Richard J. Severson

This is chapter 4 of my book, Medicine, A Phenomenological Inquiry.

Uses of phenomenology:

Many notable philosophers of the 20th century were phenomenologists, including Edmund Husserl, the movement’s chief architect, Martin Heidegger, Jean-Paul Sartre, Maurice Merleau-Ponty, and Hans Jonas, to name a few.  In the broadest possible terms, phenomenology is a theory of subjective experience.  A handful of trademark concepts exemplify the phenomenological perspective.  One of them is intentionality.  Every conscious experience, whether it is a feeling, thought, daydream, etc., is about something; it always has an intended object.  It’s easy enough to test that basic assumption: Try thinking about nothing in particular.  Without a topic to focus upon, we can’t really think at all.  Consequently, phenomenologists came to the conclusion that all of our subjective experiences require a world within which to operate.  There must be something outside of ourselves that engages our attention.  That something is the world. 

The second trademark concept of phenomenology, therefore, is being in the world.  It is our cares and concerns that bind us to projects that take us outward into the world.  Strange as it may seem, being in the world precedes our sense of self-awareness.  Whenever we become conscious of ourselves, or anything else for that matter, we are already enmeshed in a world of meaningful connections.  How could I recognize a hammer if I didn’t already comprehend what to do with it?  We come to know ourselves through our worldly activities, not by living inside our own heads.  Being in the world is the basis for our existence. 

The third trademark concept is time-consciousness.  Being in the world is something we experience temporally.  Our self-identities are like streaming narratives that reach backward and forward in time, weaving together our memories with future plans and expectations in the ever-changing moments of the present.  Life itself is a movement through time: every creature is born, grows up, then passes away.  Finitude is the price of existence.  As I mentioned before, anxiety is a mood that collapses the future upon us, thereby throwing us into rough contact with our own mortality.  Love does the exact opposite.  Of a beloved person, we invariably say, “I have always loved her (or him/them).”  That can’t be literally true since none of us has been alive forever.  But it is true nonetheless because finding a soul mate puts us in touch with the eternality of time.  We never despair of the belittling circumstances in life when there is someone to share our love.  In that sense, love is the fulfillment of subjective time, which is why it transcends even the collapse of time we experience as anxiety.     

The final trademark concept of phenomenology that I want to mention is embodiment.  (My list isn’t meant to be exhaustive.)  Our bodies create an affective communion with the world that precedes sensation and consciousness.  We don’t “have” bodies, we are our bodies.  Normally, we aren’t even aware of our bodies as objects of concern.  When writing a letter, for instance, I am not aware of how my hand grips and moves the pen across the paper.  Instead, my attention is focused on choosing the proper words to express my intended meaning.  Our bodies remain invisible to us so that we can focus on our worldly tasks.  Only when they betray us do we become aware of them as objects of concern.  If I can’t hold a pen to write my letter, for instance, then my hand becomes a concern to me.  Sickness is experienced as such a betrayal, a disruption to my normal being in the world.      

Phenomenology has made its way into medical research primarily as a method for describing the experience of sickness from the unique perspective of the patient.  In one study, researchers turned to phenomenology to get a better understanding of why schizophrenic patients are so often re-hospitalized. 1 They discovered that the key difference between schizophrenic patients who avoided re-hospitalization and those who were frequently re-hospitalized was in how they interpreted their circumstances in life.  The frequently re-hospitalized patients saw themselves as powerless, always in need of help from others, never able to measure up to the normative ideals of life—getting a good job and buying a house, for instance.  In their own eyes, they were utter failures in life, a constant burden to their families.  On the other hand, those who were never re-hospitalized viewed their own marginalization as a positive choice, not something imposed upon them by others.  They made their own friends instead of relying upon their families, and tried to make the best of their solitude by pursuing spiritual practices rather than material success.  They rejected the idea that their lives were meaningless, or burdensome to others.  They were also more playful and subversive regarding the sober realities of their situation, successfully constructing a unique life-world that served their purposes on the margins of society. 

Most rehab theories prescribe a normative world that excludes schizophrenics.  That’s why it is such a difficult task for them to avoid re-hospitalization.  It takes imagination and courage to renegotiate a meaningful place in the world for those who suffer such a fate.  Their own response to the disease is what makes the biggest difference to their success in life.  Phenomenology proved to be most insightful for understanding their unique problems.

I already mentioned the work of medical phenomenologist Kay Toombs in chapter one.2 She argued that the world of physicians isn’t compatible with the world of patients.  That’s why so many patients are frustrated by the care they receive, especially those who suffer chronic illnesses such as multiple sclerosis, as Toombs herself does.  Physicians view patient’s through the lens of their vast nosology.  Patients represent typical cases of disease, not unique individuals whose world has been disrupted, which is how patients experience sickness.  They feel betrayed by their own bodies.  Normally, we don’t want our bodies to be the focus of attention because that detracts from the ability to engage in our worldly projects.  We would never get things done if we couldn’t take our own embodiment—and health—for granted.  Being sick forces us to attend to our bodies, which creates a sense of disappointment and alienation.  What we can’t do usurps what we can, and the world shrinks accordingly.  “I’m no longer myself.”  That’s one of the things we say when stricken by illness.  The implications are far-reaching, as perhaps only phenomenological inquiry can fully disclose. 

According to Toombs, we shouldn’t assume that the two worlds of physician and patient are interchangeable, nor should we assume that the medical focus on treating diseases is sufficient for true healing.  We must attend to the subjective experience of sickness as well, and address the problems of being in the world that it represents.  Actually, I think Toombs’s message concerning the incompatibility of the two worlds is the tacit perspective in most medical phenomenology studies.  Their purpose is to humanize the medical encounter of patients by drawing attention to the “thick” implications of what it means to be sick.  It is a world-altering experience, which means that it is also a self-altering experience because being in the world is our manner of existence; it’s through our worldly engagements that we come to know ourselves.  Describing the subjective experience of illness isn’t the only role that phenomenology plays in medicine, however.  It’s also proven to be useful in the neurosciences, particularly with regard to issues surrounding consciousness and self-identity.  I will discuss the theoretical import of neurophenomenology in the next chapter.  For now, I want to focus on how phenomenology fits into my argument.   

There are two unusual pairings at the heart of my argument.  The first one is biology and spirituality.  Normally, they go together about as well as water and oil.  Biology is one of the natural sciences, spirituality a very ancient set of transcendental practices.  In my interpretation, medicine stands halfway between the two, bridging the gap that has separated the sciences and humanities for several centuries.  The German term for the humanities—Geisteswissenschaften—is revealing here.  It literally means science or study of the spirit.  The second unusual pairing in my argument is shamanism and modern medicine.  They don’t mix any better than biology and spirituality.  Most historians of medicine ignore shamanism, dismissing it as superstition, magic, or proto-religion.  As I made clear in chapter one, I look to the philosophical biology of Hans Jonas in my efforts to combine these seemingly discordant subject pairs.3 

Jonas studied under Heidegger, whose efforts to revitalize the ancient question of the meaning of being never fully panned out.  Being and Time, the book that made Heidegger famous in 1927, was actually an unfinished manuscript that he published anyway.4 In the era of modern science, however, it is more urgent to understand the ontological significance of life rather than rehashing old philosophical quandaries.  That’s what Jonas believed.  He made Heidegger’s phenomenological project more relevant by applying it to the study of biology.  According to Jonas, human existence represents the acme of life in its quest for more and more freedom; through our experience, life itself came to full consciousness regarding its own precarious journey.  Heidegger had tried to say something similar—that our being in the world is the illumination of being as such—but he couldn’t make it work.  Jonas completed the project for him by turning to biology instead.  Biology, he said, represents the only ontology possible for us. 

In Jonas’s interpretation, biology is pregnant with spiritual overtones.  Since all living organisms must feed themselves in order to survive, the most rudimentary principle of biology is metabolism.  In the necessity to reach out into the world to find sustenance, the tenets of human spirituality are already foreshadowed.  From its very beginnings, life has been burdened with the task of rising above the substrate of inanimate matter.  A spirituality rooted in biology is compatible with scientific materialism.  That was Jonas’s conviction.  The desire to keep on living for as long as possible in defiance of life’s mortal predicament motivates every organism.  In our species alone—so far as we know—that desire to transcend the belittling circumstances of life has become part of our consciousness.  The question is, how did we become fully aware of life’s existential predicament?  What spawned our unique sense of spiritual transcendence?  My claim is that medicine did. 

The desire to help those who are suffering is the first inkling of our spiritual nature.  Like every other creature, our early ancestors wanted to keep on living for as long as possible.  At some point in their development, the subversion of illness and death became a deliberate set of practices, not just an instinctive response to pain or danger.  They built shelters and weapons to protect themselves from predators and rival groups; consumed a variety of foods which helped mitigate the severities of parasites and famine; concocted teas to sooth intestinal ailments, and so forth.  They learned the medicinal uses of various herbs, barks, and clays very early on.5 They began developing rudimentary creation myths and animistic beliefs even before the widespread use of language.  I think that’s what the first curing rituals represent.  They began taking mental risks as well—flights of imagination and time travel to recover lost souls.  Why would they undergo such experimental behaviors?  Surely, it wasn’t for recreational purposes.  I think they did it out of a desperate need to help their loved ones to get well.  They appealed to animal spirits as guides and helpers.  The roots of our spiritual evolution were tied to practical matters of survival—protecting the group; caring for the sick and injured—not to grandiose theologies or dreams of heaven.  That came much later. 

Shamans were the architects of the soul.  They engineered the biology of consciousness by taking risks in order to assist those who were in distress.  They expanded their own sense of time-consciousness, especially with regard to the distant past of our origins; then they taught others how to follow suit.  When disaster struck, they were able to set the world right again through their powers of imagination.  They didn’t have a ready-made blueprint for molding the mental structures that we take for granted today.  Our mental prowess emerged haphazardly, born out of the desperate desire to help the sick and injured.  Full consciousness of our mortal predicament in life—the essence of human spirituality—emerged gradually from the front lines of medicine where shamans practiced their arts of healing.  From morality to medicine to spirituality: this is the trajectory of our cognitive evolution as I interpret it.  Whereas morality taught us to share in order to survive as a group, medicine taught us to fight back against sickness and death.  Gradually, medical intervention in life’s mortal journey gave rise to the lofty aspirations of our great spiritual awakening.  Both medicine and spirituality represent an impertinent response to the belittling circumstances of existence.  It all began with the daring tactics of the first doctors.   

Regarding the second unusual pairing in my argument—between shamanism and modern medicine—I take my initial cue from Jonas’s claim that there have been only two instances of universal agreement about the meaning of life and death in the history of our species.  As I discussed in chapter one, animism represented the first such grand synthesis, and scientific materialism the second.  Without exception, animism was the worldview of every Stone Age culture, while scientific materialism dominates the worldview of every modern culture—even those with strong religious traditions still intact.  The cognitive and cultural changes that led us from animism to modern science have been in the works for tens of thousands of years.  For my purposes, the most significant shift in that slow progression was the great reversal in time-consciousness that occurred at the dawn of the modern era.  What distinguishes animists from scientists is their orientation to time.  Our distant forebears were obsessed with the past.  It was the horizon of their dreams and governing myths that they believed would shape reality for all time to come.  Contrast that with modern exuberance regarding the future, and the unforeseen possibilities that await us.  These mindsets are worlds apart, with drastically different perspectives about the purpose of the universe and the meaning of existence.  Their incommensurability reveals just how crucial time-consciousness really is to our sense of self-identity.  What intrigues me, of course, is the role that medicine has played—and is currently playing—in the construction of these different perspectives regarding who and what we are. 

What evidence is there for the great reversal in time-consciousness that is so important to my argument?  I think there is no question that animism is oriented toward the mythic past, and that shamans tried to heal the world, and their communities, by restoring the perfect harmony of that aboriginal time.  The concept of hozho in traditional Navajo culture is a good example.  It’s usually translated as beauty, and to “walk in beauty” is the purpose of Navajo life.  It means that all one’s relationships—with nature, family, community, and the Holy People who were part of the original creation—are in a state of harmony.  Sickness is a sign of disharmony in these relationships.  The shaman, or hatali, sings the world back into its original state of order through complex ceremonies such as the Mountain Chant that can last up to nine days.  The restoration of the original state of creation in its perfect harmony is the objective of every healing ceremony.  For traditional Navajos, the mythic past holds the key to the beauty way even today.  

In western civilization, there is clear evidence that the mythic past dominated our sense of time-consciousness all the way through the Middle Ages, an era in which St. Augustine’s teachings were definitive.  In Book XI of the Confessions, written at the end of the 4th century, Augustine posed the question, “What, then, is time?”6 His answer is one of the most famous descriptions of time ever written.  It heavily influenced Husserl, Heidegger, and other phenomenologists.  Augustine’s description of time focused on memory and the importance of the past, whereas Heidegger’s description decidedly favors the future.  A brief comparison of the two will provide unmistakable evidence of the great reversal in time-consciousness.

In the beginning, how did God make heaven and earth?  That question led Augustine to his famous analysis of time.  Since nothing existed before creation, it puzzled him how (not that, but how) God could make heaven and earth from nothing.  According to Genesis, God spoke and that is how creation occurred.  Yet how could God speak if there was no time yet within which words could make their sound and then disappear as new words followed in their place until what God said was finished?  Even God, he reasoned, must follow the laws of time if time existed.  But it did not exist before creation; therefore, the first thing God created was time, and everything else emerged afterwards.  That’s what Augustine surmised.  Then he wondered, what is this phenomenon that is so closely entwined with God’s own creative identity?  The standard paradoxes of time—for instance, how can we anticipate the future if it does not yet exist?—flummoxed the saint until he carefully analyzed what occurs when a psalm is recited.  First, the mind extends itself forward when nothing yet has happened and no time has passed.  Then the recitation begins, and what was grasped in anticipation—the psalm in its unspoken entirety—begins to pass through the present with each spoken word.  Finally, the mind extends itself backward as the spoken words accumulate in memory until the entire experience of recitation is finished.   

In Augustine’s interpretation, time-consciousness is a metaphor for the fallen soul.  The soul is torn backwards and forward in the havoc of bad memories and futile expectations, reduced to a confusing state of endless temptation and internal struggle.  Time-consciousness is a burden that we bear, a mark of our troubled existence.  The soul is saved from its own temporal confusion when the havoc of change is infused with the stillness of God’s eternal presence.  Thus redeemed, the soul is restored to its peaceful repose.  The memory of God’s creation is the one thing that matters most in the Bible, and the Christian soul.  That’s how Augustine viewed time-consciousness.  His understanding wasn’t drastically different than what traditional shamans had been teaching for tens of thousands of years. 

What is important for Heidegger’s analysis of time-consciousness, in contrast to Augustine’s, is the role of being in the world.  Our primordial state of existence is to find ourselves already fully engaged in the midst of life.  We live outward and forward into the world, not in the repose of our reflective minds.  That is why Heidegger interprets the subjective experiences of time as ecstasies instead of memories and expectations.  An ecstatic experience is one that throws us into the middle of things unexpectedly.  The past, or “having been,” is experienced in moods that disclose the gestalt conditions of our existence.  The experience of anxiety, for instance, throws us into proximity with our own death.  It is a suffocating mood, as if there can be no escaping from the fate of having to die.  Only the past conveys such finality because it is already over and done with.  Moods represent a holistic transformation that sweeps over us with the power of a traumatic memory.  By the time I recognize my mood, I am already engulfed by it.  On the other hand, the future, or “not yet,” is experienced as an obligation of understanding.  In the thrownness of being in the world, we feel the necessity to look around and understand our predicament.  Anxiety throws us into proximity with our own death, but we must interpret what it means in order to understand the true direness of our situation.  Every mood has its understanding, just as every understanding has its mood.  That is the circle of time-consciousness as Heidegger viewed it.  To embrace our own mortality with full understanding is what authenticity meant to Heidegger.  We are obligated to face forward into the world with an openness that cannot be deterred. 

The call of conscience for Heidegger was to remain open to the future, however grim, whereas the call of conscience for Augustine was to restore the original condition of the soul.  One entails the obligation to look forward in time, the other to look backward in time.  The stark difference in their outlook is an indication of how the future finally eclipsed the past in human imagination.  It freed us from the burden of always having to look backward in order to go forward.  We have set aside that crooked path for good, and it has changed the meaning of our existence.   

Being in the world is a primordial experience according to Heidegger.  That means it precedes self-awareness and the ideation that we associate with thinking, planning, making decisions, daydreaming, etc.  How does Heidegger’s interpretation of being in the world align with what we know about the experience of early humans?  If being in the world is indeed primordial to human existence, our distant forebears must have had a similar sense of what life entailed.  The soul was unstable in its earliest formations because our ancestors didn’t have the memory capacity to sustain the level of consciousness that we so easily manage today.  How did they expand the parameters of the conscious mind?  I have been arguing that they did it through time travel and other efforts of imagination.  It must have required thousands of years of practice before the out of body experience of traveling into the past could be normalized into what we now experience as ordinary feats of recollection.  It is Heidegger’s interpretation of time-consciousness as a form of ecstasy that connects his phenomenology to my argument about the first doctors of the soul. 

In his landmark study of shamanism, Mircea Eliade claimed that shamans were masters of ecstasy.7 “Ecstasy” referred to their special talent for inducing trance states in themselves and others, which enabled them to travel to other places and times mentally.  In their efforts to heal the sick, they visited places in the sky and beneath the earth where the spirits of the dead congregated.  These were the same places that lost souls gathered as well.  Shamans negotiated with these spirits on behalf of their community in order to set the world on the right path again, thereby healing the sick.  What they undertook as risky out of body experiences eventually became, for us, ordinary feats of recollection and expectation.  Heidegger found traces of this ancient practice of ecstasy in the “having been” and “not yet” experiences of being thrown into the world.  In its original shamanic form, that is precisely what time-consciousness represented.  What took such skill and effort for them to achieve, we now take for granted as the routine workings of the subconscious mind.  

Not everything about Heidegger’s phenomenology of time-consciousness matches up with early human experience.  His analysis privileges the future, whereas our distant ancestors were focused upon their origins in the distant past.  In cognitive evolution, humans mastered the past first, and it is only in recent centuries that we have managed to displace the importance of the past for the sake of the future.  That great reversal in time-consciousness required the invention of external memory devices in order to supplement our own modest biological memory capacities which are best suited for narrative constructions.  It is simply not possible to plan a trip to the moon on a rocket ship without the support of mathematics, blueprints, computers, books, precision manufacturing, etc.  As I have said previously, we mastered the past first because it was the easier task, and the most amenable to biological memory.  We had to look outside of ourselves and invent a new kind of memory in order to construct the modern world.  Heidegger’s analysis of time-consciousness was meant as a critique of objectivism, though not the future orientation of modern existence.  Not only did he privilege the future, he also favored the individual.  It is in the confrontation with one’s own personal death that authenticity is achieved; that is the epitome of modern individualism.  Yet for our forebears, the community was most important, not the individual.  In order to restore harmony to the world, they looked to the distant past of their origins.  Creation was utopian in its original form; therefore, any manifestation of sickness, strife, famine, natural disaster, etc., was a sign of infidelity to a way of life handed down from eternity.  To this day, our minds long for the peace and tranquility of simpler times.  It is part of our cognitive heritage to revere the past.  The arduous path we have taken to overcome that ingrained biological bias is mind boggling, and the consequences are still unfolding.        

It is an irony of philosophy that phenomenology was invented to get us out of our heads and back into the world.  Being in the world eschews the priority of thinking over existing, a hallmark of idealism since the time of Plato.  Descartes is the modern philosopher who usually gets bashed for separating mind and body.  Phenomenology can be read as a creative response to Cartesian dualism; it’s why embodiment is so crucial to the movement.  In another twist of irony, Heidegger completely neglected the importance of embodiment even though the concept of being in the world traces to his work.  It was Merleau-Ponty who explored the co-extensiveness of the body and the world.8 “The world is not what I think,” he said, “but what I live,” (lxx).  There is a communion with things, an emergent constellation of physical relationships, that undergirds our being in the world. 

Because of his theory of a body-world communion, Merleau-Ponty has been very influential in medical phenomenology.  It makes perfect sense, for instance, that I would experience sickness as a disruption to my world if in fact my body is co-extensive with it.  Normally, the bond of body and world is invisible to us so that we can direct our attention toward the projects that engage us in the world.  We become aware of being sick or injured when we can no longer do something.  What is the first realization that I have a headache?  It’s probably when I find it impossible to concentrate on the work I am trying to finish.  When we are sick—when our bodies fail us—we experience it as a diminishment of the world because we can no longer do what we normally expect.  Living requires a world within which to live, and a body with which to do it.       

In The Spell of the Sensuous, David Abram made use of Merleau-Ponty’s phenomenology to describe the beneficial aspects of the animistic perspective that humanity set aside in its march toward modern civilization.9 Our hunter-gatherer ancestors had cultivated harmonious relationships—spiritual communions—with the entire universe as a living system, including mountains, rivers, wind, sun, moon, insects, birds, fish, four-legged creatures, grasslands, forests, etc.  It’s a worldview that we no longer understand, though there are traces of it to be found in the primordial experiences of our own embodiment.  According to Abram, everything changed with the invention of the alphabet.  It seems like a small thing to have instigated such a sweeping transformation, perhaps, but it represented the beginning of a process of alienation from the natural world that is still ongoing.  Because of its simplicity, the alphabet enabled us to convey in writing every imaginable thought that occurred to us.  Books, in addition to other tools of external memory, became the locus of our values and interests.  Slowly but surely, the ties that bound us to the natural world were replaced by the products of our own ingenuity.  While awash in our own inventions and cultural achievements, we live alone in an environment that now stands on the brink of mass extinctions and ecological collapse.        

I find Abram’s environmental classic relevant to my argument on several fronts.  For one thing, he turned to phenomenology as a way of recovering the primordial worldview of shamans.  They were intermediaries who employed their rituals and ecstatic journeys to maintain good relations with the more-than-human world around them.  They knew how to communicate with animals, for instance, and negotiate with them regarding human transgressions.  Abram noted that the original purpose of his research amongst indigenous people in Indonesia and Nepal was to study the role of magic in the practice of shamanic medicine.  He abandoned that goal when he learned that shamans believed their greater purpose was to maintain harmony between people and the natural environment.  That’s why he ended up writing an environmental tract instead of a medical one.  As he saw it, healing was a secondary outcome of shamanic ritual rather than the primary outcome.  I am not convinced that such a distinction is really necessary.

If not in response to sickness, injury, famine, warfare, or some other calamity, what would have motivated shamans to undertake dangerous journeys of ecstasy?  For them, harmony had a restorative purpose; it wasn’t a fanciful ideal.  Abram analyzed the historical meaning of the alphabet, an invention that came after the Stone Age had already ended.  He didn’t ask how or why shamans invented their practices, however.  It is a matter of speculation, of course, but I think there are enough clues to suggest how significant the experience of sickness was to the emergence of shamanism.  Even in traditional societies that still survive in the modern world, shamans are routinely called to their profession after suffering serious illness.  That is the case for the Hmong who migrated from Southeast Asia to California, Minnesota, and other places in the United States after the Vietnam war.  Anne Fadiman reported on the tragic misunderstanding between Lia Lee’s parents and the medical doctors who treated her for epilepsy in The Spirit Catches You and You Fall Down.10  To Lia’s family, her illness was an honor, a potential calling to become a Txiv Neeb (Hmong shaman), not a humiliating disease. 

I have argued that shamans were the original inventors of the soul.  Their efforts to heal the sick inadvertently led to the expansion and stabilization of human consciousness.  Were it not for their risk-taking experiments in time-travel, we would not have become so facile at merging past, present, and future into a seamless stream of consciousness.  As a species, we have been evolving through our own deliberate efforts for a long, long time.  It’s not just the alphabet and other artifacts of civilization that determine our fate.  What was it like to undertake journeys of the mind before the mind was fully capable of such feats?  That was the existential situation shamans faced.  Our abilities to think, plan, remember, and so forth, are not derived from biological evolution alone.  There is no such thing as a thinking gene.  We had to work at developing our cognitive capacities, and shamans played a critical role in that effort.  What motivated them?  They didn’t have a blueprint, or a crystal ball, that told them what to do.  Instead, they responded to the crises and competitive pressures that threatened the existence of their communities.  They undertook journeys of ecstasy in order to save their neighbors from harm.  To subvert the belittling circumstances of existence on behalf of others is the epitome of shamanism—and of modern medicine as well. 

If human sickness is a mark of disharmony in the natural world, then preventing it from happening in the first place is the best medicine of all.  That was the shamanic role long before the Greek medical tradition of Hygeia, or healthy living, was established.  In my view, the distinction between ecology and medicine is becoming less sustainable every day.  The two branches of bioethics—environmental ethics and biomedical ethics—are converging out of existential necessity.  If the ecosystems of the earth are unhealthy because of our bad habits, then our health is at risk as well.  Deep ecology is a form of preventative medicine that we would do well to practice.  That message already resonates with the nature cure traditions that stem from the Romantic movement.  Environmental medicine focuses upon the harmful effects of pollution, which misses the larger point of living in harmony with nature; but it’s a start. Ecopsychology is a new discipline with a promising research agenda regarding the health benefits of encounters with animals, green spaces, wilderness, etc.  Evolutionary medicine is also well positioned to subvert our own self-importance as a species, and put our fate back into the biological context where it belongs.  There is no denying the vital connections between air, water, earth, and every living thing, which includes Homo sapiens as just one species among many. 

There is a basic distinction in the uses of phenomenology that is important to my argument.  For example, I think Abram relies upon it to reprise the primordial experience of enchantment with the natural world.  He wants to recover the profound connections to the earth that the animistic worldview afforded our ancestors.  Like many deep ecologists, he thinks we have lost something that is more valuable than what was gained by taking the path to civilization.  Heidegger also wanted to reprise an aboriginal experience of authenticity.  That’s not my purpose in the use of phenomenology, however.  I think what we are witnessing today, especially in the neurosciences, is a recapitulation of the conundrums faced by our hunter-gatherer forbearers.  We are not reprising their experience and point of view; instead, we are confronting similar problems in a novel way.  Once again, I take my direction from Jonas in this matter.  He gave a very sympathetic interpretation of animism, but he did not waver in his turn to the materialism of modern biology.  He tried to outline what a biological spirituality might look like.  I have argued that modern medicine is a better source of a new form of human spirituality than biology.  Biology doesn’t share the same unwavering commitment to subvert the belittling circumstances of existence that has characterized the practice of medicine for tens of thousands of years.   

A new kind of biological spirituality is emerging on the neuroscientific frontier of modern medicine.  We are witnessing not a reprisal of ancient shamanism, but a recapitulation of its experimental adventure in the construction of human self-identity.  I rely upon phenomenology to help me understand time-consciousness, embodiment, and other crucial categories of our existence.  I am not trying to claim that modern medicine needs to become more like shamanism; rather, I am arguing that modern medicine already is like shamanism because it stands at the forefront of a new experiment in what it means to be human.  Shamanism invented the soul, a stable platform of human self-identity that has persisted for more than 50,000 years.  What we are witnessing today is the invention of a new kind of self-identity that is grounded in the biology of the brain rather than the animism of the soul.  It is the analogy with shamanism that is fruitful for my purposes.  Shamanism inspired our first spiritual awakening.  Is it possible that modern medicine is achieving something similar today?  That is the question that motivated me to write this book.  It’s about the spiritual awakening of medicine, not the spiritual history of it.  I find Jonas’s phenomenology of life especially useful in the interpretation of biology, medicine, and spirituality.  In my view, medicine is the bridge that connects our biology and spirituality.  It has been that way from the beginning of our uniquely self-aware mortal adventure. 

In the next chapter, I continue the discussion of the uses of phenomenology by focusing upon the new discipline called neurophenomenology.  It entails the application of phenomenology to the study of the brain.  The biology of the brain represents a new frontier in the age-old effort to make sense of the mortal adventure of our own existence.  There is a revolution afoot regarding the meaning of consciousness and self-identity.  What are its spiritual implications?  We must look to medicine to find out because that is where the new knowledge of the neurosciences will find its application in the real world.  Our own existence is the laboratory of the neurosciences.  It’s why an fMRI scan of the brain at work is one of the iconic images of our times.  It’s also why phenomenology as a theory of subjective experience is so vitally useful.      


  1. Ellen Corin, “The Thickness of Being: Intentional Worlds, Strategies of Identity, and Experience Among Schizophrenics,” Psychiatry 61 (Summer 1998), 133-46.
  2. S. Kay Toombs, The Meaning of Illness: A Phenomenological Account of the Different Perspectives of Physician and Patient (Kluwer, 1992).
  3. Hans Jonas, The Phenomenon of Life: Toward a Philosophical Biology (Harper and Row, 1966). 
  4. Martin Heidegger, Being and Time (Harper, 1962 [1927]).
  5. Timothy Johns, With Bitter Herbs They Shall Eat It: Chemical Ecology and the Origins of Human Diet and Medicine (University of Arizona, 1990). 
  6. St. Augustine, Confessions (Penguin, 1961). 
  7. Mircea Eliade, Shamanism: Archaic Techniques of Ecstasy (Princeton University, 1964). 
  8. Maurice Merleau-Ponty, Phenomenology of Perception (Routledge, 2012 [1945]). 
  9. David Abram, The Spell of the Sensuous: Perception and Language in a More-Than-Human World (Vintage, 1997). 
  10. Anne Fadiman, The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cutures (Farrar, Strauss, and Giroux, 1998). 

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