Fenomenologie van ziekte en abnormaliteit

Phenomenology of illness and abnormalityHabitually, illness or disease is considered as something abnormal. Therefore, the distinction between health/illness is often conflated with the distinction normal/abnormal. Inspired by Kurt Goldstein’s work, Merleau-Ponty makes clear, however, that abnormality does not automatically coincide with pathology. It is also interesting to note that Merleau-Ponty nowhere uses the term “abnormal” to indicate the opposite of the normal person. Similar to Georges Canguilhem he uses the pair “the normal (person)” (le normal) ‐ “the sick person”, “the pathological” (le malade, le pathologique). As Goldstein and Canguilhem make more explicit than Merleau-Ponty, the abnormal person or “deviant” is very often not sick. Instead of approaching physical symptoms from an external or statistical view (which might lead to the conclusion that something is abnormal), they claim that sickness should be defined by the patient’s own lived experience. Merleau-Ponty shares this view, but for different reasons. Goldstein and Canghuilhem, both trained clinicians, believe that patients’ own experiences should be central in clinical practice instead of objectifying measurements and tests. For Merleau-Ponty, the phenomenologist, objective physical features have no place within his phenomenology of lived bodily experience. Bracketing positivist scientific insights, phenomenology also excludes biomedical statistics from its analysis. If we assume that abnormality is a result from a comparison with what is statistically seen as normal, this means that a phenomenology of abnormal embodiment might seem a contradiction in terms. In this paper, however, I would like to show that abnormal embodiment can also be approached from a phenomenological perspective. While drawing on some ideas by Hacking on the history of statistical reasoning, I demonstrate how the statistics of abnormality directly interconnects with lived experience. Hacking explains how the descriptive “average” or “mean” has become the normative “normal”. Because our world is in many ways determined by averages, it is an illusion to think that phenomenology can just bracket statistics. The one who appears physically as abnormal can, comparable to the one who is ill, experience that his or her embodied possibilities to deal with the world dwindle. What I show in this article is that even though a clear distinction can be made between illness and abnormality, both can be accompanied by a reduction or disruption of the “I can”.