Havi Hannah Carel

What is illness? Is it a physiological dysfunction, a social label, or a way of experiencing the world? How do the physical, social and emotional worlds of a person change when they become ill? And can there be wellbeing within illness? In this remarkable and thought-provoking book, Havi Carel explores these questions by weaving together the personal story of her own serious illness with insights and reflections drawn from her work as a philosopher. Carel’s fresh approach to illness raises some uncomfortable questions about how we all – whether healthcare professionals or not – view the ill and challenges us to become more thoughtful. Illness unravels the tension between the universality of illness and its intensely private, often lonely, nature. It offers a new way of looking at a matter that affects every one of us.

What is the relationship between phenomenology and naturalism? Are they mutually exclusive or is a rapprochement possible between their approaches to consciousness and the natural world? Can phenomenology be naturalised and ought it to be? Or is naturalism fundamentally unable to accommodate phenomenological insights? How can phenomenological method be used within a naturalistic research programme? This cutting-edge collection of original essays contains brilliant contributions from leading phenomenologists across the world. The collection presents a wide range of fascinating and carefully argued answers to these questions.

Life can be non-ideal in many ways. One of the central ways is in its necessarily embodied, and hence vulnerable, nature. This vulnerability includes our susceptibility to injury and disease, other types of bodily failure, and death. In this chapter, we will describe the moral and epistemic mistreatment common to the experiences of illnesses. We use the term ‘illness’ here to denote serious and life-changing irreversible conditions, which may be chronic or acute. What we say may be applicable, at least in part, to mental illness as well, but there are important differences.

In this paper, we argue that certain theoretical conceptions of health, particularly those described as ‘biomedical’ or ‘naturalistic’, are viciously epistemically unjust. Drawing on some recent work in vice epistemology, we identity three ways that abstract objects (such as theoretical conceptions, doctrines, or stances) can be legitimately described as epistemically vicious. If this is right, then robust reform of individuals, social systems, and institutions would not be enough to secure epistemic justice: we must reform the deeper conceptions of health that underlie them.

In this paper we propose that our understanding of pathocentric epistemic injustices can be enriched if they are theorised in terms of predicaments. These are the wider socially scaffolded structures of epistemic challenges, dangers, needs, and threats experienced by ill persons due to their particular emplacement within material, social, and epistemic structures. In previous work we have described certain aspects of these predicaments - pathocentric epistemic injustices, pathophobia, and so on. We argue that thinking predicamentally helps us integrate the various social, epistemic, and practical obstacles experienced by ill persons and also unify the many concepts available for theorising them (microaggessions, epistemic injustices, and so on).

We develop a broader, more fine-grained taxonomy of forms of ‘transformative experience’ inspired by the work of L.A. Paul. Our vulnerability to such experiences arises, we argue, due to the vulnerability, dependence, and affliction intrinsic to the human condition. We use this trio to distinguish a variety of positively, negatively, and ambivalently valenced forms of epistemically and/or personally transformative experiences. Moreover, we argue that many transformative experiences can arise gradually and cumulatively, unfolding over the course of longer periods of time.

In this chapter we suggest that many experiences of suffering can be further illuminated as forms of transformative experience, using the term coined by L.A. Paul. Such suffering experiences arise from the vulnerability, dependence, and affliction intrinsic to the human condition. Such features can create a variety of positively, negatively, and ambivalently valanced forms of epistemically and personally transformative experiences, as we detail here. We argue that the productive element of suffering experiences can be articulated as transformative, although suffering experiences are not the type mostly discussed in the transformative experience literature. We correct for this here by developing a taxonomy of negatively valenced transformative experiences. We suggest three features that make such experiences ones of suffering, following Michael Brady’s definition: intensity, novelty, and attentional focus. Finally, we suggest that one possible explanation for the edifying capacity of suffering comes from it requiring more transformation than positive experiences.

Tamara Kayali Browne's suggestion to create a formal role in revision of the Diagnostic and Statistical Manual of Mental Disorders for philosophers, sociologists, and bioethicists is interesting and stems from a well-supported concern about how nosological psychiatric categories interact with both the epistemic norms of science and philosophy and with their consequences in the world. Browne is grappling with a problem that is clearly stated and pressing. However, I am not convinced that her solution, namely, using experts from these disciplines to form a veto-wielding ethics committee, is an ameliorative to this problem.Browne identifies a problem: The process of DSM revision involves making value judgements...

What counts as health or ill health? How do we deal with the fallibility of our own bodies? Should illness and disease be considered simply in biological terms, or should considerations of its emotional impact dictate our treatment of it? Our understanding of health and illness had become increasingly more complex in the modern world, as we are able to use medicine not only to fight disease but to control other aspects of our bodies, whether mood, blood pressure, or cholesterol. This collection of essays foregrounds the concepts of health and illness and patient experience within the philosophy of medicine, reflecting on the relationship between the ill person and society. Mental illness is considered alongside physical disease, and the important ramifications of society's differentiation between the two are brought to light. Health, Illness and Disease is a significant contribution to shaping the parameters of the evolving field of philosophy of medicine and will be of interest to medical practitioners and policy-makers as well as philosophers of science and ethicists.

What is illness? Is it a physiological dysfunction, a social label, or a way of experiencing the world? How do the physical, social and emotional worlds of a person change when they become ill? And can there be well-being within illness? In this remarkable and thought-provoking book, Havi Carel explores these questions by weaving together the personal story of her own serious illness with insights and reflections drawn from her work as a philosopher. Carel's fresh approach to illness raises some uncomfortable questions about how we all - whether healthcare professionals or not - view the ill and challenges us to become more thoughtful. 'Illness' unravels the tension between the universality of illness and its intensely private, often lonely, nature. It offers a new way of looking at a matter that affects every one of us.

ABSTRACT This paper offers an account of institutional testimonial justice and describes one way that it breaks down, which we call institutional opacity. An institution is opaque when it becomes resistant to epistemic evaluation and understanding by its agents and users. When one cannot understand the inner workings of an institution, it becomes difficult to know how to comport oneself testimonially. We offer an account of an institutional ethos to explain what it means for an institution to be testimonially just; we then describe how an ethos of institutional testimonial justice can break down when the institution becomes opaque. An opaque institution is especially problematic for individuals and groups already rendered epistemically vulnerable during their interactions with that institution, which we call epistemically vulnerabilised individuals. We articulate the features of an encounter between an epistemically vulnerabilised individual and an opaque institution. We end by tracing ameliorative strategies that could help repair a deteriorated institutional ethos of testimonial justice.

This article develops the concept of wrongful depathologization, in which a psychiatric disorder is simultaneously stigmatized and trivialized. We use OCD as a case study to argue that cumulatively these two effects generate a profound epistemic injustice to OCD sufferers, and possibly to those with other mental disorders. We show that even seemingly positive stereotypes attached to mental disorders give rise to both testimonial injustice and wilful hermeneutical ignorance. We thus expose an insidious form of epistemic harm that has been overlooked in the literature.

In this paper I respond to Edward Harcourt’s suggestion that human excellences are structured in a way that allows us to see the multiplicity of life forms that can be instantiated by different groups of excellences. I accept this layered (as he calls it) model, but suggest that Harcourt’s proposal is not pluralistic enough, and offer three critical points. First, true pluralism would need to take a life-cycle view, thus taking into account plurality within, as well as between, lives. Second, Harcourt’s pluralism still posits physical health as a requirement for excellence, whereas I claim that the challenges of illness give more, not less, opportunity for excellence. Third, I make a more general claim that in certain salient cases (illness being one of them) it is precisely the absence of excellence that can facilitate virtue.

In what follows we aim to show that epistemic injustice may not only unjustly reduce the credibility accorded to the autistic individual by her listeners, which may marginalize her account of everyday experiences and harms. It may also—despite there being good reason to think that autistic thriving is viable—block our ability to conceive of a good autistic life, as well as to recognize the testimonies of happy autistics as such. In practice, we show how this culminates in a catch-22 paradoxical situation whereby individuals are routinely seen as happy or autistic, but rarely both. Our argument will serve the further purpose of showing that neurodiversity also challenges us to radically broaden our conceptions of the good human life.

This paper offers a nexus of terms – mortality, limits, contingency and vulnerability – painting a picture of human life as marked by limitation and finitude. I suggest that limitations of possibility, capacity, and resource are deep features of human life, but not only restrict it. Limits are also the conditions of possibility for human life and as such have productive, normative, and creative powers that not only delimit life but also scaffold growth and transformation within it. The paper takes a less known interpretation of the term ‘ephēmeros', to mean ‘of the day', rather than ‘short-lived' and suggests that as ephemeral, human life is contingent and mutable, subject to events beyond our control. However, virtue can still be exercised – indeed, can be exuberantly displayed – when we respond to contingent events marked by adversity.

The phenomenological method has been fruitfully used to study the experience of illness in recent years. However, the role of illness is not merely that of a passive object for phenomenological scrutiny. I propose that illness, and pathology more generally, can be developed into a phenomenological method in their own right. I claim that studying cases of pathology, breakdown, and illness offer illumination not only of these experiences, but also of normal function and the tacit background that underpins it. In particular, I claim that the study of embodiment can be greatly enhanced, and indeed would be incomplete, without attending to bodily breakdown and what I term bodily doubt. I offer an analogy between illness and Husserl’s epoché, suggesting that both are a source of distancing, and therefore motivate a reflective stance.