Arne Johan Vetlesen

The medically unexplained revisited

Medicine is facing wide-ranging challenges concerning the so-called medically unexplained disorders. The epidemiology is confusing, different medical specialties claim ownership of their unexplained territory and the unexplained conditions are themselves promoted through a highly complicated and sophisticated use of language. Confronting the outcome, i.e. numerous medical acronyms, we reflect upon principles of systematizing, contextual and social considerations and ways of thinking about these phenomena. Finally we address what we consider to be crucial dimensions concerning the landscape of unexplained “matters”; fatigued being, pain-full being and dys-ordered being, all expressive momentums of an aesthetic of resistance.

What constitutes competence? That depends on the task

General practitioners (GPs) are trained for and mandated to provide continuous healthcare to the general, unselected population in a low-threshold, local setting. This presumes as a paramount precondition that the doctor is competent as a medical helper of a large variety of people of all ages attending for an increasing variety of health-related problems or complaints. The central question as regards competence is this: How does the doctor conceptualize and understand the “entity” that enters the GPs office? If one identifies the subject matter of medicine as diseases, carried by (more or less) average patients, then adequate medical competence involves knowledge about diseases. Thus, the wider characteristics of the diseased persons become of secondary significance. Such a framework attributes to diseases the status of essences, affecting people in the same manner, and consequently representing the core entities in medical knowledge production. This view accords with the biomedical framework of human bodies and their functions being the sum of biological mechanisms that can be unambiguously classified, and to which group-based data can be applied to explain dysfunctional states and achieve therapeutic success. If, however, one perceives that what enters the GPs office is persons, who are or feel diseased, in other words “are not at ease with themselves”, quite a different competence is demanded. Then, knowledge of the person becomes key in a double sense: first, to enable the doctor to understand how personhood in general, and this person in particular, is affected by being diseased [1]; and, even more crucially, to make the doctor capable of “reading” the present dysfunctional state as an impact on this persons embodied life [2]. The significance of knowing about a persons lifetime experiences to understand the manifestation of current or chronic sickness has been ever more solidly documented during the last two decades of multidisciplinary research [3]. According to Eric Cassell, a person is “an embodied, purposeful, thinking, feeling, emotional, reflective, relational human individual always in action, (and) responsive to meaning. Virtually all of a persons actions – volitional, habitual, instinctual, or automatic – are based on meanings” [4]. Engaging with a diseased person in an adequate manner demands, consequently, the ability to accrue an understanding of this persons unique biographical and relational context, in other words, a historical, socio-cultural, and linguistic competence. This demand precludes predefined labelling of a persons ailment in general and of reports on complex malfunction in particular. However, both clinical practice and research are currently hampered by the fact that phenomena like complex malfunction, typically termed co- or multimorbidity, are ill defined. This is a consequence of the biomedical concept of the nature of human beings and human bodies, failing to account for the fact that humans are situated beings and, as such, embedded in systems of symbols and of socio-culturally established values [5]. This complexity was recently exemplified in a study of how Nordic GPs perform detached diagnostic labelling of patients. It was based on simulated, video-recorded consultations with a common denominator: a simulated patient presenting so-called subjective health complaints (SHC) to a GP [6]. Such a presumably objective approach to human beings may in itself represent an ethically questionable reduction of both doctors and patients for several reasons [7]. First, the premise is a framework defining the subject matter of the medical encounter to be diseases or symptoms and not persons who experience illness. Second, it is questionable whether concordance in choice of labels is a potential hallmark for system quality, especially when the matter at hand is poorly defined. Third, aiming at labelling instead of understanding means failure to fulfil the central prerequisite for proper treatment. Finally, a detached method, prohibiting a mutual relationship, allows for limited insight. The studys predictable result, a considerable heterogeneity of labels, elegantly demonstrates that the construction called SHC lacks an adequate theoretical basis, and that SHC cannot be classified in a valid and reproducible manner based on the biomedical aspect alone. This fact points to the fallibility of health politics anchored in diagnostically based statistics. It also underscores the need for re-conceptualizing human beings from a medical perspective. Human beings are embodied beings, living their lives incorporated as lived bodies. Consequently, the biomedical framework of the de-contextualized and depersonalized biological body, devoid of history and meaning, is of limited validity. Fortunately, researchers in a broad array of disciplines are currently accumulating knowledge demonstrating the impact of a persons experience on that persons body – and health [8]. In other words: the lived body, a phenomenology-derived concept subverting the mind/body dualism that still haunts biomedicine at its core, is entering into medical awareness [9]. General practitioners in the Nordic countries and, it is hoped, worldwide, may be the medical professionals who will most eagerly embrace this knowledge because it validates what most of them already know through their own accumulated professional and personal experience: human bodies are lived bodies, and lived life and health are indivisible.

A Case for Resentment: Jean Améry versus Primo Levi

Resentment is an attitude with few advocates. When openly displayed, resentment is likely to meet with irritation. To show resentment is regarded as reflecting negatively on the agent’s character. Better then to keep it to oneself and avoid feeling it in the first place. The bad publicity suffered by resentment is in keeping with the way resentment has been viewed by influential philosophers. Friedrich Nietzsche, and after him Max Scheler, found nothing worthy of admiration in it. Quite the contrary: To show resentment toward another person means to betray deep-seated inferiority and insecurity. It reveals a mentality preoccupied, often to the point of obsession, with the past, with the suffering of blows against which one evidently was unable to defend oneself. For Nietzsche in particular, such lack of ability to defend oneself carries the sign of failure—a failure not to be explained (away) by circumstance or coincidence. Rather, the failure points to the weakness of the person. Resentment, asserts Nietzsche, is a “reactive attitude” typically taken up by the feeble, the fearful, the vulnerable. Fearing the traits that Nietzsche sees as the signs of greatness— vitality, resolve, forgetfulness—individuals who harbor resentment will do their best to bring about a reversal in the hierarchy of values: They will condemn greatness by calling it cruelty, judging that the acting-out of strong drives and urges is morally wrong and warranting punishment. By denouncing the characteristics of strength whenever met upon, the weak seek to universalize, to impose upon all men, a morality of compassion. At the core of this morality there is the demand that every individual tame his inner, possibly uncontrolled and “wild” energies, his appetite for action, for life. As Nietzsche famously says, this amounts to a morality for slaves: the “slave morality” born among the most feeble among men, who lack what it takes to tackle the calamities of life, and who therefore have a strong interest in portraying weakness and neediness as morally “worthy,” as something that ought to inspire respect and concern. The weaker the better, as far as moral value is concerned. To be sure, Nietzsche’s position is not exhausted in the claim that resentment manifests weakness. More subtly, Nietzsche has a keen eye for spotting how

Worlds apart?: Habermas and Levinas

Though doubtless two of the leading philosophers in ethics today, Habermas and Levinas have yet to be subjected to sys tematic comparison. This essay undertakes a first step. Differences of terminology aside, Habermas and Levinas can be seen to pursue, via separate routes, a similar core idea. I term this the idea of immanent normativity. While Habermas locates an unchosen normative pull in the medium of interpersonal communication, Levinas locates an unconditional ethical command in the Other as face. Hence they unite in strongly opposing social contract theorys notion of moral ity as optional and of responsibility as conditional upon self-interest.

Hannah Arendt on conscience and evil

Though there exists a vast literature dealing with Hannah Arendt’s thoughts on evil in general and Adolf Eichmann in particular, few attempts have been made to assess Arendt’s position on evil by tracing its connection with her reflections on conscience. This essay examines the nature and significance of such a connection. Beginning with her doctoral dissertation on St Augustine and ending with her posthumously published studies in The Life of the Mind, Arendt’s oeuvre exhibits strong thematic continuity: the triad thinking–conscience–evil forms its most enduring core. A puzzling core, to be sure, considering the controversies triggered, especially regarding her notion of the ‘banality of evil’. By placing the role of conscience at the very center of Arendt’s lifelong reflections, this essay explores the – in many ways related – influence exerted by St Augustine and Heidegger. Heidegger’s conception of conscience in Sein und Zeit is identified as a crucial source for understanding – so the claim holds – why Arendt found Heidegger’s philosophy particularly wanting as regards the question of evil.

Ethics and Value in Naess’ Ecophilosophy: A Realist Perspective

It appears that Naess thought his ecophilosophy could do without ethics. What made him think so? Since Naess was largely implicit about his metaethical views, I turn to Warwick Fox’ elaborate presentation of Naess’ ecophilosophy to find an answer. Doing so allows me to investigate what is insufficiently accounted for in Naess’ ecophilosophy, namely its ontological presuppositions. To be philosophically sound, Naess’ criticisms of ethics need to question the taboo against the so-called naturalistic fallacy, a commonplace in ethical theories since Hume. I argue that a realist notion of value—understood as a property of nature, operative in nature—provides ecophilosophy with a sorely needed ontological foundation.

Post-Hiroshima reflections on extinction

Hiroshima was the first sign of the possibility of the human-inflicted devastation of the natural as well as the human world. But the potential for destruction is greater than it was in August 1945. It is now incumbent upon philosophy and critical though to consider the contemporary destruction of the non-human species and ecology upon which continued human life depends. This paper uses Hiroshima as a point of entry into consideration of the need now to think beyond anthropocentrism and instead to think more ecologically.

Comments on Jürgen Habermas’ lecture ‘Plea for a Constitutionalization of International Law’

I shall in what follows address the prospects for solidarity in present-day Europe, referring to Habermas’ account but taking it in a somewhat different direction. However, I shall begin closer to home. In Norway, we just marked the two-year anniversary of the terrorist attacks that killed 77 people on 22 July 2011. I was reminded of the spontaneous reaction after the explosion outside the government building in Oslo. Both among the people on the street and among the academic experts, Al Qaeda was unanimously singled out as the most likely suspect. Grudgingly, and with profound disbelief, Norwegians a few hours later had to face the fact that the twin attack was carried out by one of their own: Anders Behring Breivik. Then, in Wroclaw in Poland on 22 June this year, sociologist Zygmunt Bauman was about to give a lecture on ‘Ferdinand Lasalle and Social Democracy’ when a group of right-wing radicals interrupted, shouting anti-communist and anti-Semitic slogans against him. You may know that Bauman was forced to flee from Poland in 1968, having been sacked from his position at Warsaw University amid an anti-Semitic campaign orchestrated by the communist government led by President Gomulka. I mention these two incidents because they throw concrete light on a topic that we philosophers are wont to discuss in an abstract manner: solidarity, or rather its negation, as highlighted in xenophobia, racism and anti-multiculturalism. In present-day Europe, Greece not excluded, these are issues potent with conflict, even violence, polarizing the population and redefining the political landscape.