Ontological analysis of the ill-being

G.W.F. Hegel, Phänomenologie des Geistes

Philosopher’s word on the forum of the medical humanities is not always welcome. The tangible reality of suffering seems to be something sacred to the extent that excludes the play of speculation from its domain. Indeed, very much the same thing has been thought very often about Godly things. Therefore, I was happy to have presented the following few speculative ideas (although quite Kierkegaardian, and therefore somewhat anti-speculative at the same time) initially in the town which was the birthplace of the man who had enough courage to say (against theologians) that "there is nothing more excellent than philosophizing" and that "only philosphers are wise men." These are words of the arguably the greatest mind of Linkoping and Sweden as a whole, of the Boetius of Sweden.

In my presentation I intend to sketch a few dialectical moments constituting the existential nature of the living, resp. organic entity, in so far as this entity is human. For the man to be a living being is to have body. The split into natural and spiritual ways of being in man, and the character of our unity overcoming this split-the unity relying upon the intentional creations of culture: words, concepts, ideas-determines our corporality as alienated and meaningfull at the same time. Since we are not capable any more of being in the Nature, our way of being in it, after all, is the way of ill-being. Being not of this world, we are permanently ill. This is our "nature"-the sanity, the health is nothing more than "forgotten illness," precisely as in Nietzsche’s aphorism on truth: as we remember, for Nietzsche, the truth is nothing but a forgotten metaphor.

The point of departure of my reasoning is the statement that the ill-being is not a peculiar state of a living body, but rather the ontological, substantial determination of the living organism-specifically of the human organism-whose existence consists in living-towards-death-that is, in illness.

Naturally, there is nothing new in undermining the simplified opposition of the health as the natural state of organism and the illness as its violation. Let us take for granted the basic issue of the constructionists’ analysis that makes us perceive illness as a socially and linguistically constructed entity, related to the judgments, expectations, ideals and needs of man. If a man and/or a women are partly spiritual beings, then their ways of being healthy or ill are also creations of the spirit or culture. Without denying that health and illness are concepts of the living human culture, which should be considered within the antropology, I would add that both these concepts surely have also their purely ontological meanings related to the organic fundament of the spiritual life of man. These meanings are opposed to the cultural ones in so far as human attempts to overcome Nature are an effort to oppose Nature. And the nature is neither healthy nor disordered in itself; it is rather that both these aspects remain complementary features of Life as such. Only as a cultural being, is man healthy or ill. And exactly: as a cultural being, man is an ill-being; his overcoming of Nature, his consciousness are precisely what make him/her ontologically an ill-being. Ill-being is not meant here in the antropological sense of the eternal unhappiness or in the sense of the "unhappy consciousness" of some kind, but in the ontological sense of internalizing in ourselves the painfull opposition of the nature and the spirit. We are ill-beings-this means that we suffer not only as spiritual creatures, but also as natural entities. We are degenerated, alienated not from Nature as such, but from our very nature, from the nature of our own being. We are ill-beings as internally contradictory entities, whose identity is always and only postulated, intended, apparent. Our efforts to maintain our sense of individuality and, subsequently, our actual identity, are hopeless tasks-this is so since we must die before we attain this goal. And it is precisely because of this, that our suffering is so real. Its reality is just a negative, the other side of the intentional, artefactual way of being-and it can aggravate even the worst diseases. We must die as humans. We die, we surrender, for Culture must surrender to Nature. We perhaps win our spiritual eternality when ascending up from the common all too practical intersubjecive culture (do we really?), but at the same time we lose our lives. A being of culture cannot sustain itself in the confrontation with pure Nature. Neither is it able to sustain its own identity in the confrontation with the upper world of the spirit which incorporates that which is extra-temporarily valid in us: the truth we seize, the virtue we acquire. Man is mortal because man is a historical and a cultural being; as a cultural being he is a mortal-being; as such he is also an ill-being. Animals are not. And therefore they never really die, they are never really ill. Their death, their suffering is just the way nature goes, the course of changing forms, the movement which is Life itself.

But the order of tangible reality makes itself apparent again. Should we at all speculate about what is the question of the painfully personal experience-the suffering of the ill person? Besides, what may be more organic in nature than a disease? What may be more real in human life? Do not we say: let us only stay healthy? I feel that I must explain myself once more.

Well, we should acknowledge that we are organisms, organic beings, irrespective of the fact whether we would like to claim that our life cannot be wholly reduced to the life of an organism, or not. If so, then who are we as organisms?, what is the existential nature of the organism? Is an individual organism an autothelic substance, maintaining itself throughout its own activity, i. e. living substance? Not at all. There exists only one stream of life, one substance of Organic Life. The separate entities-cells, organisms, species-are only relatively and temporarily independent parts of it. The idea of a body, of a body being a subject or being an aspect of the "I" pertains only to Man. This is an anthropological idea. When we genuinely suffer, that means that it is we, as bodies, that suffer. And this does not mean that we suffer as the genuine elements of Nature; just the opposite: this means that we suffer as Bodily Entities, which assumes: as Cultural Beings. Through postulating the idea of the body within our own life and on the public stage of our intellectual culture, we set in motion the struggle for ourselves, for our identity which is always to be belived and claimed for, and never to be experienced. Human intentional body is a struggling body. But we do genuinely have our bodies. Our intentional, culture-made body is real-it is exactly this featherless, vertical, slim, degenerated body. We are always doomed to suffer the soreness of our body, for we are ill-beings. Our body is of this world, althought we, women and men, are not of this world! Therefore the life of our contradictory bodies-at the same time physical and intentional ("culture-made") bodies-means the permanent struggle for maintaining itself. The body lives in a way which relies on permanent ensuring its own coherence and substantiality in the course of the permanent effort. What we ascribe willingly to the organism-that it is a whole constantly defending its own integrity-concerns only human body. The animal, the organism does not "want to live"-it just lives, just continues to go on, together with Nature. It never dies for real, since the nature, the very substance of animal life subsists continuously. Animals are eternal in the nature like humans are eternal in the spirit.

Having the body, suffering the illness, awaiting the death-these are typical aspects of the human way of existence. When reffering to animals we can use these terms, but only in an analogous sense. Originally, these terms are mediated in the sphere of human intentionality and self-creation, as parts of the socially elaborated self-understanding of man, as parts of his "natural antropology." This makes the concepts of body, illness, death, ambiguous and illusoric in a way. At least as far as they report the consciousness of failure dominating in human culture whenever it discovers (and it discovers it everyday) that culture and its transitory, temporal creatures, as such only imitate what is the true home of man, the purely spiritual world. In other words: the very concept of illness symbolises the failure immanent to human life, to human culture-the failure in attaining the goal of our vocation and the failure in subsisting as a part of Nature.

Thus, a body lives through having its own negativity in itself. As an impossible idea of something spiritual within Nature, the body as such is ill. Its inherent negativity, its internal contradiction is illness. The resolution of this contradiction, the end of every impossible body, the end of its ill-being is death. Death, therefore, is a negative telos of a body and the very essence of body’s existence is its living-towards-death. This way of living, the (very own) life of a body is precisely an illness. Thus, mortality means being always on the way to death, being always ill. The ontology of the ill-being is the ontology of the mortal-being.

These metaphysical remarks have their consequences also for medical concepts. The illness as it is commonly understood, i. e. in a sense of a more or less sudden event, emerging from the basic state of "health" seems to be nothing but the accidental symptom of the permanent, existentially-grounded illness of a body which is a way of being of any human living entity. It means that every occasional illness as such is "symptomatic," as a superficial appearance of the Illness of human being as such. The regard on that fact annuls subsequently the distinction between causal and symptomatic therapy. The treatment is revealing the state of the common, average ill-being (called "health") and it this sense this activity is loyal to the regular everyday course of self-realisation of the body, to its tendency to die subsequently to a kind of continual and regular process of decline. This means solidarity with the general ill-being against occasional illness: let us die later and more peacefully. However, from the point of view of our real vocation and necessary failure of our efforts to make it true within the temporal, natural scope of our life, the very sense of any treatment is quite dubious. Does a longer life, free of pain, bring us closer to our goals? Does it make us wiser, better or at least more happy? This is very doubtful indeed.

The same dialectical ambiguity concerns also the difference between nature (naturalness) and pathology. If "natural" means satisfying statistically justified expectations, then typical, normal-pathology would mean untypical, unusual. In a sense of a core medical knowledge, pathology, would make something domesticated, usual of something previously unknown and unusual. Therefore, along with the proposed definition, any therapy would contradict itself-illness would become natural to it (isn’t it quite a wise thing for a doctor to say: "it is natural for humans to be sometimes ill"?). For illnesses, all of them, are statistically natural; they are also natural in terms of something being ultimately accepted by God (if you prefer this way of conceiving the concept of nature). The same with death. And who would dare to improve nature (or God)!?! Of course, this dialectics is quite common in the practice of treatment: when facing "natural being ill" or "natural death" of old people, medicine keeps much more quite and passive, than in a case of "unjust," "unnatural" pathology and death of young people. Perhaps then the practice tends towards another concept of pathology, more subjective, namely as something bad, painful which is as such unexpected, unaccepted or even unjust, and claims for our counterreaction. This is obviously a moral determination, reffering to the cultural and not only organic human life. Moreover it is untranslatable into the language of physiology. But we should not complain about that. Involving suffering, emotions and moral ideas into the determination of pathology is in harmony with the essence of the matter itself. For illness is intrinsic to the core of human life, to the ontological essence of Man: the ill-being.

Originaly, illness is the phenomenon of the intelligence, or, to put it more strictly: of the self-consciousness. Psychic pain, knowledge of the self as an ill-being, unhappy with that what he or she has and experiences is a precondition of illness. It is more crucial and essential point that we might suppose considering only the remark that man suffers consciously and the self-knowledge of illness belongs to its very phenomenon. For this truth has also its deeper aspect: any full objectivisation of pathology, grasping it in the physiological terms and-as purely descriptive-forfeiting any valuation, completely loses any sense of evil involved in suffering. On the other hand-which is not less important-we face the same lack of understanding and compassion when taking the above, purely idealistic position. Namely, from the point of view of principles of human being and his vocation, the whole corporal life of man is going to be absolutely subordinated to the sovereign power of the rational human being, who is as such completely free of any suffering and any other form of dependence of Nature. This is just the stoic point of view. This vanishing of the true concept of suffering and illness on two poles-naturalistic and purely spiritual-confirms only that the human ill-being belongs to the transitive and artefactual sphere of being-in-culture.

The essential difference grasped in the popular opposition of the health and the illness seems to rely upon the circumstances in which the body tends towards the resolution which is its death: functional or mechanic disorganisation, as well as infection or intoxication, especially if they make us suffer or if they shorten our life-these are "illnesses" and "diseases." However, in any case, it is our cultural determination that we tend to think that it is better for us to live longer than shorter. This principle-which is the prime motive of the whole medical science-has no rational justification and this very fact makes medicine a very ambigious kind of human activity. There seems to be no essential difference between prolonging ones life for ten years or ten hours. For the Nature itself, it is wholly indifferent how long we live-if you die, someone will replace you. On the other hand, our ideal vocation is neither to live longer nor to suffer less. Our vocatiion is to acquire the truth and virtue, then-to enter the eternal world. So simple as it is, since Renaissance we got unable to treat this truth seriously. This is our madness and ultimate confirmation of our modern ill-being.