Clinical interpretation: The hermeneutics of medicine

I argue that clinical medicine can best be understood not as a purified science but as a hermeneutical enterprise: that is, as involved with the interpretation of texts. The literary critic reading a novel, the judge asked to apply a law, must arrive at a coherent reading of their respective texts. Similarly, the physician interprets the text of the ill person: clinical signs and symptoms are read to ferret out their meaning, the underlying disease. However, I suggest that the hermeneutics of medicine is rendered uniquely complex by its wide variety of textual forms. I discuss four in turn: the experiential text of illness as lived out by the patient; the narrative text constituted during history-taking; the physical text of the patient's body as objectively examined; the instrumental text constructed by diagnostic technologies. I further suggest that certain flaws in modern medicine arise from its refusal of a hermeneutic self-understanding. In seeking to escape all interpretive subjectivity, medicine has threatened to expunge its primary subject — the living, experiencing patient.     

Indeterminiertheit,Iterabilität und Intentionalität

In his recent paper Indeterminacy, empiricism, and the first person John R. Searle tries to refute Willard V. O. Quine's famous indeterminacy of translation thesis by arguing that this thesis is in fact areductio ad absurdum of Quine's own linguistic behaviorism. Searle accuses Quine of being (irrationally) antimentalistic and suggests that the absurdity of Quine's thesis might be avoided if a full-fledged intentionality were tolerated in the debate on meaning. — This anti-Quinean approach in some respects reminds of the improbable debate between Searle and Jacques Derrida ten years ago, when Derrida had split and deferred intentionality by showing that the essential iterability of signs inevitably infects every intentional act with an unremovable non-presence.In this paper it is argued that Searle's attacks on Quine and Derrida have both failed — and that there are structural similarities between these two failures which reveal some interesting parallels between Quine's and Derrida's philosophy.     

Language in action

A number of general points behind the story of this paper may be worth setting out separately, now that we have come to the end.There is perhaps one obvious omission to be addressed right away. Although the word information has occurred throughout this paper, it must have struck the reader that we have had nothing to say on what information is. In this respect, our theories may be like those in physics: which do not explain what energy is (a notion which seems quite similar to information in several ways), but only give some basic laws about its behaviour and transmission.     

Wahrheitsähnlichkeit als Regulativ der Intentionalität?

Is there still any importance of Husserl's Phenomenology for contemporary forms of philosophy of science? A comparison between Phenomenology and a prominent form of such modern philosophy of science, the so-called Critical Rationalism of Karl Popper, may help to answer this question. Therefore, the different levels of argumentation have to be worked out to make the respective arguments applicable to one another. We are arguing for the following thesis: the strategy of corroboration in Critical Rationalism can be justified by means of the phenomenological conception of intentioality of consciousness. A typical example may illustrate how Popper's conception of taking the degree of corroboration as an indicator of the degree of verisimilitude can find its deeper foundation in Husserl's genetic interpretation of ordinary kinds of experience.     

Where “Sex” Is Born(e): Intersexed Births and the Social Urgency of Heterosexuality

Our beloved genders of the present moment are neither universal nor trans-historical presences in the world. The specific gender order which we employ today is the legacy of a particular cultural and political history, and there is still a great deal at stake in preserving it. As a graduate student I stumbled upon the topic of intersexuality a few years ago and found myself enthralled with its implications. Continuing to present itself inspite of all our scientific knowledge about the supposed immutability of female and male, intersexuality disrupts the gender order. The response to this disruption has been swift and terrible: from the intersexed infants who enter our world everyday are carved (literally and figuratively) supposedly normal boys and girls (mostly girls). The following exposition represents a pre-fieldwork (theoretical) stage in my current research and attempts to demonstrate that medical authorities manage intersex cases as they do in order to stabilize the always precarious institution of heterosexuality.     

Emeralds are no chameleons — Why “Grue” is not projectible for induction

The model function for induction of Goodmans's composite predicate Grue was examined by analysis. Two subpredicates were found, each containing two further predicates which are mutually exclusive (green and blue, observed before and after t). The rules for the inductive processing of composite predicates were studied with the more familiar predicate blellow (blue and yellow) for violets and primroses. The following rules for induction were violated by processing grue: From two subpredicates only one (blue after t) appears in the conclusion. As a statement about a future and unobserved condition this subpredicate, however, is not projectible for induction whereas the only suitable predicate (green before t) does not show up in the conclusion. In a disjunction a v b where a is true and b false the disjunction is true. When, however, the only true component is dropped, what remains is necessarily false. An analogous mistake may be observed in the processing of grue, where the only true component (green) was dropped in the conclusion. — As a potent criterion for correct inductions a check of the necessity of the conclusions is recommended.The author is indebted to Prof. Curt Christian for valuable suggestions.     

Between Science and Nature: Interpreting Lactation Failure in Elizabeth von Arnim's The Pastor's Wife

Interpreting a scene of lactation failure allows us to represent breast-feeding as a contested social practice. This essay reads a novelistic scene of lactation failure in the context of the decline of breast-feeding in the twentieth century. The protagonist's ignorance of the female experiences of pregnancy, childbirth, and lactation is an effect of her objectification within the opposition between science and nature. Unnatural as a woman because she is a natural individual, the pastor's wife exemplifies the dilemmas of breast-feeding as a biosocial practice of maternity in a technological society which features the breakdown of traditional female networks in which knowledge about maternity and breast-feeding are circulated.     

Coming Out: Considering the Closet of Illness

This essay explores key concerns surrounding coming out as a person with illness and addresses important professional and social considerations for those who are closeted in various kinds of illness. Using central tenets of Queer Theory and Disability and Cultural Studies as a theoretical base, I examine the politics of coming out in the specific context of my lived experience during the 2002 NEH Summer Institute, Medicine, Literature, and Culture While such an environment might foster unusual candor about personal illness experience, I discovered that the choice to come out as a person with chronic, non-infectious disease (Inflammatory Bowel Disease) was nevertheless complicated in interesting ways.     

Belief and the problem of Ulysses and the sirens

While self-contained, this paper is a sequel to my Belief and the Will (1984); see theBibliographical Note at the end of this paper for a survey of the relevant literature since then and supplementary references. I have meanwhile benefitted greatly from Brad Armendt's commentary and Richard Foley's How should future opinion affect current opinion?, both presented at a symposium at the APA Central Division, April 1993.     

On fideism and Alvin Plantinga

The first version of this paper was presented at a summer workshop on Skepticism and Fideism in 1986 at the University of Notre Dame, sponsored by The Society of Christian Philosophers. Subsequent versions have been read at the Mississippi Philosophical Association and the American Academy of Religion. I would like to thank the director of the workshop, Phil L. Quinn, and the participants for providing an intellectual springboard for developing my ideas on the topic of fideism and the proper basicality of theistic belief.     

A Work in Progress

After expressing gratitude to each contributor, and briefly commenting on each, I probe several main themes of my work, addressing the question of the apparent difference between my earlier philosophical and later clinical writings. Central to both is the reflexivity of the human agent, and that each exhibits a form of practice regardless of the specific aims embedded in each. I then address the theme of narrative writing as my work has developed over the past several decades – at the heart of which are questions of self and integrity.     

Is medicine hermeneutics all the way down?

Several recent publications have suggested that hermeneutics, the method of literary criticism, might prove to be useful in medicine. In this essay I consider this thesis with particular attention to the claim that medicine is hermeneutics all the way down. After examining an anti-positivist critique of positivist medicine and arguing that hermeneutic interpretation involves a more radical critique of modern medicine, I examine the supposed consequences of hermeneutical universalism:relativism, skepticism andantirealism which further evaluation reveals to be only potential consequences of hermeneutics. A brief discussion ofphronesis and of the possible texts of medicine concludes the article.     

Introduction

My special thanks are due to Dr Paul Joseph Chu who proofread all the texts and who collaborated on the whole project of the collected writings of the Lvov-Warsaw School (in preparation for publication in separate volumes). I am also indebted to Gwen Burda for her linguistic correction, Stanisaw Judycki for his comments and Zofia Kolbuszewska for her linguistic remarks. My student Lila Wesierska helped me with the bibliographical research. Kazimierz Dudkiewicz and Jarek Kinal from the University Computer Centre assisted me in solving all technical questions. Due to my fellowship at the Catholic University in Leuven (August-September 1994) where I was able to work in the Husserl Archive, it was possible to prepare the editorial addition to the bibliography. I would like to thank also the Polish Scientific Publishers for their permission to include the following essays in the present collection: K. Twardoswski, Imageries (see [Twardoswki 1965], 114–148), K. Ajdukiewicz, The psychophysical nature of humans (see [Ajdukiewicz 1985], vol. 1, 317–324). Ajdukiewicz's paper is translated here by kind permission of Mr. Bron Ajdukiewicz. I would like to extend my grateful thanks to Kluwer Academic Publishers and to Prof. Robert S. Cohen for their kind permission to publish H. Mehlberg's paper On psychophysical parallelism (a modified version of this paper appeared as a supplement in [Mehlberg 1980], 261–285]).     

Foucault on the Case: The Pastoral and Juridical Foundation of Medical Power

This paper employs Foucaults concept of governmentality to examine critically the efforts by medical humanists to reform the medical case. I argue that these reform efforts contribute to the individualizing dimensions of medical power through the development of a pastoral technique that medicine has taken over from religious authority. Clinical experiences at this NEH Institute also revealed a juridical dimension of the medical case that treats a patients statements as suspect and in need of corroboration by evidence provided by the patients body. The combination of these pastoral and juridical dimensions of the case contributes to the normalizing power of modern medicine, and medical humanists need to be aware of their own contribution to this form of power as they reform the case.     

Ethical Reasoning And The Embodied,Socially Situated Subject

My discussion is concerned with how symbolic power constitutively structures our very identities in relation to one another and at the bodily level of lived experience. Although many accounts of the self and of subjectivity as socially situated have difficulties in their explanations of agency, Zaners work suggests a basis upon which the selfs independence from others can be understood. His phenomenology of embodied subjectivity explains how the emerging self presupposes presence with others. At the same time, however, co-presence also reveals the selfs distinct perspective and capacity for circumstantial possibilizing, that is to say, actualizing another possible than the actual. My aim is to examine critically the intersections between Zaners phenomenology and other theoretical accounts of the socially situated self. I also show how Zaners work contributes to these discussions a way of understanding the possibility of agency that is rooted in embodied experience.     

Imageries

Wyobrazenia i pojcia [Imageries and concepts] in [Twardowski 1965], 114–197.     

Ein Argumentationsspiel um das Münchhausen-Trilemma

By means of a strategic game the present paper tries to answer the question of whether the so-called trilemma of Münchhausen (H. Albert)as it stands is able to perform the twofold task of both refuting the methodology of foundationalismand of getting us thereby nearer to the methodology of critical rationalism.The formal reconstruction of the argument provides us with four possible versions which however can only be called trilemmas in a wider sense of this term. Moreover, a test shows three of them to be invalid. The subsequent discussion of the only valid one makes clear that in order to save the truth of its premisses as far as possible the latter have to be modified in a way that brings us still farther away from the original trilemma of Münchhausen. But even then it may be doubted whether the remains of the argument can fulfil the above-mentioned twofold task.     

Medical Intellectuals: Resisting Medical Orientalism

In this paper, we propose analogies between medical discourse and Edward Said's Orientalism. Medical discourse, like Orientalism, tends to favor institutional interests and can be similarly dehumanizing in its reductionism, textual representations, and construction of its subjects. To resist Orientalism, Said recommends that critics—intellectuals—adopt the perspective of exile. We apply Said's paradigm of intellectual-as-exile to better understand the work of key physician-authors who cross personal and professional boundaries, who engage with patients in mutually therapeutic relationships, and who take on the public responsibility of representation and advocacy. We call these physician-authors medical intellectuals and encourage others to follow in their path.