From method to hermeneutics: which epistemological framework for narrative medicine?

The past 10 years have seen considerable developments in the use of narrative in medicine, primarily through the emergence of the so-called narrative medicine. In this article, I question narrative medicine’s self-understanding and contend that one of the most prominent issues is its lack of a clear epistemological framework. Drawing from Gadamer’s work on hermeneutics, I first show that narrative medicine is deeply linked with the hermeneutical field of knowledge. Then I try to identify which claims can be legitimately expected from narrative medicine, and which ones cannot be. I scrutinize in particular whether narrative medicine can legitimately grasp the patient’s lived experience of his or her illness. In the last section of this article, I begin to explore the potential usefulness of this epistemological clarification. This analysis allows for a further understanding of what is really at stake with narrative medicine, and thus to identify when it may be convenient, and when it may not. Furthermore, this clarification opens up promising new possibilities of dialogue with critics of the field. I conclude that narrative medicine finds its proper place as a possible tool available to mediate dialogue, which is at the heart of the clinical encounter in medical practice.     

Dialectic and dialogue in the hermeneutics of Paul Ricœur and H.G. Gadamer

The present paper uses the theme of dialectic and dialogue to begin unraveling the similarities and differences between the hermeneutics of Paul Ricoeur and H.G. Gadamer. Ricoeur is shown to distance himself from Heidegger by insisting on a dimension of explanation and distanciation (which he sometimes identifies with Plato's `descending dialectic') that cannot be reduced to, or absorbed by, understanding and appropriation. This same move, however, leads him to reject Platonic dialogue, with the attendant prioritizing of oral conversation over the written text, as a model for hermeneutics. Ricoeur therefore sees in Gadamer's recourse to such a model a regression to the problematic position of Heidegger. Yet the conception of philosophy as dialectical and dialogical which Gadamer finds in Plato is capable of responding to Ricoeur's objections. Where the fundamental difference between the hermeneutics of Ricoeur and Gadamer emerges is in the question of whether experience is fundamentally dialectical and whether language is inherently dialogical.     

Hermeneutics and philology: “Understanding the matter,” “Understanding the text”

In Gadamer's hermeneutics the relationship of philology to philosophy and to the Geisteswissenschaften often became a focus of his hermeneutical reflection. In the first part of my contribution, I investigate and reconstruct this relationship in Gadamer's thinking. In the second part, I take up a recent debate about Gadamer in Hungary, and in connection with it offer a case study in which Gadamerian thinking is present in a twofold way: as that with which I am reflecting and at the same time what it is about – the object of this reflection. The first part comes to the conclusion that the interconnectedness of philology and philosophy, with each side referring to the other, is central to Gadamer's work; it is moreover the element in which Gadamer's writings move. It is the focus on the text as text versus a focus on the text as the mediator of a matter [Sache] that makes the difference between philology and philosophy. This difference may give rise to a kind of tension, and this is addressed in the second part of the paper, by way of showing a passage from Gadamer's work susceptible to philological objections.     

The Concept of the Subject in the Philosophical Hermeneutics of Hans‐Georg Gadamer

Abstract

Certain critics, e.g. Manfred Frank and Hans‐Herbert Kögler, claim that Hans‐Georg Gadamer’s philosophical hermeneutics reduces the individual subject to a mere instrument of history and tradition, the latter reproducing themselves through the subject. However, Gadamer also emphasizes the active role of the subject in shaping and creating history and tradition. In this article I argue that the critics mistakenly emphasize a one‐sided conception of history. By incorporating both active and passive aspects of the subject, Gadamer’s philosophical hermeneutics provides the means by which the individual may be conceived more aptly in an interdependent, dialectical relation to their corresponding historical, cultural, and social context.     

A Gadamerian Critique of Kuhn’s Linguistic Turn: Incommensurability Revisited

In this article, I discuss Gadamer’s hermeneutic account of understanding as an alternative to Kuhn’s incommensurability thesis. After a brief account of Kuhn’s aesthetic account and arguments against it, I argue that the linguistic account faces a paradox that results from Kuhn’s objectivist account of understanding, and his lack of historical reflexivity. The statement ‘Languages are incommensurable’ is not a unique view of language, and is thus subject to contest by incommensurable readings. Resolving the paradox requires an account of incommensurability that is self‐referentially consistent, open‐ended, and historically reflexive whereby we recognize that our very interest in incommensurability is historically conditioned. By meeting these conditions, Gadamer’s account of historical understanding offers a middle ground between two extremes: on the one side is the claim that understanding involves becoming a native of an incommensurable language, and on the other side is the rejection of the prospect of understanding a contextually removed language altogether. Gadamer is discussed as a mediator between Kuhn’s epistemic and historical projects, and thus paves the way for a new hermeneutics of science. The notions of traditional horizon, historically effected consciousness, the universality of interpretation, alienation, dialogical openness, and the fusion of horizons are also discussed.     

Historicism and Critique in Herder's Another Philosophy of History: Some Hermeneutic Reflections

In Another Philosophy of History, J.G. Herder claims that his aim is not to compare and judge different cultures, but merely to describe and explain how each came into being and thus to adopt the standpoint of an impartial observer. I argue, however, that there is a tension between Herder's understanding of his own project—his stated doctrine of historicism and cultural relativism—and the way in which it is actually put into practice. That is, despite Herder's stated aims, he is nevertheless unable to avoid justifying premodern forms of life and making context‐transcending evaluative judgments in the process of trying to understand cultures on their own terms and holding them up as exemplars vis à vis the Enlightenment. This tension presents the challenge of accounting for it in the most charitable and illuminating way. I argue that this goal can be achieved by appealing to the resources of the philosophical hermeneutics of Hans‐Georg Gadamer, which enables us to disclose two enabling conditions for Herder's project of which he was not explicitly aware, viz., the internal connection between understanding and justification and the enabling character of prejudice as the condition for the possibility of understanding as such.     

Socrates with a cane

Abstract

Key to Gadamer’s theory of hermeneutics are notions of translation, conversation, and openness. What is often not known is just how much Gadamer himself embodied those notions in his own practice as a teacher and a friend. In what follows, I speak of how the man I knew Hans-Georg Gadamer to be, illustrated some of the traits of hermeneutic theory that show that such a theory is always a practice of life and an ethical practice. Not a theoretical text but a recollection follows.     

Philosophical Hermeneutics and Theological Education

This article explores the resources that the philosophical hermeneutics of Hans‐Georg Gadamer can bring to the challenge of teaching theology to undergraduates. The author offers a sympathetic reading of Gadamer but is influenced by the insights of liberation theology. In this interpretation of his work, Gadamer's contribution lies in his emphases on intersubjectivity and on praxis as the goal of historically conscious understanding — and thus of historically conscious theological education. To suggest what philosophical hermeneutics can tell us about the process of teaching and learning in theology, this essay examines Gadamer's approach to historicity, conversation, truth, objectivity, subjectivity, practical wisdom, and praxis.     

Play, agreement and consensus

In this paper I employ the analysis of play to clarify the distinction between an agreement and a consensus, and I argue that it is the conditions supplied by the playful process that enable us to partake in the recognition and creation of truth. Gadamer's hermeneutical truth, unlike propositional truth, speaks of the interpretive act whereby meaning is recognized. This interpretive recognition of meaning is described by Gadamer as an occurrence of interpretive play orgenuine understanding. Regarding Gadamer's conception of truth as modelled on agreement rather than consensus, I demonstrate that it is in the process of play that we achieve the making and maintaining of the conditions that are necessary for agreement, and that the nature of understanding is most clearly revealed by viewing it as a playful process.     

The significance of Gadamer’s hermeneutics for cross-cultural understanding

Abstract

Edward Said’s book Orientalism stands in a long lineage of critique of European scholarship responsible for shaping European understandings of foreign cultures. His book contributed significantly to the debate about the epistemological presuppositions informing European scholars of other cultures. However, while Said exposed in considerable detail the ways in which the Orient was distorted by the theories of the European academy, he left unexamined the possibility of genuine cross-cultural understanding. This article considers the significance of hermeneutics for cross-cultural rather than historical understanding. It explores the implicit claim Gadamer makes for the universal validity of hermeneutics not only for understanding in history, but for a genuine intellectual rapprochement across geographical and cultural lines as well.     

Can there be a science of the symbolic?

Science means not just 'knowing', but knowing verified by replicability. Science is particularly hard to bring to depth psychology because the individual uniquenesses that can't be repeated are what make people most deeply themselves. Everyone, including the analytic investigator, however, has a science, in the sense of a world-view that is replicated by experience. Jung offered hermeneutics as an alternative mode to science for getting to know the psychological subject. But as Heidegger emphasized, hermeneutics always begins with the projection of a world-view, i.e., the science of the would-be interpreter. In the analytic situation, dialogue is available to test the world-view and enlarge its horizon, in accord with Gadamer's expansion of hermeneutics, 'the classical discipline concerned with the art of understanding texts', into a method of inquiry open to the possibilities of otherness. An example is given from an analytic training seminar, in which the author began by projecting his version of the theory of psychological types onto the dream material a candidate offered in response to the seminar. A dialogue with the candidate ensued which enabled the teacher to correct his original, somewhat rigid, application of his scientific viewpoint. In such a dialogue, psyche emerges as the final interpreter of what is, generating hypotheses that can fruitfully be applied to the understanding of other cases.     

Regression in the countertransference: working with the archetype of the abandoned child

Abstract :  The author describes briefly some experiences of his sense of non-existence as an analyst in relation to five patients. He considers the possible countertransference significance of these experiences and puts forward a hypothesis that his sense of non-existence as an analyst might be a clue to regression in the patient to the anxieties of a baby without a mother, even though other clinical evidence of regression might be lacking. Referring back to Jung's early formulation of transference and countertransference as aspects of the unconscious identity shared between analyst and patient, he further develops his hypothesis, suggesting that, in the cases he has presented, analyst and patient were relating through shared dynamic roots in the archetype of the abandoned child. He briefly demonstrates how the understanding thus achieved was of clinical use in the analyses of the patients he has presented.     

Nietzsche and Gadamer: From strife to understanding,Achilles/Agamemnon to Achilles/Priam

Nietzsche penetrates behind any rational discussion to its affective ground, but though he goes deeper than Gadamer's fusion of horizons, he nevertheless fails to acknowledge any other affective disposition besides the will to power. Hence for him Gadamer's Sichverständigung, or reaching an understanding, is fiction. In contrast, Gadamer's Zugehörigkeit, a sense of kinship, and Nachlassen, relenting, suggest not only the possibility of reaching an understanding but its real, affective ground. Two passages from Homer's Iliad illustrate how Nietzsche might penetrate behind Gadamer's intellectualism yet how, at the same time, Gadamer ultimately gets beyond Nietzsche. In Book I, Achilles and Agamemnon can get no further than strife because of their pathos of rage and hostility. Here Nietzsche's will to power explains their altercation entirely. On the other hand, when Achilles is confronted with the devastated Priam in book XXIV, philia and eleos, kinship and mercy, replace his anger; and with the corresponding affective shift in Priam from fear of Achilles to his own feelings of kinship and forgiveness, antipathy becomes sympathy. Only this fusion of affect allows them to reach an understanding.     

Self-Formation and the speculative: Gadamer and Lacan

Abstract

Gadamer’s project in Truth and Method is as much about truth in the human sciences as it is about human subjectivity, for, following Heidegger, he claims that truth is reducible to method (technical rationality) only if one is misled by old Enlightenment subject/object dualisms. Posing the question of the possibility and nature of truth in scientific thinking, where a strict division between subjective and objective has fallen away, Gadamer belongs, as one of its inaugural figures, to an alternative tradition of philosophical complexity, which implicates environmental systems (culture, ideology, institutions), embedded in language, in the constitution of human subjectivity.

With these theoretical shifts in mind, what caught my attention in a press report concerning the trial of (subsequently convicted) serial killer, Stewart Wilken (“Boetie Boer”), was the strangely anachronistic question that dominated the front page of a Port Elizabeth newspaper: “Boetie: Is he Sick or Evil?” This question, in my view, harks back to a questionable framework of Enlightenment autonomy, which depends upon the easy technical rationality of clear-cut dichotomies. In what follows I hope to show that in acknowledging the role of complex interrelations between cultural and other systems, a tradition of philosophical complexity justifiably claims a more adequate framework for understanding self-formation than that underpinning the discourses at work in Wilken’s trial. I shall draw on Gadamer’s hermeneutic model of an “embedded” subject, which is based on his speculative model of “play” outlined in Truth and Method, and supplement this with Lacan’s psychoanalytic account of subject formation.     

Through hermeneutics of suspicion to a rediscovery of faith

Ric?ur argued that the critique of religion developed by the three modern masters of a hermeneutics of suspicion – Marx, Nietzsche, and Freud – is liberating insofar as it makes possible a mature faith. In the first part of the article, I explore this issue in relation to Kierkegaard. In the second part of the article, I discuss how Kierkegaard uses a biblical critique of religion, particularly the figure of the prophet, in his final attack on the church in his pamphlet “What Christ Judges of Official Christianity”. Through my investigation of the role of a hermeneutics of suspicion in Kierkegaard’s rediscovery of faith, I aim to question Ric?ur’s dichotomy between an external, atheistic hermeneutics of suspicion versus an internal hermeneutics of faith.     

Constructivism and Technology Critique: Replies to Critics

1. Thomson's critique: Despite the efforts of his followers to show that Heidegger had a progressive theory of technology, his work is clouded by nostalgia. His positive contribution is a fragmentary opening toward a phenomenology of daily technical practice, which I use to develop de Certeau's distinction between the strategic control of technical systems and their tactical usage by subordinates. Heidegger himself made no such application of his own phenomenological approach. 2. Stump's critique: Can an ontological essentialism and a historically oriented constructivism be combined as Questioning Technologyattempts to do? Stump claims they cannot, but assumes that I accept far more ontological and epistemological baggage from each position than I do. In fact, what I retain from essentialism is primarily the analysis of the basic technical relation to reality, and from constructivism, historical and hermeneutic methods of analysis of the realization of that relation in actual systems and devices. These elements of the two theories are compatible.     

Confusion of Horizons: Gadamer and the Christian logos

This paper argues for Gadamer's indebtedness to logs Christology. Gadamer's language philosophy and hermeneutic experience both depend on theological insights gleaned mainly from St. Augustine and German Pietism. In Truth and Method , Gadamer uses Augustine's rewriting of Platonism to establish his language philosophy and employs the Pietist formula of application to describe the hermeneutical experience as word event. Gadamer's silence about these influences in his later works leave his interpreters and critics (such as Jürgen Habermas) puzzled about his seeming naïve trust in philosophical hermeneutics as a means to improve human interaction. This article tries to contribute to an understanding of Gadamer's hermeneutics by arguing that Gadamer's optimism in language and reason make sense when seen in the theological context from which crucial elements of his philosophy are derived.     

Defending Desire: Scanlon's Anti-Humeanism

In the opening chapter of What We Owe To Each Other , Tim Scanlon produces a sustained critique of a Humean conception of practical reason. Scanlon claims he will argue that unless having a desire just is to see something as a reason, desires play (almost) no role in the explanation or justification of action. Yet his specific arguments against Humeanism all employ a very austere understanding of desire (which he calls the "standard model"), and attempt to show that desires so understood are not up to any explanatory or justificatory task. Since the standard model represents only one understanding of desire (distinct from the "recognition of reasons") his specific arguments cannot establish his stated general thesis. I show how a more robust conception of desire will leave the Humean account safe from Scanlon's specific arguments.     

"Reflexive Embodied Empathy": A Phenomenology of Participant-Researcher Intersubjectivity

In this article, I advocate a research process that involves engaging, reflexively, with the embodied intersubjective relationship researchers have with participants. I call this practice reflexive embodied empathy. First, I explicate the concept of empathy through exploring ideas from the philosophical phenomenological literature. I then apply this theory to practice and offer examples of reflexive analysis of embodied empathy taken from various hermeneutic phenomenological research projects. Three interpenetrating layers of reflexivity are described, each involving different but coexisting dimensions of embodied intersubjectivity. The 1st layer-connecting-of-demonstrates how people can tune into another's bodily way of being through using their own embodied reactions. The 2nd layer-acting-into-focuses on empathy as imaginative self-transposal and calls attention to the way existences (beings) are intertwined in a dynamic of doubling and mirroring. The 3rd layer-merging-with-involves a "reciprocal insertion and intertwining" of others in oneself and of one in them (Merleau-Ponty, 1964/1968, p. 138), where self-understanding and other-understanding unite in mutual transformation. Through different examples of reflexive analysis from my research, I have tried to show how intersubjective corporeal commonality enables the possibility of empathy and how, in turn, empathy enables understanding of the Other and self-understanding. I discuss how the coexisting layers of empathy and the resultant understandings can be enabled through hermeneutic reflection and collaborative research methods.