November 13, 2008

As a sociologist, not a philosopher, I must admit that I was slightly hesitant about reviewing this book. However, I am glad that I did. I can honestly say that this was one of the most profoundly moving (as well as academically worthwhile) books I have had the pleasure (if that is the correct word) to read for a long while.

Essentially Carel has aimed to make philosophical sense out of the concept of illness and has written a book founded on her own experience of living with Lymphangioleiomyomatosis (LAM), a rare, fatal lung disease for which there is currently no treatment or cure.

Initially reading the book sleeve, I imagined it would be a cathartic indulgence; a look into a personal world of degenerative illness - but how wrong I was. As Carel says, "this 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". And it certainly does.

The book seamlessly blends philosophical writings in illness (mainly those of Merleau-Ponty and Heidegger) with phenomenology to privilege the first-person experience of illness. It begins with a discussion of what is meant by the phenomenology of illness, and by the end of the first chapter it is clear why Carel chose to adopt a phenomenological approach. We learn more about how the illness affects her on a personal basis, rather than a simple statistical charting of her decreasing lung function.

Next, Carel examines the social world of illness. She suggests that rather than viewing illness through either the first or third person (depending on your relationship to it), it should be managed through what Buber calls the I-Thou encounter, of one person genuinely encountering another. Using this approach to illness, Carel argues that the principal exchange between doctors and patients should be more empathetic and compassionate, rather than based on the "objective" method most commonly associated with Western approaches to health and illness.

Later chapters examine death and what Carel terms "health within illness". Here, the philosophical discussion centres on Heidegger's characterisation of human existence as "being able to be". Carel asks whether ageing and illness means coming to terms with being unable to be. Given that somebody might be ill, does being ill mean that he or she is unable to have a good life?

From an academic perspective, the book appears to cut across several disciplines. Most certainly philosophical in orientation, it also examines issues of Cartesian mind-body dualism along with the social aspects of death and dying. Drawing on Heidegger again, Carel suggests that to accept death we need to also accept that our life is finite, from birth to death, and being towards death captures the temporal existence of human existence. Despite its philosophical underpinning, the book is easy to read. It is written in such a way that the reader is made to feel, as well as understand, the subjective experience of the ill person.

From a teaching resource perspective in the social sciences (and sociology in particular), this book will be a useful addition on reading lists for modules that examine illness and disability and death and dying from what C. Wright Mills termed the "Sociological Imagination" (ie, history, biography and structure). Carel's blunt description of her encounters with two individuals whom she calls "the rude man" and "the horrible man" have the potential to generate excellent discussions about how both the individual and society deal with illness and disability.

Finally, the book will also be a useful addition to research methods courses as a definitive example of how the phenomenological perspective can help us to understand subjective meanings and feelings.


By Havi Carel. Acumen Publishing, 160pp, £9.99. ISBN 9781844651528 Published 18 September 2008.

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