The Meaning of Illness A Phenomenological Account of the Different Perspectives of Physician and Patient

A PHENOMENOLOGICAL APPROACH My interest in exploring the nature of the patient's and the physician's understanding of illness has grown out of my own experience as a multiple sclerosis patient. In discussing my illness with physicians, it has often seemed to me that we have been somehow talking at cross purposes, discussing different things, never quite reaching one another. This inability to communicate does not, for the most part, result from inatten­ tiveness or insensitivity but from a fundamental disagreement about the nature of illness. Rather than representing a shared reality between us, illness represents two quite distinct realities - the meaning of one being significantly and distinctively different from the meaning of the other. In this work I shall suggest that psychological phenomenology provides the means to examine the nature of this fundamental disagreement between physician and patient in a rigorous fashion.! In particular, psychological phenomenology discloses the manner in which the of his or her experience. individual constitutes the meaning In providing a phenomenological description,2 the phenomenologist is committed to the effort to begin with what is given in immediate ex­ perience, to tum to the essential features of what presents itself as it presents itself to consciousness, and thereby to clarify the constitutive activity of consciousness and the sense-structure of experiencing.

One: The Separate Worlds of Physician and Patient.- 1. Own World.- 2. Common World.- 3. Different Perspectives of Physician and Patient.- 4. Implications for Medical Practice.- Two: Illness.- 1. Levels of Constitution of Meaning.- 2. The Patient’s Apprehension of Illness.- 3. The Physician’s Apprehension of the Patient’s Illness.- 4. Implications for Medical Practice.- Three: The Body.- 1. The Lived Body.- 2. Body as Object.- 3. Lived Body in Illness.- 4. Body as Object in Illness.- 5. The Body-as-Scientific-Object.- 6. Implications for Medical Practice.- Four: The Healing Relationship.- 1. Illness-as-Lived.- 2. Empathic Understanding.- 3. Clinical Narrative.- 4. The Healing Relationship.- Notes.