Gadamer - What Is It To Be Healthy ?
Modern medicine has only a negative definition of health – the absence of disease. But what does a positive understanding look like ? And what does it say about our time that we have no such understanding ? Philosopher Hans-Georg Gadamer gives us some insight into these questions.
Like his teacher Martin Heidegger, Gadamer was a sharp critic of Modernity, and in particular the limitations of Modern science and technology as a way of understanding and living in the world. The scientific world view posits truth as something ‘objective’, standing outside of ourselves, timeless, placeless, universal in its application, and as such best captured in the abstract language of mathematics. Gadamer, by contrast, saw truth as an event, a phenomenon, that reveals as much about ourselves as it does about its content. Truth is historical in the sense that how we define it, what we count as truth, evolves over time, it forms part of a tradition, our tradition. Science is no different, it belongs to a particular conception of truth that arose in Western Europe in the early part of the 17th century, and continues to dominate our world today.
From this insight, Gadamer developed the field of ‘hermeneutics’, which is the study of understanding, interpretation. He sought to establish a position that would allow us to understand science itself, and the technology it has generated, from a critical standpoint, to see the limits and the dangers posed by its universalising, totalising, nature. Gadamer sought to preserve a historical perspective, the very possibility of history, that is, the capacity to interpret and understand the world in NEW ways, and to create ways of living that reflect this. It is this ability that Modern science and technology places under threat, for its conception of truth is a totalitarian one, it allows room for no other.
Among his lesser known works is a book entitled, ‘The Enigma Of Health’ with the subtitle, ‘The Art Of Healing In A Scientific Age’. Here Gadamer turns his attention to Modern medicine, and his critique of current medical practice is of great relevance to the debates raging over nutrition at the present time.
Gadamer’s first observation is that while Modern science has shown a strong capability to combat and even eradicate many illnesses that have plagued humanity in the past, this capacity does not “equally extend to fostering and sustaining human health and natural well-being”.* (p.328) This echoes my own argument that the nutrition mainstream lacks any positive definition of health, viewing it purely as the absence of disease (see here). Gadamer also puts this in a similar context, stating that the aim of medicine is to enable, “patients to recover their health and to return to their everyday lives”. (p.332) Sickness is a problem not because it demonstrates the absence of health, but because it disrupts a daily existence in which health plays no positive role, where physicality plays no positive part, and which therefore has no meaningful conception of what it is to be healthy (see here).
Modern medicine is well suited to tackle disease because its essential project is “the mastery and control of nature” (p.329). When it comes to health, however, it comes up empty. This is because health is not something to be controlled, it is something to be produced, this sets it apart from a microbe that only needs to be discovered and neutralised. Health does not exist in the objective world, it is not something knowledge can grasp and then recreate in a laboratory, it is something we, as human beings, generate through the way we live, it is a product of our life-world.
On this basis, Gadamer provides us with an initial understanding of what health is – it is to live in a life-world, to be connected to that life-world, to belong within it. If we take the men of Ancient Greece as an example, health was intimately related to athleticism, the ability to throw a discus, to wrestle, and to sprint on the sports field, and to be the victor in battle. Health was defined in these positive terms, and as we shall see, not only for their practical utility, but on aesthetic grounds. In the same way, illness was understood negatively, as what prevents us from possessing these positive attributes of health, from bringing them out into the light of day, for all to see and appreciate. Obesity hides our natural shape, it keeps it hidden from view, our health is “concealed”. (p.332)
This is the direct opposite to our Modern conception, where we have a positive understanding of disease – we can name every one, list them, describe them in great detail, and, apart from the chronic conditions, for the most part successfully treat them, but, we have only a negative definition of health, an empty category, the absence of… illness.
Gadamer’s conception allows us to see what is wrong with the current practice of medicine. If health is a connection, a belonging, an ability to thrive, within a life-world, then disease is first and foremost a problem of DISCONNECTION. If we are sick, it means we are disconnected from health, from our life-world, for whatever reason, and the task of the healer is to restore this connection. This is of course a ‘holistic’ approach to medicine, something the Greeks themselves made explicit, as in the words ascribed to Phaedrus by Plato (p.334) This leads to a view of healing as a ‘praxis’, an art, rather than ‘techne’, a science, in the sense that each patient finds themselves in a unique set of circumstances, those of their life situation, and the skill of the doctor is to help find a way to navigate through that situation successfully. This stands in contrast to the idea that what the doctor does is apply a scientifically valid, as in standard, universal, treatment, that ideally is proven to work in all cases under known conditions. In our time medical practitioners do not treat patients, they treat diseases, over which they apply mastery and control through the use of technology. This is why the default treatment is always a drug that targets a symptom, or a virus, or a tumour, and it is why diagnostics are always preferred when they are quantified, given in numbers, translated into the abstract language of mathematics.
Gadamer examines this question of measurement, drawing on Socrates’ differentiation in ‘The Statesman’ between two Greek terms – ‘metron’ and ‘metrion’ to make his point (p.335). “the first kind - preferred by modern science - tries to apply a uniform (possibly quantitative) scale to all phenomena”. We measure the size of a tumour in standardised units, we compare bloods against a reference range. The second is entirely different – here we seek what is “fitting” or “appropriate” for that particular individual, in the context of their life-world, the metric we use is set against alternatives that are less fitting or inappropriate for that same person. This calls for ‘phronesis’, the life skill of knowing what to do next.
This introduction of ‘appropriateness’ is extremely important. It brings in an ethical dimension to the problem. This is something I have been trying to do consistently on this blog, in my manner of argument. If we take the macronutrients as our example, which I say we should forget about, my claim is NOT a scientific one. I am not trying to say ‘there are no such things as carbohydrates, protein, and lipids’. Instead I am arguing that from my point of view, as an ethical carnivore, opposed to the nutrition mainstream, it is not HELPFUL, or appropriate, to adopt these categories when thinking about food, for reasons I go on to explain (see here). Unlike a truth claim, which we can settle by looking at the evidence, the persuasive power of my argument rests on whether you accept my ethical position. If you agree with the nutrition establishment and their recommended way of eating, if you share their conception of ‘the good life’, then you will be unconvinced and will stick with macronutrients.
Likewise if you hold the view that our current way of life in the West is a desirable one, then you will be content with Modern medical practice, including its negative definition of health and its treatment of disease. This is because they are all a package, they are ‘fitting’ to one another. You will also be comfortable with its disinterest in curing long term illnesses such as diabetes, even though this is easy enough to do through a simple modification in diet, focusing instead on managing symptoms indefinitely with pharmaceuticals.
Our conception of what it is to be healthy, therefore, is a DECISION, it is an ethical choice. Once we have made such a decision, we are then in a position to decide what is ‘fitting’ or ‘appropriate’ as a way of eating. This is why I choose carnivore, it is because I associate red meat with strength, with virility, with fertility, with beauty, and with grace. It is because I value these qualities that I make the choices I do over food, and it is my invitation to you to do the same if you share these values.
Health understood as musical harmony
Gadamer’s approach is consistent with this way of posing the issue, as is his next move, which is to bring the aesthetic angle into view. For Gadamer, the best model for understanding the nature of health is MUSIC, musical harmony in particular. This idea is similar to Cate Shanahan’s use of the term ‘proportion’ as part of her positive definition of beauty, as applied to the female human form (see here). The significance of this is that it also slips out of the domain of techne, for harmony is not something we control, it is something we FIND, and allow to appear by not standing in its way. Shanahan follows the same reasoning when in discussing what is a healthy diet she places the emphasis on child development, one that permits a child to develop PERFECTLY and so emerge as a BEAUTIFUL person. We recognise a healthy way of eating in the BEAUTY it produces, the measure is an aesthetic one, and it is metrion not metron because the beauty is a product of nature, not of technology, and it belongs to that person, it is uniquely theirs’. It also belongs to us, in allowing it to shine forth, in nurturing it, in recognising it, and in valuing it.
It is on this basis that we can critique mainstream nutrition, because it lacks ANY sense of beauty, it is completely indifferent to this question, it has nothing to say on the matter. It has no concept of harmony, of proportion, and it makes no effort to nurture one, it does not include these as metrions against which to measure its dietary recommendations. This is why it is silent in the face of such widespread disfigurement among the younger generation today – fat, skinny fat, boxy, stumpy – never in human history has any society witnessed such massive disproportions across its population as what we see now, and these people are considered ‘healthy’.
This IS a negative definition of health, it is where it leads. We see the results all around us, not just in the creeping catastrophe of chronic illness, obesity, diabetes, Alzheimers, but equally among those who are not ‘sick’, not incapacitated, who do participate in our life-world, in everyday living. The debate over nutrition is for them too, its for all of us, and it goes way beyond the question of what to eat for dinner. Gadamer helps us place this discussion in its proper, historical context, and to understand what is at stake.
* All citations are taken from Fred Dallmayr’s discussion of Gadamer’s “Enigma of Health”, which is available online here. Some are Gadamer’s own words, others are Dallmayr’s paraphrasing. See the text itself for clarification over which is which.
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