Hans-Georg Gadamer
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"I think, then, that the chief task of philosophy is to justify this way of reason and to defend practical and political reason against the domination of technology based science. That is the point of philosophical hermeneutic. It corrects the peculiar falsehood of modern consciousness: the idolatry of scientific method and the anonymous authority of the sciences and it vindicates again the noblest task of the citizen - decision-making according to one's own responsibility - instead of conceding that task to the expert. In this respect, hermeneutic philosophy is the heir of the older tradition of practical philosophy." - Gadamer









Introduction
Hans-Georg Gadamer was born February 11th 1900 in Marburg, Germany. He was the son of a chemistry professor at the University of Breslau. Gadamer began his studies of humanities at the University of Breslau and later on at the universities of Marburg, Freiburg, and Munich. He eventually earned a Doctorate of philosophy in 1922 under philosopher Martin Heidegger, at the University of Freiburg. Later he went on to teach philosophy at the Universities of Marburg, Kiel, Leipzig, Frankfurt, and Heidelberg.

In the 1950’s Gadamer came to represent a major position in the philosophy of the humanities, philosophical hermeneutics, which was contradicted by Marxists philosopher, Jürgen Habermas, and radically anti-methodical interpreters such as Jacques Derrida and Eric Donald Hirsch. Not only was Gadamer the spokesperson for philosophical hermeneutics, but he redefined the meaning of hermeneutics and took it beyond that of his predecessors. Hermeneutics was originally understood as an art of interpretation, which could uncoversecrets from difficult texts that were originally addressed to past audiences. Philosophers argued that in order to interpret a historical text, it requires an act of historical understanding. Gadamer disagreed and following Heidegger's lead, he expanded on the meaning of hermeneutics, to encompass a broader sense. He said, “It is a theory of human existence arising from the study of the events of understanding and interpretation in which human beings are always involved.”[[#_ftn1|[1]]]

He goes on to explain that “the key to understanding is not manipulation and control but participation and openness, not knowledge but experience, not methodology but dialectic.”[[#_ftn2|[2]]] For Gadamer, it wasn’t about setting forth rules as to how come to a scientific understanding, but rather to conceive understanding itself as fully and deeply as possible. In 1960, he published Truth and Method, which described most thoroughly his work on philosophical hermeneutics. The book itself can be seen as an extension of Heidegger's ontology into critical hermeneutics.






Philosophy and Practical Medicine
Gadamer begins his treatment of philosophy and practical by ensuring that his work in this area is not that of an expert, but it is rather, “his own reflections alongside everyone else’s” in that philosophy is a “natural propensity within us all rather than some sort of professional skill or ability.”[[#_ftn3|[3]]] Gadamer asserts that it is within our abilities and responsibilities to carefully consider and reflect on the philosophy of practical medicine as it is a concern of all of ours. He begins his discussion with a deeper look at the language surrounding modern medicine—a hermeneutical approach to the subject.

Gadamer illustrates how the practice of medicine is neither definable in terms of science, nor of art. Science is based in theories and theories are based upon repeated outcomes that seem to follow particular rules, thus allowing them to be applied in similar circumstances with the same, or a similar, outcome expected. Medicine cannot be strictly considered a science because once doctors are equipped with the general, scientific knowledge, they are still not able to simply apply the theories in exactly the same way in all similar cases. Doctors are expected to treat on a case by case basis—recognizing what they ought to do differently, for different patients, suffering exactly the same condition.[[#_ftn4|[4]]] In this respect, medicine falls under the domain of art. Art, explained by Gadamer, is the result of an individual’s skills and abilities as they allow that person to create or construct something unique. Each case that a physician treats is unique in the fact that they are treating a different, individual human being—thus making medicine somewhat of an art, as it can be readily applied to individuals in spite of the case by case differences that make it less systematic than a strict science.


Gadamer first investigates the use of the term ‘case’ within the scope of practical medicine. Gadamer points to the contradiction in meaning of the word case based on its use. It is the case within the scientific realm when something follows particular rules, principles, or regularity. When we speak of the ‘case’ of the individual patient, however, we intend a meaning that contradicts the latter definition of case. A ‘case’ of a patient does not follow regularity—rather a disease or condition presents the patient with irregularity, which is the very reason that they have indeed become a ‘case’ in the medical sense. The patient is an exception to, and excluded from, the rest of society by their being a ‘case’.[[#_ftn5|[5]]] It is similar from the doctor’s viewpoint. The doctor’s case is also an exception to norms of physiological functioning, rather than the case of following a particular scientific rule or law.


Next, Gadamer addresses the paradox of health. Modern medicine and science are focused primarily on illness because we would not need medical treatment or care without the presence of illness. Illness, Gadamer explains, we recognize as “that revolt or rebellion which takes place when something starts to dysfunction.”[[#_ftn6|[6]]] On the other hand, Gadamer points out that we would not recognize illness if we did not first observe a state of health—free of disease and illness. Thus illness is dependent upon health, but we do not recognize our health in the same way that we do our illness, “health is not something that is revealed through investigation but rather something that manifests itself precisely by virtue of escaping our attention.”[[#_ftn7|[7]]] We are able to consciously ignore our body’s health until it becomes affected by illness, and at that point we recognize a need to turn toward medicine as a means to help heal the physical body. The fact that there is the possibility of restoring health is a “miraculous example of nature’s own capacity for self-renewal.”[[#_ftn8|[8]]] Gadamer quotes a Greek physician, Alkmaion, who describes death as an inability in this respect of self-renewal, “We humans beings must die because we have not learnt to connect the end with the beginning again and this is something we can never accomplish.”[[#_ftn9|[9]]]


Through his treatment of health, illness, and self-renewal, Gadamer concludes that we need the whole person, body and soul, and the physician to recognize illness and to address it as to restore health. The problem that faces the physician then, is how to use objective, scientific medicine to aid his patient in regaining their state of health. Since the focus of modern science is to objectify and measure, the doctor must begin his pursuit for health by a ‘measure’ of illness. To ‘measure’ can have two meanings. To measure from within the object, in this case acknowledging the patient’s own experience of the disease state, or a measurement can be taken from outside the object—modern medicine has constructed norms and standards for this purpose. Gadamer expresses his concern regarding the way in which modern medicine ‘measures,’ “Instead of learning to look for illness in the eyes of the patient or to listen for it in the patient’s voice, we try to read it off the data provided by technologically sophisticated measuring instruments.”[[#_ftn10|[10]]] Gadamer does believe that both methods of obtaining a ‘measure’ are necessary, but it is difficult if not impossible to give sufficient attention to both results, and thus modern medicine and the practice of mass health care has learned to focus on the one they can more readily depend on in all ‘cases’—test results.


Obtaining data about a person’s state of health, or more precisely their illness, in this manner of comparing test results and numbers with ‘standards’, is driving health care away from the patient as a person and toward their illness as a ‘case’. According to Gadamer, this becomes most painstakingly evident as we look at the case of the chronically ill, the elderly, and the dying.[[#_ftn11|[11]]] It is these patients in particular that are a reminder that medicine is used to treat human beings—bearing dignity and deserving of respect—rather than to ‘treat’ a ‘case’ of an illness, disease, or dysfunction. It is most important that in the face of modern science’s objectivism of practical medicine that doctor’s actively realize their patient’s human dignity, “doctors are called on not merely to ‘act upon’ their patients but to ‘react to’ them by treating them in a proper manner.”[[#_ftn12|[12]]] Gadamer’s philosophy of practical medicine gives a careful demonstration of how the problems of language and of scientific objectivism in medicine are able to destruct the necessary, human relationship that should exist between a physician and their patient.




The Experience of Death
Gadamer addresses the current state of the human relationship to mortality and death. What Gadamer refers to as the “demythologizing of death,” was brought on by a “new, second enlightenment.”[[#_ftn13|[13]]] This second enlightenment is a result of the vast advancements in science and technology—most specifically in the field of medicine. As science has come to explain our very existence and has provided observable evidence for life through modern theories such as evolution, it has at the same time achieved an uncanny ability to conceal the evidence of death—both from societal and individual experience. Gadamer illustrates how we once were subordinate to death, “…the funeral procession—prompting everyone to remove their hats before the majesty of death as it drew past…” in an effort to contrast our past experience of death with the modern experience of death—or lack there of.[[#_ftn14|[14]]] Modern medicine has eliminated the human experience of death as it once was. This is an issue of concern, as our death is a part of our inherent nature as mortal human beings, and Gadamer—alongside many other modern thinkers—suggests that this lacking experience of death in our modernized society is as much dehumanizing as it is an achievement of our scientific and technological progress.


Most people are now dying in the hospital rather than at home amongst their grieving family members and friends as people once did. The advancements of modern medicine and healthcare have allowed us to prolong life when the end is near, but according to Gadamer, “the prolongation of life finally becomes a prolongation of death and a fading away of the experience of the self.”[[#_ftn15|[15]]] Death has become depersonalized and dehumanized as both the family and the individual are unable to embrace or fully experience the death due to barriers within the modern hospital. For the individual, death has often become a long and slow journey that takes place in an unfamiliar and unwelcoming setting—a sterile hospital room. They are often surrounded by the hospital staff who are there to “care” for them, but not in a personal sense; modern medicine has a tendency to focus on the pathology rather than the person. There are remarkable machines that enable a dying individual to carry on beyond their own physical capacity. The underlying question remains whether these “life-sustaining” machines are enabling the patient to carry on their life, or their death. Most people also receive an adequate amount of anesthesia to ensure that they do not feel any pain or discomfort with their death.[[#_ftn16|[16]]] While people do want to avoid the sensations of pain, there is concern that these drugs may cause them to feel nothing—making people unable to experience their death or the love of their family and friends as the end inevitably approaches. Dying was once a process within the human experience in which the whole person was taken care of. A doctor would address the physical needs as much as possible, the family the emotional needs, and a religious leader the spiritual needs, but now dying has been reduced by modernity to only a physical, or physiological, event. Many of the past common elements of death have gone missing in the modern experience of dying.


Gadamer further speaks of the history surrounding death, and what it implies about human nature that is still prevalent today—perhaps even responsible for our enlightened age’s “systematic repression of death”.[[#_ftn17|[17]]] As far back as we are able to trace human history, we can also trace the evidence of funeral rites and offerings for the deceased. This, Gadamer concludes, is proof that humankind has always objected to admitting fully that the deceased are wholly gone and cease to be as we understand it. This reflects the human phenomena of the incomprehensibility of our own mortality; human beings find it difficult to conceive of the fact that the very conscious we use to conceive of anything will, one day, no longer exist.[[#_ftn18|[18]]] All of the traditions that have surrounded death and dying throughout human history are a part of our inherent fear and confusion regarding our own mortality. We need to experience both the deaths of those close to us and our own as a means to fully grasp what it is to be human and finite; the systematic repression of death from society and individual experience will only hold us back from realizing what it is to be human.




Hermeneutics and Psychiatry
Gadamer illustrates the importance of hermeneutics in psychiatry by first explaining hermeneutics as philosophy. He said that hermeneutics is universal and encompasses all our thoughts and reason itself. It is the heart of philosophy, “a pursuit of the logic of dialogue.”[[#_ftn19|[19]]] Gadamer goes on to explain that thinking is the dialogue of the soul with its being.[[#_ftn20|[20]]] We are in a state of constant questioning. The hermeneutics of psychiatry can be understood, “if philosophy is an attempt to understand the incomprehensible, an attempt to take up the major human questions to which the religions, the world of myth, poetry, art and culture all offer responses, then [psychiatry] must encompass the mystery of the beginning and the end, of being and nothing, of birth and death, and above all, of good and evil.”[[#_ftn21|[21]]]


Psychiatry like the art of conventional medicine is indeed an art, but it requires a different set of skills and understanding. Conventional medicine is based on a patient practitioner relationship and the ability of the patient to recognize when he or she is lacking a characteristic of health that needs restoring. Psychiatry on the other hand is a patient practitioner relationship of a different sort. The psychiatrist must interact with patients that have an altered insight into their condition and may not even realize they are ill. Often times it is difficult to establish a therapeutic relationship with the patient, because the practitioner is often met with resistance. Gadamer emphasizes that the practitioner in this case, “must seek to reach understanding with the patient, even where the patient withdraws from such understanding.”[[#_ftn22|[22]]]


The concept of mental illness is and has always been a complicated issue. Mental illness is often further complicated by social and political points of view. It is significantly affected by the social norms of society, because what may be considered socially acceptable in one country or community, may be deemed social unacceptable in another. An example could be something as generic as depression. In the United States, “Approximately 18.8 million American adults, or about 9.5 percent of the U.S. population age 18 and older in a given year, have a depressive disorder.”[[#_ftn23|[23]]] In Japan, however, psychiatrists do not treat depression or anxiety based disorders, instead they treat the more serious mental disorders such as; mood disorders, schizophrenia, Alzheimer’s, etc. A study done on Japanese women discovered that women who were often suffering from untreated depression suffered from somatic complaints of shoulder pain according to Lawrence Kirmayer.[[#_ftn24|[24]]] Up until the last five years, it has not been socially acceptable to be diagnosed with “depression.” Until about five years ago there were no SSRI medications in Japan. Eli Lilly, a U.S. based pharmaceutical company, didn't even try to introduce Prozac in Japan, because they thought there would be no market. Finally another pharmaceutical company tried, and now the idea of depression has taken off.[[#_ftn25|[25]]] Turning back to hermeneutics in psychiatry, it can clearly be seen that drawing distinct lines for determining what is and what is not mental illness is extremely difficult if not nearly impossible to do cross culturally.


Despite the vast availability of such pharmaceutical resources, it does not seem that hermeneutics can help bridge the gap between patients and practitioners. However, Gadamer points out that, “even in these most difficult cases the doctor-- and, who knows, perhaps the patient as well—must give due recognition to the fact that what is involved is always a relationship between two human beings.”[[#_ftn26|[26]]] Ultimately it would seem that it all comes down to the individual relationship that is formed between the patient and the practitioner, no matter the nature of the patient’s illness.




Anxiety and Anxieties
In Gadamer’s essay on anxiety and anxieties he mentions that,

If we could succeed in at least partially grasping the internal connection that exists between such different things as anxiety, the various anxieties, the process of becoming anxious, the persistence of anxiety and the overcoming of anxiety, we would be in a better position to understand how anxiety can actually become an illness.[[#_ftn27|[27]]]

It is evident that in today’s society that anxiety and anxieties play an important role. In fact, according the National Institute of Mental Health, over 18% of the adult population in the United States, have anxiety disorder in any given year.[[#_ftn28|[28]]] According to an online dictionary, anxiety is, “a state of uneasiness and apprehension.”[[#_ftn29|[29]]] Using Heidegger’s description of anxiety as a fundamental disposition of humankind, Gadamer works to facilitate a deeper more philosophical understanding of anxiety. [[#_ftn30|[30]]]


An anxiety that Gadamer insists that everyone is able to relate too is that of the anxiety concerning death. This too is unique to human beings, because of our ability to think. He said that, “because we are thinking beings…we must concern ourselves with death.”[[#_ftn31|[31]]] Gadamer then goes on to explain the story of Prometheus, who stole fire from the heavens and taught humans how to use it. Prometheus took the burden of knowing when death would come away from the humans. As soon as this burden was lifted, it was said that the humans began to transform the world that they lived in, into a habitable place, which further allowed them to be able to forget about death.


He says that anxiety has put distance between things and humans. Specifically, anxiety puts distance between a person and his own self. Still, Gadamer wants us to delve deeper into what language tells us and what Heidegger said about care. Heidegger said that, “all care, all solicitude, is care for or about something, just as all anxiety is anxiety in the face of something or anxiety about something.”[[#_ftn32|[32]]] It is this anxiety that helps to distinguish us from other highly developed animals. Gadamer believes that, “the particular form of knowledge and certainty which modern science produces through experiment and prediction has increased the human need for security.”[[#_ftn33|[33]]] There is a stronger underlying drive to feel secure. Max Scheler, a German philosopher, introduced the word Herrschaftswissen, which is translated as controlling or mastering knowledge. In pursuit of security we strive for knowledge, because with knowledge comes mastery and control. With mastery and control comes less anxiety related to the unknown. Take for example a surgeon who is performing his/her first tonsillectomy. He/she is anxious in performing an unknown procedure, but through diligent preparation the surgeon comes to be more confident in his/her skills and the more confident the surgeon becomes, the less anxious he/she is. It is also important for the surgeon to realize the limits of his or her mastery, failure to realize the limits of mastery may lead to greater anxiety down the road.

Gadamer goes on to explain the type of anxiety that we live with today saying, “we build our lives within the realm of “care” in so far as we constantly concern ourselves with different things, constantly try to procure them, constantly live in a state of concern… we make ourselves at home in the world we create.”[[#_ftn34|[34]]] Gadamer is saying that we constantly live our day to day life with anxiety as our companion and most people are comfortable that way. However, there are those who do not know how to cope with new or increased anxiety and suffer because of it. Gadamer says that, “anxiety is not itself an illness.”[[#_ftn35|[35]]] He does recognize that there are mental illnesses, such as psychoses that are composed of psychotic anxiety.


Gadamer tries to emphasize that the goal should be to try to figure out where on the continuum does anxiety fall into simple daily worries and where does it constitute falling outside the normal range. He compares this to the phenomenon of equilibrium or balance, by using the illustration of a child learning to ride a bike. He said that as soon as one learns to ride without falling over, the whole experience seems so much easier than it did when one was still praying not to crash with the greatest effort. As soon as one learns to balance, it seems as if everything simply goes by itself. By using this illustration it can be interpreted that it is normal for people to experience anxiety at different points in their life, but one should learn to adapt, just as one learns to ride a bike. Once the individual learns how to handle the new anxiety, it seems as if were a mere nothing. This marks a normal developmental aspect of learning to cope and adjust. We learn to recognize illness or abnormal responses to anxiety when one fails to effectively adjust or cope with the anxiety. Perhaps past coping mechanisms failed the individual or perhaps the anxiety was too great for the individual to handle, whatever the case may be, it is important that the individual seek out help. This help could be in the form of friends, family, or a trusted physician, but in order to ask for help, one must recognize that he/she has a problem and be willing and open to suggestions. Anxiety is first and foremost a part of life. How one deals with it effects individual’s growth and development, either promoting growth or hindering it.




Conclusion
Beginning in the 1970’s Gadamer regularly taught part of the year in North America, visiting different universities. He continued to pursue research, especially in classical Greek philosophy. For today's students, Gadamer is a living witness of the vitality of the great teachers of his youth, as seen in his essays in Part II of Philosophical Hermeneutics (1976) and Philosophical Apprenticeships (1985). Gadamer died in Heidelberg on March 14, 2002, at the age of 102.



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