The Phenomenological Foundations of Fundamental Medicine

Both the physical and biological sciences of our day are based on a belief in miracles - the miraculous emergence of awareness and aware beings an otherwise non-aware universe of matter and energy - of bodies in space and time. It seeks to explain our capacity for conscious awareness through studying particular phenomena within our own field of awareness - for example the physical body or brain. The terms 'physical' and 'physics' derive from the Greek verb phuein - to 'emerge', 'arise' or 'manifest'. Physics offers explanations of how things emerge or arise but does not begin by recognising them as phenomena emerging or arising within a field of awareness. From a phenomenological point of view, the known universe is not merely a universe we happen to be aware of and can therefore attain knowledge of. The universe as we know it is the universe of our present human awareness. Deepening and broadening our knowledge of both human and natural phenomena can therefore take two forms - researching and representing relationships between them or deepening and broadening our own awareness of them.

The focus of phenomenological science is not a world of pre-given 'things' independent of our own awareness, but the very nature of those things as phenomena manifesting in a field of awareness. Field-dynamic phenomenology is concerned with the physical dynamics of phenomena in the root sense of this term - the dynamic process by which phenomena emerge or arise (phuein) - not as objects of observation for a localised 'subject' of awareness but as events occurring in non-localised field of awareness. This observer is but one localised centre or locus of this non-localised field of awareness, which includes both observer and observed. The observed phenomenon gives form to the observer's awareness of the field as a whole. But the awareness that constitutes this field as such is not an awareness of any phenomena at all. Within field-dynamic phenomenology, awareness is not, as Husserl claimed, essentially awareness of something, still less a mental act on the part of a subject or ego which turns these phenomena into 'intentional objects'. Instead any given phenomena is itself a patterned figuration of awareness - one which both gives shape to the source field of awareness from which it emerges and configures its own awareness of other phenomena within that field. The dynamic relation between field and phenomenon can be compared to the relation between an ocean and the life forms that emerge within it. Each of these life forms gives form to the life of the ocean as a whole, and is in this sense a self-manifestation of it. But the very form of each these life-forms also configures their awareness of the ocean as a whole and of all other life forms within it. The shark is aware of the ocean and perceives its other life-forms in a quite different way to the jellyfish. Indeed, what appears to us as the form of a shark or shellfish may bear little comparison to the way the jellyfish perceives the shark and vice versa. As human beings, we are not divinely gifted with a unique figuration or field-pattern of awareness that allows us perceive the 'true' form of a shark, jellyfish or any other organism. What any organism essentially is, is nothing more or less than an organising field-pattern of awareness, one which in-forms its own patterned field of awareness and configures its perception of other organisms within that field. The organising field-patterns of awareness that constitute a shark or jellyfish each in-form their awareness both of the ocean as a whole and of other life-forms within. Each is at the same time the individualised self-manifestatin of the life of the ocean as whole.

From a field-phenomelogical perspective, since all phenomena are the patterned self-manifestation of source fields of awareness, no phenomenon cannot ultimately be explained by or reduced to any other phenomena manifesting within the same field and in-formed by the same field-patterns. Nor can fields of awareness as such be explained by or reduced to the physical phenomena that emerge within them. To do so is comparable looking for the 'causes' of a dream in the dream, or looking for the causes of a text in that text. Understood phenomenologically, fields of awareness are the condition for us becoming aware of any phenomena whatsoever, but are not reducible to or explainable by any phenomena we can observe within them.

The identification of subjectivity with a localized subject or ego is the philosophical reflection of the standard physical scientific model of visual perception. According to this model, seeing is a result as a result of light being reflected off objects in the world and coming to focus in the human eye. This optical focus in the human eye is the analogue of the localized subject or "I". The brain then supposedly interprets signals channeled by the optic nerve and someone produces and projects an 'image' of the object perceived. This physical-scientific model of visual perception is self-contradictory in a double sense. For one thing, it begins by assuming the existence of a pre-given world of physical objects from which light is reflected and ends up arguing that these objects are in fact effigies - projected mental images produced by the human brain. Secondly it ignores the fact that what we know of the human eye and brain comes from studying them too as objects of visual perception. It rests not only on the assumption that perceived objects 'are' as we perceive them to be. It also rests on the assumption that perceiving objects i.e. 'organs' of perceptions such eye and brain, are also pre-given physical objects which appear to us just as they are. There is an inherent paradox in not recognizing that our very knowledge of the body's organs of perception is conditioned, and therefore perhaps limited by our bodily perception of them. The paradox consists in explaining the processes of visual and sensory perception through studying the very products of these processes, for example our visual perception of the human eye and brain.

Physical science starts with the idea of a pre-given world of localised subjects and the objects they perceive in space. The subjects too are perceived as objects (bodies, brains, eyes etc) and the process of perception is explained as a mechanism whereby light from perceived objects impinges and comes to a focus in perceiving objects. From a phenomenological point of view, we do not perceive objects in empty space. Rather space is nothing more or less than the spatial field of awareness itself. Ordinary visual perception can no more be explained by events and interactions occurring within this space or field of awareness than can our visual perception of dream objects be explained by events and interactions occurring in the dream itself. The basic error of the physical-scientific model lies in the attempt to explain phenomena occurring within a field of awareness through their 'causal' relations to other phenomena within that field. This is like seeking to find the cause of a particular dream object or event in some other objects or events manifesting within the dream, ignoring the fact that both the caused and the causal object or event are dreamt phenomena - joint manifestations of a singular field of awareness.

The physical-scientific world outlook treats awareness as such as a localised 'epiphenomenon' - a product of physical events and interactions. As a result, it is left with the unanswerable question of how exactly awareness is can be generated by these physical phenomena, given its essential and qualitative difference from them. The unanswerable question is ultimately a false and misleading one, for it ignores the fact that physical phenomena are, first and foremost, phenomena emerging or occurring within a field of awareness. Physically, perception can be represented as a process in which light reflected off objects in space comes to focus in the human eye. Phenomenologically, it is just the opposite - the process by which a larger 'peripheral' field of awareness manifests or comes to light us as a perceived object 'in' space.

The basic principles of a fundamental or field-phenomenological science - one grounded in this understanding of the field character of awareness or subjectivity itself - can be summarized as follows:

1) Fields of awareness cannot be reduced to or causally explained by the phenomena that manifest within them. We can no more find the 'causes' of illness in the bodily phenomena that emerge within our field of awareness than we can find the causes of 'bad' language or poor sentence contruction in a text itself or the causes of a nightmare in some monster that appears within it.
2) Phenomena manifesting in a field of awareness cannot be reduced to or causally explained by reference to other phenomena manifesting in the same field. Example: a monster in a nightmare cannot be said to be caused by other objects or events in that same nightmare. Similarly, it makes no sense to claim that certain words or sentences in a text are 'caused' by other words and sentences in that text, for the latter too are self-manifestations of a con-textual field of awareness linking author and reader.

The words phenomenon and phenomenology derive from the Greek verb phainesthai - to 'shine forth' or 'come to light'. Phenomenological science distinguishes between physical phenomena on the one hand and primordial phenomena on the other. A physical phenomenon is an event occurring within a field of awareness (eg. hearing a word spoken) or an object perceived within such a field eg. seeing a word on the page. A primordial phenomenon (what Goethe called an Urphänomen) is not something merely present or 'given' in our field of awareness. It is a phenomenon in the primordial sense - that which comes to presence or 'comes to light' in that field. It must be emphasized that the word 'light' is not used here as a metaphor but in its primordial sense. What we perceive as physical light is something which is itself only visible in the light of our own awareness of it. The 'light of awareness' is light in the primordial sense. It is what Heidegger referred to as "the clearing" (Lichtung), his term for the open region or "field" (Feldung) of awareness which is the condition for anything coming to light as a phenomenon, and which "is not only free for light and darkness, but also for resonance and echo, for sound and the diminishing of sound…the open region for everything that becomes present or absent."

It is in fact modern physics which uses the term 'light' as a metaphor drawn from the realm our everyday experience of light and darkness, and applied to describe something in no way 'visible' within this realm - for science has long since ceased to regard light as merely the visible part of the electromagnetic spectrum. Instead it now sees the photon as the basis energy 'quantum' or wave-particle mediating all electromagnetic interactions. Coming to light (phainesthai) has the nature both of physical emergence (phusis) and of speech (logos). The written or spoken word can be regarded as a physical phenomena - as ink marks on a page or sound waves traveling through the air. Meanings too, can be turned into objects as if they were just present, pre-given entities. But the word as word - as a primordial phenomenon - can never be reduced to a pre-given object or set of objects. It is not something present but the coming to presence of a meaning. To be sure, we can define or describe meanings as if they too were pre-given objects. But in this way the process by which meanings come to light in language and words come to mean what they do will always elude us.

The third basic principle of phenomenological science is that primordial phenomena cannot be reduced to or explained by physical phenomena. We do not understand words because we hear them spoken or see them on the page and our brains then 'decode' or 'interpret' them as physical phenomena. We understand words because, as aware beings, we already dwell within the world of meaning from which they emerge. If I am disturbed the sounds of loud music being played in the room next door, I am aware of a physical phenomenon, sound vibrations, but I am not actually hearing music. We understand music not because our ears and bodies pick up sound vibrations and audible 'tones' but because we already dwell, as aware beings within the world of feeling tone room which music emerges. But trying to logically justify the phenomenological standpoint to a scientist or positivist philosopher is a hopeless endeavour - for it like trying to explain words and music to someone who has no experience of reading or hearing music. We can, by definition offer no physical 'evidence' of primordial phenomena such as meaning, feeling, love etc. The scientist, examining the marks on the page or the oscillations of sound waves in the air will and can find no empirical evidence of an invisible 'world' of meaning or an inaudible world of feeling - any more than they can find empirical evidence of grief in tears. The philosopher will rightly argue that the existence of such worlds cannot be logically proved. Only someone who has already learnt to read or appreciate music to a certain extent will be persuaded of their reality as primordial phenomena.

Biological medicine focuses on illness as a biological phenomenon ie. as a physical phenomenon in the broad sense. Phenomenological medicine is concerned not only with illness as a physical phenomenon - an identifiable symptom or syndrome for example - but with what this symptom or syndrome brings to light. Following the basic principles of deep phenomenology it does not accept etiologies which seek to explain the symptoms as a physical phenomena in terms of other physical phenomena which are then treated as 'causes' of illness. Instead it seeks to understand the patient's awareness of their illness and direct experience of their symptoms in in the larger context of the field or 'world' of awareness in which they dwell. Awareness is intrinsically relational - an awareness of ourselves in relation to something or someone other than self. A secretary who feels humiliated by her boss, but unable to speak out and confront him develops a visible skin rash on her face and goes to her GP. The physician is not in the least interested in the symptom as a primordial phenomenon - in the humiliation, shame and pregnant anger that the red rash brings to light and makes visible - but only in the physical phenomenon. Just as for our scientist and positivist philosopher, there was no proof, empirical or logical that words and sounds pointed to world of meaning and feeling, so for the physician, the idea that symptoms might have meanings and not just causes is unprovable speculation. His interest is in illness as a physical rather than a primordial phenomenon, in human body not in the human being as such, still less in the worlds or fields of awareness in which they dwell; that is to say in the fields of relatedness in which find themselves and comport themselves.

We can study and respond to illness as a physical phenomenon or understand the physical signs of illness themselves in terms of what they bring to light - as primordial phenomenon. Both conventional and alternative medicine focus on the physical causes and cures of disease. Neither seek to explore the human being's awareness of dis-ease and the meaning it holds for them in their life. As far as diagnosing the patient's symptoms is concerned, it is as if someone's words would be treated purely as physical phenomena: subject to exacting linguistic, phonological and grammatical analysis without any attempt to hear what they are saying through them. We can subject someone's words to detailed phonological, syntactic and even 'semantic' analysis without in any way hearing what the human being is saying through them. Similarly, neither X-rays or blood tests, cannot tell us anything about a person's awareness of dis-ease, or indeed about their physiology in the primordial sense - what emerges or comes to presence (phusis) through the speech (logos) of the body.

There is today not a single form of medicine, orthodox or alternative, biogenetic or psychoanalytic, Western or Eastern, that does not in one way or another confuse the measurable organic signs of disease with the human being's own felt experience of illness - their dis-ease. We can measure a person's heart pressure and pulse. We can diagnose disorders of the heart and circulation. But can we measure heartbreak, heartlessness or 'loss of heart'? The human being dis-ease, whether in the form of stress or distress, discomfort or pain, anxiety or demoralising incapacity, is not itself anything measurable, whatever its measurable bodily or behavioural signs. The confusion of disease with dis-ease rests, however on a far more fundamental between the physical body and the 'phenomenal body' - the body as a physical phenomena and the body as a primordial phenomenon.

It is this fundamental distinction that Heidegger pointed to through the German words Körper und Lei b. The Leib or phenomenal body is not only the so-called 'lived' or 'experienced' body: the body as we are aware of it from within rather than the body perceived from without as a physical object. It is the unified field of our bodily awareness, a field that embraces both the 'inner' field of our 'subjective' bodily self-awareness with the 'outer' field of our own 'objective' sensory awareness of the world and other bodies within it. It is for this reason that Heidegger could declare that: "The phenomenal body (Leib) is certainly no thing, no physical body (Körper), but every body; in other words the body as Leib is always my body." By this he meant that our awareness of our own bodies and of other bodies in our environment are not separate. For one thing, our awareness of other bodies in our outer physical environment, whether those of objects or people, co-constitutes our inner awareness of our own physical bodies and vice versa. In the neighbourhood of extremely tall, large or heavy persons our own bodies feel shorter, smaller or lighter for example. The contrast between the anorexic's experience of their own bodies as gross or fat and other people's perception of them as waif-like and starved cannot be put down to the 'body image' of the former. Bodily self-image has to do with how we imagine ourselves to appear to others from without. What the anorexic is describing is not a mental image of their own physical body as this appears from without but a felt sense of their own phenomenal body - the body as they experience it from within. The phenomenal body, as Heidegger pointed out, is not essentially bounded by the measurable dimensions of the physical body. We can feel fatter or lighter, taller or shorter, without physically fattening or lightening, and without our measurable height changing in any degree at all. And "When I direct someone towards a windowsill with a gesture of my right hand, my bodily existence as a human being does not end at the tip of my index finger. While perceiving the windowsill….I extend myself bodily far beyond this fingertip to that windowsill. In fact, bodily I reach out even further than this to touch all the phenomena, present or merely visualised, represented ones."

Heidegger' conclusion is a radical one "The boundary of the phenomenal body is the horizon of being in which I dwell." As a larger body or unified field o f awareness, it embraces both our both our experience of ourselves and our experience others and otherness, including both our 'proprioceptive' of our own bodies and our perceptual awareness of other bodies around us. Understood phenomenologically, both our experience of ourselves as localized subjects and the objects that we perceive around us are inseparable aspects of a singular field of awareness. It is this larger body or field of awareness that we are in the habit of thinking of merely as the pre-given physical 'space' in which our bodies are located, a space which, according to the scientific model, somehow happens to contain both perceived objects and subjects capable of perceiving them and the space in which they exist. A space which happens to contain physical objects of a special and miraculous sort - bodies with eyes and brains which miraculously generate subjective awareness of itself and mysteriously 'contains' a localised subject which projects mental images of space and of objects into the very space in which is supposedly located as an object in the first place.

The unrecognized and unresolved paradoxes of this model make it rather unconvincing, to say the least, and Heidegger was not averse to pointing out the double standards involved in applying it.

"When it is claimed that brain research is a scientific foundation for our understanding of human beings, the claim implies that the true and real relationship of one human being to another is an interaction of brain processes, and that in brain research itself, nothing else is happening but that one brain is in some way 'informing' another. Then, for example, the statue of a god in the Akropolis museum, viewed during the term break, that is to say outside the research work, is in reality and truth nothing but the meeting of a brain process in the observer with the product of a brain process, the statue exhibited. Reassuring us, during the holidays, that this is not what is really implied, means living with a certain double or triple accounting that clearly doesn't rest easily with the much faulted rigour of science."

The Ontological Foundations of Fundamental Medicine

The term 'ontology' derives from the Greek ontos - 'being'. The ontological foundation of biological medicine is the reduction of the human being to the human body and its biological organs. The basis of human existence and experience, as experienced in the everyday process of living, is sought in a purely biological understanding of 'life'. In the topsy-turvy world of medical science it is not human beings that think and feel but their brains which 'produce' thoughts and feelings, 'store' memories etc. and in the process constitute the human being as a being. I term the reductionistic position 'bio-ontology'. Heidegger questioned its basic metaphysical assumptions, arguing instead that he human being cannot be reduced to the human body. On the contrary, the human body and its organic functions can only be understood as an embodiment of the intrinsic potentials and capacities of the human being. Heidegger often remarked that our understanding of truth depends most essentially on correctly appreciating the obvious. The obvious, in this context, is that it is not ears that listen and hear, eyes that look and see, or brains that think but beings.

Bodily organs such as the human eye, do indeed have functions in the same way that tools or instruments such as pens and computers. The function of a pen is to serve as an instrument of writing - it is something to write with. But however sophisticated its functional design and operation, no pen is capable of writing. And seeing and hearing, like writing are essentially capacities not functions. As beings we possess a capacity for writing whether or writing instruments are available, and this capacity belonged to us as a potential of our being even before such instruments were invented. As a functional instrument (Greek organon) a bodily organ is the embodiment of a capacity belonging to the human being - not the basis of those capacities. That is why the very development of our bodily organs depends on the exercise of these capacities. We learn to write, drive or swim by writing, driving and swimming. In the process of exercising these capacities - in however primitive a way at first - our brain functioning is itself stimulated, transformed and developed. We do not first alter our brain's neurological functioning and then somehow find ourselves able to exercise a capacity. According to Heidegger "..we cannot say that the organ has capacities, but must say that the capacity has organs." The organ does not 'posses' a capacity but is "in the possession of a capcity" - subservient to it in the same way that the pen is subservient to our capacity to write. For Heidegger life itself is essentially capability (Fähigkeit). "This capability, articulating itself into capacities creating organs characterizes the organism as such." "It is not the organ which has a capacity but the organism which has capacities."

Heidegger goes even further than this however, suggesting that the very 'organismic' capacities embodied in our organs and their functions are not essentially biological - rooted in our body's genes - but rather ontological, having to do with intrinsic potentials of the human being?

"We hear, not the ear…Of course we hear a Back fugue with our ears, but if we leave what is heard only at this, with what strikes the tympanum as sound waves, then we can never hear a Back fugue…if we hear, something is not simply added to what the ear picks up; rather what the ear perceives and how it perceives will already be attuned (gestimmt) and determined (bestimmt) by what we hear, be this only that we hear the titmouse and the robin and the lark…(O)ur hearing organs…are never the sufficient condition for our hearing, for that hearing which accords and affords us whatever there really is to hear."

"The same holds true for our eyes and vision. If human vision remains confined to what is piped in as sensations through the eye to the retina, then, for instance, the Greeks would never have been able to see Apollo in a statue of a young man…."

Damage to functional organs can itself be the result of inhibition placed on the exercise and embodiment of capacities. An infant with an infection in one eye had a patch placed on the eye for a considerable period during its treatment. When the infection had disappeared and the patch was removed it was found that the child was no longer able to see through this eye. The medical explanation of this phenomenon was that the patch has been placed on the eye at a critical time in the child's neurological development. Lacking visual stimuli, the necessary nerve pathways were not formed for this eye. Put in other words, the patch prevented the child from exercising its capacity to see through this eye - with the result that an organic, neurological impairment in its functioning resulted The capacity itself, however, involves far more than simply a functional receptivity of the eye to visual stimuli and their translation into nerve impulses transmitted to the brain. Just as a pen cannot write, nor does the eye or brain itself possess a capacity to see. That capacity is exercised by an aware being not a bodily organ.

For Heidegger, thinking itself "is a listening that brings something in view" - that enables us to see. But he firmly rejected the view that such 'insight' was a type of 'seeing' only in a metaphorical sense. "If we take thinking to be a sort of hearing and seeing, then sensible hearing and seeing is taken up and over into the realm of nonsensory perception…In Greek such a transposing is called metaphorein. The language of scholars names such a carrying-over "metaphor". So thinking may be called a hearing and a listening, a viewing and a bringing into view, only in a metaphorical sense. Who says "may" here? Those who assert that hearing with the ears and seeing with the eyes is genuine hearing and seeing."

We we 'see' that somebody is unhappy or tense, or 'hear' frustration in their tone of voice this is not a deduction made from some sort of quasi-clinical observation. Similarly, when our impression of somebody is that they look or sound 'unwell' we are not, like the physician, medically interpreting certain overt diagnostic 'signs'. What Heidegger refers to as "genuine" seeing or hearing is not in the first place, a seeing or hearing which has as its object something or 'some-body' in the literal sense, but rather 'some-one' - a being and not a body in space and time. What I have termed the 'phenomenal' body as opposed to the physical body is precisely that body with which we directly see and hear, sense and feel, touch and move other beings, doing so quite independently of physical sight and hearing, touch and movement. When we speak of being close to someone, being touched by their words or moved by their suffering it is not physical intimacy, touch or movement we are referring to. Nor however, is our reference to closeness, touch and movement merely a metaphorical way of describing in physical terms something psychical. Rather the converse - moving closer to someone physically or touching them in a intimate way is itself a form of metaphorical action - a way of 'bearing across' (metaphorein) our closeness to them as beings. Sexual intimacy, intercourse and reproduction, far from being the biological foundation of human behaviour (a viewpoint shared by both science and psychoanalysis are themselves the expression of an ontological capacity - our capacity for intimacy with other human beings. When human beings engage in sexual intercourse their body temperature rises like that of other animals. But the warmth they feel for one another as beings is not a measurable physical phenomenon but a primordial one, independent of its expression in body heat. Though it may be stirred by physical closeness it is more often it is not the psychical 'result' or 'effect' of such closeness or a physical result rubbing their bodies up against one another.

The term 'onto-biology' refers to an ontological understanding of biological functions of the sort that Heidegger indicated. This is not the same thing as a psychological or psychoanalytic understanding of such functions. When someone speaks of feeling 'stifled' or of having no 'room to breathe' this is not usually meant in a literal sense, but nor are they merely describing a emotional or 'psychological' state using a respiratory metaphor. But if someone's breathes more freely as a result of feeling their 'spirits' lift, their bodily breathing does indeed serve as a living, biological 'metaphor' of their state of being. Respiration is not merely a biological function but the embodiment of a primordial organismic capacity of our being - the capacity to engage in a rhythmic exchange with the essential 'atmosphere' of our life-world, 'breathing in' our awareness of it, drawing inspiration and meaning from it, and in turn allowing our awareness to flow out into it and find meaning within it. A person can jog or exercise, or practice Yogic breathing exercises for hours, days or years without it significantly affecting their fundamental respiration - without it bringing new sources of spiritual meaning and inspiration into their lives. But a person can be neither spiritually inspired nor dispirited without it being instantaneoulsy embodied in their physical breathing.

At what point does the air we inhale become a part of us? At what point does our exhaled air cease, not only to be a part of our bodies but a part of us? Whether we draw into our awareness a 'breathtaking' landscape or a 'idea, we feel moved to inhale and then exhale deeply. Why? Because breathing is the embodiment of our primordial capacity to fully take into ourselves our awareness of something other than self, and in turn allow it to freely flow out into atmosphere or field of awareness linking us with it. The words 'respiration, inspiration, aspiration etc. come from the Latin spirare - to breathe - just as the Greek word psyche originally meant the 'breath' that vitalised an otherwise lifeless corpse (soma). To speak in a modern way of the 'psychosomatic' dimension of breathing disorders such as asthma, to either claim or dispute their 'psychogenic' causation therefore misses the point. It ignores the question of what breathing as such fundamentallyis - not as an organic function of our body but as an organismic capacity of our being.. Changes in the pattern and flow our bodily breathing embody differently patterned flows of awareness. As such they may also provide the medium by which our relationship as beings, to particular phenomena first comes to presence in our field of awareness.

The Diagnostic Foundations of Fundamental Medicine

An elderly woman whose husband Harry has recently died from a heart attack finds herself suffering chest pains at night and goes to sees her GP. The physician's only interest in her symptoms is as signs of a possible organic disorder which might be 'causing' them. He sends her to a consultant to test for possible heart conditions. Proving inconclusive, the consultant ends up diagnosing mild angina, and prescribes tablets. These in turn prove to have little effect on the patient's symptoms. On visiting her GP a second time however, the latter recalls her recent bereavement and, as a result, begins to read the somatic 'text' of her symptoms in a different way, understanding them in the life context of her loss and the pain it be may be causing her. Rather than seeking a purely medical diagnosis of the patient's symptoms he himself listens to his patient in a genuinely patient way. Suddenly an insight flashes through his mind. He 'sees' that she may be suffering from a doubly broken heart "the one that killed Harry, and the one you're left alive with, that hurts when you're most alone in the middle of the night…the broken heart that gave up and the one has to carry on painfully." This heartfelt hearing of the patient and the heart-to-heart talk that ensue are the first time anyone has ever acknowledged the pain of her grief. It gives her the strength of heart to acknowledge and bear it in a new way. Her symptoms disappear.

This case history is cited by Dr David Zigmond in an article on different modes of patient-physician communication, goes to the heart of the contrast between medical diagnosis and fundamental diagnosis. The term 'diagnosis' means 'through knowing' (dia-gnosis). Gnosis derives from the Greek gignostikein - to 'know' in the sense of being familiar or intimate with. Gnosis is not knowledge of or about something, but the sort of knowing we refer to when we speak of knowing someone well or intimately. The relation that distinguishes this type of knowing is one in which, as Heidegger put it "we ourselves are related and in which the relation vibrate s through our basic comportment." Medical knowledge, like other forms of scientific knowledge, including psychology, is knowledge of or about. It represents the outer relationships between things or between people as if this were quite independent of our inner relation to them - our inner bearing towards them.

The change in the GP's relationship to the patient in the second consultation was crucial. Rather than simply bringing to bear his medical-biological knowledge of the heart he had the patience to bear with his patient - to acknowledge her heartbreak and bear it with her in a heartfelt way. As a result she herself, no longer felt herself so painfully alone in bearing it, and was able as a result, to find a new bearing towards the loss that occasioned it. The paradox is, that despite the inconclusiveness of the medical tests, without adopting this bearing the patient might well have gone on to bear and body the pain of her lonely grief through increasingly acute symptoms, using them as to feel and communicate it indirectly through a type of 'organ speech'. The GP's new bearing was preventative in the deepest sense, forestalling a process whereby this patient might well have ended up as a genuine 'heart case' requiring medical intervention or a 'heart sink' case in which no conclusive, measurable signs could be found of any organic disorder. When doctors speak of the 'heart-sink' patient perhaps all that is referred to is the type of patient that all too clearly needs this type of fundamental or 'deep' diagnosis, rather than fruitless attempts to diagnose their symptoms in the ordinary way ie, to hear, see and respond to their inner dis-ease rather than seeking its causes in a medically labeled disease or disorder.

The focus of biological medicine is certainly not the 'phenomenal body' but rather the clinical body - the human body as represented in the body of medical knowledge about it that provides the foundation of medical training. The gaze of the physician is a clinical gaze, one which turns the body into an object of medical-scientific examination and clinical testing. At its heart is a fundamental separation between the human body and the human being, between biological life processes and the everyday life of the individual, a separation that further distances the patient as a human being from their own body and turns their dis-ease into an impersonal thing - an "It". The purpose of medical treatment is seen as identifyiong and eliminate this "It" - to make "It" go away, or to make "It" better. The physician is not trained to apply a phenomenological gaze - to see what specific physical symptoms bring to light as phenomena - but rather seeks physical causes for them. His interest is not in the patient's felt dis-ease but only its measurable physical signs. The fact is, however, that the patient's dis-ease, distress or discomfort is not itself essentially measurable. The sort of space that 'pain' occupies is not a physical space. The inwardness of dis-ease is comparable to the inwardness of the word. It is a non-spatia l interiority that 'internal medicine' can find no evidence of it, no more than it can find evidence of someone's hearbreak or loss of heart by prizing open their chest in surgery. The case described by Zigmond is a pertinent one, given Heidegger's comments on the immeasurability of grief: "How does one measure grief? Obviously we cannot measure it at all. Why not? Were we to apply a method of measurement to grief, this would go against the meaning of grief and we would rule out in advance the grief as grief." Nor can one measure tears, for "when one measure one measures at best a fluid and its drops but not tears."

More than once Heidegger approvingly cites Aristotle's remark that "...it is uneducated not to have an eye for when it is necessary to look for a proof and when this is not necessary." Seeking evidence of organic disorder through clinical testing and physical measurements of one sort or another is one thing - though it tells us nothing of what this disorder reveals as a primordial phenomenon, the dis-ease it embodies and brings to light. Seeking evidence or proof of psychiatric disorders through questionnaires or brain scans is 'uneducated' in just the way that Aristotle suggests. For it is rather like needing to prove someone's unhappiness by asking them how often they cry, by looking for 'evidence' in the form tears or tear stains, or worse still, seeking a reliable 'scientific' index of their unhappiness by weighing their teardrops.

The Organismic Foundations of Fundamental Medicine

"To what do tears belong? Are they something somatic or something psychic? Neither one nor the other." Martin Heidegger. Field-dynamic phenomenology identifies the human organism neither with the physical body or soma nor with the psyche understand in the traditional sense - as a localized subjectivity bounded and contained by the physical body. Instead it understands the organism as dynamic boundary between the two field of awareness that constitute our larger body of awareness or phenomenal body - an 'inner' field awareness of our own bodies and 'outer' field awareness embracing other bodies in our sensory environment. The organism as such is the dynamic boundary state that both distinguishes and unites these two fields. As such it is also the dynamic interface between what we experience as 'self' and that which we experience as other-than-self, uniting our self-awareness with our awareness of others and otherness. Self-awareness is also an awareness of ourselves in relation to something or someone other-than-self. Indeed it is co-constituted by that very relation. Our self-experience is always inseparable from an experience of others and otherness. The "I" that I experience in the context of one relationship or activity is not identical to that which I experience in another. The "I" experienced in a professional role is not the same "I" experienced in a domestic context or engaged in a pleasurable recreation. When we feel ill, we do not 'feel ourselves', our bodies or minds feel foreign or alien to us in some way. This 'not feeling ourselves' however, is always the expression of change in our felt relation to something or someone other-than-self. Historically, medicine has always interpreted this relationship in an essentially paranoid way. The change in our bodily self-awareness and the sense of foreignness that characterize the felt experience of illness has been represented as the work of a foreign entity - whether a malignant spirit or a foreign body such as a virus or cancer cell. Immunology is founded less on biological fact than on conceptual metaphor - an empirically and biologically highly questionable distinction between so-called 'self' and 'non-self' cells. It is dominated by the military metaphor of a body as battlefield for a war against foreign 'non-self' cells and organisms, just as medical discourse as whole is dominated by the metaphor of war against illness as such. Just how pervasive this metaphor is, not just in everyday discourse but in biology itself, can be seen from the language used in the following, quite orthodox accounts of immune functioning. "[W]hen immune defenders encounter cells or organisms carrying molecules that say 'foreign', the immune troops move quickly to eliminate the intruders." "The immune system stockpiles a tremendous arsenal of cells. Some staff the general defenses, while others are trained on highly specific targets."

The military metaphor extends beyond immunology and represents the all-embracing metaphor of modern medicine. The metaphor is rigorously defended under the banner of medical 'science' even though it is the foundational metaphor of this science, the basic metaphorical framework determining the medical interpretation of empirical data and the scientific representation of biological 'fact'. Behind it is the questionable concept of an immune self, constituted by a genetically-programmed biological identity. This concept can be understood as a projection of the traditional metaphysical notion of the subject - the Cartesian ego - on the human body. The root meaning of 'self' is 'sameness'. Biologically, the body is in fact never the same from one moment to the next. It constantly recreates itself and does so precisely through the incorporation and assimiliation of previously 'foreign', 'non-self' substances - air, water, nutrients etc. Our felt, bodily self is also not a fixed identity - it too recreates itself constantly by assimilating and incorporating our experience of others and otherness. The human organism is our felt, bodily sense of self - a sense of self that is ever-changing, forever and continuously altered by our felt relation to others and otherness. The ego on the other hand is a mental identity 'immunised' from its experience. It is the self represented the linguistic subject - the word "I". When we say "I feel cold" or "I feel hot" we imply that the "I" is the same "I" in both cases, a subject immune from its predicates, a subject whose identity is never altered by its own verbs and objects, actions and experiences. The ego uses language to identify a feeling as one of "coldness" or "heat", "joy" or "sadness", and to identify 'reasons' why it should be feeling one way or the others. The organism - our felt, bodily sense of self - is fully identified with what it feels. It is the feeling of coldness or heat, joy or sadness - even if, as is often the case, it has, unlike the ego no words to label, represent and objectify the feeling in question.

Medical immunology and the immune self it postulates is an ideologically-shaped representation of and response to the dis-ease experienced by the ego when its own identity is disturbed by an organismic state - an alteration in the individual's felt, bodily sense of self. Organismic states are in turn the expression of an individual's felt relation to something or someone in their outer field of awareness. But just as 'nature abhors a vacuum', so the organism abhors an absence. Life frustrations, deprivations, disappointments, losses and bereavements all represent an experience of absence which the organism can only register to the ego as the positive presence of a particular feeling, albeit a so-called 'negative' feeling such as grief, unhappiness or pain. Actually, such 'negative' feelings are feelings negated by the ego, which, unlike the organism seeks to immunise itself from feeling as such. Whereas the organismic self is the felt self - identified with what it feels - the ego is the 'immune self' - the part of us that does not allow what we feel to alter our identity and transform our sense of who we are. The ego has 'feelings' (plural noun). The human organism is like the hand with which we feel (verb). If we feel someone's face with our hand, what it feels like to our touch, the 'feeling' (noun) that we have of it, depends on the way we touch it, the way we 'feel' it (verb). For the human being 'feeling' is an activity and not merely a state. And it is we who feel, not our hands. We feel out other beings, sensing their presence or absence, nearness or distance, approach or withdrawal, openness or closedness, weight or lightness of being, and this feeling out constitutes our phenomenal body - our 'field' or 'feel-d' of awareness. In feeling we are invariably touched and transformed by what we touch and feel. The organism is our felt, bodily sense of self, a bodily self that, unlike the 'immune self' is never the 'same'.

For the widow whose awareness of a felt absence, the loss of her husband Harry, took the positive form of chest pains that she felt at night, it was not her felt grief, but the ego's failure to acknowledge her own feeling self, that was the problem. Indeed the very nature of her symptoms represented an identification with her late husband, who himself had died of a heart attack. It was through this identification - itself not acknowledged directly but instead embodied in her physical symptoms and their diagnosis, that she could sustain and hold onto a physical relation to him - one she could feel in a physical way despite his physical absence from her life. Allowing himself to be touched by the feeling of grief he sensed organismically, the physician used his own ego to directly acknowledge the widow's own organismic state - thus supporting her own ego in doing the same. As a result, she learnt to bear and embody this state in a new way - no longer needing her symptoms as physicial symbols of her own organismic state - her felt, bodily sense of self and her own altered but enduring felt relation to her husband.

The Pathosophical Foundations of Fundamental Medicine

"Feeling is the very state, open to itself, in which we stand related to things, to ourselves, and to the people around us." (Heidegger).

The term 'pathosophy' was coined by Viktor von Weizsäcker, the first scientist and physican to attempt the creation of a 'medicine beyond medicine' - a comprehensive new model of health and illness based both on philosophy and on psychoanalytic depth-psychology. He understood illness as one expression of the 'pathic', defined as "the essential suffering of a person that is related to that which they lack and that towards which they are aiming." The literal Greek meaning of 'pathosophy' is 'the wisdom of suffering' or 'the wisdom of feeling'. The traditional aim of medicine has always been the alleviation or elimination of the suffering experienced by the sick person, and with it the diminution of any intense feelings, fears or anxieties accompanying or amplified by their illness. At the heart of almost all forms of medicine is the assumption that illness and suffering are not only undesirable in themselves but lacking in any intrinsic meaning. The practice of medicine is founded on the medicalisation and medication of disease, which is reduced to some form of diagnosable mental or physical 'pathology' and not in any way seen as a meaningful expression or embodiment of the pathic. The suffering of the human being is seen as an expression of their medical condition. The medical condition is never seen primarily as an expression of an individual's problems but as the problem itself. There is no question of seeing their bodily or behavioural 'pathology' as the meaningful embodiment and expression of the pathic - of a felt dis-ease. For to do so would surely be tantamount to 'blaming the patient for the illness'. But behind this accusation, so often levelled against those who question the accepted wisdom of the medical establishment, lies one of the most concealed and yet basic assumption of medicine in all its forms - the assumption that illness and suffering something blameworthy and therefore 'bad' in the first place, something for which a cause or scapegoat must be found.

Many thinkers have questioned this assumption. Balint argued that "Patients turn their problems into illnesses, and…the physician's job is to turn them back into problems." Groddek saw the meaning of illness as a warning: "Do not continue living as you intend to". Others have gone on to argue that not only is illness a warning sign but that successful 'treatment' or 'cure' is equivalent to simply disabling or destroying the warning light itself. Psychiatric treatment through neuroleptic drugs is a rather literal case in point. For these work precisely by diminishing brain functioning and in the long term producing chronic brain damage. Indeed the very term 'neuroleptic' refers to the way these drugs simulate the effects of brain disease or brain damage. As far as the toxicity effects of medical treatment in general concerned, the facts speak for themselves - it is the single largest medical cause of death after heart disease, stroke cancer and AIDS. As for the benefits we all assume modern medicine to have brought and to be furthering through its scientific development, the empirical data suggests otherwise. By the time antiobiotics began to be used widely the major infectious diseases had already gone through their most dramatic decline, attributed primarily to better housing and nutrition. Today the life-expectancy of untreated cancer patients is significantly higher than that of those treated with chemo- and radiotherapy. There is no statistical evidence for the efficacy of (expensive) intensive care units. "Neither the proportion of doctors in a population nor the clinical tools at their disposal nor the number of hospital beds is a causal factor in the striking changes in overall patterns of disease." (Illich) Nor have they contributed to improvement in life-expectancy. If anything, quite the opposite. For the vast sums of money spent on medical care in developed countries, and, increasingly by the developing ones has deprived the latter of crucial resources for dealing with poverty, malnutrition and starvation, the latter being still the single largest cause of death in the world.

"Health and suffering as experienced sensations are phenomena that distinguish men from beasts. Only storybook lions are said to suffer…" (Illich). In the past, spiritual meaning was attached to illness, and different cultures each had their own rituals for the vital expression and communication of human suffering. Today's culture, on the other hand, regards the medicalisation and medication of suffering as the only rational response to it, and perceives the rejection of medical help as vain masochism. "Blaming the patient" means making them responsible for their suffering. Medicine does the opposite. It deprives human beings not only of their responsibility for suffering but 'response-ability' to it - their ability to respond to their own felt dis-ease and thereby experience their suffering not as passive surrender to fate as a meaningful and responsibleactivity. Children tend to actively express and embody their moods, their sense of ease or dis-ease, communicating it through their bodily countenance and demeanour. Parents however, often react harshly to any attempt on the part of the child to actively communicate their suffering in an bodily or behavioural way - telling the child, for example, not to sulk or brood, not to make a long face. The child is taught that suffering is something to be privatised and masked or else communicated only in a verbal way - that it must only no account be actively bodied.

"Every feeling is an embodiment attuned in this or that way, a mood that embodies in this or that way." (Heidegger). Actively bodying feelings is not be confused with what psychoanalysts call 'acting out'. 'Acting out' is actually 'reacting out' - a reactive behavourial response to a particular feeling which prevents us from having to feel that feeling in a more direct bodily way and to find a bearing that allows us to bear or contain it.. Acting out feelings through our behaviour is essentially a flight from feeling those feelings, albeit one which may take the form of a fight response which serves discharge and evacuate the feeling. To body a feeling or attunement means simply to allow ourselves to feel that feeling it in a bodily way, and to let it take shape it a bodily way - to express itself as a bodily demeanour or comporment. This is quite different from just representing and relaying what we feel in words or suppressing it in silence. Nor is it the same as a reactive response to what we feel which takes the form of 'neurotic' patterns of verbal or non-verbal behaviour. To body a feeling is to let it be what it essentially is - "an embodiment attuned in this or that way, a mood that embodies in this or that way".

The phenomenological, ontological and medical significance of this understanding of feeling and their intrinsic relationship to bodyhood cannot be overestimated.

For as Heidegger himself suggested:

"We know by now a great deal - almost more than we can encompass - about what we call the body, without having seriously thought about what bodying is. It is something more and different from merely 'carrying a body around with one'." "As simple and obscure as that which we know as gravitation is, gravity and the falling of bodies, the bodying of a living being is just as simple and just as obscure." "The bodying of life is nothing separate by itself, encapsulated in the 'physical mass' in which the body can appear to us…"

The Physiological Foundations of Fundamental Medicine

In the psychoanalytic literature the term 'bodying' (equivalent to the German leiben) does not exist. In its place is the term 'somatisation'. The psychoanalytic explanation of the so-called 'psychosomatic' dimension of illness is that the pathic takes the form of a somatic pathology through the process of somatisation. Feelings not given form as verbal symbols will be experienced instead as somatic states and sensation and find expression in somatic symptoms and disorders. The tendency to somatise feelings results from an inability to cognitively 'process' them - to mentally represent what one is feeling and relay it in words. The term alexithymia has been coined to denote this deficiency in the cognitive processing of one's emotional life. This psychoanalytic model is phenomenologically questionable for a number of reasons. To being with it one might ask how it is possible for an individual to mind their own feelings - to acknowledge them in words or 'process' them cognitively - without first feeling and giving form to those feelings in some bodily way, without bodying them? The model assumes we begin with two separate things - a disembodied and disarticulated emotion on the one hand and its somatic or verbal expression on the other. The model suggest that what is experienced by the alexithymic individual only as a bodily sensation is really an emotion in disguise. If so, what sort of reality does this emotion, and what sort of psychic space does it occuply have prio r to cognitive processing necessary to acknowledge as an emotion?

This an important question because the model does imply that emotions are not merely the result of cognitive processing and verbal labeling of feelings but but some sort of pre-given entity - internal psychical objects comparable to external physical objects.

In contrast Heidegger understands feelings not as 'internal objects' or labelled 'emotions' but as Stimmungen. These are 'moods', 'attunements' or 'feeling tones' which permeate and colour our awareness of both ourselves and our world, and allow our felt relation to things and people to resonate within us. Unlike named nameable emotions, such primary feeling tones cannot, according to be 'ascertained' ie. identified and represented in thought. In this they are comparable to musical tones and chords, for those they may evoke nameable emotions in themselves they which defy emotional labeling. Independently of any processes of 'somatisation', emotions are already, and in themselves, specific embodiments of feeling tone. In the Zollikon seminars Heidegger asks at one point whether a phenomenon such blushing is to be regarded as the psychological experience of a somatic state or the somatic expression of a psychological state - for example an emotion such as embarrassment or shame. In doing so he points to something essential to an understanding of feeling that transcends the mind/body, psyche/soma distinction. The question he poses rhetorically is unanswerable. This is not because of any lack of empirical evidence - for what sort of evidence could offer a definitive answer - but because of the very terms in which it is posed. We cannot therefore, simply rest content with regarding phenomena such as blushing as the somatic expression of emotions such as shame or embarrassment. Nor is it convincing to suggest that the blushing merely a pre-programmed 'physiological' response that somehow generates or happens to be accompanied by a psychical awareness of such emotions. We can look at such phenomena as blushing or going red with anger in a different way however, seeing both the 'somatic' phenomena and the emotions that accompany them as ways of bodying a specific feeling tone - a felt relation to something or someone that cannot be reduced either to a programmed physiological response or pre-given emotion.

Thus emotions such 'anger', 'shame' or 'embarrassment' for example are not internal psychical objects or states that exists prior to their verbal or physical expression. They are different possible ways of experiencing the same felt relation to something or someone, all of which have in common a certain outward movement or e-motion, one which has the specific character of bringing our felt awareness of this relation to the surface, not only psychically but also somatically, through the reddening of our faces. Such basic movements or dynamics of awareness (establishing a surface boundary, bringing awareness to this surface, expanding or contracting a bounded field of awareness etc, withdrawing awareness from a surface and 'going into oneself' etc.) are natural ways in which feeling tones, as felt relationships or to something or someone other than self, body themselves. It is not some mentally unacknowledged emotion such as 'grief' but the tears that are not shed in grief, the loss that is not bodied in tears which then finds expression in either psychological disturbance or somatic symptoms. We can understand why it is therefore, that the medications used to treat certain conditions suspected of having a 'psychosomatic' dimension (asthma for example) tend to stimulate the very physiological processes that accompany specific psychological emotions such as anger. Through purely chemical means they bring about the somatic embodiment of a motion that the individual is otherwise incapable of letting be and freely bodying.

In his essay on "The Essence and Concept of Phusis" Heidegger discusses Aristotle's account of a living being as one whose movedness has its order and origin within itself. The term 'movedness' does not refer merely to motion in space but to change and transformation of any sort. The essential character of this movedness is a self-unfolding, which, like that of the plant is at the same time a rooting or grounding movement of 'going-back-into-itself'. Movements as such is something which "has itself within its own end". Rest is not merely the opposite of movement or its mere cessation, but its consummation - the end from which it originates and orders it from within as its essential direction or telos. The ceaseless and apparently restless motion that make up the physiological life of the organism, is at the same time a constant coming to rest - the stabilization of an inner order and organization (logos) that manifests (phusis) as the bodily form of the organism (morphe). The 'physiology' of a living being is essentially a movedeness that bodies and comes to rest in this bodying, not only unfolding from within itself but also, and at the same, constantly going back into itself.

These two basic movements - the movement out of self-unfolding, and the movement-in of going back into oneself - are characteristic not only of the plant or animal organism but of the the human being as such. But they are not organic 'processes' we can study like the growth of a plant, nor even movements we are necessarily aware of in any sense at all, for they are themselves basic movements of awareness. As such, they may or may not be in accord or harmony with our own 'physiology' in the primordial sense; that is to say, movements which come to rest in a bodying of our being, and which constitute a type of self-originating physiological speech (the logos of our phusis. This is a bodying, which in the case of the human being - implies giving bodily form to what, how and who we feel ourselves to be at any given time.

The Self-Psychological Foundation of Fundamental Medicine

In modern Western culture, the movement of going in is associated with a type of introspective or depressive withdrawal which removes us from contact with things and people and leads to the dead end of inner isolation and despair. There is no acknowledgement that the movement in is not only inseparable from the movement of self-unfoldment or 'self-actualisation' that leads us outwards into engagement with the world but its very ground. As in the case of the rooting plant, it is also a going down and going under, movements which also have nothing but negative connotations in our culture. Even as thinking beings distinct from plants, we can no more 'come up' with something without going down into ourselves than a plant can grow upwards and 'come up' with flowers without roots that dig into a fertile soil. In Eastern cultures, the movement in and down found specific forms of embodiment in meditational practices and postures which lead to, through beyond the self. This 'self', however was at the same time a 'not self' - something fundamentally other than the self we ordinarily identify with. It was not, in Buddhist thinking, seen as a singular centre of subjective awareness bounded by the body, but rather as a open-ended or unbounded field of awareness with countless centres, centres which links us, as enlightened beings or Buddhas, with all other beings in the indivisible field-continuum of Being that constitutes basic reality. Today, on the other hand, psychoanalytic models of the self have left us with the notion that any inner relation we feel to another being, can be nothing more than the psychological internalization of an outer physical relation, the product of a process of 'introjection' or 'projective identification'. From the perspective of ield-dynamic phenomenology on the other hand, quite independently of any processes or 'projection' or 'introjection' it is impossible to come face to face with another human being without at the same time coming face to face with ourselves in a new way. The face of the other is always and at the same time another face of the self. The other is not only an 'alter ego', an independent centre of awareness. The other is also an alternate centre of our own larger field of awareness - another self. What we call 'feeling' is not only the expression of a felt resonance with something or someone other than self. It is at the same time an attunements to other self of our own - an alternative locus of awareness from which we can experience ourselves in a new way and in a new light. Human beings mean something to one another not only because of what do or say to one another because as being they already are something for one another - they embody other aspects of our own being and attune us to them.

That we ask someone feels with the question 'how are you?' or 'how are you faring?' (German Wie geht es dir? or English How are you doing?) points, in Heidegger's understanding to a fundamental 'ontological' unity of being and feeling. "A mood manifests 'how one is' and 'how one is faring'. In this 'how one is', having a mood brings Being to its There." In my view, however, we cannot develop a feeling undersanding of health and illness without recognizing that at the heart of all human experience is the combination of familiarity and foreignness that marks every genuine encounter, not only with others but with ourselves. The sense of foreignness, of not feeling oneself, that characterises the experience of essential dis-ease can be the starting point, either of disease, or a movement of awareness which takes us beyond the which leads us to feeling another self. Health, from this point of view, is not simply feeling one-self again, together with the restoration of a state of bodily 'well-being'. It is a continuous activity of bodying our inner being, one which requires us to assimilate and incorporate in our own self-awareness new and 'foreign' aspects of inner being hitherto associated only with others. These are not just other aspects of 'ourselves' (ie the self we know) but other selves - alternate centers of self-awareness within the larger field of awareness that centers itself in them, whose self-manifestation they are, and which therefore alone warrants the title of soul. We encounter these other selves in other people, which is why we tend to identify them with others rather than identifying with them ourselves. Without them, however we would be incapable of 'empathic' attunement to another human being, for this depends on an expansion of our own field of awareness to include those aspects of ourselves that are in resonance with the other and constitute our inner link to them.

The idea of one self / one body has been the ruling self- and body-concept of Western culture for centuries. We speak of "Multiple Personality" only as a disorder. Yet we accept without question the body's sophisticated and complex division into multiple organs and cell types. We accept that individual's show different faces, adopt different life roles, or go through subtle changes in personality over time, but do not see the individual as a family or society of selves but rather as a singular subject or centre of awareness - the conscious ego - with different 'subconscious' layers or 'sub-personalities'. Identity and selfhood in all its diverse aspects, conscious, subconscious and unconscious is seen as the private property of this singular ego or "I".

The physical body or soma is the 'objective' physically perceived spatial exteriority of the human organism. What we call the psyche is its non-spatial 'subjective' interiority. This non-spatial interiority is no more bounded by the physical body than is the inwardness of the word - its meaning and message - bounded by the physical dimensions of letters on a page. As beings we dwell 'within' our bodies in the same way that we dwell within the word, inhabiting an unbounded, multidimensional world of meaning. The physical body is a living biological language of the human being. But just as a text is the visible two-dimensional surface of a multi-dimensional world of meaning, so is the fleshly text of the human body. The psychic interiority or inwardness of the human organism leads into this world of meaning, one which is limited neither by the boundaries of the physical body nor by the outer field of sensory awareness surrounding it. Instead it is an inwardness that both surrounds and permeates this outer field. Understood in this way, the psyche is not a physically encapsulated soul but an inwardness linking us directly with the inwardness of the things and people we perceive in our external world. The human organism is the instrument or organon through which we translate our inner relationship, as beings to other entities, into phenomena manifesting in our outer field of awareness. This inner relationship has the primary character of attunement. We do not first hear someone's words and then deduce from then what they are saying. On the contrary "We hear, not the ear." Our attunement or felt resonance with another human being, allows us to hear what they are saying. Our physical hearing then gives form to this attunement as perceived phenomena in our field of sensory awareness - audible words that we hear spoken. We need only remind ourselves, in this connection, of the notorious unwillingness of parliamentarians of all nationalities to listen what politicians from opposing camps have to say, an unwillingness constantly revealed in their body language through fidgeting, falling asleep, leafing through papers etc. It is not surprising that a German study has revealed that an abnormally large percentage of parliamentary politicians suffer from poor hearing. The capacity for attunement that would allow them to hear what others are saying - rather than picking up on and nit-picking their words or disputing their verbal propositions and proposals - is not merely unexercised but actively inhibited, to such an extent that their organs are functionally affected and their hearing measurably diminished.

Kurt Goldstein was one of the fathers of modern neurology who brought to bear a variety of different holistic, ethical and philosophical perspectives. In his major work entitled "The Organism" he describes how what Heidegger calls 'capacities' are exercised in the form of ordered or organised performances such as walking or talking, writing or reading, calculating or describing. The latter are in turn a response to a specific environmental field or 'milieu'. If organs are damaged these performances are hindered. Not being able to embody certain capacities through the functioning of its organs the organism cannot 'function' properly ie. cannot respond adequately to a particular milieu. This does not mean however, that it is unsuited or unable to respond to the demands of a different milieu. Goldstein's point is that organic 'disease' is not essentially something intrinsic to the organism or to the physical body and its organs but rather has to do with the relationship between an organism and its milieu. Every change in this relation alters both. For human beings in particular however, loss of ability to exercise their capacities and fulfil their potentials of being through ordered performances in their existing milieu can be experienced as 'catastrophic' threat - tantamount to loss of meaning and loss of being or 'essence'. Echoing the language of Heideggerian ontology Goldstein writes: "This…the organism' being, is its raison d'etre. All individual processes take their meaning from and are determined by this being. We describe this as the organism's essence."

"..health is not an objective condition which can be understood by the methods of natural science alone. It is rather a condition related to the mental attitude by which the individual has to value what is essential for his life. "Health" appears thus as a value; its value consists in the individual's capacity to actualise his nature to the degree, that for him at least, is essential. "Being sick" appears as a loss or diminution of value, the value of self-realisation, of existence."
Health in other words, is not the physical or mental ability of an individual to function effectively or 'normally' within a pre-given physical or social environment - their milieu. Health is value fulfillment - the individual's ability to find or shape a milieu in which their intrinsic values or potentials of being can be fulfilled as capacities through ordered performances.

According to Goldstein, every organism, including the human organism, dwells in two environments - a 'positive' one which it can respond to effectively through its performances and a 'negative' one which it cannot. Together these make up its milieu. Disease is not the expression of an inborn genetic 'weakness' of the organism in 'adapting' to its environment, but an inability on the part of the individual being to adapt that environment to its needs - to find or create the right milieu for itself. Stimuli impinging from a negative environment may damage organs, disturb, derange or disable the organism's responses and performances or render them inadequate. The natural response of the individual is to avoid such impingements and/or to alter its positive environment so that it places less demands on functions that are organically impaired - or in danger of becoming so. Neither the bodily and behavioural symptoms of 'disease' necessarily point to organic 'causes', however. Instead they may themselves be healthy and adaptive responses to a negative environment - an attempt to escape that environment or transform it into a life-enhancing milieu. For the individual too, is on one level a cell within a larger social body that may itself be more or less healthy. The health of the individual and their relation to society cannot therefore be separated from the general health of human relations in society - the health of the social organism.

That is why the Maslow rejected "our present easy distinction between sickness and health, at least as far as surface symptoms are concerned. Does sickness mean having symptoms? I maintain now that sickness might consist of not having symptoms when you should. Does health mean being symptom-free? I deny it. Which of the Nazis at Auschwitz or Dachau were healthy? Those with stricken conscience or those with a nice, clear, happy conscience? Was it possible for a profoundly human person not to feel conflict, suffering, depression, rage, etc.?"

A sick social organism may reject a healthy cell, treating the individual - or an entire group - as a malignant foreign body or antigen. If the individual suffers or even becomes sick as a result of this response is this healthy response or not? Is it the task of medical science to seek the technological annihilation or 'final solution' to all symptoms of social dis-ease or of individual's dis-ease with society. Or is its fundamental task to tackle sickness of the social organism itself - a sickness of human relations that lie at the heart of both individual and social ill-health, and one that is no more clearly expressed than in its own pathological forms of medical diagnosis and treatment.

© Peter Wilberg, 2001