Tis in ourselves that we are thus or thus

I must have learned a bit about phenomenology in Philosophy courses at university, but except for the fact that it has something to do with lived experience and consciousness, I have pretty well forgotten almost everything about it in the intervening years, I’m afraid. The name alone was enough for it to merit a place of its own in a dark corner of a barely reachable shelf inside my brain somewhere. Strange names like Husserl and Heidegger stand guard, but in all that time, they were relatively undisturbed by any neuronal probes -any interest whatsoever, in fact.

And now, in my yellow leaf, I’ve stumbled upon it once again, but this time in the context of health, ironically. Given that phenomenology purports to concern itself with experience, and nurses would like -and in fact, need– to understand the subjective experience of those under their care, it seems like a good, if somewhat awkward fit I suppose.

After more than 40 years in Medicine myself (as a specialist in Ob/Gyn) I recognize that it would be an advantage for all of us who deal with people with health needs, to understand how those individuals experience their worlds. But an essay written by Dan Zahavi, a professor of philosophy at both Oxford and the University of Copenhagen helped me to realize how nurses, especially, might benefit by looking at it from a more phenomenological perspective: https://aeon.co/essays/how-can-phenomenology-help-nurses-care-for-their-patients

‘By being interested in patient experience and striving to understand people’s experiences of health, illness and care, the discipline of nursing might have more affinities with the social sciences and its qualitative methods than with medicine and its reliance on the quantitative methods of the natural sciences. Indeed, if the aim is to provide proper care for, say, stroke patients, or patients with diabetes or Alzheimer’s disease, it is important to have some understanding of what it is like, subjectively, to live with such conditions, just as it is important to understand the meaning that patients attach to the events that disrupt their lives.’

This is not to diminish the role of Medicine in any way, but merely to suggest that Nursing and Medicine each have complementary roles in the provision of care. After all, ‘This focus on patient experience isn’t simply about monitoring (and increasing) patient satisfaction. It is about obtaining information that will allow for more adequate healthcare… one reason why nursing science became interested in phenomenology was precisely because the latter was seen as a resource that could bridge the gap between research and practice… It might, in short, help to ensure that the academic field of nursing research actually led to an improvement of nursing practice.’ Medical practice as well, but for now, let’s stick with Nursing.

The issue, however, is not to become too entangled with the competing nuances of the various philosophical movements that call Phenomenology home. Does it really matter, for example, that the philosopher Heidegger stressed ‘the ontological difference, inauthenticity, solicitude, average everydayness, thrownness and fallenness’ -whatever in the world that means? Or that  Jonathan Smith (a psychologist) ‘has argued that his own approach, which is called Interpretative Phenomenological Analysis (IPA), is phenomenological because it seeks to ‘explore the participant’s view of the world and to adopt, as far as is possible, an “insider’s perspective” of the phenomenon under study’?

How about Max Van Manen distinguishing ‘what he calls the heuristic, hermeneutic, experiential, methodological, eidetic, ontological, ethical, radical and originary reduction as important elements of the phenomenological method’? I mean, come on, eh?

As Zahavi sees it, ‘nursing research’s current use of phenomenology faces three challenges: it risks being too superficial by mistakenly thinking that phenomenology is simply about paying attention to experience; it risks being too philosophical by employing too many theoretical concepts with little clinical relevance; and it risks being misled by misguided methodological requirements.’

But, shouldn’t it be enough to extract what value you find in viewing the world from the point of view of the person under your care -call it what you will? A balance, please: a just-right-baby-bear, Goldilockean approach would do just fine, thank you.

As a now-retired doctor, I have worked with nurses all my career; we have always worked as a team, each with subtly overlapping roles, and yet I blush to admit that it wasn’t until I required a minor surgical procedure that I truly appreciated the difference.

One cold night, as I lay in bed with the covers pulled up to my chin for warmth, I noticed some lumps in my neck. Subsequent specialist medical consultation did little to reassure me -despite the delicacy and empathy with which the differential diagnosis was outlined for me. To further clarify whether the lumps were indeed malignant, as the consultant expected -and if so, their origin- a surgical biopsy would be required.

A speedy diagnosis was deemed essential so that treatment, if necessary, could be started as soon as possible. But there was apparently no expeditiously suitable time available in the operating theatre, so the consultant surgeon agreed to do it under local anaesthetic in the outpatient department of the hospital within the next day or so. That was fine with me -I just wanted a diagnosis.

What I hadn’t anticipated, however, was just how very anxious I would feel as I lay in one of the same rooms -and maybe on the same table- where I had performed many of the gynaecological procedures so common in my own practice. I knew the surgeon, and we talked pleasantly enough about our lives, and how often our specialties intersected. I knew he was trying to be empathetic and set me at ease, but we both realized there was an unbridgeable gap that separated us now, no matter the care we both took to disguise it: I was the patient -and not just a colleague. It’s difficult enough to be a patient, but perhaps even more so when the roles are suddenly reversed.

I knew the nurse in the room, of course -she had helped me on many occasions with the procedures I had booked in the department. But that day, her eyes were seldom far from mine, even though she was helping the surgeon set up some of his equipment. I could sense her concern whenever our eyes met -she’d always been attentive when she’d helped me before, and yet it was subtly different this time: she was dividing her attention between helping the surgeon and making sure I was okay.

But I wasn’t; I was terrified, although I tried my best to disguise it. Even though the local anaesthetic was working, I could still imagine what the surgeon was doing because of the subtle pressure changes I could feel on the skin distant from the lumps -you can’t freeze an entire neck. I tried not to tense any muscles in the area, but I suppose panic was starting to set in…

Suddenly, there it was: a hand gently grasping mine. The warmth of it, skin to skin, was soothing, reassuring, and although I couldn’t turn my head to look, I knew it was the nurse. I also realized she was aware of what I was going through –she had been all along, I sensed. She was living it herself in a way.

Until that moment, I don’t think I really understood the true value of rapport in caring for people. Of course I often used touch to reach out and connect with others in my own practice: on morning hospital visits to my patients after surgery or with new mothers and the babies I had helped deliver, and frequently in the office just to show anxious and fearful patients that I was listening and would try to help… That I wasn’t just a voice from the door, or on the other side of the desk.

And yet, that reassuring hand during the biopsy taught me something else: that there is more to compassion than a reassuring smile, more than just an offer of help. Care involves trying to understand what the other person is going through, and guiding them thoughtfully and kindly along the way. We can probably never really know the pain of another, but we can let them know we are trying.

If that is what Phenomenology offers, then by any other name, it would smell as sweet…

The Me of Science

This is going to sound trite, but have you ever wondered about your role in Science? Really. I mean that of your consciousness in apprehending and interpreting that which is measured: the ‘Me’-ness which separates each of us from whatever we’re doing -or, rather, which joins us to it: joins us to the other?

I don’t mean to sound Cartesian here; I don’t want to get into mind-body stuff, and yet it comes down to whether or not we believe that the Mind is reducible to a bundle of interconnected neurons, or something more, doesn’t it? An emergent phenomenon -a synergism- or merely a synthesis: an entity wholly explainable in terms of its constituents.

Where, in other words, do I come in? And if I don’t, is there any proof -apart from my saying so- that I even exist?

Of course, why should I even care? I mean, cogito ergo sum, eh? I know I exist, and so I can investigate anything I want, acting in my own right as a valid agent. Science and I can look into any box and measure its contents… except, perhaps, reality itself -I can assume no God’s-eye view of that. I cannot absent myself from that box while I measure it -I am immersed in it. The box, really, is all there is.

I have to say, I was re-seduced into this type of thinking by a very perceptive essay in Aeon written as a collaboration between Adam Frank, professor of astrophysics at the University of Rochester in New York, Marcelo Gleiser, a theoretical physicist at Dartmouth College in New Hampshire, and Evan Thompson, professor of philosophy at the University of British Columbia. https://aeon.co/essays/the-blind-spot-of-science-is-the-neglect-of-lived-experience

‘In our urge for knowledge and control, we’ve created a vision of science as a series of discoveries about how reality is in itself, a God’s-eye view of nature. Such an approach not only distorts the truth, but creates a false sense of distance between ourselves and the world. That divide arises from what we call the Blind Spot, which science itself cannot see. In the Blind Spot sits experience: the sheer presence and immediacy of lived perception.’

So, ‘Elementary particles, moments in time, genes, the brain – all these things are assumed to be fundamentally real. By contrast, experience, awareness and consciousness are taken to be secondary.’ And yet, ‘We never encounter physical reality outside of our observations of it… [and] these tests never give us nature as it is in itself, outside our ways of seeing and acting on things. Experience is just as fundamental to scientific knowledge as the physical reality it reveals… The point is that physical science doesn’t include an account of experience; but we know that experience exists, so the claim that the only things that exist are what physical science tells us is false.’ Or maybe misleading.

‘Husserl, the German thinker who founded the philosophical movement of phenomenology, argued that lived experience is the source of science. It’s absurd, in principle, to think that science can step outside it.’ And Alfred North Whitehead, who taught at Harvard University in the 1920ies, ‘argued that science relies on a faith in the order of nature that can’t be justified by logic. That faith rests directly on our immediate experience… he argued that what we call ‘reality’ is made up of evolving processes that are equally physical and experiential.’ You’ve gotta love this stuff.

Anyway, I suppose the importance of all this palaver is to point out that ‘When we look at the objects of scientific knowledge, we don’t tend to see the experiences that underpin them. We do not see how experience makes their presence to us possible.’ However, let’s face it, without an observer -a measurer- the results are unacknowledged. Science is not science, if we are not there to do it and record it.

The whole subject is reminiscent of the discussions I remember from my university days when we would sit around for hours in a pub exploring our growing awareness of the world.
“I don’t know how you could say that,” somebody at the table -Brian, usually- would exclaim, throwing his arms up. “Science is about objects! It’s not at all comparable to religion…”

“And why is that?” someone else -usually Jonathan- would answer. “It just deals with reality a little differently, that’s all.”

“A little differently?” The arms again. “Religion is completely subjective! You can’t prove anything…”

“And does Science prove anything -or is it just the scientist who looks at the instruments who proves it? Somebody has to read the data. Experience them…” This was always Jonathan’s argument, I remember.

Brian was a little more excitable, and he would roll his eyes at the slightest provocation as disdain dripped unchecked from the rest of his face. “Come on, Jonathan! You don’t experience science in the same way as religion. You do science!”

“How do you read an instrument, or interpret a result without experiencing it, Brian? There has to be someone who looks at the measurement.”

Brian would always shake his head in disgust when Jonathan disagreed with him. “But the measurement was not created by the scientist, it was made by the machine, or whatever -and that’s about as objective as you can ever get.”

A little smile would always creep onto Jonathan’s face at this point. “Well, who designed the machine? Who built it for the purpose…?”

“Give me a break, eh? Once it’s built, it’s an object!”

“But the experiment -the question- which the object is built to answer, is subjectively constructed, is it not? And the results have to be formulated into a conclusion, don’t they? Accepted, or rejected, the results have to pass their way through a mind. Through consciousness… They have to be experienced!”

“And what is doing the experiencing? It’s just your brain -a physical, an objective, thing.” Then Brian would smile and sit back in his seat with his beer to deliver the coup de grace. “The brain is not a ‘who’ but a ‘what’ isn’t it?”

But Jonathan would like this part of the argument, I remember -it always took this turn. “If that which interprets data is an objective ‘what’, and if that which it is experiencing is also a ‘what’, then everything is a ‘what’ -Religion included; it’s doing the same thing… sort of like Science, eh?”

The arguments, fuelled no doubt by the effects of alcohol on inquiring minds, would go on in increasing complexity and implausibility until the pub closed, and we would all wake up the next morning with hangovers -but still friends, willing to take each other on again at the next opportunity. In a way, it makes me wonder what those authors of the Aeon essay were going on about with their questions about what role subjectivity and experience has in dealing with the world -its role as the Blind Spot. My friends and I -subjects all- don’t experience it as anything like a problem -not really. We see it simply as friendship. And that is the foundation for everything isn’t it…?