Challenging Carel’s (2007) Phenomenological Account of Illness: What Physical Comedy May Tell Us About Defining Health and Illness

By Kaitlin Sibbald, The University of King’s College

Introduction

In this paper, I critically examine Havi Carel’s definitions of ‘health’ and ‘illness’ as explored in her article “Can I be Ill and Happy?”. Using analogous phenomenological accounts described in theories of comedy, I argue that Carel’s account is too limited to include all phenomenological experiences of health and illness and propose an adaptation to her definition to account for experiences she may neglect.

In “Can I be Ill and Happy?”, Havi Carel argues that incorporating a phenomenological account into how we understand illness gives credence to the lived experience of illness and opens up opportunities to achieve a state of health within illness (108). A phenomenological account focuses primarily on the lived experience of illness and how this affects a person’s relationship with her body and her world. It “directs our attention to an exploration of embodied consciousness, perception, and the…intersubjective dimensions of our being in the world” (Woods 124). Pertaining to illness, it attempts to understand the experience of the ill self in the world. Carel suggests that illness causes a phenomenological divide between the lived body and the biological body, which makes lived experience no longer valid (99). She then argues that finding a way to reconcile these two bodies allows for a state of health even though the biological body still remains biologically abnormal. Thus, Carel bases her definition of health on a unified experience of the lived and biological body and illness on separation of these two bodies, regardless of the presence of disease. She thus argues it is possible to achieve a state of health within illness.

While Carel’s paper offers valuable insight into the phenomenology of disease, and I agree with the proposal that biological understandings of disease should be supplemented with phenomenological accounts, I argue that her definition of health is still too limited. Carel argues that a division between the lived and biological body is problematic because it invalidates lived experience (99). Reconciling this divide, regardless of the biological state, promotes a state of health (Carel 108). I argue that this account is not comprehensive. On this view, health rests on the unity of the lived and biological bodies because, in this state, lived experience is validated. I argue that although she alludes to the problematic nature of illness, Carel does not explore the possiblity that the separation between the lived and biological bodies is itself problematic; it may lead to the problem of invalidating lived experience. I will attempt to make clear, therefore, that the phenomenological experience of illness lies not in the separation between the biological and lived bodies, but the problematic invalidation of lived experience that may result.

In order to make this argument, I will attempt to demonstrate that illness is not the only phenomenon that results from a division between the lived and biological bodies, but that experiencing physical comedy does as well. I will argue that because the difference between the two is that illness is experienced as problematic, and physical comedy is not, a phenomenological definition of illness should rest on the problematic nature of the division between the lived and material body instead of purely on the division. I will also draw on Paige Johnson’s empirical research to support this claim and suggest that when the problematic nature of invalidated lived experience disappears, what is left is what Carel describes as a state of health. In these circumstances, I argue that although the space between the biological and lived body is maintained, the person still moves towards a state of health because her lived experience has been validated, suggesting the problem may not be the separation, but the invalidation. Following, I will explore the applications of understanding health as a validation of lived experience and illness as an invalidation of lived experience to treatments of short term and dynamic illnesses. Finally, I argue that understanding health and illness in this way allows us to promote health in a greater number of people.

The Biological/Lived Body Divide in Illness and Physical Comedy

In this section, I argue that there is a similarity, from a phenomenological perspective, between laughter and illness by suggesting that both arise out of the same phenomenon, the separation between the lived body and the biological body.

I will begin by explaining one theory of why we find things comical. Henri Bergson’s Le Rire. Essai sur la signification du comique, was first published in 1900 and attempts to explain what things are humorous. Although he attempts to explain all forms of comedy, the one that I will focus on for this paper is physical comedy. Using various examples such as a person who sneezes while giving a speech and a man who slips and falls while walking, Bergson suggests a comic moment arises out of incongruence between the body and its expected lively fluidity.

Bergson, who is a dualist, suggests the body is made up of two parts, the material body and the soul. The material body is the actual matter that the body is made of. However, this body remains inanimate without a soul. The soul, which is “infinitely supple and perpetually in motion” (Bergson 293) animates the body with a synchronous graceful fluidity. This graceful body is what I will refer to as the ‘fluid body’. The fluid body is what we typically perceive in others and in ourselves when there is cohesion between what we actually do and what we are trying to do. It is constantly able to adapt to various circumstances and exists in harmony with the world. However, Bergson suggests that the material body, which cannot be as fluid as a soul, creates a tension and thus the body cannot always be the fluid body that the soul tries to make it. Instead, there are times when the body’s “machine like obstinacy” (Bergson 414) interrupts the fluid body’s relationship with the physical world. For example, someone who is walking down the street exhibits a fluid body, but when she slips and falls on a pebble, it is because the material body ceases to be fluid and adaptable, and is instead material and obstinate. Bergson suggests that it is these types of instances, those where we are drawn to the material bodies of others where the fluid body should exist, that are comic. As Bergson puts it, “ANY INCIDENT IS COMIC THAT CALLS OUR ATTENTION TO THE PHYSICAL IN A PERSON WHEN IT IS THE MORAL SIDE THAT IS CONCERNED [sic]” (Bergson 414).

In trying to defend the idea that health is different from the absence of disease, Carel (2007) explores the phenomenology of disease. Like Bergson, she too suggests a phenomenon emerges from incongruence within the body, but for her, this phenomenon is illness and not comedy. Citing Merleau-Ponty, Carel suggests that illness is one of the rare opportunities that we have to perceive the gap between the biological body and the lived body (98). For Carel, the biological body is the physical body, the body that is examined in the doctor’s office and that produces results that can be used for standardized tests (99). The lived body, in contrast, exhibits “mental-body unity” (Carel 100) and directs itself towards objects to achieve goals. It makes a person a “being in the world”(Carel 100). In illness, this unity is disrupted and a space emerges between the lived and material bodies. This state is negative both because it poses practical problems as well as metaphysical ones because it invalidates lived experience (Carel 99).

I propose there is a direct parallel between the ‘material body’ for Bergson and the ‘biological body’ for Carel, and similarly the ‘fluid body’ and the ‘lived body’ respectively. It is thus reasonable to then suggest that the gap between the biological body and the lived body that Carel perceives in illness is the same gap as the one between the material body and the lived body Bergson suggests creates comedy.

Before I proceed, I must address one major objection to my argument thus far. Bergson, writing at the turn of the 20th century, follows a Cartesian dualist model of the relationship between the mind and the body where the body and the soul are distinct entities that coexist in the same location. In contrast, Carel’s approach, along with that of others who study phenomenology, suggests this is not the case as “phenomenology can be understood as transgressing any dualistic picture of a soul living and directing the ways of the body like some ghost in a machine” (Svenaeus 100). It appears that these two ideas have roots in opposing theoretical schools, and so are irreconcilable. I suggest this is not the case.

I argue that although the properties of the mind and body differ on a metaphysical level for Carel and Bergson, on a physical level, they are still analogous. Thus, just as we do not have to agree that purple and orange are made of the same components to examine the relationship of these components when they form both primary and secondary colours, Carel and Bergson do not have to agree that the components of human existence are the same to produce the same types of experiential states. For example, Bergson suggests there is an a priori soul that has fluid properties and comes to inhabit a material body (293). In contrast for phenomenologists like Carel, ‘me-ness’ (Svenaeus 2013) is developed from bodily experience of the world with which the body interacts (Carel 100). While this is a pointed difference, it does not suggest that the same state cannot exist when things are working smoothly and when they are disrupted. For example, for both Bergson and Carel, when the body is working well, it is experienced as being invisible and seamlessly integrated into the world. This is because for Carel and other phenomenologists, ‘me-ness’ is developed from being in the world and so the two are seamlessly entwined. For Bergson, the soul is a fluid entity able to adapt to a variable world and thus also flows seamlessly with it. Similarly, both Carel and Bergson suggest that the materiality of the body sometimes causes it to show up and it resists one’s effort to live in synch with the world. I therefore argue that although these two theories are founded in different schools of thought that diverge in their conceptions of the properties of the mind and body, the states produced by the relationship between these entities are remarkably similar and therefore similar enough for my purposes.

Thus far, I hope to have illustrated that there are at least two phenomena that produce a similar division between the lived and material bodies, that of illness and that of physical comedy.

The Role of ‘The Problematic’ in Illness and Physical Comedy

I will now argue that what distinguishes these two phenomena is whether or not the experience is perceived as problematic. Carel (99) asserts that illness invalidates lived experiences and thus is problematic. If comedy is not also problematic, then this would be a feature that distinguishes between these two phenomena. As Robert Solomon suggests, comedy is not experienced as invalidating; in fact, it may be quite the opposite.

While every theory of laughter contributes important insight into what it means to laugh, the one from which I will draw my analysis is the Inferiority Theory, proposed by Robert Solomon. In this theory, laughter is seen as a way of changing self-image (Solomon 182). It makes one forget one’s sense of status and pretentious emotions such as pride, envy, and anger.  This theory suggests that there is a dignity in humor, “the dignity of the unpretentious” (Solomon 180).

In relation to the biological/lived body divide, under Solomon’s theory, laughter at oneself would indicate acknowledgement of the division between the lived body and the material body, and a lack of contempt for the division. Emerging instead is a sense of dignity in spite of and in light of this division. Solomon suggests there is a strength in laughter that comes from not taking oneself too seriously because “Humor is not ‘giving in’ and it is not weakness. It is a special kind of strength, harmony conceived in foolishness” (Solomon 181). Laughing at one’s self under this theory would indicate a harmonious existence in the world, regardless of a disunity between the lived and material body.

As physical comedy rests on a phenomenon comparable to illness, it thus follows that it may not be this phenomenon alone that causes the experience of illness. Instead, we may argue that the lived/biological divide has the potential to be experienced as illness or as comedy. However, as these two experiences have opposite properties, it is likely not to be both simultaneously. If, as Carel argues illness is experienced as invalidating and thus problematic and as Solomon argues comedy, through laughter, is experienced as dignifying and strengthening, we may look to this distinction to differentiate between the two phenomena. Thus, we may conclude that a more accurate conceptualization of the phenomenological experience of illness is the experience of the biological/lived body divide in a way that is invalidating to the person experiencing it.

How then can we produce health?

I have thus far argued that physical comedy and illness are rooted in the same phenomenon but experienced in different ways – illness is experienced as invalidating and comedy is typically experienced as, well, comic. It would thus follow that to get rid of the experience of illness, it is not necessary to get rid of the lived/biological divide as Carel argues – although it is indeed one possible way – but it may be enough to change one’s perception of the experience. Changing the experience from that of invalidation to validation, while maintaining a lived/biological body divide, may help to overcome the experience of illness and subsequently produce a state of health. Research by Johnson supports this possibility.

Paige Johnson conducted a qualitative study examining the relationship between spirituality and humor for nine women with breast cancer. She indeed found that humor helped the women to understand themselves better, helped them have the strength to help their families to cope, and helped them to laugh at themselves and at life (Johnson 694). Furthermore, much of this humor was surrounding their hair loss because of chemotherapy (Johnson 694), an example of circumstances where the lived and material bodies diverge. The lived body, for these women, has an identity that includes having hair, when this is not the reality for the physical body. Thus, the results of this study suggest that actualizing the potential humor in the division between the lived and material body impacts one’s understanding of the self and improves quality of life. One reason for this may be because humor recognizes and helps to cope with the phenomenological divide between the lived and material body that occurs in illness. In coping, the state of biological/lived body separation thus ceases to be problematic and can be used for benefit.

Thus, evidence supports the claim that laughter has beneficial effects on one’s well-being, but it remains to be seen whether or not we can say that the person who achieves these effects is in a state of improved health. I suggest that if we use Carel’s description, adopted from research by Lindsey, then we can.

Carel refers to Lindsey’s description of health within illness suggesting the following themes emerge: “honouring the self, creating opportunities, celebrating life, and transcending the self” (Carel 103). Similar themes, although worded differently, emerge in Johnson’s research. Johnson’s participants honored the self through understanding themselves better, created opportunities by wanting to help others, celebrated life by gaining purpose, and transcended the self by taking themselves less seriously (Johnson 694). Thus, by using humor to make the space between the lived and biological body validating, the participants in Johnson’s study achieved what Carel describes as a state of health within illness (Carel 103). We may thus conclude that the experience of illness arises not in the experience of the biological/lived body divide, but in the experience of this divide as problematic. And, we may see evidence that using humor to validate lived experience despite this divide, may produce what Carel defines as a state of health.

Possible Applications to Treatment and Research

The purpose of Carel’s paper is to argue that it is possible to achieve a state of health within illness. In order to avoid confusion, I will refer to this state as ‘health within disease’, where disease is a physiological ailment, and illness, as we have described, is the problematic phenomenological division between the lived and biological body. Carel argues that to produce a state of health within disease, the biological and lived bodies must be reconciled (108). However, I argue that because illness is not rooted in this division, but the invalidation that results, Carel’s account cannot consider all instances where a state of health within disease is achieved. I instead propose, using the example of how laughter promotes health, that it may be more accurate to conceive of health as validated lived experience that can be achieved despite disease by understanding the division between the lived and biological bodies as unproblematic, or by reconciling this divide in the manner Carel suggests. We may therefore pursue routes of treatment where it is impossible to reconcile this divide while maintaining the possibility of achieving the goal of health within disease.

I argue that viewing health as validated lived experience gives us a theoretical tool with an even wider ranging applicability than Carel’s. Carel argues that phenomenology allows us to understand health within disease, which in turn allows us to “understand the positive experience of well being by ill people” (108). However, she also suggests it can take months or years to achieve biological/lived body unity in illness (109). Many people with terminal illnesses do not have this time. As well, many diseases are progressive and thus the divide between the lived and biological body is constantly changing and often widening. For people experiencing these types of illnesses, it may be impossible to achieve the biological/lived body unity that Carel describes and thus may also be impossible for these people to achieve a state of health within disease.

However, just as Carel argues that lived/biological body unity in her account allows people to achieve a state of health despite not being able to achieve biological normality, the account provided here argues that validation of lived experiences allows people to achieve a state of health who otherwise could not achieve biological/lived body unity. It thus opens up opportunities for treatments, such as laughter, to direct people towards a state of health when other opportunities are not available. If one can come to view this change as unproblematic, and potentially as comic, it may produce a state of health within disease.

In some circumstances, it may also be desirable to pursue a state of health but undesirable to achieve biological/lived body unity. In the cases of acute illness or injury when the biological body will return to its normal unity with the lived body in a short time, a full transformation of the person’s lived world to achieve unity for just a short time seems unnecessary. It may also produce illness once the body is biologically returned to normal because the healed biological body is no longer congruent with the lived body that has adapted its state of being-in-the-world to accommodate disease. It is arguably still desirable to promote health in these states of biological/lived body division, but it may be more beneficial in the long run to do this by making the division cease to be problematic rather than to reconcile it.

Thus, I argue that because of her definition of illness, Carel’s account of how treatment can help overcome illness is incomplete. Treatments may overcome the problematic division of the biological and lived body because they repair this division, as Carel suggests (108), but, as I have argued using the example of laughter, they may also overcome the problematic division by framing it in a way that is no longer problematic. If both of these statements are true, then illness lies not in the division between the lived and biological body, but in the problem that this division creates. We may therefore also look to ways of ceasing to make the division between the lived and biological bodies problematic, as well as reconciling this division, if we are looking to promote a state of health within illness.

Final Remarks

Before I conclude, I must address some final points. Using the example of laughter, throughout this paper I have argued that comedy may be a useful way to overcome disease and produce a state of health. However, this does not mean that people should laugh at all outward physically manifested illness. Furthermore, it may not be possible for each person to come to view their experience of disease as comical. Laughter, as Bergson suggests, has a social signification (78) and whether we laugh at what is inherently potentially comic, as I have argued that diseases may be, depends on social factors. For example, although by Bergson’s definition (414) there is inherent comic potential in experiencing a car crash, whether we laugh at that crash will depend on factors like if it occurs on a major highway and involves one of our friends, if it playfully occurs in child’s play, or if it occurs in jest by clowns at a circus. Thus, we must distinguish between what is inherently comic, and what is comic and socially laughed at. As such, even though illness may have similar phenomenological roots to comedy, it is not appropriate to laugh at all ill people. We may also wish to pursue other ways of promoting the same phenomenological experience, such as through love or acceptance, which may have similar phenomenological roots as well.

Also, in this paper I have used the type of laughter described in Solomon’s Inferiority Theory of comedy to support the relationship between illness and comedy. However, it is important to consider that philosophy and physiology agree that there are multiple kinds of laughter with multiple different meanings, some of which promote harm in both the person who is laughing and the person who is laughed at (Smuts). As I have suggested that laughter may be an important tool for promoting health, it is important that there is further research to examine how it can best be used. It should not be assumed that all laughter, with its various social significations, works in the same way. Thus, although laughter may be an important tool for promoting a state of health within disease because of its phenomenological roots, it is important to understand how it is used and what effects it may have in order to prevent harm and further invalidate lived experience.

Finally, I wish to make one clarification on my use of Carel’s theory. Throughout her paper, Carel does allude to the fact that the biological/lived body division that is experienced as illness is inherently negative (105). Yet, she does not incorporate this element directly into her definition of illness, which states “The two bodies are torn apart, and the gap between them is acutely experienced as illness” (Carel 108) However, even if we generously grant that Carel agrees that illness must be experienced as a problematic division and not just a division, and that this problematic nature is inherent in defining illness, she does not explore the possibility of uncoupling this division from its problematic nature to produce a state of health. Her definition of health within disease still rests explicitly on the notion that this division is reconciled (Carel 109) and thus, she leaves no room for the experience of a divided, yet unproblematic conception of health. Using theories of laughter, and research by Johnson, I hope to have suggested that this may be possible and so a broader definition of health from a phenomenological perspective may be necessary.

Conclusion

In this paper, I hope to have suggested that, as Carel proposes, it is important to understand the phenomenology of illness in order to find ways of promoting health, particularly for those whose biological abnormalities have previously denied them entrance into this state. However, I challenged Carel’s stated definition of illness as a division between the lived and biological bodies. Using Bergson’s theory of the comic, I hope to have shown that the division between the biological and lived body may not only be experienced as illness, but also as physical comedy. As the division may result in at least two different experiences, there must be something distinct about the experience of illness, other than simply the experience of the division itself. I proposed that the distinction between the experience of illness and comedy is the experience of this division as problematic because it invalidates lived experience, as Carel (99) suggests. Using Solomon’s inferiority theory of laughter, I hope to have shown that the division between the lived and material body is problematic in illness, as Carel suggests, but not in laughter, as Solomon suggests. Johnson’s research seems to support this claim. Thus, we may define the experience of illness as an experience of the biological/lived body divide that is problematic and invalidating.

Carel (104) proposes that in defining illness as a lived/biological body division, we may find opportunities for treatment in reconciling this divide. I suggest that in defining illness in the way I have proposed, we may also find ways of promoting health by making this division unproblematic, as well as by reconciling it. For example, we may seek to make the division between the lived body and biological body unproblematic for those with progressive or temporary illnesses where reconciliation may be impossible, or undesirable. I have also proposed, that because of the link between physical comedy and illness, promoting humor, as Johnson did, may be one way of doing this. However, as laughter has social signification and it is not always appropriate to laugh, we must be careful in the way we apply this possible treatment. Thus, I argue that a phenomenological account of illness that defines illness as a problematic division between the lived and biological body is more accurate and more useful than a definition that views it simply as a division.

Works Cited

Bergson, Henri. Laughter: An Essay on the Meaning of the Comic. Trans. Cloudesley Brereton. Kindle HTML version, Gutenberg. 1900. Web. 2 Jan 2014.

Carel, Havi. “Can I be ill and happy?”. Philosophia 35 (2007): 95-110. Web. Feb. 2014.

Johnson, Paige. “The use of humor and its influences on spirituality and coping in breast cancer survivors”. Oncology Nurse Forum 29.4 (2002): 961-965. Web. 10 Feb 2014.

Solomon, Robert. “Are the three stooges funny? Soitainly! (Or when is it okay to laugh?).” Ethics and Values in the Information Age. Ed. J. Rudinow & A. Graybosch. Wadsworth. 2002. 180-187. Print.

Smuts, Aaron. Humor. Internet Encyclopedia of Philosophy: A Peer-Reviewed Academic Resource. Web. 1 May 2014.

Svenaeus, Fredrik. “What is phenomenology of medicine? Embodiment illness and being-in-the-world.” Health Illness and Disease: Philosophical Essays. Ed. H. Carel & R. Cooper. Durham: Acumen Publishing Limited, 2013. 99-111. Print.

Woods, Angela. “Beyond the wounded storyteller: Rethinking narrativity, illness and embodied self-experience.” Health Illness and Disease: Philosophical Essays. Ed. H. Carel & R. Cooper. Durham: Acumen Publishing Limited, 2013. 115-128. Print.

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