What does it mean to be ill? Philosophy of Disease and Corona Crisis

Illness is never entirely ‘mental’ or entirely ‘somatic’; illness is unhomelike being-in-the-world of Dasein including both aspects as inter-nested.

(Fredrik Svenaeus, Med Healthcare, and Philosophy, 2011)

By Saumya Liyanage

The COVID-19 outbreak has already brought about a myriad of medical, political and military procedures. Efforts are being made by national health institutions to curb the virus under the guidance of the World Health Organization (WHO). In this country, a Presidential Task Force has been set up to adopt measures to control the transmission of the virus.

The corona outbreak has led to racial and anthropocentric sentiments among communities and some social groups. The racial sentiment has been developing as humans are the carriers of the disease, and people who are infected, or are suspected to be infected, are required to undergo self-quarantine for the protection of society. Anthropocentric sentiment has developed among people because this viral infection has germinated through bats or other animals that humans have come into contact with.

This negative feeling towards nature and anthropocentrism further reflects how we think of the natural world and our sharing of it with other animals. This viral outbreak has gradually given rise to the idea that human existence is detached from the environment; the coronavirus infection has heightened this anthropocentric mentality that we are superior to all other species in the world. Humans have not only alienated themselves from the environments, mainly others species but separated the sick from the healthy. Social distancing has come to stay.

The distancing of humans from the environment due to the corona outbreak further reflects other suppressive apparatuses at work. As the form of anthropocentrism operates through the government regulations, this patriarchal domination suppresses women, children and old people in the community. My observation is that this dominant ideology is operated through medical and military structures through which the government is trying to battle against the viral infection. For the patriarchy, the coronavirus appears as the other, and their battle is to fight it. Countries like Sri Lanka, India, and many African nations have failed to practise social distancing due to diverse social stratifications. It is evident how the elite and bourgeoisie gather around supermarkets one-metre apart in keeping with medical and military procedures. As expressed in social media, social distancing and waiting hours at supermarkets reflect the apolitical sentiment of the bourgeoisie and their subordination, whereas the poo rush to other markets and try to grab anything they can find. However, this anthropocentric sentiment is othering not only the nature in which we live in but other marginalised communities who are weak and vulnerable to the pandemic. Under these circumstances, measures such as ‘social distancing’ are what only the bourgeoisie can practise.

Descartes’s Body and illness

In the traditional Cartesian philosophy, the human body is defined as something similar to a machine, and the spirit or the soul is defined as something separated from this mechanical body. This philosophical assumption is reflected through western medicine and the problem with the current medicinal practices is that the human body and its functionalities are defined and understood as a mechanical body that consists of certain parts and organs. According to this conception, the body organs and other body parts such as limbs are mere mechanical parts of the body that can be dissected, replaced or repaired (Kibbe 2014, Goldenberg 2010). This long historical problem of conceptualising the human body as a biomechanical entity has serious medical circumstances when it comes to how we understand the meaning of patient–health care worker relationship in the current medical care settings. James A. Marcum argues: ‘Working from the biomechanical model of the body, today’s physician operates primarily as a mechanic or technician, whose clinical gaze is focused neither on the patient as a whole nor on the patient’s lived context but exclusively on the diseased body or body part’ (Marcum. J. A., 2004, p. 311).

The dominant medical discourse in the world is thus focused on the human corpus as a place for performing dissections and replacements. This corpus can be opened, removed, replaced or have organs transplanted due to certain illnesses. The problem with these biomechanical approaches to the human body is that the medical world has forgotten the fact that the human body is not merely flesh or a collection of organs or limbs. The phenomenological understanding of the body in contrast to the biomechanical understanding of the body is somewhat different as phenomenology understands the human body as a sentient being or a ‘lived body’ that is already and always attuned to the world. The body thus has its own ways of being-in-the-world and the body also understands the world better than we rationally think of it. Hence, the phenomenal body challenges the biomechanical body in contemporary medical discourse. Writing about current medical practices and patient care, Goldenberg argues that, modern medical technology such as stethoscope, ophthalmoscope, and X-ray have conceptualized the human body as a mechanical object and this conceptualization has permitted us to dissect the lived body (Goldenberg M. J., 2010 p. 51).

First, I would like to briefly discuss why phenomenology is vital for us to understand the nature of illness in contrast to wellbeing. The coronavirus infection has brought up certain assumptions of the human body and its existence as something decayed through illness and death. The daily death tolls in the US, Italy and elsewhere have gradually created the sentiment that the human body is merely a physical entity that can be infected by a viral pandemic or it is a body that can be saved through mechanical manipulation of medical and political discourses. It is true that amidst this pandemic crisis, human beings have to abide by government regulations and medical procedures in such a way that they can deal with the viral pandemic.

However, in this catalytic situation, the human body becomes a mere object of medical and political manipulation. As seen in many of the international news channels, the human body is becoming a canvas for medical procedures as well as torture and violence. Web channels and Facebook circulate how the human body is being diseased and also being tortured by the military because of noncompliance with the rules and regulations amidst this coronavirus pandemic. One cannot contemplate these paradoxical reactions of law enforcement and medical institutions. The body is treated as a surface of violence, torture, diseased to establish its beauty, wellbeing, and immortality. In this respect, bodies’ presence in the current social milieu is somewhat controversial and fragmented. The ruling government and medical institutions need people to be healthy and adopt preventive measures. On the other hand, bodies are being threatened, beaten, isolated and further imprisoned or left behind amid corona warfare.

Phenomenology and the lived body

A new discussion about the human body has come to the fore because our bodies have been continually threatened by both the viral infection and law enforcement. As seen so far, whether it is medical or military discourses, the human body is being manipulated and treated in many forceful ways. The coronavirus infects the internality of the body while the government is policing the flesh of the body. But what it means to have a body and what the role of the body is in human existence are vital questions to be discussed in this difficult time. Hence, I turn to Edmund Husserl (1859-1938) known as the founder of phenomenology; he provides two sets of words to denote the existential natures of the body. The German word körper uses for the physical body or body as an object. The term Leib is used for the lived or living body. That is the body we perceive as a subject. Here, Husserl distinguishes two aspects of the human body. This means that in some situations, we tend to experience our bodies as objects; solid, physical like nature of the body; whereas, in some situations, we experience our body as a transcendental or a living entity which is known as the lived body. Generally, the word ‘lived body’ presents the body as a non-dualistic, sentient being in contrast to the Cartesian split of the body as a machine and the mind as an extended rational soul. The main difference between the lived body and the physical body is that this lived or animate body is always given as my own body (Crisis §2) and I experience myself as ‘holding sway’ over this body. The lived body is not just a centre of the experience, but a centre for action and self-directed movement (Luft and Overgaard 2014, ).

In this discussion of illness and disease, the German philosopher Martin Heidegger’s key concepts of phenomenology will also help to shed light to understand what it means to be diseased or what it means to be healthy. In this regard, concepts such as ‘being-in-the-world’ can be elaborated as to how a person is attuned to her/his environment and how this attunement is disrupted when the illness is invaded into a healthy body (Svenaeus 2011). Further, the French phenomenologist Maurice Merleau-Ponty developed the idea of ‘body-subject’ where he explains the power and expression of the human body not just as a corpus but as a consciousness establishing its ‘intentional arc’ as the power of attuning with the world. In this sense, I am motivated to write about the current illness caused by the coronavirus and understand the conundrum of being ill and not being ill in the light of phenomenology.

Alienation

When a person is ill and feeling unwell, one’s conscious experience is directly focused on her/his body, and the functionality and the smooth flow or the attunement of the body with its environment is primarily fractured or ceased. When one’s intentionality is directed towards her/his body, the autonomous nature of the body is paralyzed and ill-treated. This uncanny mood creates a disjuncture of our being-in-the-world which means our natural flow of being-with- other.

When someone is diseased, our natural flow of coping with the world and our emotional engagement with the world is disrupted. In a phenomenological sense, this can be understood as something similar to ‘unhomelike’ being-in-the-world (Svenaeus 2011). As Heidegger speculates in his Being and Time (1927), our natural attitude is that our body is thrown into the world where the body and the world are intertwined and bound together through its practicalities. The practicalities here refer to our bodily engagements with certain projects through tools and equipment. When we feel sick, that means our natural engagement with certain projects through the equipment is disrupted and disturbed. Our homelike being-in-the-world is fragmented or disrupted. Heidegger calls this ‘authentic anxiety’.

In this illness situation, our bodies experience the ‘otherness’ within oneself or alienation from oneself from her/his self. The idea of alienation is very familiar in theatre theory and especially Bertolt Brecht’s conceptualization of the actor’s disengagement with the character. In German, it is known as the verfremdung, which means the alienation or defamiliarizing of the familiar (Liyanage 2016). But the otherness that one may experience during illness is something that is to do with the duality of self and the experience of being self while possessing the dual existence. (the otherness of one’s own body comes to the fore). When the illness occurs the patient feels disengaged with her daily projects and she may feel pain, anxiety, dizzy and many other ailments. In such a situation, in a phenomenological sense what we experience is unhomelike being-in-the-world. This ‘unhomelikeness’ is the ‘otherness’ that one may experience during illness. In a healthy situation, a person’s projects are operated through bodily actions that are intertwined with the outer world. These activities always function with ease because the body is always absent in the delivery of human action. Yet the diseased body is not operated in this manner. When the body is diseased, it is not operated behind the curtain or in other words, the body is not absent. The body always comes to the fore. In contrast to this unhomelikeness, when the person is fully operative and engaged in projects in the world, these healthy engagements are characterized by the mood that one possesses in engaging ‘life-world’ activities (Nagatomo 1992). For instance, if I am not yet infected by the virus, my daily routine activities are not disturbed by the illness and my full operation as a healthy person is manifested by the emotional engagement and the expression that I have during my activities. This is vital for us to understand the ‘mood’ of the person who is fully being-in-the-world.

Gaze and Illness

In the recent discussion on the corona outbreak and the battle against the disease, one of the major social psychological factors that have developed in recent weeks is that people are afraid of being identified as COVID-19 infectious individuals. The problem of this phenomenon is that whether you are infected or not, people have a great fear of being identified as a diseased person. How can we understand this mental condition? As I discussed earlier, it is a fear of being alienated from our selfhood. Jean-Paul Sartre, in his book Being and Nothingness (1943) articulates this concept through the gaze of the other. The fear of being ill encapsulates the individual’s experience of her/his objectification of the body as an ‘unhomelike being-in-the-world in the wake of a disease. In Sartre’s lexicon, there are other ways that one’s body can be gazed at by others and alienated from her/his self. For instance, seeing a doctor check whether I have been infected by a disease demonstrates that in the confrontation of the doctor’s gaze, my body is becoming an object to me. However, this alienation of my own body from my own conscious experiences is the moment that I experience the discomfort and further the shame of being ill. In Sartre’s philosophy, ‘the gaze of another person has the power of objectification of my own body. Therefore, I experience the ‘otherness’ or the alienation of my own body as if someone who is a conscious person looking at me and makes my conscious attention towards my body’ (Svenaeus 2009).

Conclusion

The human body is an unprecedented creation of nature that is always being in the world as a living and sentient being. It is a sentient being because it always demonstrates to the world of its ‘becoming’ rather than being a final product. ‘The human body is a unique aesthetic material; it is a living organism, always in a state of becoming; that is, in a continual process of transformation’ (Fischer-Lichte 2014, p. 25). We need to understand the living nature of our bodies in this difficult time because, as argued in the foregoing, the human body is not merely a collection of organs or an assemblage of outer and inner materials combined to develop a physical body. As Merleau-Ponty speculates, the human body is a living entity and it is already anchored in the world before we rationally think of our outer world and environment. This is why medical doctors and health workers need to rethink how they should interact with or treat patients. Especially at this difficult time of the coronavirus outbreak, we further need to change our perspectives towards those who are affected with COVID-19, and how we understand their illness and how we take care of the diseased.

Acknowledgments

The author wishes to thank Himansi Dehigama and Sachini Senevirathne, PGIE, Open University Colombo who have proof read this paper.

Saumya Liyanage

(PhD) is an actor and a Professor of theatre and drama, at the Faculty of Dance and Drama, University of Visual and Performing Arts Colombo.

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