Review - Illness
The Cry of the Flesh
by Havi Carel
Acumen, 2008
Review by Diane E Pitt
Sep 15th 2009 (Volume 13, Issue 38)

Illness: The Cry of The Flesh written by Havi Carel is part of Acumen's The Art of Living series. The aim of this series as the editor puts it is' to open up philosophy's riches to a wider public'. Drawing on insights from classical antiquity, the question, 'How Should we Live?' is the preoccupation of authors in the series, who draw on their own personal experience and reflections to engage the reader with this question.

How one lives life with illness, and how that illness experience shapes a life is the focus of Havi Carel in her book for the series. Carel takes us on a journey through the rich landscape of philosophy, and shows us how philosophy can act as a tool-kit for life. Particular consideration here is her own life, and living that life with a rare, and debilitating lung disease, lymphangioleiomyomatosis (LAM), which is progressive, and has a poor prognosis. Despite this the book is never sentimental, indeed the profound observations offered here are likely to give comfort and affirmation to people experiencing the transformations induced by illness.

 The introduction gives us a contextual framework for the philosophical deliberations to come, and here Carel clearly positions the scope of her enquiry, and goes on to state that the book: "is neither a personal story nor a purely philosophical reflection on illness. It stands in the (sometimes difficult) position of being committed to both" (13). What follows in five main chapters is a personal narrative of illness experience woven seamlessly into the complexities of philosophical theory, thereby putting philosophy to work to make sense of illness. The philosophy at work here is that of phenomenology, and specifically that of Maurice Merleau-Ponty, and Martin Heidegger. However Carel also offers insight from classical antiquity, specifically Epicurus, and shows us that philosophy gives us a storeroom of insight, and that our philosophical tradition is a tremendous resource.

Through the lens of a phenomenological perspective Carel guides the reader through the complexities of illness (a complexity that is invisible in much clinical practice), and shows us how the first person experience of illness is critical to an understanding of illness. Each chapter examines an aspect of life with illness from a phenomenological perspective, and here we become acutely aware of the lived experience of illness through Carel's account, and the way in which philosophical reflection can act as a navigational aid to confronting the pressing questions that necessarily come to the fore in illness.

Carel contrasts this first person experience with the third person or objective experience of illness, which is a naturalistic account that is dominant in clinical practice, and where illness tends to be seen as a dysfunction of the biological body. The focus is then on returning the biological body to normal functioning. We become increasingly aware of the limitations of this approach through Carel's discussion of her illness experience, and her philosophical analysis where this partial understanding comes into sharp focus. We gain a powerful recognition here that the first person experience of illness is very different from the third person or objective experience of illness. We learn of the impact of chronic illness, and that it involves a constant re-orientation to a changing world, to a changing self, and we see clearly the tension between the embodied nature of illness, and the disembodied focus of clinical practice. Carel argues that there is a need to augment the naturalistic approach in clinical medicine with a phenomenological perspective thereby shifting the lived body into focus, and she makes the point that: "phenomenology distinguishes the lived from the biological body, but does not reject the latter" (71).

  One of the most important insights in the book is the proposed notion of health within illness, and where she asks: can I be ill and happy? Here we learn of the complexities of illness, and the nature of chronic illness, and how this shifts the relationship between health and illness. I found that what was particularly instructive about Carel's arguments and insights here, was that in insisting that illness and health are not binary opposites, and thereby disrupting a powerful dichotomy, she demonstrates to us that there is a kind of permeation of health and illness with each other, and that all of our bodies are permeated with bits of illness and bits of health in a way that doesn't allow them to be set up as opposites of each other; this insight is crucial phenomenologically to an understanding one's body.

Carel suggests here that the notion of health within illness is a helpful concept for capturing a sense of well being that some people with chronic illness say they experience. Here she further suggests that adaptability and creativity are both common responses that are positive, and show that health within illness is possible. Therefore people can still cultivate a subjective sense of well being in illness.

Perhaps one of the most disturbing accounts in the book was when Carel described her experience of the clinical encounter. Here we learn of an experience that was tainted by uncaring, insensitive clinical practitioners exhibiting an impersonal and uncaring approach, and who made what was clearly often a traumatic experience worse because of a lack of empathy, and basic humanity. While this served to demonstrate the gulf between naturalistic and first person perspectives on illness, it also served to demonstrate that clinical practice is far more than 'applied biology'. As Carel explains: "I do often wonder if the encounter must be so impersonal, so guarded. Could some genuine care be introduced to the exchange?" (41).

Overall this book offers an important contribution to the ongoing project of the phenomenology of illness, and offers a powerful argument for the inclusion of applied phenomenology in medical and healthcare training.

One of the main strengths of this book is that it forces you to think, and to think philosophically; indeed it is quite surprising how many of us are averse to this. As Bertrand Russell remarked, 'Most people would rather die than think, and most people do'.

 Carel neatly lifts philosophy off the page, and places it out there like a talisman in our everyday life. The book deserves to be read widely by the public, and I would suggest needs to be read widely by clinical practitioners as a point of reference for their own practice.

© 2009 Diane E Pitt

Diane E Pitt, Honorary Research Associate in Philosophy,Centre for Research into Embodied Subjectivity, Department of Humanities, University of Hull, UK