The meaning of illness : a phenomenological approach to the physician/patient relationship.

It is my purpose in this thesis to explore the "reality" of illness, using philosophical phenomenology as a guide. In particular, I am concerned to show that the experience of illness, rather than representing a shared "reality" between physician and patient, represents in effect two quite distinct "realities" (the meaning of one "reality" being significantly different from the meaning of the other). Philosophical phenomenology focuses on the nature of experience, and particularly upon the manner in which all experience is structured by the activity of consciousness. In so doing phenomenology emphasizes the unique nature of experiencing and particularly the correlation between the perceiver and that which is perceived. Meaning is seen to be a function of the activity of individual consciousness. In the first chapter consideration is given to some basic concepts which are fundamental for phenomenology and a distinction is made between "own world" and "common world." In the second chapter these concepts are shown to provide insights into the nature of the discrepancy between the physician's and the patient's understanding of illness. Consideration is given to the manner in which the separate worlds of the physician and patient are constituted. It is argued that it is through attentional focusing that the sense of illness is made explicit for the individual. An analysis is provided of the manner in which such attentional focusing is determined. In the third chapter consideration is given to the question of how it is possible to construct a shared world of meaning between patient and physician, given the unique nature of experiencing. An eidetic interpretation of illness is proposed and attention is directed towards some ways in which we do, in fact, come to some understanding of the Other. In the final chapter it is suggested that the notion of healing presupposes a shared world between physician and patient. A distinction is made between healing and curing disease. It is noted that the manner in which the "reality" of illness is defined directly influences the way in which the end of the patient/physician relationship is defined. It is argued that the end of the patient/ physician relationship is healing and that healing is a mutual act which is accomplished within the context of a shared world between physician and patient.M.A