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- Seniuk, Patrick
(författare)
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Encountering Depression In-Depth : An existential-phenomenological approach to selfhood, depression, and psychiatric practice
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This dissertation in Theory of Practical Knowledge contends that depression is a disorder of the self. Using the existential-phenomenology of Maurice Merleau-Ponty, I argue that if we want to disclose the basic structure of depressed experience, then we must likewise disclose how selfexperience is inseparable from depressed experience. However, even though depression is a contemporary psychiatric category of illness, it is nevertheless a historically and heterogenous concept.To make sense of depression in the context of contemporary psychiatric practice, I show that depression has historically been characterized by two broad models of causation; that is, a phenomenon that is causally explained by either a biological dysfunction or a psychological conflict. But this stark characterization is not limited just to history; by conducting qualitative interviews with psychiatric professionals, I illustrate how this causal dichotomy remains prevalent in contemporary psychiatric practice. On one hand, the clinicians report dissatisfaction with the depression diagnostic criteria (i.e. it is impersonal or vague), while on the other hand, the clinicians also recognize that a depression diagnosis is useful insofar as a diagnosis facilitates access to various resources associated with psychiatric care. Consequently, clinicians have developed a coping strategy that is witnessed in their empathetic desire to distance patients from their depression diagnosis, which led to statements such as, “you are not the problem, the problem is depression.” One consequence of this approach is that depression is artificially cleaved from the person who experiences depression, which subsequently means that depression is viewed to be something independent of oneself.Because I argue that depression and the self are mutually implicated, it is crucial to disseminate some of the most influential contemporary models of selfhood. I show that the brainbound, situated, psychological, and narrative model of self, all have respective strengths and weaknesses. But I also go beyond these models and characterize selfhood as a developmental phenomenon that is expressed as an embodied-style. This style reflects the way in which we establish perceptual contact with the otherness, without which there could be no self-experience.
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| 2. |
- Gunnarson, Martin
(författare)
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Please Be Patient : A Cultural Phenomenological Study of Haemodialysis and Kidney Transplantation Care
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis examines the practice of haemodialysis and kidney transplantation, the two medical therapies available for persons with kidney failure, from a phenomenological perspective. A basic assumption made in the thesis is that contemporary biomedicine is deeply embedded in the cultural, historical, economic, and political circumstances provided by the particular local, national, and transnational contexts in which it is practiced. The aim of the thesis is twofold. On the one hand, the aim is to examine the forms of person- and patienthood enacted and negotiated in haemodialysis and kidney transplantation care and in the daily lives of persons with kidney failure. On the other hand, the aim is to investigate the ways in which the enacted and negotiated forms of person- and patienthood are culturally embedded and normatively charged. In order to examine and investigate this twofold aim, an empirical material has been gathered that comprises observations and in-depth interviews with patients and caregivers at four haemodialysis units, one in Riga, Latvia, and three in Stockholm, Sweden. The theoretical approach and methodology of the study is cultural and phenomenological in character, drawing on an ethnological and anthropological understanding of culture as processual and relational, and on a phenomenological understanding of personhood as embodied and intertwined with the surrounding world. The thesis shows that patients’ encounters and attempts to deal with the diagnoses and treatments associated with kidney failure are complex and often misalign them with the normatively charged orientations enacted and recommended by medicine. The complex situation that emerges when they undergo transplantation, for example, stands in stark contrast to the widespread official view of organ transplantation as a self-evidently health-bringing and normalising therapy. Through their repeated and extensive experiences of undergoing haemodialysis and living with the disease, patients eventually become able to create a synthesis between their lived experiences of their own body and their body as a medical object – what in the thesis is called a ‘sick body’ – a synthesis that allows them to reorient themselves in life and experience a sense of direction. This process relies, to a large extent, on the temporal structure that haemodialysis affords life; it is by repeatedly undergoing the treatment that patients become able to create a sick body. Even so, many of them find this temporal structure problematic; they experience it as disruptive of their control and future-orientedness and as causing an existentially difficult-to-handle boredom. The thesis also shows that the political developments and the norms prevalent in the two national contexts studied greatly affect the orientations of the treatment practices and the participants’ lives. In both Riga and Stockholm, ideals of freedom, activity, control, and self-actualisation influence what forms of patienthood and personhood are enacted. The study indicates that persons who fall ill with a serious and chronic disease only gradually become able to understand and actively cope with their differently embodied circumstances of life. This suggests that medical professionals should not too hastily enlist their patients as experts on their own bodies, but rather provide them with the time and support necessary for making repeated attempts at creating and maintaining a life with a sick body.
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| 3. |
- Malmqvist, Erik, 1980-
(författare)
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Good Parents, Better Babies : An Argument about Reproductive Technologies, Enhancement and Ethics
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This study is a contribution to the bioethical debate about new and possibly emerging reproductive technologies. Its point of departure is the intuition, which many people seem to share, that using such technologies to select non-disease traits – like sex and emotional stability - in yet unborn children is morally problematic, at least more so than using the technologies to avoid giving birth to children with severe genetic diseases, or attempting to shape the non-disease traits of already existing children by environmental means, like education. The study employs philosophical analysis for the purpose of making this intuition intelligible and judging whether it is justified.Different ways in which the moral problems posed by reproductive technologies are often framed in bioethical debates are criticised as inadequate for this task. In particular, it is argued that the intuition cannot fully be made sense of in terms of harm to the children that such technologies help create.The study attempts to elaborate an alternative to that broadly consequentialist approach, by drawing on Martin Heidegger’s philosophy of technology, Hans Jonas’s ethics, and Aristotle’s practical philosophy, as it has been received and developed in the hermeneutical tradition. It is suggested that reproductive choices, unlike decisions for already born children, are characterised by a peculiar one-sidedness: the future child appears to the parents as something wholly theirs to decide about, not as a concrete other with whom they must interact in a responsive and attuned way. This is problematic because it means that such choices cannot call upon the particularised moral understanding only gained in interpersonal encounters. In particular, it makes them easily shaped by various tendencies, to which parents are always susceptible, to relate to children in instrumentalising ways, and at risk of reinforcing such tendencies. However, this does not mean that all uses of reproductive technologies are equally troubling. When selecting against severe disease the parents can rely on a widely shared illness experience to escape the dangers that one-sidedness involves. It is concluded that the intuition under discussion, thus explicated and in some ways qualified, makes sense morally.
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| 4. |
- Shutzberg, Mani
(författare)
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Tricks of the Medical Trade : Cunning in the Age of Bureaucratic Austerity
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Being a “good” doctor nowadays involves more than having virtues and capacities conducive to the content of encounters between physicians and patients. Physicians can and must be able to act on the surrounding conditions of the doctor-patient encounter, in order to keep external interests at bay. Hence, the patient-related virtues, such as compassion, prudence, temperance and the like might not constitute sufficient cause for “good” doctoring. Resistance against the invasion of external interests requires another set of capacities. In this compilation thesis, one such capacity is explored: cunning. While certainly not part of the repertoire of skills in relation to the patient, cunning intelligence is an indispensable “virtue” of good doctoring insofar as doctors must cleverly navigate institutions that block off paths toward the ultimate ends of healthcare. The role of cunning is examined through a particular case, namely, the struggle over social insurance, especially sickness benefits (“sjukpenning”), and the complex relationship between physician, patient and the Swedish Social Insurance Agency (“Försäkringskassan”). In these times of increased austerity, physicians have honed skills, retaining thereby good medical practice, and by extension also maintaining the integrity of the patient-related virtues of medicine. In the empirical material, techniques were identified, particularly with respect to the way in which the sickness certificate is written to ensure approval by the SSIA. Based on these findings, the ambiguities, contradictions and possibilities inherent in the cunning resistance of physicians are analyzed and problematized. Despite its many issues, what doctors do when issuing sickness certificates in this particular way, is certainly motivated and carried out by more than mere ignorance. Cunning intelligence is not merely a defective form of prudence (phronesis), nor is it simply an instance of instrumental reason (techne), but rather an ability that occupies a distinct place among the intellectual abilities generally ascribed to professionals. Finally, I explore if the use of these capacities indicates a change in the doctor-patient relationship. I argue that both doctor and patient are conditioned by an equality in powerlessness—the hallmark of “the age of bureaucratic parsimony”, which can be appropriately described in terms of solidarity between comrades.
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| 5. |
- Svenaeus, Fredrik, 1966-
(författare)
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The hermeneutics of medicine and the phenomenology of health : steps towards a philosophy of medical practice
- 1999
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This study is an attempt to develop an ontology and epistemology of medicine with the aid of the philosophical theories of phenomenology and hermeneutics. Medicine, in this work, is considered to be a particular form of practice with a certain intersubjective structure, rather than an assembly of scientific theories and technologies applied in the clinic. To be more precise, medicine is suggested to be an interpretive, helping meeting between two persons - doctor or other health-care professional and patient - the goal of which is health for the ill, help-seeking party. Phenomenology and hermeneutics, mainly in the forms developed by Martin Heidegger and Hans-Georg Gadamer, are then used to more fully understand what is meant by an interpretive, helping meeting and by its goal - health. Health is characterized with the aid of the phenomenology of Heidegger, developed in his main work Sein und Zeit, as homelike being-in-the-world. Its opposite, illness, is explicated as an attunement (Befindlichkeit) of unhomelikeness, lived through every aspect of the being-in-the-world of Dasein, from body to language, and thus penetrating the entire understanding of the ill person. Medical practice, having the goal of establishing homelikeness in the patient's being-in-the-world, is then laid out, with the help of a reading of Gadamer's Wahrbeit und Methode, as a dialogic, interpretive coming together of the two different lifeworld horizons of doctor and patient. The two parties of the meeting must through this process of gradual fusion of horizons ultimately reach a to some extent shared understanding, which results in a therapeutic decision. The hermeneutics of medicine is thus, to speak with Gadamer, an applicative hermeneutics - a kind of understanding and interpretation put to work in a certain setting with a specific goal. This attentive, dialogic, goal-directed hermeneutics of medicine is shown, not to exclude, but to envelop the explanations, predictions and therapies of modern medical science. The philosophical analysis in this study is carried out through the illustrative use of clinical examples. Through choosing common types of illnesses and medical encounters, strategically placed in different paradigmatic corners of the clinical territory - streptococcal infection, chronic fatigue syndrome, prostate cancer, diabetes and stroke - the author has attempted to encompass as much as possible of the vast and diverse area of clinical practice.
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