Havi Hannah Carel

Many interpretations of David Cronenberg’s 1986 film The Fly read it as a film about monstrosity. Within this framework, the protagonist Seth Brundle’s progressive illness and decay are subsumed under his metamorphosis into a monster. Illness is taken to be a metaphor for the changes in Seth, changes that continuously turn him away from the human and towards the monstrous. Seth’s monstrosity, in turn, arises from the fusion of human and non-human, in this case the fusion of a man with an insect. I suggest an opposite interpretation: instead of seeing Seth’s illness as a metaphor for monstrosity, I suggest that monstrosity is a metaphor for illness. Seth’s physical corruption as he becomes more and more monstrous is, in fact, a depiction of illness, and elicits disgust in the viewer that is identical to the disgust elicited by physical corruption brought about by illness. The external deformation of Seth as he becomes more and more fly-like, shown so spectacularly in the film, is a representation of the internal destruction and physiological chaos caused by disease. I argue that the notion of the monstrous that is so central to the film in fact supports the health/ illness dichotomy, in which the two states – health and illness, or human and monster – are posited as mutually exclusive. Instead of accepting the dichotomy and focusing on the dialecticbetween human and monstrous, as many interpretations have, I claim that the film in fact demonstrates the fallacy of this dichotomous view, showing that ultimately we all have ‘the disease of being finite’. I propose to understand the film as a tragedy portraying the terminal illness of a decent man. As such, the film dupes the viewer into accepting the human/ monster and healthy/ diseased dichotomies, only to grasp their illusoriness by the end of the film.

Ill persons suffer from a variety of epistemically-inflected harms and wrongs. Many of these are interpretable as specific forms of what we dub pathocentric epistemic injustices, these being ones that target and track ill persons. We sketch the general forms of pathocentric testimonial and hermeneutical injustice, each of which are pervasive within the experiences of ill persons during their encounters in healthcare contexts and the social world. What’s epistemically unjust might not be only agents, communities and institutions, but the theoretical conceptions of health that structure our responses to illness. Thus, we suggest that although such pathocentric epistemic injustices have a variety of interpersonal and structural causes, they are also sustained by a deeper naturalistic conception of the nature of illness.

Chronic fatigue syndrome or myalgic encephalomyelitis remains a controversial illness category. This paper surveys the state of knowledge and attitudes about this illness and proposes that epistemic concerns about the testimonial credibility of patients can be articulated using Miranda Fricker’s concept of epistemic injustice. While there is consensus within mainstream medical guidelines that there is no known cause of CFS/ME, there is continued debate about how best to conceive of CFS/ME, including disagreement about how to interpret clinical studies of treatments. Against this background, robust qualitative and quantitative research from a range of countries has found that many doctors display uncertainty about whether CFS/ME is real, which may result in delays in diagnosis and treatment for patients. Strikingly, qualitative research evinces that patients with CFS/ME often experience suspicion by health professionals, and many patients vocally oppose the effectiveness, and the conceptualization, of their illness as psychologically treatable. We address the intersection of these issues and healthcare ethics, and claim that this state of affairs can be explained as a case of epistemic injustice. We find evidence that healthcare consultations are fora where patients with CFS/ME may be particularly vulnerable to epistemic injustice. We argue that the marginalization of many patients is a professional failure that may lead to further ethical and practical consequences both for progressive research into CFS/ME, and for ethical care and delivery of current treatments among individuals suffering from this debilitating illness.

When someone close to us dies, we usually say that we are with them ‘in our thoughts’ or that they remain alive in our minds. The film Vital challenges this disembodied view of grief by posing the following question: what would grief be like if we could keep the dead with us not only in our memories, but materially? The film provides an intriguing answer to this question, provided through a unique setting, that of a medical school dissection class. Despite the macabre setting, Tsukamoto’s aim is not to shock but to offer an intense meditation on the embodied nature of mourning.

This article analyses the phenomenon of epistemic injustice within contemporary healthcare. We begin by detailing the persistent complaints patients make about their testimonial frustration and hermeneutical marginalization, and the negative impact this has on their care. We offer an epistemic analysis of this problem using Miranda Fricker's account of epistemic injustice. We detail two types of epistemic injustice, testimonial and hermeneutical, and identify the negative stereotypes and structural features of modern healthcare practices that generate them. We claim that these stereotypes and structural features render ill persons especially vulnerable to these two types of epistemic injustice. We end by proposing five avenues for further work on epistemic injustice in healthcare.

Epistemic injustice is a harm done to a person in their capacity as an epistemic subject by undermining her capacity to engage in epistemic practices such as giving knowledge to others or making sense of one’s experiences. It has been argued that those who suffer from medical conditions are more vulnerable to epistemic injustice than the healthy. This paper claims that people with mental disorders are even more vulnerable to epistemic injustice than those with somatic illnesses. Two kinds of contributory factors for epistemic injustice in psychiatric patients are outlined: global and specific. Some suggestions are made to counteract the effects of these contributory factors, for instance we suggest that physicians should participate in groups where the subjective experience of patients is explored, and learn to become more aware of their own unconscious prejudices towards psychiatric patients.

The experience of illness is a universal and substantial part of human existence. Like death, illness raises important philosophical issues. But unlike death, illness, and in particular the experience of being ill, has received little philosophical attention. In Phenomenology of Illness Havi Carel argues that the experience of illness has been wrongly neglected by philosophers and provides a distinctively philosophical account of illness. Using phenomenology, Carel explores how illness modifies the ill person's body, values, and world. The aim of Phenomenology of Illness is twofold: to contribute to the understanding of illness through the use of philosophy and to demonstrate the importance of illness for philosophy. Phenomenology of Illness develops a phenomenological framework for illness and a systematic understanding of illness as a philosophical tool.

Patient support tools have drawn on a variety of disciplines, including psychotherapy, social psychology, and social care. One discipline that has not so far been used to support patients is philosophy. This paper proposes that a particular philosophical approach, phenomenology, could prove useful for patients, giving them tools to reflect on and expand their understanding of their illness. I present a framework for a resource that could help patients to philosophically examine their illness, its impact on their life, and its meaning. I explain the need for such a resource, provide philosophical grounding for it, and outline the epistemic and existential gains philosophy offers. Illness often begins as an intrusion on one’s life but with time becomes a way of being. I argue that this transition impacts on core human features such as the experience of space and time, human abilities, and adaptability. It therefore requires philosophical analysis and response. The paper uses ideas from Husserl and Merleau-Ponty to present such a response in the form of a phenomenological toolkit for patients. The toolkit includes viewing illness as a form of phenomenological reduction, thematizing illness, and examining illness as altering the ill person’s being in the world. I suggest that this toolkit could be offered to patients as a workshop, using phenomenological concepts, texts, and film clips to reflect on illness. I conclude by arguing that examining illness as a limit case of embodied existence deepens our understanding of phenomenology.

This paper offers an overview of the philosophical work on epistemic injustices as it relates to psychiatry. After describing the development of epistemic injustice studies, we survey the existing literature on its application to psychiatry. We describe how the concept of epistemic injustice has been taken up into a range of debates in philosophy of psychiatry, including the nature of psychiatric conditions, psychiatric practices and research, and ameliorative projects. The final section of the paper indicates future directions for philosophical research of epistemic injustices and psychiatry, concerning neurocognitive disorders, identity prejudices in psychiatric illness, concepts of epistemic privilege in psychiatry, and the prospects for combining phenomenological psychopathology and epistemic justice. We argue that much remains to be done in the conceptualization of these epistemic injustices and suggest that this future work should be multidisciplinary in character and sensitive to the phenomenology of psychiatric conditions.

This paper explores the phenomenon of vulnerabilisation in relation to the experiences of persons with chronic illnesses. We distinguish a range of kinds of vulnerability, including epistemic vulnerabilities related to epistemic injustices, and describe various interpersonal and institutional processes which can create, exacerbate and intensify those vulnerabilities. The dynamics of vulnerabilisation are related to individual vices and institutional failings, the pervasive pathophobia of many societies and various contingent life-events. We conclude that susceptibility to varieties of vulnerabilisation is ultimately reflective of the fragility that is definitive of the human condition.

This is a review article of Elizabeth Barnes’ new book, Health Problems. In this article, I try to offer a sense of where this exciting sub-discipline of philosophy of medicine has got to. I do that in three ways. First, I make a few comments on the general idea that there are theories of health competing in the field of philosophy of medicine; second, I offer specific comments on the phenomenological approach; and finally, I comment on Barnes’ claim that health is messy. I do not provide an overview of the book but a response to some of its themes.

In lieu of an abstract, here is a brief excerpt of the content:Vulnerabilization and De-pathologizationTwo Philosophical SuggestionsHavi Carel, PhD (bio)Alastair Morgan raises useful and interesting philosophical critiques of the 'power-threat-meaning' framework proposed by Johnstone et al. (2018). In what follows I make two suggestions that may clarify some aspects of the debate. First, to broaden the notion of threat: we can think more broadly about adverse life events as the source of mental suffering by broadening the notion of threat to what I term (in joint work with Ian James Kidd) Vulnerabilization. Second, I offer a distinction between de-pathologizing psychiatric disorders (i.e., removing stigma and negative stereotypes) and de-medicalizing such disorders (i.e., rescinding them from a diagnostic manual), in order to suggest that de-medicalizing on its own does not solve the problem of stigma, but de-pathologizing is a better candidate for achieving that.Threat and VulnerabilizationMorgan argues that the notion of threat is too limited to cover the breadth of psychiatric conditions and presentations. Threat and power may often be present, but how they lead to the appearance of behaviors that meet certain diagnostic criteria, is, as Morgan states, unclear at best and only a partial explanation for psychiatric disorders (it explains some behaviors, not all). I suggest we view threat as one type of a broader category, which I propose to term 'Vulnerabilization' (Carel & Kidd, 2021).Vulnerabilization refers to the effects of interactions and actions that impact on people by harming them and making them more vulnerable to future adversity. For example, removing a struggling child from a classroom causes them to miss the lesson, and if done repeatedly, harms their capacity to continue studying. Leaving a weak patient unsupervised in the wrong kind of bed may cause them to fall and become more vulnerable to disease and infection. Failing to organize accommodation for an inmate about to be released from prison forces them onto the streets and makes them more vulnerable to reoffending. The point of the term is to draw attention to the fact that one is not born vulnerable, to paraphrase de Beauvoir, [End Page 73] but becomes vulnerabilized through acts and omissions of others. Such acts and omissions often take place under the auspices of an institution—health care, social care, education, criminal justice, and so on—and are therefore intimately tied to ethoi and conduct of institutions (for a full analysis see Carel & Kidd, 2021).Vulnerabilization is a common theme in the testimonies of people who have negative experiences of social institutions, including, of course, health care institutions. Ideally, health care systems, schools, courts, and other major institutions scaffold and protect our agency, efficiently support our endeavors, and fairly and reliably disperse social and epistemic resources. But while some people have reliably satisfying experiences of social institutions, others find that many, if not all, of the institutions they encounter abandon, ignore, silence, harm, or even kill them and people like them (this is not an exaggeration: inquiries such as the Francis Report (2013) on the Mid Staffordshire patient neglect case and the Sheldon Review (n.d.) provide plentiful examples of that).1 When vulnerable people encounter institutions, they are often at an epistemic and communicative disadvantage that makes their interactions with institutions a source of suffering and injustice and indeed makes such people even more vulnerabilized. They may be affected by poverty, disability (especially mental ill health and learning disabilities), trauma, domestic violence, ill health, racism, sexism, ageism, or other sources of disadvantage, prejudice and discrimination; and, of course, they can be disadvantaged by a combination of such factors. Seeing power as the source of much suffering, social injustice and poor mental health is, of course, entirely in line with this view and I agree with Morgan that Johnstone et al. (2018) identified an important source of suffering.De-Medicalizing Versus De-PathologizingAnother important issue about psychiatric diagnoses is the stigma and negative stereotypes surrounding mental illness. Calls to de-medicalize a specific or all mental disorders is, in part, a call to remove stigma and negative stereotype from the behaviors and mental states that characterize a mental disorder. However, to de-medicalize...

In August 2021, Froese et al. published survey data collected from 2,543 respondents on their subjective experiences living under imposed social distancing measures during COVID-19 (1). The questionnaire was issued to respondents in the UK, Japan, and Mexico. By combining the authors’ expertise in phenomenological philosophy, phenomenological psychopathology, and enactive cognitive science, the questions were carefully phrased to prompt reports that would be useful to phenomenological investigation and theorizing (2–4). These questions reflected the various author’s research interests (e.g., technology, grief, time). Between April 7th and July 31st, 2021, a second questionnaire with the same question set was issued to respondents of the original who had agreed to do a follow-up. This was intended to capture subjective reports of life under social distancing measures a year after the initial survey. By this time–depending on their country of residence and health status–respondents had potentially lived with repeated and prolonged lockdowns and a variety of other restrictions on their social lives. When taken together, Survey I and Survey II provide a cross-cultural and longitudinal dataset that allows for analysis of longer-term impacts of imposed social distancing measures on people’s experiences. For researchers working in diverse disciplines, this dataset offers a rich resource that reflects people’s reactions to the imposition of different social restrictions in different countries and over different time periods.

This paper offers an overview of the philosophical work on epistemic injustices as it relates to psychiatry. After describing the development of epistemic injustice studies, we survey the existing literature on its application to psychiatry. We describe how the concept of epistemic injustice has been taken up into a range of debates in philosophy of psychiatry, including the nature of psychiatric conditions, psychiatric practices and research, and ameliorative projects. The final section of the paper indicates future directions for philosophical research of epistemic injustices and psychiatry, concerning neurocognitive disorders, identity prejudices in psychiatric illness, concepts of epistemic privilege in psychiatry, and the prospects for combining phenomenological psychopathology and epistemic justice. We argue that much remains to be done in the conceptualization of these epistemic injustices and suggest that this future work should be multidisciplinary in character and sensitive to the phenomenology of psychiatric conditions.

This article examines the philosophical role of illness. It briefly surveys the philosophical role accorded to illness in the history of philosophy and explains why illness merits such a role. It suggests that illness modifies, and thus sheds light on, normal experience, revealing its ordinary and therefore overlooked structure. Illness also provides an opportunity for reflection by performing a kind of suspension (epoché) of previously held beliefs, including tacit beliefs. The article argues that these characteristics warrant a philosophical role for illness. While the performance of most philosophical procedures is volitional and theoretical, however, illness is uninvited and threatening, throwing the ill person into anxiety and uncertainty. As such it can be viewed as a radical philosophical motivation that can profoundly alter our outlook. The article suggests that illness can change the ways in which we philosophise: it may shape philosophical methods and concerns and change one's sense of salience and conception of philosophy.

New Takes in Film-Philosophy offers a space for the advancement of the film-philosophy debate by some of its major figures. Fifteen leading academics from Philosophy and Film Studies develop new approaches to film-philosophy, broaden theoretical analyses of the topic and map out problems and possibilities for its future. The collection examines theoretical issues about the relationship between film and philosophy; looks at the relationships film-philosophy has to other media such as photography and literature; and applies theoretical approaches to particular films and directors. Written in a clear style that assumes no previous knowledge of any particular philosopher, this collection will appeal to advanced students and scholars in philosophy, film studies, cultural studies, media studies and the arts. _.

In lieu of an abstract, here is a brief excerpt of the content:The Ubiquity of MoodsMatthew R. Broome (bio) and Havi Carel (bio)Keywordsphenomenology, Heidegger, moods, affects, meaning, self, philosophyPhilosophy is often caricatured as one of the most disconnected and anemic academic enterprises. Yet in philosophers’ own accounts of what drew them to the problems they have sought to address they answer, typically, in two broad, passionate, ways: wonder or anxiety. As such, philosophy, and philosophers’ self-understanding of themselves and their enterprise, can serve as a way to address some of the important topics raised by Rosfort and Stanghellini. Even for philosophers, the emotional experience of moods and affects is employed in narrativity, or at least, employed when one is called to give an account of oneself. One could envisage a party conversation along these lines:So why did you become a philosopher?Well, I wanted to go to university but wasn’t interested in science or in the humanities and I’ve always been dreadful at languages.(Laugh) But you must like something about it as you wouldn’t have become a professor?You know how it is... you drift into things. I did well as an undergraduate, my tutor suggested I should do a PhD. Found an excellent supervisor, and got a few papers published and then a teaching post....You must be very committed to the subject.Ummm—I guess so. I thought about joining the civil service after my PhD, but always managed to find work and the hours are much more flexible at universities!Well I think it is amazing: to think and teach about such important things.Do you?There is something slightly baffling here that may simply be part of the inherent irony and self-deprecation of some academics. The philosopher's interlocutor is asking about what philosophy means to the philosopher: why he has given his life to it. As such, she is alluding to a deeper, philosophical question that, after decades of falling out of favor, is returning to the attention of philosophers: namely, how has philosophy given your life meaning? The philosopher responds with possible irony, banality, or superficiality and invokes luck rather than meaning in his narrative. He serves as Nietzsche's feared nihilist. The account offered also seems to fail to meet normative standards, and depending on how the philosopher carries it off, this gap between expectation and reality in the conversation may generate humor.However, the greater likelihood is that the conversation engenders perplexity and disappointment in the interviewer. Rather like the characters in Evelyn Waugh's early novels, the philosopher is buffeted passively by life and luck and eschews agency or meaning. In Waugh's skilled hands this becomes tragic comedy; for the philosopher and his interlocutor we have disconnection and sadness. The crucial reason for this is that we need to use terms referring to moods, affects, meaning, and emotion when we offer an account of ourselves and when we try to understand ourselves. [End Page 267] Otherwise, something is missing and the reason a person gives for their actions either look like poor reasons or not reasons at all (Bortolotti and Broome 2008). Further, agency, rationality, and self-knowledge may themselves be dependent upon reason-giving.In invoking moods and affects in one's narrative the practical understanding (or ‘affordances’) of the world one inhabits are laid open in clear view. Hence Aristotle's account of wonder as the stimulus for philosophy. Aristotle says: ‘For it is owing to their wonder that men both now begin and at first began to philosophize; they wondered originally at the obvious difficulties, then advanced little by little and stated difficulties about the greater matters’ (1984, 1554). Conversely, given the experience of transcendence, of ambiguity, of finitude rather than wondrous awe, the philosopher may be motivated by anxiety (Kant's awakening from his dogmatic slumbers, Heidegger's battles with ‘Crisis’ and the flight of the gods). Either manner of accounting for one's interest seems to work normatively in the giving of reasons and in generating a narrative, and, moreover, a philosophical narrative.Our fictional dialogue and discussion aims to reinforce the important link between narrative, reason-giving and moods and affects argued for by Rosfort...

In this article, I propose that illness is philosophically revealing and can be used to explore human experience. I suggest that illness is a limit case of embodied experience. By pushing embodied experience to its limit, illness sheds light on normal experience, revealing its ordinary and thus overlooked structure. Illness produces a distancing effect, which allows us to observe normal human behavior and cognition via their pathological counterpart. I suggest that these characteristics warrant illness a philosophical role that has not been articulated. Illness can be used as a philosophical tool for the study of normally tacit aspects of human existence. I argue that illness itself can be integral to philosophical method, insofar as it facilitates a distancing from everyday practices. This method relies on pathological or limit cases to illuminate normally overlooked aspects of human perception and action. I offer Merleau-Ponty’s analysis of the case of Schneider as an example of this method.

In this paper I explore the tacit underlying sense of bodily certainty that characterizes normal everyday embodied experience. I then propose illness as one instance in which this certainty breaks down and is replaced by bodily doubt. I characterize bodily doubt as radically modifying our experience in three ways: loss of continuity, loss of transparency, and loss of faith in one's body. I then discuss the philosophical insights that arise from the experience of bodily doubt. The paper uses a Humean framework with regards to bodily certainty, treating it as a taken for granted tacit aspect of normal experience. I argue that although bodily certainty is not rationally justifiable, we are nonetheless unable to reject it. Bodily certainty is thus revealed to be part of our brute animal nature. I conclude by suggesting that the study of pathology is a philosophical method useful for illuminating tacit aspects of experience.

I have been breathless for a long time. I lagged behind others when walking uphill. I became breathless when dancing. I couldn’t play tennis. But I somehow convinced myself that this was normal. I was getting older—perhaps in one’s mid-30s fitness drops like this, I thought? Perhaps I have “small lungs,” my husband speculated. But we were both physically active, and as we were living in Australia at the time, we enjoyed bush-walking, bike riding, and the sunshine that permeates outdoor life down under. So I masked my breathlessness as best I could, and never went to see a doctor, despite my clear and increasing respiratory difficulties.Two years went by. We returned to live in the United Kingdom—in hilly Bristol..