Science, humanism, and the nature of medical practice: a phenomenological view.

ions through which we understand the person and his or her social moorings achieve integration only if we relocate that person within the more concrete setting of the pre-scientific lifeworld. The Lifeworld as the Source of Meaning for Medicine The processes of abstraction that constitute scientific thought presuppose experiences that are more concrete. This idea has been amply demonstrated by Jean Piaget and other developmental psychologists: the mental operations involved in the formalizations and generalizations of science evolve out of more basic experiences of sense perception and bodily action [14]. Children first learn to perceive the properties of objects through their senses and to transform them through bodily action. Such sensory-motor experiences serve then as a necessary foundation for the development of rational and conceptual thought. Only the child who can bodily manipulate things in space can learn to conceive of geometrical spatiality and the infinite divisibility of space. Scientific thought, in other words, has a history or genesis [14]. The abstractions of science can be traced back to their concrete origins in pre-scientific life. Human beings who can conceive of things through scientific theories are first of all beings who can' perceive things through their senses and act on things through their bodies. Scientific thought harbors a crucial presupposition: scientific interpretations of the world are possible only because there are more fundamental ways of experiencing that same world. Scientific experience necessarily presupposes pre-scientific experience [5]. Consider some examples. Biologists who study the function of the cones of the eye in vision can develop scientific explanations of them only because they already know, in a pre-scientific manner, what an eye is, what role it plays in ordinary perception, and what is ordinarily involved in perceiving objects. Without such ordinary, pre-scientific knowledge of the eye and perception, scientists could not even locate the topic of their study. Scientific interpretation of the eye presupposes a larger context of everyday experience within which we already comprehend, to some extent, the place, possibilities, and functions of the human eye [15]. This reliance on ordinary knowledge is even more evident in medical practice. Ophthalmologists require the same kind of pre-scientific knowledge of vision when they deal with a cataract. In a similar vein, the pulmonary specialists are able to understand the cellular pathology and radiological findings associated with emphysema because they are already familiar with breathing and breathlessness in everyday life. The technical conception of emphysema, of course, moves far beyond the ordinary understanding of breathlessness. But the scientific notion draws on and always presupposes this pre-scientific experience. Likewise, any physician is able to comprehend what the patient talks about only because the patient voices complaints in the natural language that physician and patient share by virtue of their participation in a common social world. A psychiatrist may wonder about the particular grimace on the patient's face because he or she already knows what grimaces usually mean in human experience. In the case of a paranoid patient, the psychiatrist is able to begin to understand what the patient says about his or her experience because the psychiatrist is already familiar with the feelings of fear and mistrust in everyday, pre-scientific life. In other words, the understanding of other people that the physician possesses through daily living with them is presupposed in the doctor's more scientific work. The everyday world within which we communicate with others and strive to make sense of their experiences constitutes the larger social context within which medical understanding can emerge (16]. Because everyday experience constitutes the fundamental context that bestows meaning even on those activities that go beyond it, Husserl called the lifeworld "the foundation of meaning" for all of human existence (12]. He argued, however, that this basis of meaning had been forgotten in our modern age through the spread of the spirit of abstraction. This forgetfulness has led to a crisis in the meaning of humanity. We can no longer resolve our perplexity regarding the meaningfulness and coherence of human activities because we always overlook the ground and source of human meaning, the everyday lifeworld. Hence the basic value and meaning of humanity can be recovered, Husserl thought, only if this lifeworld is restored to its rightful place. The lifeworld, accordingly, is the foundation for both science and humanism. The present crisis of medicine can be overcome only if the lifeworld is recognized as "the foundation of meaning" of medical science and humanism. Restoring the lifeworld to its proper place becomes crucial therefore for our project of developing a phenomenological model for medicine. Doing so will not prove easy, however, because of the pervasive spirit of abstraction that prompts us to overlook the lifeworld. For this reason, we must devote some time to explicating the lifeworld and its central components: the lived body and understanding. Only when this fundamental reality is fully recognized as the ground of all experience will we then be able to describe the special features of medical science and medical humanism. Medicine takes on its true meaningfulness for human life when it is seen as arising out of and always relying on the lifeworld. Pre-Scientific Experience: the Lifeworld, the Lived Body, and Understanding If pre-scientific experience proves to serve as the genetic foundation for medicine, this pre-scientific origin must be at least sketched in its basic components. We shall focus on three constituents of pre-scientific life: the lifeworld, the lived body, and understanding. Our primary purpose in describing the lifeworld and the lived body is to indicate their differences from the physical universe and the biological organism depicted by science. We are describing everyday understanding because we wish to distinguish it from scientific understanding, although, as we shall maintain more extensively later, the former does provide the basis for