological world
and body which we find at the core of the subject are not the
world or body as idea, but on the one hand the world itself
contracted into a comprehensive grasp, and on the other the body
itself as a knowing-body. (1995, p. 408)
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continental philosophy, and especially the phenomenology by Husserl,
Heidegger, Gadamer, and – most important – the phenomenology of
Merleau-Ponty. In such research approach we have found the guiding
methodology that we need to be enough open for the lifeworlds of patients in
health care, their suffering and their well-being. In particular, we have found
substance in “the philosophy of the flesh” by Merleau-Ponty. The
epistemology of his philosophy gives us to understand that it is never either or, but always both - and. He has clearly shown how all lived meanings and
nuances are intertwined, and if we are to separate anything from anything
else, we have to relate the one to the other by way of figure and background.
The whole is always a gestalt: a gestalt that is momentarily stable, but that
shifts over time and with place.
To openly meet and illuminate lifeworld phenomena and their meanings we
try to use different methods. In the project with people with several illnesses
we have practised interviews. Inspired by Merleau-Ponty we want to give
room for a corporeal field. The reciprocity of intercorporeal communication,
or “carnal intersubjectivity”, as Merleau-Ponty (1987), also calls it, is not:
… by a mind to a mind, but by a being who has body and language
to a being who has body and language, each drawing the other by
invisible threads like those who hold the marionettes – making
the other speak, think, and become what he is but never would
have been by himself. (p. 19)
When we are open to phenomena and their wealth of meanings we see their
particularity, what makes them unique. Seeing the unique requires an ease with
complexity and in order to understand the world we have to pay attention to the
actual, lived reality, and especially its internal dialectic and many-sidedness, its
dimensions and layers. However, the phenomenological interest in particularity
does not exclude an interest in generality, which is also a phenomenological idea.
Particularity and generality, uniqueness and sameness, is a natural paradox
within being and of the lifeworld, and consequently also of lifeworld
research. As humans we are at once both unique and irreducible, and similar
to others with whom we share consensus about the lifeworld. Uniqueness is
irretrievably coupled with sameness; humans are at once both much more
alike than different and, singularly, us. We share sameness insofar as we all
exist as humans having lifeworlds, being part of the same world, the same
“flesh”, but we are unique through our choices about how to live that
existence and see meanings of it (cf. Merleau-Ponty, 1968, 1995; Sartre,
1998).
In phenomenological research, we prefer generality in our results
descriptions in the form of essences, i.e. structures of meaning.
“Phenomenology is the study of essences”, Merleau-Ponty (1995, vii) says,
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again in his famous preface to Phenomenology of perception. Essences
belong to the world that is “already there” (ibid.); they belong “already” to
the lifeworld and the everyday manner of which we live our lives,
researchers or not. He further argues that matter is “pregnant” with its form
… (Merleau-Ponty 1964a, p. 12). Consequently, essences are not something
that we as researchers explicitly add to the research. They are there already,
in the intentional relationship between the phenomena and us.
Merleau-Ponty also teaches us that all essences are open, infinite and
expandable and they are never completely explored and described. Meaning
emerges in relation to “events” of the lifeworld, and when the lifeworld
changes, meaning changes as well.
In conclusion, we want to argue that thanks to phenomenology in general
and Merleau-Ponty in particular health sciences can be an important
complement to the science of medicine. His philosophically well grounded
and thoroughly worked through ontology serves as a spotlight on the human
existence when it is stricken by ill health. Accordingly, the
phenomenological epistemology of Merleau-Ponty gives us the foundation
necessary to build a strong methodology with which we can develop health
sciences research that is understood as valid.
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