Reading existentialism through the lens of Buddhism is especially illuminating in this regard because, as we saw earlier, there is an obvious tendency in the existentialist tradition to romanticize suffering as if it signified a life lived with more self-awareness, intensity, and passion. The aim of Buddhism is not to simply recognize that the human condition is fraught with meaningless pain. Nor is it to show that there are deeper levels of suffering rooted in the fundamental impermanence of things and in our conditioned efforts to deny impermanence by clinging to things we hope will make us real. Existentialists have made similar points. The difference is that Buddhism attempts to offer a ‘path’ or ‘way’ to end suffering by showing us how we can decondition our reflexive need to secure ourselves from the threat of impermanence. By cultivating the meditative practices of the fourth noble truth, Buddhism teaches us how to free ourselves from attachments, to become centered and still in the flux of impermanence rather than compulsively recoiling from it. Such practices silence the din of habituated thoughts, feelings, memories, and desires that keep alive the illusion of the self, and in the stillness one is able to merge into the flux and become no-thing. In these moments, there is no suffering because there is no self.
Recent scholarly conversations between existentialism and Buddhism have helped to breathe life into the emerging field of comparative philosophy, helping to legitimize Eastern thought not only in the mainstream philosophical tradition, but also in new approaches to psychotherapy and psychiatry and to healthcare practices in general. With the issue of human suffering now fully in view, we can turn our attention to our final topic, a practical one that engages the question of what it means to be healthy or ill. In this concluding section, we will see how existentialism offers an important corrective to scientific medicine by challenging healthcare professionals to see their patients as more than biological bodies that need to be ‘fixed’ but as vulnerable, self-interpreting beings that, more than anything, need to be able to make sense of and give meaning to their condition.
Health and illness
Tolstoy's The Death of Ivan Ilych is arguably the most powerful account of an individual confronting death in world literature. But hidden within the story is a compelling indictment of modern medicine and the scientific worldview in general for being poorly equipped to address the experience of human suffering. After injuring himself in a banal home decorating accident — falling off a ladder while hanging curtains in his new house — Ivan is plagued by a persistent pain in his left side. The pain gradually becomes worse and is accompanied by a strange taste in his mouth and increasing irritability. Reluctantly, he goes to see the doctor. Tolstoy's description of Ivan's clinical encounter paints the classic picture of the modern doctor as a detached observer, dispassionately gazing at the suffering Ivan from the perspective of objectivity. For the doctor, Ivan doesn't show up as a frightened and vulnerable human being but as an interesting set of symptoms to be observed and categorized and that may lead to a diagnosis of a floating kidney, chronic catarrh, or perhaps appendicitis. For Ivan, the doctor's detachment is not only cold and impersonal; it is dehumanizing in its failure to address the gravity of his condition. Ivan doesn't want to know what disease he has and what pills to take; he wants to know if he is going to live or die. “ ‘Vermiform appendix! Kidney!’ he said to himself. ‘It's not a question of appendix or kidney, but of life and … death’ ” (Tolstoy 1960, 129–130, my emphasis).
Ivan's frustration with the doctor is symptomatic of a larger problem in modern medicine, where the aim of the healthcare professional is to fit the human being into preestablished diagnostic categories with little attention paid to the patient's own needs and feelings. The patient is reduced to a set of objective and testable facts, to heart rate and blood pressure, to cholesterol levels and kidney and liver functioning. From this perspective, the first-person reports of the patient's own experience often get in the way of a proper medical assessment. What is of primary importance for the doctor is the diseased body itself, not how the patient lives, feels, or interprets their dis-ease. The signature piece of equipment in modern medicine, the stethoscope, helps to illuminate this point.
The invention of the stethoscope in the early nineteenth century allowed the doctor to attend, with objectivity and precision, solely to the sounds emanating from the body, and it has became a symbol of the scientific distance that should exist between doctor and patient. Instead of attending to the voice of the person, the stethoscope made it possible to listen only to the palpitations and rumblings of the heart and lungs. With this technological breakthrough, doctors began to neglect, even distrust, the patient's own words, regarding them as unreliable and subjective. The patient came to be treated more as an object of scientific investigation than as a suffering person (Svenaeus 2001, 30–31). And with each new observational tool or ‘scope’ introduced in the clinic — from the ophthalmoscope and rhinoscope to the otoscope and gastroscope, to X-rays, CAT scans, and MRIs — the further medicine has moved away from attending to the lived experience of the patient and toward the objective facts that are read off the body from the instruments, resulting in an increasingly impersonal and instrumental approach to care (Aho and Aho 2008, 79).
But, as figures like Merleau-Ponty, Heidegger, Beauvoir, and Marcel have shown, the human being is not a ‘material body’ (Körper) whose biological functions can be controlled and measured. Such a view creates the impression that the body is somehow separate and distinct from me. But my body is not something external; it is what I am; it is a ‘lived body’ (Leib). In fleshing out the distinction between Körper and Leib, existentialists illuminate the extent to which self and body are bound together and that any experience, perception, or feeling we have is invariably embodied. In this sense, the body cannot be understood as a static thing in the world. It is, rather, the mediating activity or way of being through which the world comes into being for us. And when we are healthy and caught up in the flow of everyday life, our body actually recedes from our awareness, operating inconspicuously as we move about, handle equipment, and engage in various situations. When struck with a serious illness or injury, however, there is a breakdown in this seamless flow, and the body begins to obtrude as something foreign and clumsy (e.g., Fuchs 2005, Leder 1990, Svenaeus 2001, Toombs 1992). Indeed, we may only become aware of our body when it is dysfunctional, and this dysfunction can fundamentally alter our self-understanding and experience of the world (Nettleton 2001, 53). In Ivan's case, his taken-for-granted ability to walk, get dressed, bathe, and use the toilet begins to erode. His once manageable and well-ordered world eventually shatters, and he retreats to his room, shutting out his friends and family. His previously sociable and optimistic disposition is replaced with dark brooding and dread. Tolstoy makes it clear that living his body has dramatically transformed who Ivan is.