Do Technologies Make Us “Posthuman”?
Do technologies advance our self-identities, as they do our bodies, cognitive skills, and the next developmental stage called postpersonal? Did we already manage to be fully human, before becoming posthuman? Are we doomed to disintegration and episodic selfhood? This book examines the impact of radical technopoiesis on our selves from a multidisciplinary perspective, including the health humanities, phenomenology, the life sciences and humanoid AI (artificial intelligence) ethics. Surprisingly, our body representations show more plasticity than scholarly concepts and sociocultural narratives. Our embodied selves can withstand transplants, bionic prostheses and radical somatechnics, but to remain autonomous and authentic, our agential potentials must be strengthened – and this is not through ‘psychosurgery’ and the brain–computer interface.
V. Empowering the Agent, Not the Patient. Gadamer, Kępiński, Dąbrowski and Waldenfels vs. Technopoiesis
Therapeuin (ars medicinalis in Latin) is a peculiar technê, which does not create human health ex nihilo. Therefore, the therapist is not the absolute creator or miracle-worker. Rather, she is a skilled demiurgos who restores the cosmos: who harmonizes the elements, powers, functions, etc. previously thrown into disorder (chaos in Greek). As a result, therapeuin would not imply a radical technopoiesis, i.e., fabricating something very artificial as typical for advanced technologies that try to exceed the border between the human and posthuman, to reinvent or to negate the identity and the self in humans. The message intended by Plato with his idea of self-mastery was affirmative. Following the imperative gnṓthiseauthón even provides an efficient tool of resistance (and resilience) against manipulative technologies. In particular, following this imperative might empower an agent in persons who have gone into the condition of patient in the medical sense of the term. Getting addicted to technologies that strip us of self-reference and self-governance (for example, by means of narratives that have an effect on our activity) can be placed in the same, semantic field as the notion ‘patient’. This chapter aims to display four examples of our inward agent and her autotherapeutic potentials. They have been derived from contemporary hermeneutic philosophy and psychiatry. They teach us how to re-empower the agential competences of the overtechnicized selfhood on the edge of the posthumanism.513 This re-empowerment would not be possible without the hermeneutic tools such as narratives,514 dialogue, understanding, explaining,515 and ←145 | 146→enabling a patient to take at least a partner’s role – or even the central role – within their relationship with therapists and further medical professionals. To put it another way, empowering therapy is one that mobilizes an intrinsic agent in a person who defines herself as passive, e.g., homo patiens. Making oneself stronger than one is feeling oneself here and now embodies the true meaning of “kreittoautou”516 and gnothiseauton, which always already called for caring for oneself and curing oneself. It was not simply knowing the truth about oneself, understanding oneself across the constant changes one undergoes, and aspiring to be a better moral self, but – essentially – caring for self-integrity by the activities undertaken by an individual.517 Developing these agential qualities would be a self’s most appropriate answer to excessive techno- and autopoiesis: a healing answer, for “selfhood (ipséité, ipse) articulates a relationship one has to oneself,”518 or a relationship one restored after having lost it once.
Ulrich Oevermann insists that despite the fact that the art of healing uses technê and is widely regarded as an effective alliance between science and technology, it is not engineering.519 Therapeutic intervention is not just the application of means to achieve specific objectives. For example, unlike engineers, doctors cannot simply decide that if they cannot find a solution to a patient’s health problem, they will cease their involvement. According to Oevermann, the doctor is guided not only by scientific knowledge (Wissen) and technical competence but also by conscience (Gewissen). Conscientious professionalism, in turn, ←146 | 147→is demonstrated by humanistic and social competences. Although “the goal of medical art is to cure (…) it does not lie only in the power of man, but also in the power of nature (…). Therefore (…) our entire civilization, with its foundation, science and its technical capabilities, always leads us astray, with the belief that we can do everything.”520 However, nature here does not mean the laws of physics and the cosmos, nor natural law in the biblical sense. Rather, it is a zoological and biological phenomenon of life which, as Gadamer says, has been awakened in human beings and prompts them to think and ask beyond (i.e., transcend) all kinds of limitations. Gadamer thereby questioned the belief in the omnipotence of medicine (and of science and technique in general), showing that even ancient doctors were aware that a therapist who had managed to cure someone was not a miracle maker, did not produce something from nothing, and that the state of health depended on many different factors. Thus, salvation is not a reconstruction of a being called health (“treating someone, making someone healthy”), but a restitutio ad integrum, that is restoring the patient to their previous place in everyday practice and in everyday relations with others, returning them to some “we” (Wir). This can also be understood to mean that the therapist restores the patient’s own subjective competence, which, as I will show in this chapter, can be active and instrumental, yet also passive, helpless and suffering (the term patient/homo patiens means passive suffering). Only this restoration opens the way to full regeneration, but it often exceeds the possibilities and competences of the therapist;521 even more frequently, the therapist stops accompanying the patient on this path, and the patient often deviates from it.
No less important in this regard are the therapeutic potentials located in the patient herself. Medical art achieves its purpose and fulfillment as a practice only when it unlocks the patient’s potential, and at the same time achieves its own potential (die ärztliche Kunst vollendet sich in der Zurücknahme ihrer Selbst und in der Freigabe des anderen).522 This also applies – and even above all – to psychotherapy. Apart from Gadamer, the representatives of this position, which emerged in contemporary phenomenology and the hermeneutics of medicine, are Bernhard Waldenfels and Kazimierz Dąbrowski. To some extent, it derives from the anthropology of crisis, which suggests that crisis or disintegration mobilizes the body (or individual) to be active and to seek solutions that lead to crisis resolution and reintegration. Dąbrowski called this mobilization ←147 | 148→“a positive disintegration,” with its success depending on the potential inherent in life, from the biological and organic level to the mental and spiritual level. Besides this potential, the patient’s ability to start the process is essential. This concept of crisis and disintegration thus understood does not, of course, deny the basic characteristics of life and existence, e.g., the patient’s vulnerability and mortality. However, it stands in opposition to passivity, powerlessness, and fatalism in the face of illness, including one that is chronic and incurable. And to the concept of human life as a project, supported by Arendt and Levinas, it adds an element of relatively autonomous intervention, which lies in the power of the patient, and is only supported and supervised by medicine and medical technologies. Its significance was known in ancient times, and Foucault reminded us of this in Techniques of the Self. However, both ancient and modern techniques of autonomous reintegration focused and still focus on selfhood as a reality independent and isolated from its embodiment. It was only through psychoanalysis, phenomenology, and existentialism, after Husserl and Heidegger, that the self could be embodied and embedded in the reality of a holistically understood experience, and not only a mental-spiritual reality. Being embedded in a vulnerable, mortal body allowed the self and her adventures to be considered in the perspective of the order of immanence, instead of in the order of transcendence. Transcendence was to have been a radical transformation: purifying and forever freeing the “false” embodiment, i.e., fallen or corrupted by sin, and then leading to the “real” self, whether divine (mystical) or deep in nature. For centuries, the founding experience of such self-healing was the Road to Damascus. At the same time, in this neo-Platonic-Christian tradition, completely correct ideas were formed, concerning the fact that the self is a deeply internal phenomenon (inner Self, inner man) and that it has within itself its own potential, capable of triggering radical transformations (powers of the soul, the soul as mutable).523 “The conviction, that Augustine invented the concept of private inner self is thus not inconsistent with the observation that the inner self has long been a formative element in Western experience (…) For the mature Augustine, there is no such divine, immutable part of the soul. Hence, we can turn to the highest and best part of our self and still find nothing but our own solitary self.”524 Augustine himself accepted the principle of the alternation of both body and soul, including ←148 | 149→the self. “This is precisely the soul’s own distinctive kind of mutability.”525 Cary attributes the following words to Augustine: “There is a nature mutable in space and time, namely body. And there is a nature which is not at all mutable in space, but only in time is it also mutable, namely soul.”526 Today we seem to face some novel, paradoxical potentials of the body and mind, namely the body changing in time and even against the current of time – through rejuvenating technologies; the mind, in turn, seems mobile because it will change its spatial location to the extent that its medium, extension or replacement will be artificial intelligence.
Despite the widespread belief today that ars medicinalis belongs exclusively to the field of the natural sciences, its scientific character has always extended to the fields of anthropology and the humanities, not least because no therapy is based merely on scientific “professional medical expertise.”527 It is also – as Wesoły emphasizes – “a noble and charitable art, which concerns every human being”528 and is practiced by human beings on other human beings. Its human-centric message remains unquestionable, even in the face of posthumanist metamorphoses to which people subject themselves today, as they increasingly use technopoiesis. It is particularly relevant in the light of self and identity, whose existential necessity remains at the center of attention, even in the context of such a radical, postmodern deconstruction of subjectivity that Michel Foucault carried out. He is considered to be one of the culprits behind the death of the subject, and yet at least two of his books stress and update the importance of “technologies of the self” and “care of the self.”529 No matter the extent to which the patient wants to feel human the “self” still means at least something here, “what distinguishes beings who are self-conscious, who can think themselves as separate from the worlds that they inhabit and thus consciously make choices about their course of action (…) The range of potential causes for a human agent to be predisposed to make certain types of choices is enormous. Such arguments could ←149 | 150→draw upon social, psychological, biological, or even anthropological research”530 (social includes moral).
Addressing the issues of “self” and “identity” in the context of health and therapy (understood holistically, i.e., psychosomatically) is fraught with risk because no one other than ourselves has the necessary knowledge, and even less the authority, competence and legitimacy, to make diagnoses, to judge the state of someone’s self and, as a measure of a “healthy” self, use some normalizing criteria, as is the case with conventional psychiatry or psychology, where mental health is clearly the issue. Can we, therefore, speak of technological health, having the condition of the self and identity in mind, even in such a radical case as the loss of identity due to the influence of technopoiesis? It is already possible to refer to brain researchers who diagnose and describe “cyber diseases”531 caused by the influence of technologically generated “mental events” on the functioning of the brain and mind. For example, Manfred Spitzer’s research findings refute the belief that previous contact with a stranger on Facebook or a chat application weakens the social fear of strangers; on the contrary, it has been established that such fear is increasing in people susceptible to phobia, and that social isolation is increasing. Many people suffer from nomophobia (fear of being separated from your phone) and FoMoS (Fear of Missing Out Scale), which create the feeling that the internet user has lost something, ‘missed something’ or ‘been excluded.’ On the other hand, for some people being permanently connected with the virtual or hyperreal world enhances a strong sense of being included, of having control, and a sense of certainty that they may not experience in real life. The ambivalent impact of such experiences and practices on the human “self,” not to mention behavior, can make it difficult to make an unambiguous diagnosis as to whether a particular technology (e.g., digital, social media, etc.) reinforces or weakens “my” being myself. The sense of being oneself and being at home, or alternatively the sense of disintegration, exclusion, alienation, etc., are among the most hidden symptoms of health and illness, as Gadamer says in Die Verborgenheit der Gesundheit. It should be stressed that both Gadamer’s integrative hermeneutics and Oevermann’s objective hermeneutics, as well as Kazimierz Dąbrowski’s conception of positive disintegration, suggest that not all diseases are strictly defined pathologies, and that they are not precisely located in elements of the body that can be easily removed through surgery. Oevermann also defines ←150 | 151→illness, disorder, and ailment in terms of crisis. Furthermore, Erik H. Erikson and KazimierzDąbrowski have also included crisis among the dynamic factors in the circumstances that subject the personalities of adult, healthy people to tests of endurance.532 On the other hand, the fact that many people today define phenomena such as disease and crisis in terms of an alien body, and define therapy mainly in terms of surgery, may indicate a crisis in social therapeutic awareness.
Dąbrowski is an example of a psychotherapist who is aware that the self and identity are not deeply embedded in the body but embodied and exposed to invasive factors such as “the pace of change in the contemporary world, the invasion of the new in (…) technology.”533 These factors may disturb (or even irreversibly destroy) the balance within the framework of what Dąbrowski calls the disintegrative mechanism of the “subject-object within itself,” which is responsible for the ability of “self-psychotherapy.”534 Technology has become one of the factors that interfere with the dynamics of the biological and ontogenetic development of human beings. Its impact is not decidedly positive or negative but is rather ambiguous. It is not possible to talk about general rules at this point, because some people use technology efficiently, as a tool, while others become tools of technology. The former have retained their ability to disintegrate positively, while the latter have lost it, which means that they remain in a state of chronic breakdown, crisis, “scattering and splitting up,” “decomposition,” “fragmentation” and “disintegration”535 affecting the structures of their mind, personality and self-identity.536 They indicate that the integrating activities of the “management and control centre” have ceased.537 While other scholars focus on ←151 | 152→the destructive effects of these phenomena, Dąbrowski (likewise Erikson and Kegan in developmental psychology, and Waldenfels in psychological phenomenology) stressed their curative power:
Disintegration is a positive developmental process in general. (…) This disintegrative process – although it (…) destroys and creates conflicts (…) is the basis for positive development, the basis for the creation of new developmental dynamics, the development of personality at a higher level, which marks out the path to re-integration.538
Dąbrowski distinguishes many types of disintegration, including one-level disintegration (manifesting itself only affectively, for example) and multi-level disintegration, pathological disintegration (associated with developmental disorders and dysfunctions), permanent and periodic, negative and positive, as well as comprehensive disintegration. Both “the lack of a tendency to transform oneself” and the global “crisis process” are the most difficult examples of disintegration. “The overall process of negative disintegration is found in the case of people suffering from severe somatic and mental illness,”539 in people with disabilities and, finally, for people who have become victims of technology, although they were supposed to be its beneficiaries.
If a person experiencing disintegration lacks the strength to transform this experience into a developmental effect, e.g., through creativity, cognitive exploration, involvement in activity, etc., disintegration becomes negative. While creativity is the optimal way in which the positive disintegration of the “developmental instinct” manifests itself, it takes place in the tension between the self and external reality, to which it cannot adapt during disintegration. Stimulated at first by biological factors and adaptation to the world, the “developmental instinct” is activated due to various disturbances, which lead to the state of internal crisis. Mental reintegration takes place through creative activity but does not necessitate recreating the initial starting point and restoring the disturbed state of affairs to this. Dąbrowski argues that “disturbances are necessary for the individual’s evolution towards a higher level of integration,”540 when confronted with crises caused by ever-changing circumstances, which we respond to with shock at first, and then we develop the ability to be ourselves creatively, in a way that we have ←152 | 153→not experienced before. In a sense, we become a new self, strengthened by our own work of reintegration, or positive disintegration. For Dąbrowski, the master of the creative materialization of energy generated by the chronic crisis was Franz Kafka. As I have shown in a previous chapter, Kafka’s work grapples with peculiar crises of identity and existence, up to the final negative disintegration and “nightmare visions of human automatons.”541 Dąbrowski diagnoses Kafka as being “on the borderline between psychasthenia and schizophrenia;” he was considered to be a “highly impractical person in life, having fundamental difficulties in adapting, and yet was highly original and creative.”542 Thus, he tended to disintegrate negatively rather than positively. It was only at the end of his life that positive disintegration, liberated by love, was allowed to prevail in the Kafka’s personality. All of this does not mean that “most so-called normal people, with a poor mental universe”543 limit themselves to everyday, routine practices, and adapt to the world of “comfort and relaxation.” Many of them straddle the border of negative disintegration, and the users of digital technologies are increasingly among their numbers.
The question now arises of whether the energy of a mental or, more broadly, psychosomatic crisis triggered by disruptive technologies can be directed in a similarly creative way, i.e., lead to positive disintegration which is manifested, for example, in the “strong development of the personality ideal”544 and in the determination to pursue this ideal. Is such a personality capable of “self-education” and “self-psychotherapy,” as Dąbrowski suggests? This hypothesis guides the whole of this book. As its author, I believe that positive disintegration is the only adequate response to the destabilizing, distracting, and constant crisis-inducing impact of technologies, especially intelligent ones that interact with our minds. In this case, disturbances caused by technology should be approached in the same way as Dąbrowski envisages for “reintegration” based on a series of multi-level disintegrations: actively or creatively implementing “dynamisms of autonomy and authenticity,”545 that are appropriate for me in the sense of my individual agency. If it is a repetitive experience, it will also include “a sense of identity in the present moment, identity with oneself in the past and projection of oneself ←153 | 154→in the future.”546 With regard to the projection, Dąbrowski himself admitted that “the idea of further, perhaps infinite development is close to him,”547 without this meaning development that would be accessible in experience. Instead, he considered the experience of multiple identities, as would a student of philosophy. It is certainly instructive almost half a century later, when various hyper-realistic representations, profiles and versions of a particular person are available to her, simultaneously rather than sequentially (diachronically): the person chooses “herself,” and is unable to decide which of the many versions is ‘the truest.’ “I have chosen myself from many of myself and have to say that I am constantly making this choice,” i.e., that “it is the self who is getting closer to me, unlike the one that seems more and more alien to me. Despite this study, my other me is still very strong and causes fears in my internal environment, about what is really me and what is not me. I am continually choosing my true self.” It should be added here that the person who embodies the ability to evaluate, choose and self-affirm is my true self: “when my fears are weakening and my real self strengthens – it is easier for me to withstand the pressure of my other, strange self (…). I become stronger then, more consistent …”548
Withstanding pressure proves that therapeutic self-healing has taken place, that the mechanism of natural psychotherapy (to recall Kegan’s term) or reintegration has worked. Proof of its effectiveness will be to maintain the choice made, the stability of the “I,” while proof of ineffectiveness will come if the choice is questioned as soon as an unprocessed disruptive impulse appears. According to the concept of positive disintegration, such a person becomes a patient, i.e. requires professional therapeutic assistance. She cannot be entrusted with her own development (it cannot be “placed in her hands,” as Dąbrowski writes) until she finds enough strength in herself to “approach autopsychotherapy” by herself.549
Could this type of self-psychotherapy be employed by adults, for example, those who, on the one hand, experience some form of physical disability, and on the other, have a prosthesis, or other devices or technologies that compensate for their morphological and functional deficiencies? Of course, one can identify artists whose activity “was driven” by the tensions related to the chronic discomfort resulting from the impairment. These include bionic violinists playing the violin ←154 | 155→with a special prosthetic arm, such as Adrian Anantawan and Manami Ito. Her co-citizen Mamaru Samuragochi is a music composer, despite his deafness.550 AJ Brockman creates digital art, and yet he suffers from spinal muscular atrophy.551 One of the Paralympic disciplines is brain-computer interface assisted gaming with virtual avatars. According to the theory of reciprocal recognition developed by the German philosophers, there can be no autonomous and authentic self without getting involved in an intersubjective relation of recognizing and being recognized by other-selves. Moreover, recent research findings show that advances in gaming technologies and design allow persons with impairments to be better involved in a virtual game-like intersubjective world. Not only gamers’ belongingness, but also their integral representations can be strengthened in this way. Patricia da Silva Leite highlights a therapeutic link between self-representation (particularly its socio-cultural aspects discussed in the previous chapters of this book) and gamification.552 In my opinion, the above-described model of self-psychotherapy corresponds with elements of the game, such as the player’s freely-made choice to identify with a digital character, and above all their independent selection of attitudes, abilities, powers, virtues, etc. – sometimes enhanced or supernatural – which give this digital character a personality. In this way, players identify themselves with characters who personify what they see as an ideal self that is worth striving for. At the same time, they become active and interactive in the virtual world of games, with a sense of agency that contrasts positively with the passivity they experience in their real lives. The positive attitude and the experience of choice and agency experienced while playing digital games mean that players discover, experience, and try out being the self that is closest to them. Through its constant availability, the game offers a favorable opportunity for players to train themselves in a large number of embodied decisions, actions, roles, rules, and interactions (verbal and nonverbal) with others.553 Designing such therapeutic, digital, socially inclusive network within a ←155 | 156→game would be an important contribution to auto-psychotherapy. Gamification-related advances in auto-psychotherapy are still at the experimental stage as of now, but before we accuse digital games of making players dependent in the way shown by Spitzer, it is worth considering how often players feel more themselves when playing their favorite characters in a digital game, and what is it that is happening in the real world that causes them to feel less than themselves in it, or to feel disintegrated in a negative way – as Dąbrowski describes it?
Body- and mind-abled people are concerned by the fact that when they finally become their authentic true self, it is related to the natural human tendency to enhance their self and become more authentic throughout their lifespan.554 Also, crisis, disintegration, or the “mere” addictions attributed to the excessive use of technology, will lead ever more people to ask which “I” is authentic to them, or how to define this being oneself in these new conditions. Hence my idea to build a working definition of autopsychotherapy in terms of phenomenology, hermeneutics, and psychiatry – insofar as the latter adopts a therapeutic model free from coercion, i.e., open to autonomy. On the subject of coercive psychotherapy (and therapy in general) which is aimed at healing or normalizing not only people with diseases and disorders in a strictly medical sense, but also ‘sinful souls,’555 ‘sick ←156 | 157→minds,’556 abnormal bodies, sexes, etc., the critical works are so numerous that it is impossible to cover them all here. In view of the coercive, controlling influence of technology and its addictive influence on people, it makes sense to strengthen the arguments in favor of autopsychotherapy: but not to compete with psychology and psychiatry on scientific grounds. The arguments of phenomenologically-minded psychiatry in favor of self-psychotherapy are rather aimed at promoting awareness of the importance of prophylaxis, as well as the meaning and scope of work that a person seeking help from professional psychotherapists and psycho-somatotherapists can contribute to mutual cooperation with their therapists. The passivity and helplessness that afflict us when we become almost exclusively a homo patient, even though it is in our power to oppose it (except when it exceeds our subjective limitations), I do not call a ‘disease’ or ‘disorder’ of the self. It is rather a weakness, a crisis, a disintegration that intensifies the vulnerability and susceptibility to the impact of various factors and interactions with the world that are inherent in human beings, as living and natural beings. When the capacity for resilience is too low, the impact turns into an attack. To some extent, however, we can control its strength, and what is more, we can strengthen it in ourselves through my conception of the philosophical strategies of autotherapy discussed here. In this regard, I cite Szasz: “one would be for freedom and against coercion–not for or against (…) medicine or psychiatry.”557 This freedom, as Dąbrowski showed, also includes the choice of the true ‘self’, mainly because the ability to regenerate is the very precondition of resilience. And similarly, other, hermeneutic and phenomenological approaches to autopsychotherapy discussed below. Today, scientific psychotherapy identifies with the Hippocratic tradition, while the roots of autopsychotherapy can be traced back to Socrates. If we view Socrates as the one who discovered an independent, subjective “agency,” and, at the same time, as someone who taught others how to take care of themselves “for the highest welfare of (…) [their own] souls” (Plato’s Apology 30b),558 the relationship between self-psychotherapy and ←157 | 158→philosophy will become immediately clear to us. For example, in his hermeneutic approach to autopsychotherapy, Gadamer refers to Socrates’ maieutic method.
Autopsychotherapy came into being in the second half of the twentieth century at the crossroads between phenomenology and psychiatry. In terms of technologies that make human beings passive by stifling their activity, and thereby the source of this activity (i.e., their agency), the conceptions of Gadamer, Waldenfels, and Thomä are particularly valuable. Their basis is the phenomenological splitting of the self into the active “I” and the passive “me,” which experiences, and often suffers and bends under the weight of various psychosomatic ailments. For Gadamer, as a representative of the same existentialist tradition as Heidegger, the symptom of such a splitting is care, being concerned (Sorge, besorgt), as an expression of discomfort, being-not-oneself and by-oneself, oscillating in and out of oneself, because existing as a human being involves movement and change: “There can be no change [mutatio] without movement,”559 Augustine claims. That changeable position in the world implies vulnerability, and vulnerability, again, implies discomfort and concern.
Concern is a form of mental and spiritual agility, which even has its counterpart in the vegetative life of an organism. Splitting– although it seems to us that it divides, distracts, and destroys the self, actually constitutes its proper structure. Within this structure, various processes can take place, which fill it with content and cause the subjective self to attain and experience its fullness. During his Frankfurt period, Hegel also described the human self in a similarly dynamic and naturalistic way. Liveliness and activity, qualities that are subjective, personal, agential (in the sense of taking decisions and responsibility) and creative – contrasted with a “oneself” that is passive, experiencing, reactive, and impersonal, and too weak to resist technical pressure, authority, etc. – can, therefore, be considered both in terms of Heidegger’s fundamental ontology as well as in terms of Jonas’ naturalized phenomenology of life.
An important aspect of concern is anxiety – vital and existential, which for Heidegger meant the basic mood of being. It is expressed, Gadamer writes, “in the fact that man desires to be at home, so that he may be isolated from all ←158 | 159→threats, in contact with that which is familiar (…) being free from all concern”560 (Sorge, Angst). Thus, being at home clearly has a soothing, regenerating, therapeutic effect. The spatial dimension of this being “at home” is experienced in many ways, including as a living, psychophysical entity in which our subjective Dasein is embodied. Depending on the extent to which we accept the naturalized version of phenomenology as the point of reference for the description, both fear and the disturbances to being at home, and regeneration itself, can be considered both at the vital and existential levels.
When he considers these issues in his essays Hermeneutik und Psychiatrie and Schmerz, Gadamer addresses psychotherapy and other medical professions. He reveals the challenge that the fears associated with these dangers and disturbances create for the self, whose self-therapeutic efforts need to be strengthened by a professional therapist.561 This is a situation when I am beset by diseases and ailments (as a patient) that I– despite my great anxiety – cannot cope with on my own (as an agent). When the situation is critical (overwhelming the patient), the patient’s helplessness, limitations, and fear make the life world shrink to the dimensions of the sickbed, as van den Berg says, and the life perspective is reduced to now or the next few weeks or months. But also in this narrow space of the sickbed (or hospital), the patient only feels “at home” temporarily, at most, because of her present condition. This kind of hospitality is the response of the society to the condition of a patient as that who has lost her agential energy. But the very role of medical hospitality is to re-empower the agent in the patient, hence, to re-enable her to look “to the future, as opposed to a dull return to the cave”562 (die stumpfe Einkehr). The very sign of a patient having the position of supremacy – e.g., of her temporary only potential agency – would be a doctor’s serving position and that of the health service as such. Therefore, being under treatment, especially when combined with modern patient’s autonomy, promises not only recovery but also getting back the real autonomy, self-command and self-possession.
Sadly, institutional medical practices often reveal an opposite tendency – to dominate and capture a patient. “What does it come from? I believe that the kind of knowledge and confidence that has been created by modern science, which is focused on experimentation and control, has increased the human need ←159 | 160→for safety (…) You will certainly know,” writes Gadamer, addressing medical professionals directly, “the limits of that ‘control over something’ that you experience and become resigned to in your medical work.”563
Psychiatry is an example of a medical discipline where “practice is not only the application of science”564 and technology but remains, above all, a practice, i.e., a form of activity whose source is the subject, the agent, and an active “I” in relation to “me” (but also in a dialogue with another “I”). Nevertheless, people have false ideas about psychiatric help. They expect the use of “miraculous means of modern medical technology,”565 which will place them in the position of a passive, objectively treated patient, instead of strengthening their agentive, “energetic”566 I, and instead of letting a patient disremember her position and condition as a patient.
According to Gadamer, such strengthening comes from an understanding in which, in the light of the hermeneutics of medicine, a basic interpersonal reference is made, which is so important in psychotherapy and also in somatotherapy.567 After all, situations emerge in which man – in particular a psychiatric patient – becomes ‘incomprehensible to himself, incomprehensible to others’,568 and this is noted by the philosophy of technology which is sensitive to humanistic approaches, and which does not limit itself to celebrating new scientific discoveries. In the patient-doctor relationship, understanding takes place ←160 | 161→through the medium of conversation. As in any other intersubjective relationship, it is also the case that in the doctor’s office, “we are a conversation and can listen to each other:” it is precisely in these special circumstances that “understanding of that which wants to be understood absorbs all our reflexiveness (…) The psychiatrist will immediately recognize his proximity because of the incomprehensibility he encounters in the illnesses of the soul and the spirit with which he is constantly confronted,”569 Gadamer stresses.
The therapist’s reaching an understanding of the patient in the space of the conversation is intended to stimulate the patient’s self-understanding, and thus help him/her with autotherapeutic mobilization and the processes of self-recovery. In contrast to the case of stimulation ensuing from the ‘therapeutic’ gaming discussed above, stimulation by conversation and understanding takes place without the participation of technology. It is an integral part of humanistic-therapeutic praxis and poiesis. In therapeutic conversation understood from the hermeneutic perspective, there is no room for manipulative and disempowering conversation “about” someone as an impersonal “case” or “it” (Es), about an anonymous “disease entity” and its purely technical, categorical, and specific symptoms. A hermeneutical approach to another person with such conditions, experiencing pain, chronic suffering and threats, and living with a disease, is groundbreaking in this respect. On the basis of contemporary literature, which allows human beings to give voice to all the peculiarities and ailments of their condition, Bachtin observed a similar breakthrough in Dostoyevsky’s works. Dieter Thomä writes about this in his book Erzähle dich selbst: “the place of the person who is spoken about is taken by the person who speaks. For such a person, the only time is the present of the dialogue (die Gegenwart des Dialogs), in which she is also present. Thus dialogue itself becomes profoundly real (als fest identifiziert wird).”570 It does not cease to be a dialogue – and therefore does not lose its therapeutic power, which is based on understanding and on the therapist opening up to the patient – because it does not transform into an objectivizing discourse, in semantic terms. Discourse plays a significant role in the practice of healing, but it is a further step, which is usually taken by a collegial medical decision-maker in clinical settings. In the times when scientific medicine dominates, the hermeneutics of communication and understanding between the therapist and the patient retains its humanistic advantage over procedures that can hardly be called humanistic. Such hermeneutics may seem anachronistic to ←161 | 162→the eyes of those who see technology and science as having the advantage, since they have now almost come to dominate healing and medical practice. However, it is precisely this anachronistic conversation and understanding of another person – together with what is incomprehensible in them, and also to them, but which also demands understanding – that is probably the last and very humanistic feature of therapy and autopsychotherapy. They prevent the progressive dehumanization and post-humanization of therapy itself, as well as help those who have already fallen prey to post-humanization or dehumanization by technology. They go far beyond reductionist generalizations and allow the interpretation of a single “case” as well as “from case to case” (von Fall zu Fall).571 It is not impersonal statistics, but rather case studies that allow us to preserve a patient’s empowerment, which is only possible in an intersubjective relationship between a therapist and a patient. This does not prevent the development of a strategy of objective hermeneutics, as Boris Zizek shows with the example of an extremely interesting interpretation of Robinson Crusoe’s case, in which the protagonist is dealing with his own identity and crisis of the self.572
Gadamer acknowledges that his hermeneutical-dialogical orientation in the context of psychotherapy contrasts with that of his father, who was a recognized pharmacist and who, while on his deathbed, confessed his disappointment with the choice of his son’s career to Heidegger (Gadamer received his habilitation degree under Heidegger’s supervision). Even at that time, Gadamer considered the technological approach to human ailments – including physical and mental pain – to be not only posthumanizing, but also dehumanizing, as it basically forbade the subjective voice of “I,” which could, with understanding, be actively and self-therapeutically related to the passive, experiencing, and often suffering “me.” “We face the proper dimension of life in pain (im Schmerz) when it is impossible to overcome it” (wenn man sich nicht überwinden lässt).573 However, Gadamer did not take into account the view of human existence as dolorous and the glorification of pain that are typical of the Christian tradition. He focused on overcoming, a word suggesting “the mastery of pain,” being remaining agent’s task even when her actual shape is rather a patient’s attitude at present:574 “Verwinden, was für ein Wort! Daraus spricht sozusagen eine Meisterung der Schmerzen ←162 | 163→(…) Vielleicht die größte Chance, endlich mit dem fertig zu werden, was uns aufgegeben ist.”575
Mastering a condition is something other than obtaining temporary relief from its symptoms, the importance of which should not be overestimated – although it should also be appreciated despite all the limitations that accompany every technesis and which science and technology, of course, wish to overcome.
But the issue here is not a specific ‘pain,’ but is rather a synonym of vulnerability, which for the human condition, identity and my “self” is as natural and integral as the crisis described in Dąbrowski’s example of disintegration. Furthermore, in the mental-spiritual order, Gadamer’s vulnerability is a continuation of the vulnerability to the environment, which is characteristic for living organisms in general. This organic vulnerability (Verletzlichkeit)576 was described by Hans Jonas, who has shown that this sensitivity is exacerbated by technesis, to an extent which is not yet known; in other words, humans are using invasive techniques to attack their own inherently vulnerable condition, instead of making efforts to immunize themselves against it (Unverletzlichkeit) or, as Gadamer puts it, to strengthen their life forces (Lebenskräfte, Lebensformkräftigen). Thus, a clear affinity can be seen between Gadamer’s hermeneutical strategy of verwinden and Jonas’ vitalistic strategy of immunization, and they have shared views on irreversibility, and even on the vital and existential necessity of vulnerability, and on responsiveness and responsibility being key attitudes towards ailments, and in an ethical context – the damage and harm that a human being, as a living being with the greatest potential for freedom, does to other living beings and to itself. However, while vulnerability is a constitutive (vital and existential) feature of a natural living being, this will not be the case with beings that embody artificial life based on non-organic carriers. After all, artificial creatures will be programmed so as to be free from vulnerability, and at the most only capable of recognizing and responding to it.577
Therefore, ailments and suffering are foreign bodies and are radically other, but they are not external beings: they are an immanent challenge, one which is also faced by human beings, who, although they have new possibilities at their ←163 | 164→disposal in comparison to other living beings who are more powerless when facing ailments, pain and suffering (humans are also, after all, strongly determined by nature, and the human being embodies at least that which P. Becchi and R. Franzini Tibaldeo call “needful freedom,”578 but I would call painful freedom). Human beings are of course not left to fend for themselves; however, the thing is that without their participation and help, a purely technical overcoming of the ailment is not possible, and moreover, this would restrict the active responsiveness of the “I” in favor of a passive and reactive “me.”
Despite the fact that Gadamer did not claim that therapy is exhausted in autotherapy, his late phenomenology of pain was controversial for therapists from the outset. They argued that patients were far from the ideal of self-therapeutic personality proclaimed by Gadamer (“der normale Schmerzpatient ist … schwächer”) and that in the therapy of chronic pain other, more pragmatic criteria than hermeneutical-phenological ones applied. Gadamer defended his position, accusing therapists of serving the chemical and pharmaceutical industries rather than patients. He accused them of no longer providing patients with an understanding of what was being done, through dialogue. He also reiterated that scientific knowledge is limited. When the source of ailments and suffering is poorly understood, and yet they are still voiced in verbal and nonverbal language, the correct response is to try to understand them: “It is a matter of expressing our [therapists and patients’ - E.N.] understanding of certain things (…) and coming to an agreement on who we are (…) and strengthening the life form”579 (die Dinge zur Sprache zu bringen, uns darüber zu verständigen, was wir sind, die Lebensform zu kräftigen), what situation we find ourselves in; how we can remedy it by own powers (das eigene Können). As Gadamer, Levinas, Waldenfels, and Jonas insist, understanding is the basis for human responsiveness and responsibility. So, for example, when asked how doctors should treat a person who has undergone technological enhancement, but who has ultimately fallen victim to technology, Gadamer’s answer is that doctors should talk to him/her, create a space for understanding and self-understanding, and should do so on the basis of their own medical responsibility to themselves and to life in all its forms (Eigenverantwortlichkeit sich und dem Leben gegenüber)580 important for their patient. “The doctor performs a maieutic function here: he helps ←164 | 165→us to become aware of our own life resources,” and pain – and this is certainly controversial from the point of view of conventional medicine – “plays a significant role in this.”581 In this way, hermeneutics can become a medium between consciousness and a human being’s naked experience of any ailment or weakness. On the other hand, it becomes a medium of intersubjective understanding, supporting intrasubjective understanding, supporting the “I” in its reintegration. Apart from the “incurable disease,” as Gadamer describes it, while for others, it is the “scandalous negation” of death (die scandalöse Negativität des Todes),582 no human ailment is completely beyond understanding, although many of them still escape cognition. And as long as this is still the case, the therapist – and even more so the patient – needs to be able to talk and understand.
The most serious of my objections to the hermeneutics of understanding the patient through conversation is technical in nature. After all, there are disturbances, dysfunctions, ailments, and conditions that limit patients’ ability to express and affirm themselves, as well as their readiness to hold conversations and engage in communication with their environment. If illness and ailment diminish a patient’s dialogical abilities, the therapist has little access to the content that would form the subject of mutual interpretation and consultation, thereby mobilizing the patient’s intrinsic potential for autorecovery. In discussion with, among others, like Olson583 and McDowell,584 Budnik585 emphasizes that in extreme cases, when mental continuity is broken and the mentalistic criteria of identity and selfhood have disappeared, the personal self is radically disintegrated (das betreffende menschliche Lebewesen aufgehört hat, eine Person zu sein). Such cases still retain their individuality, although the criterion of individuality is primarily (and in the light of Olson’s animalistic – only) biological in nature (das Kriterium der biologischen Kontinuität immer noch erfüllt ist)586. However, this does not entitle therapists to take a reductionist stance, which would lead to the patient’s depersonalization and disempowerment. This is the ←165 | 166→moment when the patient’s understanding becomes objectively hermeneutical beyond the intersubjective “fusion of horizons,” because it is devoid of the central first-person perspective and horizon personified by a patient as the Other.
Articulation and understanding also have their limitations. Describing the ways which lead to “getting to know the patient,” the Polish psychiatrist Antoni Kępiński assumed the possibility of attaining objective knowledge of another persons’ mental states including mental ailments (e.g., mental pain), disorders, and diseases:
If this cognition were not objective, the organism would be condemned to decomposition in a short period of time, it would become similar to the ‘objects’ from its surroundings, which have a hostile attitude to it, and would flee from attempts at relationship.(…) Lacking faith in their own cognitive apparatus, psychiatrists and psychologists try to prove the objectivity and truthfulness of their sense of someone else’s mental condition with the use of ‘objective methods’, i.e. those used in natural cognition, where only the object is observed (…)It is possible to explain thatsomeone is sad (…) or fearful because their physiological reactions are changing, along with certain behavioral patterns, etc. Observations of this kind contribute a great deal to knowledge of people, but they cannot be an objective test of someone else’s mental state (…) A statement that someone in a state of anxiety has an accelerated heart rate, or performs worse in some test task, is true, but (…) may be associated with other mental states (…) The subject’s attitude to an object [which is what a patient reduced to a vegetative state would become- E.N.] is harmful [not only to the patient, but also] to the psychiatrist himself; it causes aggression, when the ‘object’ does not want to submit to his will, when it does not act according to a pre-conceived idea.587
However, the attitudes of natural cognition and of understanding of the other –including oneself – are utterly different and are not mutually interchangeable. Understanding is not cognition, it rather begins where cognition ends: thus understanding on the basis of manifest signs and symptoms is almost always possible if there is someone who reacts to these signs and responds with an effort to understand. For example, when another person sleeps or has perhaps fallen into a coma, my sight, hearing, and touch must confirm for me whether it is sleep or a coma, which are two completely different internal conditions but manifest themselves in the same way at first glance. Only a second and subsequent look undermines the first impression and mistaken conclusion that the person I have ←166 | 167→in front of me has fallen asleep because it turns out that he/she is probably in a coma. We can call this act “recognition,” but due to the limited cognitive access to other people’s mental states, we can rather speak of interpretation or comprehension, at least at the initial stage in the diagnosis of the case. The word “recognition” is used in precisely this sense by Paul Ricoeur. Only additional diagnostic techniques (e.g., brain magnetic resonance) can reveal more about another person’s internal condition. However, “more” does not mean “everything.” With some types of coma there is no prognosis for awakening the patient, so can this state of knowledge be called “cognition?”588
The inability to reach someone else’s internal state through linguistic communication, and through conversation in a language spoken by both sides of the doctor-patient relationship, prevents the patient form mobilizing their own vital and existential strength. It was this mobilization that Gadamer considered to be the primary objective of the therapeutic actions taken by a doctor who is adept at using the arcane skills of hermeneutics. Therefore, as Kępiński emphasizes, the optimal situation is,
when for a sick person the psychiatrist is the person before whom she can fully ‘open himself up’ to the first time in his life, the only one who, in his opinion, can understand and help him. (…) On the other hand, the psychiatrist, before whom the mystery of human life opens up in its unheard-of richness, in its most hidden layers (…) feels ‘obliged’ to his patient, who allows him access to a mystery which from that moment will be shared (…) Together they create a common world of experiences (…). In this way the burden of responsibility is shared between them.589
Since both of them try to explore this mystery together, despite their limited knowledge and capabilities. Moreover, by “objectification” Kępiński meant something, that usually does not appear in the hermeneutics and phenomenology based on dyadic dialogical relationships, and more precisely on:
talking about a sick person as a third person. What emerges then is an ideal patient, an object that is observed by the real patient and the doctor. At this point, the psychiatric method becomes similar to the naturalistic method, the difference being that here the work is collective, the researchers are the patient and the doctor (…) In this way, the ←167 | 168→patient learns to look at himself from the outside, he compares his way of seeing himself with the doctor’s way. The doctor and the patient have equal rights to present their point of view, defend it and possibly change it. In this form of dialogue, the Delphic principle gnothiseauton becomes realized (…) Dialogue is not idle, unrelated chatter, but a laborious and, at the same time, incredibly interesting creative work. Two authors –the doctor and the patient– try to recreate a structured whole, a specific biography, from the chaotic and loose fragments of psychic experiences, where not so much the facts as the experiences (…) play a role. Just as a template in a novel irritates us, so here every scheme which views everything from the perspective of one theory or another discourages the patient from further cooperation (…) This work (…) can become a passion for both the patient and the doctor. It also encourages curiosity in relation to oneself, the desire to find an answer to the question: ‘What actually am I really?’590
And, finally, the ability to draw even the simplest conclusions about the importance of autotherapy. Kępiński and Gadamer’s approach to the patient and doctor-patient relationship reveal striking correspondences at the level of hermeneutical assumptions. At a time when the human psyche and mind are increasingly being overwhelmed by technological representations and projections, the answer to the question “What am I really?” becomes even more difficult. However, it becomes most difficult when people are caught up in their post-humanistic and transhumanistic inclinations, are no longer curious about themselves, and stop asking themselves such questions. Then auto-psychotherapy loses its raison d’être. But even in such a situation, the human therapist will not have the right to treat a patient as an object, in an impersonal way.
Although language (and the thinkable itself) is limited, and philosophy not only shows no therapeutic effect but it “leaves everything as it is,”591 philosophy is “running up against the limits of language.”592 “The name ‘philosophy’ might also be given to what is possible before all new discoveries and inventions,” despite the use of words as vehicles of the communicative actions or interactions whose rational power has been described by Habermas. Hence, philosophy as a therapeutic tool ←168 | 169→does not necessary imply addressing powerful words to someone. “There is not a single philosophical method, though there are indeed methods, different therapies, as it were.”593 One of them would be understanding, although Wittgenstein cautions against “understanding as a ‘mental process’ ”594 as belonging itself to our experiential condition. Thinking and understanding have to provide us with a minimum of therapeutic tools insofar as in doing so, we become distant to own corporeal existence, its finitude and vulnerability (with Gadamer: “von sich selber distanziert zu sein”595). Combined with speech, conversation, and the narrative, they provide an optimum of such tools. Sense emerges from transsubjective interrelations, beyond the one-track, subject-object relation, as if it was a higher stage of “the therapeutic course: Wo Es war, soll Ich werden.”596 Maybe “in the sense in which there are processes (including mental processes) which are characteristic of understanding, understanding is not a mental process,”597 but an intelligible one, and this is why philosophy is able to describe its patterns. For autotherapeutic reasons “we should have to be able to think” and to make comprehensible “what cannot be said”598. While Wittgenstein’s imperative to think addresses a ‘lone climber without the ladder,’ Waldenfels points out that nowadays thinking – in particular, asking “Who am I?” (Wer bin ich) – can no longer rely on an “unshakeable foundation” (unerschüttlichen Fundament).599 There is no reason, however, to replace that question with “What am I?” (Was bin ich). Waldenfels strives to transform the “paradoxes of self-exclusion” (Paradoxien der Selbstabgrenzung) and self-alienation to autotherapeutic (and intratherapeutic) tools related to everyday forms of life. Wittgenstein seems to improve similar tools600 with his plea for thinking against the limits of language, skepticism, and the fate of ‘nonsense’ as a result of reciprocal understanding. Also, ←169 | 170→he invents tools closely related to everyday lifeforms (linguistic, heuristic, and even philosophical-autotherapeutic tools) as the original shape of his philosophy “resists certain mystifying tendencies in philosophy.”601
Like all the thinkers revisited in this chapter, Bernhard Waldenfels conceives of there being a phenomenological and hermeneutical link between the modern, clinical concept of patient’s empowerment (Stärkung des Patienten)602and the medieval resilience (Resilienz) as a method of improving “a person’smental ability” (Seelenstärke) “to successfully overcome a crisis,”603 or to bring relief to someone suffering under deadweight (the German language provides here terms such as Entlastung and Elastizität, whose original meaning was physical,604 but they can also be applied to experiential phenomena, e.g., physiological well-being, psychological mood, spiritual balance, etc. In her writings, Małgorzata Bogaczyk-Vormayr explores mere creativity as one of the most powerful waysof becoming resilient. In their narrative hermeneutics, Ricoeur, Thomä, and Rorty emphasize the role of narratives and understanding of the self to deal with own, vulnerable, contingent, and “idiosyncratic” condition as a human being – or just our poor condition.605
When discussing the weakness, wounds, and crisis of the modern condition humana, Waldenfels uses the term homo patiens (doing so probably after Viktor Frankl) – people who are dependent and passive, suffering, depersonalized, and objectified, who discover a ‘foreign body’ within themselves (this could be Gadamer’s pain, Levinas’ invasive Otherness, or Dąbrowski’s dissociation generated by external violent factors, including excessive use of technologies) and must refer to it or respond to it with responsiveness, i.e., as an agent whose mere trait is agility, intentionality, strength, initiative, engagement, creativity, responsiveness, efficiency, etc., in contrast to a patient’s (der Leidende) passive (das Getroffensein), less responsive and more pathetic (das Pathos) traits:←170 | 171→
The instance, which modernity called the subject, from the beginning appears as a patient, i.e. someone who responds to an encounter with foreignness in an engaged way, but not as an initiator. Rather, as someone deeply experienced, as a subject in this peculiar sense, which Lacan and Levinas use: On this side of intentionality there is pathos, and the answer comes from that: Responsiveness (die Responsivität) goes beyond intentionality because dealing with what comes to us (was uns zustösst) means more than just realizing, understanding and verifying what needs to be answered.606
Every modern subject needs to enable her internal agency (Täter) to actively respond on her internal patient’s woes, crisis, and suffering. As a result, “this being annoyed throughs omething transforms itself into responding to something, as one rises to it in speech and action, mobilizing defence forces (…) and, finally, expressing it” (dieses Wovon des Getroffenseins verwandelt sich in das Worauf des Antwortens, in dem jemand sich redend und handelnd darauf bezieht, es abwehrt … und zur Sprache bringt).607
The effect of an agent’s response to a patient’s afflictions vows depends on affective, cognitive, communicative and practical factors synergizing. Waldenfels eventually refers to cognitive auto-therapy when he assumes responsiveness to be transcending and exceeding both intentionality and the present state of affairs – as it opens new paths to pass the impassable of here and now: “emotions, usually considered as dysfunctional and explosive, transform into motions. Their energy becomes a kind of power bank, it will re-empower us whenever we are exhausted.”608 How this occurs can be put in clinical terms such surmounting fear and uncertainty, regaining lost self-control and equilibrium, restore hope in improvement and convalescence, and – most importantly from a therapeutic perspective – overcome one’s own helplessness and answer the questions “Now what? What can I do?”609 which yields effects often classified as “clinical pragmatism” or “clinical intervention.”610 The very first step out of the “now” to any “future” is of fundamental existential importance, as it provides a patient with feeling of persistence and futurity in Martin Heidegger’s sense of Worumwillen or, according to its much more vital variant developed by Hannah Arendt – with the feeling of a new beginning, revival, rebirth referring to natality as the very beginning of one’s existence. It has a clear pendant in medical contexts as ←171 | 172→“experiences of strength, confidence and vitality”611 are an integral part of existential self- and who-interpretation, which is very different to being interpreted as a “passive object.”612
As we see, overcoming the crisis by virtue of the immanent auto-therapeutic potentials released within the patient – the respondent relationship rather occurs by the means and tools of our “proactive brain” than by means of the limited therapeutic potential of circular transcendental reflection (Kant’s and Husserl’s “auf-sich-selbst-intentional-bezogen-sein,” “Einheit der transzendentalen Apperzeption,” etc.), autopoiesis, or the overstated, absolute response of the Cogito.613
Rather, Waldenfels emphasizes the auto-therapeutic potentials of the embodied self as encompassing its two irreducible modalities: living and lived, passive and active, emotional and cognitive-reflective – as they were explored in phenomenology from Descartes to Merleau-Ponty. He points out the idiopathic, inner polarity and crisis which is a very natural – even constitutive – feature of the human condition:
our entire behavior emerges from a kind of self-excitement which chances upon us when inasmuch as we respond to this self-excitation. We are older than ourselves (…) as a preoriginal trait of my existence, the retardation produces an unavoidable alienness which I name ecstatic alienness. I am falling beside myself and this is not about accident, disease, or weakness, but about I am what I am (ich bin was ich bin). This alterity results from my broken self-reference (…). Connected to myself and, simultaneously, disconnected from that, I am neither onesome, neither twosome, but twosome in onesome, and onesome in twosome614
Restoring equilibrium among tensions sounds challenging, but it shows affinities with Dąbrowski’s approach discussed above. Next and beyond this “normal split” of the self, Waldenfels refers to the “anomalous” and “pathological”615 splits whose effect can be a radical self and body (or mind and body) dissociation – which, again, shows we cannot define the self only in terms of postdualist, psychosomatic ontologies. There is an “inner” and an “outer” side of existence as a corporeal, lived, self-experiencing human being. A demarcation line between ←172 | 173→them might be elastic, flexible, almost invisible, but sometimes – as for example in illness – it becomes fixed, distinct, real. Dramatic existential consequences follow, as being ill often implies the limitation of a patient’s “ability to self-determination”616 including very basic potentials such as auto-therapeutic judgment and decision making, communication and interaction with others and oneself. Waldenfels relates a couple of examples to illustrate the point: “cases such as the depersonification when a patient’s hand rests on the table like a stone; cases such as schizophrenia when someone is disconnected from her thoughts; or cases of traumatic disorder when someone freezes, fixed on what was a blow for her, unable to respond to it in any flexible way.”617
Waldenfels also develops an original taxonomy and a spatial topography of human afflictions, doing so beyond the artificial, positivist, ‘physical’ versus ‘mental’ dichotomy618. Certain of them affect the peripheral territories of our “embodied self,” while other ones penetrate the “nuclear parts of our existence”619which remain impenetrable to evidence-based medicine and external remedies. However, even strengthened enough, the mental and spiritual nucleus is not an omnipotent auto-therapist. A professional therapist will become her next companion empowering her to re-empower on her own by his therapeutic virtues, such as effective explanation and communication, which are usually initiated620 by questions like these:
“Factual: ‘What is the matter/what happened?
Affective: ‘How do I feel in my situs?
Existential: ‘What does this mean for my everyday existence?”621
Preparatory conversation, narrative medicine, a discursive doctor–patient relationship, a shared decision-making model, etc. are all tools for empowering a patient to transform herself into an agent inwardly devoted to pursuing solutions together with therapists. She can get truly involved in cooperation as an interactive and proactive agent, not just as a reactive homo patiens. This reactive model, which is still very popular in paternalistic medical cultures, pays ←173 | 174→most intersubjective respect and attention622 to a patient’s subjectivity. At the same time, it is most patient-oriented, empowering, hospitable, and inclusive for a patient. Despite the radical epistemological and experiential asymmetry between a patient and her therapist (being afflicted versus being healthy)623 the empowered patient is a therapist’s equal partner in conversation, understanding, and the decision-making process. It is language that connects both – and provides enough distance624 for their reciprocal respect. Whereas the modernization of the doctor-patient relation seem to evolve towards efficiency and discourse rules (or it is discourse-centered instead of patient-centered), considering the relationship in terms of phenomenology and the philosophy of dialogue moves the balance point to the patient to facilitate her internal self-re-empowerment by means of interactional dialogical processes. When analyzing those processes, I tried to bypass a general clinical and educational tendency to separate physical health from the mental and social health because a considerable number of authors representing the medical humanities attempt to motivate all the participants and contributors of therapeutic contexts to rethink human health as a holistic phenomenon instead of selected and isolated afflictions. Even surgical or pharmaceutical solutions can be more efficient when accompanied by the patient’s auto-therapeutic activity. Certainly, clinical practices and interactions could be more efficient if they were accompanied by simple discursive tools, such as for example making a patient familiar with difficult information and immediately leaving her 10 to 15 seconds of silent thinking time to process the information in her mind (hence, not talking to her during this short period of time)625.To conclude, healthcare institutions as the interhuman enclave of “the healing dialogue that is so urgently needed in a world still riven by injustice and hatred,”626 “in ←174 | 175→which hallowed democratic institutions are under siege,” and in which the face-to-face relations as well as hand-in-hand cooperation are rapidly declining – seems a promising alternative to artificial interfaces and networks, and – last but not least – an alternative to narrative medicine.627
Regardless of those promising perspectives (in times of less promising, technological developments both in medicine and human life, the therapist’s activities are under pressure of institutional structures and only a few phenomenologists problematize this seriously. Waldenfels is one of them: his “institutional framework is no less complicated than the juridical framework. Parallel to the advocate’s client, the therapist’s patient (…) appears as somebody suffering from diseases, disturbances, or pains: such personal sufferings are transformed into cases of sickness, but from the outset they are more than general cases. A sub-system, governed by leading differences such as healthy/unhealthy or legal/illegal, is a life construct and by no means a life sphere. (…) Such constructs of man, which return in the formal approach of the recent system theory in terms of anonymous codes, are to be deconstructed without invoking the phantasm of the ‘total man’…”628
Whereas ‘the total man’ seems to erode in proportion to increasing dialogue-, discourse- and narrative tools, and in line with the inclusion, empowerment, and emancipation of the patient as agent and decision-maker, there are still powers and their “techniques” considered to be immanent and integral element of such tools, including language and its rules. Foucault and his followers named them biopolitical powers which are ‘strategic,’ ‘technical,’ and ‘tactical’ dispositions. They may imply ‘manipulations’ and ‘maneuvers,’ and the development of machinery, ‘strategic game plans,’ and ‘battlefields’ which are very different than modern totalizing power structures such as “state apparatuses.”629 They can be increasingly controlled and managed by nonhuman intelligent networks entangled with capitalistic strategies offering and recommending entire lifestyles and lifeforms to the recipients of health care, which was a clear tendency ←175 | 176→to make a patient’s condition even more passive and recipient-like instead of strengthening its potential as agency. This strategy would be more successful in the case of persons with mental powers weakened by their addictions to technologies. Strengthening a patient must thus involve educating her doctors and therapists to respect an inner agent within the patient. This means that the main reason to revisit their reciprocal relationship and improve the autotherapeutic potentials within it is to protect their curative effects in patients more instructed in a phenomenological/hermeneutical sense of “travail spiritual,” “pratique de nous-mêmes,” “cura sui” etc., as nowadays the key competence of the self630 against a permanent counteroffensive from dominant, objectifying, and normalizing discourses, and other “dangerous”631 ones.
On the other hand, Waldenfels’ re-involvement of professional medicals as facilitators of autotherapeutic practices seems a more realistic approach – and one that is safer for patients – than dismissing them as radically as Gadamer did, despite the rapid technological advancements in medicine. My approach does not address their technological equipment. It only addresses their ability to speak and to listen to others (as it addresses the corresponding ability in patients) beyond the necessitations632 of the modern medicine which Gadamer intends to not “deflate and criticise” in his ultimate confrontation with doctors.633 Rather, he appreciates therapeutic potentials of conversation as a great facilitator for disclosing the unutterable and nameless, and making it become speakable (as was mentioned above, when recalling Wittgenstein): a conversation is an overture to– and indeed a companion of therapy. Tracking the progress, regression, or stagnation in therapy means (at least to some important extent) tracking the changes in ←176 | 177→conversation as evidence of autotherapeutic progress, regression, or stagnation. Its further key role is creating a tool for cooperative decision-making (the question of how the interlocutor scan ensure that they made their agreements cooperatively634 would demand additional research on the essential, dialogical and hermeneutical skills, which goes beyond the scope of this project). But its very first role from the research perspective taken in this book would be the adoption of a therapeutic hermeneutics that would make conventional therapy simply more integral – but not as a rival. One’s self-development through co-responsive (in German: Ko-respondenzprozesse, the question-response scheme immanent to the human mind as speaking and listening to, in Aristotle and Arendt’s terms)635 processes, with respect for patients’ life contexts, brought to conversation and promising the novel step of ‘bio-sedimentation’. This, again, refers to the crucial experience of hearing oneself: “in hearing myself speak I stay completely in what I mean myself. The viva vox of the ‘phenomenological voice’ animates and inspires the corporeity (Körper), transforming it into body (Leib) and providing it with a ‘conscious corporeality/bodily reality’ ”636 (geistige Leiblichkeit by Husserl). “While attending his own sense-giving in terms of a permanent birth of sense, the speaker is close to himself in what is meant, he is close to himself in the-thing-itself, attaining an absolute form of proximity that merges presence and self-presence within the ‘vivid presence.’ ”637 To sum up my investigations ←177 | 178→encouraging the autotherapeutic (also: self-understanding, self-convincing, self-regaining, self-recovering, etc.) potentials to deal with 1. The anthropological ‘negativity separating the human condition from itself,’638 2. the ambiguous technology “that simultaneously liberates and deprives (…) us,”639 and 3. manifold, open, and opaque discursive powers that attempt to contaminate agency and subjectivity. At the same time, the intra- and intersubjective, dialogical competencies are preserved here, as they are the most powerful facilitators of health communication. Especially because
the second hand hearing and seeing (…) have taken on such gigantic proportions in our age of telehearing and televiewing and are enhanced by various hearing and visual aids (…) It is precisely the phenomenon of attention, however, which endows the modalization of experience with such importance, that brings about its technization. Here too we find that phenomenology and phenomenotechnology go hand in hand.640←178 | 179→
513 See Braden R. Allensby, Daniel Sarewitz, The techno-human condition, Cambridge, Mass., London, England, The MIT Press, 2013.
514 According to Charles Taylor, “like any other human being at any time,” the modern man “can only find an identity in self-narration,” Sources of the self. The making of the modern identity, Cambridge, Harvard University Press, 1989, pp. 288–289.
515 Nowadays, the “gnṓthiseauthón” becomes much more demanding because of the complexity of medical knowledge and this is why an individual needto be supported by professional medical expertise, explication, counseling, etc. which, however, cannot be equated with making therapeutic decisions solely by professional authorities.
516 Ch. Taylor, Sources of the self, p. 115.
517 See Michel Foucault, Hermeneutik des Subjekts, trans. U. Bokelmann, Frankfurt am Main, Suhrkamp, 2004, pp. 16–17.
518 Andrzej Wierciński, “Hermeneutic notion of a human being as an acting and suffering person,” Ethics in Progress 2013, vol. 4, no. 2, p. 22.
519 See Ulrich Oevermann, Klinische Soziologie auf der Basis der Methodologie der objektiven Hermeneutik, Frankfurt am Main, Institut für Hermeneutische Sozial- und Kulturforschung, 2002; “Die objektive Hermeneutik als unverzichtbare methodologische Grundlage für die Analyse von Subjektivität. Zugleich eine Kritik der Tiefenhermeneutik,” in: Thomas Jung, Stefan Müller-Doohm (Eds.), Wirklichkeit im Deutungsprozess. Verstehen und Methoden in den Kultur- und Sozialwissenschaften, Frankfurt am Main, Suhrkamp, 1993, pp. 103–189; Klinische Soziologie. Konzeptionalisierung, Begründung, Berufspraxis und Ausbildung, Frankfurt am Main, Suhrkamp, 1990. In the essay “Hermeneutik und Psychiatrie” (1989), Hans-Georg Gadamer stresses that medical art (ärztliche/medizinische Kunst) should not be equated with the pursuit of scientific research or the use of scientific discoveries through techniques, practices, and procedures. Über die Verborgenheit der Gesundheit. Aufsätze und Vorträge, Frankfurt am Main, Suhrkamp, 1993.
520 H.-G. Gadamer, Über die Verborgenheit der Gesundheit, pp. 50–64.
521 H.-G. Gadamer, Über die Verborgenheit der Gesundheit, pp. 50–64
522 H.-G. Gadamer, Über die Verborgenheit der Gesundheit, p. 64.
523 Phillip Carry, Augustin’s invention of the inner self. The legacy of the Christian Platonist, New York, Oxford University Press, 2000, p. xi.
524 P. Cary, Augustin’s invention, p. 114.
525 P. Cary, Augustin’s invention, p. 116.
526 P. Cary, Augustin’s invention, p. 116.
527 M. Wesoły, “Po co nam dziś Hippokrates,” p. 31.
528 M. Wesoły, “Po co nam dziś Hippokrates,” p. 31.
529 Michel Foucault, “Technologies of the self,” in: L. Martin, H. Gutman, P. Hutton (Eds.), Technologies of the self: A Seminar with Michel Foucault, Amherst, The University of Massachusetts Press, 1988, pp. 16–49; “The ethics of care for the self as the practice of freedom,” in: J. W. Bernauer, D. Rasmussen (Eds.), Final Foucault. Cambridge, The MIT Press, 1994, pp. 1–20.
530 Andrew B. Kipnis, “Agency between humanism and posthumanism,” Journal of Ethnographic Theory 2015, vol. 5, no. 2, pp. 49–52.
531 See Manfred Spitzer, Cyberkrank.
532 See “Wachstum und Krisen der gesunden Persönlichkeit,” in: Erik H. Erikson, Identität und Lebenszyklus, Frankfurt am Main, Suhrkamp, 1966, p. 55.
533 Kazimierz Dąbrowski, Dezintegracja pozytywna, Warszawa, Państwowy Instytut Wydawniczy, 1989, p. 5.
534 K. Dąbrowski, Dezintegracja pozytywna, p. 6.
535 K. Dąbrowski, Dezintegracja pozytywna, pp. 10–11.
536 In comparison, Erikson represents a more psychoanalytic and narrativist position than a phenomenological one; he more often writes about identity crisis in terms of autobiography and pathography.
537 K. Dąbrowski, Dezintegracja pozytywna, p. 13. In his description of the case of Peter as feeling “on the fridge of being,” Laing also emphasized “the lack of direction” and “the pointlessness,” Ronald D. Laing, The divided self, p. 125. Analogies with schizophrenia are less superficial than with hypocrisy, compare Jeff Stone, Joel Cooper, Andrew W. Wiegand, Elliot Aronson, “When exemplification fails: Hypocrisy and the motive for self-integrity,” Journal of Personality and Social Psychology 1997, vol. 72, no. 1, pp. 54–63.
538 K. Dąbrowski, Dezintegracja pozytywna, p. 11.
539 K. Dąbrowski, Dezintegracja pozytywna, p. 15.
540 K. Dąbrowski, Dezintegracja pozytywna, p. 18.
541 K. Dąbrowski, Dezintegracja pozytywna, p. 103.
542 K. Dąbrowski, Dezintegracja pozytywna, p. 103.
543 K. Dąbrowski, Dezintegracja pozytywna, p. 20; see Leo Navratil, Schizophrenie und Dichtkunst, Munich, DTV, 1986, pp. 91–95.
544 K. Dąbrowski, Dezintegracja pozytywna, p. 28.
545 K. Dąbrowski, Dezintegracja pozytywna, pp. 32–33.
546 K. Dąbrowski, Dezintegracja pozytywna, p. 35.
547 K. Dąbrowski, Dezintegracja pozytywna, p. 35.
548 K. Dąbrowski, Dezintegracja pozytywna, p. 44.
549 K. Dąbrowski, Dezintegracja pozytywna, p. 61.
552 Patricia da Silva Leite, Inclusive digital game elements for gameplay in the context of people with disabilities through embodied interaction perspective, unpublished dissertation (original in Portugese), Curitiba, Universida de Tecnológica Federal do Parana, 2017, URL: http://repositorio.utfpr.edu.br/jspui/handle/1/2892, last accessed on September 2, 2018.
553 P. da Silva Leite, Inclusive digital game elements, pp. 78–85.
554 According to the research based on subjective judgments and self-evaluation, “a self-enhancement perspective would predict a linear authenticity progression from the past to the present and the present to the future (…) people tend to believe that they are getting closer to their true selves over the course of their lives,” Elizabeth Seto, Rebecca J. Schlegel, “Becoming your true self: Perceptions of authenticity across the lifespan,” Self and Identity 2018, vol. 17, no. 3, pp. 12–14.
555 Including “the pastoral cure of souls” and “cura animarum” which “causes them [e.g. patients] to be moral agents,” but, through indoctrination, false authority and exaggerated paternalism, it can lead to the opposite effect, i.e. make the soul a chronic “moral patient,” Thomas Szasz, The myth of psychotherapy, New York, Anchor Press/Doubleday, 1978, pp. 25–26; see also John T. McNeill, A History of the cure of souls. New York, HarperCollins, 1987; and Morton Winston, “An ethics of global responsibility: Moral patients,” 2018, accessed on April 4, 2018, http://ethicsofglobalresponsibility.blogspot.de/2008/02/moral-patients.html. Szasz also describes “Jesus’ role as a psychotherapist,” The myth of psychotherapy, p. 31. The patristic tradition focused on fostering the inner powers of human being (also Augustine’s “inner self”) in order to help man in his emancipation from oppressive political and legal powers are also drawn from this source. In addition to degeneration of these traditions towards indoctrination and obedience to church authorities mentioned above, the second degeneration would be what, beginning with Hegel, is called the “unhappy consciousness,” which seeks fulfilment of its hopes and even basic needs such as freedom in the sphere of “jenseits,” instead in the sphere of “diesseits.” An adequate interpretation of the patristic tradition of autotherapy can be found in Clemens Sedmak, Małgorzata Bogaczyk-Vormayr, Patristik und Resilienz. Über die Seelenskraft, Walter de Gruyter, 2012.
556 T. Szasz, The myth of psychotherapy, p. xxiv.
557 T. Szasz, The myth of psychotherapy, xxiv
558 The emphasis is thus placed on “personal independence from worldly authority” in such self-healing practices, T. Szasz, The myth of psychotherapy, p. 28. What is also important is that Socrates “shows us that both the dichotomy between and the equation of body and mind, curing body and curing the soul, are utterly misleading.”
559 See Cary, Augustine’s invention, p. 116.
560 H.-G. Gadamer, “Angst und Ängste,” in Über die Verborgenheit der Gesundheit, pp. 189–200.
561 H.-G. Gadamer, “Hermeneutik und Psychiatrie,” pp. 201–213.
562 H.-G. Gadamer, “Angst und Ängste,” p. 194.
563 H.-G. Gadamer, “Angst und Ängste,” p. 195.
564 H.-G. Gadamer, “Hermeneutik und Psychiatrie,” p. 201.
565 H.-G. Gadamer, “Hermeneutik und Psychiatrie,” p. 202.
566 See Jakub Zawiła-Niedźwiecki, “Antoni Kępiński’s philosophy of medicine. An alternative reading,” Acta Universitatis Lodziensis. Folia Philosophica. Ethica – Aesthetica – Practica 2016, vol. 28, p. 27. Furthermore, Kępiński “recognizes the continuity and unity of the medical disciplines. Even if neurology is distinct from psychiatry with only small overlap, psychiatry still requires training in all medical disciplines and expert knowledge of various ailments of the body as well as disorders of the mind. He also recognizes that every medical doctor is a psychiatrist from time to time, when needed, as somatic diseases have psychiatric components” or psychogenic background, p. 33.
567 After the psychosomatic turn and the prosthetic turn, it can be assumed that this whole also includes the organs and morphemes that create a powerful “assemblage” (in terms of Deleuze and Guattari).
568 H.-G. Gadamer, “Hermeneutik und Psychiatrie.” Unlike the physically ill patients whose organism shows some kind of self-awareness (Krankheitsbewusstsein) protecting them against a conventional medical classification as ‘being ill,’ in psychiatric patients their self-awareness is ill (die Krankheitseinsicht selbst erkrankt ist), p. 207.
569 H.-G. Gadamer, “Hermeneutik und Psychiatrie,” p. 205.
570 Dieter Thomä, Erzähle dich selbst. Lebensgeschichte als philosophisches Problem, p. 232.
571 Christian Budnik, Das eigene Leben Verstehen, Berlin, Boston, De Gruyter Ontos, 2013, p. 23.
572 Boris Zizek, Probleme und Formationen des modernen Subjekts. Zu einer Theorie universaler Bezogenheiten, Wiesbaden, Springer VS, 2012, pp. 127–130.
573 H.-G. Gadamer, Schmerz, p. 27.
574 Chronic and incurable diseases need more complex strategies.
575 H.-G. Gadamer, Schmerz, p. 27.
576 Hans Jonas, The imperative of responsibility, pp. 3–7.
577 I refer here to the model robot model exhibited at the festival “Cywilizacja Algorytmów I Festiwal Przemiany” [The Civilization of Algorithms and the Festival of Transformation] (Copernicus Science Centre, September 2018), whose program included an algorithm for the stroking of robotic hand – the hand of a man in a terminal state.
578 Paulo Becchi, Roberto Franzini Tibaldeo, “The vulnerability of life in the philosophy of Hans Jonas,” in: A. Masferrer, E. García-Sánchez (Eds.), Human dignity of the vulnerable in the age of rights, Cham, Springer, 2016, p. 81.
579 H.-G. Gadamer, Schmerz, p. 29.
580 H.-G. Gadamer, Schmerz, p., 39.
581 H.-G. Gadamer, Schmerz, p. 36.
582 Manuel Franzmann, “Autonomie und Bewährung im Kontext einer säkularisierten Transzendenz,” in: O. Behrend, B. Zizek, L. Zizek (Eds.), Autonomie und Bewährung, Wiesbaden, Springer VS, 2019, p. 115.
583 Eric T. Olson, The human animal. Personal identity without psychology, New York, Oxford, 1997.
584 John McDowell, “Reductionism and the first person,” in: Jonathan Dancy (Ed.), Reading Parfit, New York, Oxford University Press, 1997, pp. 230–250.
585 Ch. Budnik, Das eigene Leben verstehen, p. 23.
586 Ch. Budnik, Das eigene Leben verstehen, p. 23.
587 Antoni Kępiński, Poznanie chorego, Kraków, Wydawnictwo Literackie, 2002, pp. 32–35.
588 Here I do not consider the ontological continuity and discontinuity of a sleeping brain which “vanishes” or is replaced “by a sleeping brain,” and wakes up anew in the morning, as analytical philosophers do, see Eric T. Olson, What are we? A study in personal ontology, New York, Oxford University Press, 2007; and idem, “The nature of people,” in: Steven Luper (Ed.), The Cambridge Companion to Life and Death, New York, Cambridge University Press, 2014, pp. 30–46.
589 A. Kępiński, Poznanie chorego, pp. 49–50.
590 A. Kępiński, Poznanie chorego, pp. 50–51.
591 Ludwig Wittgenstein, Philosophical Investigations. The German texts, with English translations by G. E. M. Anscombe, P. M. S. Hacker, and J. Schulte. Malden, Willey-Blackwell, 2009, § 124.
592 L. Wittgenstein, Philosophical Investigations, § 119.
593 L. Wittgenstein, Philosophical Investigations, § 133.
594 L. Wittgenstein, Philosophical Investigations, § 154.
595 H.-G. Gadamer, “Angst und Ängste,” p. 194.
596 Adriana Warmbier, Tożsamość, narracja i hermeneutyka siebie [Identity, narrative and hermeneutics of the self], Kraków, Universitas, 2018, p. 163.
597 L. Wittgenstein, Philosophical Investigations, § 154.
598 Ludwig Wittgenstein, Tractatus Philosophicus, Preface, trans. D. F. Pears, B. F. McGuiness, London, Routledge and Kegan Paul, 1961; see also Gurczyńska-Sady’s comparative analysis of “unspeakable” in Wittgenstein and Arendt: Katarzyna Gurczyńska-Sady, Troska o świat, Kraków, Uniwersytet Pedagogiczny Publishers, 2019, pp. 70–78.
599 Bernhard Waldenfels, Grundmotive einer Phänomenologie des Fremden, p. 21.
600 Thomas Wallgren, Transformative philosophy, Lanham, Lexington Books, 2006.
601 Thomas Wallgren, “Hintikka’s later Wittgenstein – some problems,” Sats – Nordic Journal of Philosophy 2001, vol. 2, no. 2, p. 113; also Kurt Mosser, “Kant and Wittgenstein: Common sense, therapy and the critical philosophy,” Philosophia 2009, vol. 37, no. 1, pp. 1–20.
602 See Christian Hick, “Patientenerklärung,” in: Klinische Ethik, Cologne, Springer, 2007, p. 9.
603 Małgorzata Bogaczyk-Vormayr, “Resilienz und Seelenstärkung,” MThZ 2016, vol. 67, p. 264.
604 According to A. Gehlen, Entlastung and Plastizität are anthropological determinants, see Der Mensch
605 D. Thomä, Erzähle dich selbst, p. 132.
606 B. Waldenfels, Grundmotive einer Phänomenologie des Fremden, p. 45.
607 B. Waldenfels, Grundmotive einer Phänomenologie des Fremden, pp. 44–45.
608 B. Waldenfels, Grundmotive einer Phänomenologie des Fremden, p. 45.
609 H. Hick, “Patientenerklärung,” p. 9.
610 H. Hick, “Patientenerklärung,” p. 8.
611 Kevin Aho, “Notes from a heart attack,” in: E. Dahl, C. Falke, T. E. Eriksen (Eds.), Phenomenology of the broken body, New York, Routledge, 2019, p. 195.
612 Kevin Aho, “Notes from a heart attack,” p. 195.
613 See L. Metzger, Philosophische Interpretation des Selbst. Untersuchungen zur Subjekttheorie bei Paul Ricoeur, p. 12.
614 L. Metzger, Philosophische Interpretation des Selbst, p. 82.
615 L. Metzger, Philosophische Interpretation des Selbst, pp. 83–84.
616 Ch. Hick, “Patientenaufklärung,” p. 11.
617 B. Waldenfels, Grundmotive einer Phänomenologie des Fremden, p. 82.
618 H. F. Dunbar, Synopsis of psychosomatic diagnosis and treatment.
619 B. Waldenfels, Grundmotive einer Phänomenologie des Fremden, p. 84. Here Waldenfels confirms his slightly egological (or ego-centered, respectively) view on the embodied self.
620 As Martin Buber stresses, “Nie ist Sprache gewesen, ehe Ansprache war,” Sprachphilosophische Schriften. Martin Bubers Werkausgabe 6. Gütersloh, Gütersloher Verlagshaus, 2003, p. 131.
621 Ch. Hick, “Patientenaufklärung,” p. 16.
622 In its cognitive and normative sense as “empathy” and asymmetrical “Interattentionalität,” see Thiemo Breyer, Attentionalität und Intentionalität. Grundzüge einer phänomenologisch-kognitionswissenschaftlichen Theorie der Aufmerksamkeit, Munich, Wilhelm Fink Verlag, 2011, pp. 259–269.
623 See Matthias Kettner, Matthias Kraska, “Kompensation von Arzt-Patient-Assymetrien im Rahmen einer Theorie kommunikativen Handelns,” in: J. Vollmann, J. Schildmann, A. Simon (Eds.), Klinische Ethik, Frankfurt am Main, New York, Campus Verlag, 2009, pp. 249–251.
624 “Das Werden der Sprache bedeutet (…) auch eine neue Funktion der Distanz,” M. Buber, Sprachphilosophische Schriften, p. 133.
625 Ch. Hick, “Patientenaufklärung,” p. 24.
626 Constantin Konzi Kalamba, The Japan Mission Journal, Editorial 2018, vol. 72, no. 2, p. 73.
627 If it is true that “the narrative self has reality insofar as it is a real social construction” and “stories are not simply records of what happened, but continuing interpretations and reinterpretations of our lived lives,” Dan Zahavi, “Self and other: The limits of narrative understanding,” Royal Institute of Philosophy Supplement 2007, vol. 60, pp. 181–182.
628 Bernhard Waldenfels, “In place of the other,” Continental Philosophical Review 2011, vol. 44, pp. 158–159.
629 Michel Foucault, Psychiatric power. Lectures at the Collège de France 1973–1974, trans. by G. Burchell, New York, Palgrave Macmillan, 2006.
630 In a sense also explored by the late Foucault who returned to subjectivity after having become famous for its deconstruction, see Hermeneutik des Subjects, pp. 16, 47, 127.
631 E.g., disability and other excluding discourses, whereas the empowering ones would also imply relativization, such as for example “the instability of the disabled body, far from being peculiar to that putative category, is simply a more acute instance of the instability of all bodies,” Margrit Shildrick, Dangerous discourses of disability, subjectivity and sexuality, New York, Palgrave Macmillan, 2009, p. 35.
632 Including “diagnoses, verdicts, reductions to an instance of a rule” and countless further objectivization forms that “take away the freedom of the suffering subject” to deprive her of the status of agent, Deyan Deyanov, Svetlana Sabeva, Todor Petkov, “Bourdieu and Stanghellini: Socioanalysis and phenomenological psychopathology,” in: D. St. Stoyanov (Ed.), Towards a new philosophy of mental health: Perspectives from neurosciences and the humanities, Cambridge, Cambridge Scholars Publishing, 2015, p. 313.
633 H.-G. Gadamer, “Behandlung und Gespräch,” in: Über die Verborgenheit der Gesundheit.
634 Harold A. Goolishian, Harlene Anderson, “Menschliche Systeme. Vor welche Probleme sie uns stellen und wie wir mit ihnen arbeiten,” in: E. Reiter et al. (Eds.), Von der Familientherapie zur systemischen Perspektive, Berlin, Heidelberg, New York, London, Paris, Tokyo, Springer Verlag, 1988, p. 212.
635 Hilarion G. Petzold, Integrative Therapie. Modelle, Theorien und Methoden einer schulübergreifenden Psychotherapie, Bd. I, Klinische Philosophie: Transversale Diskurse, Paderborn, Junfermann Verlag, 2003, p. 143.
636 Bernhard Waldenfels, “Hearing oneself speak: Derrida’s recording of the phenomenological voice,” The Southern Journal of Philosophy 1993, vol. 32, Supplement, p. 67. Beyond that phenomenological context, hearing oneself would promote health responsibility in patients and their caregivers. The famous Polish pediatrician Janusz Korczak shows this when asking Esther to loudly enumerate all his prescriptions when addressing Esther’s little brother, whom she was treating: “Esther is 13 years of age and she has already educated three young children. She would be even able to instruct and to encourage another mother…,” Janusz Korczak, “Obrazki szpitalne” [Hospital scenes], Pisma Wybrane, vol. II. Warszawa, Nasza Księgarnia, 1984, p. 30. Korczak belongs to the most dialogical practitioners in the history of prewar Polish medicine (pediatrics).
637 B. Waldenfels, “Hearing oneself speak,” However, phenomenological presence is not just the presence of a material object (Körper). According to Husserl, “everyone relates his I-experience (…) to the lived body [Leib]. Thus, he localizes them in the body, sometimes on the basis of direct experience, in an immediate intuition, sometimes in the mode of an indirect experiential or analogizing knowing. It is completely sui generis,” nevertheless, it empowers the I to “perform acts of empathy,” responsivity, etc. in relation to one’s own lived body, Edmund Husserl, The basic problems of phenomenology from the lectures - winter semester 1910–1911. Trans. I. Farin, J. G. Hart, Collected Works, vol. XXII. Netherlands. Springer, 2006, pp. 4, 5, 92.
638 Roberto Esposito, Bíos. Biopolitics and philosophy, Minneapolis, University of Minnesota Press, 2008, p. 48.
639 R. Esposito, Bíos, p. 48
640 Bernhard Waldenfels, Phenomenology of the alien, p. 65.