Text and disease: thinking beyond Ricoeur

Ricoeur, in explicating the anti-foundationalism of hermeneutics, which rests on the phenomenological legacy of Husserl but is resolutely opposed to its idealism as a metaphysical nostalgia for the Hegelian absolute, places the philosophically informed work of hermeneutics in the immanence of the text, whereby the texuality of the text, or its being, is the being that exists beyond the subjectivity of the author, even the field of her comprehension (Ricoeur 1975, p. 91 and p. 94).

In the context of nursing theory, which has as its imperative the healing of the patient or the palliative care of the dying, what confronts the nurse is not only the texuality of her communication with the patient, but with the sheer immanence of the patient’s diseased condition itself. Without falling into the objectivism of pathophysiology, the hermeneutically trained nurse looks for the uncanny (unheimlich) belonging-together of Dasein and disease in the being-in-the-world of the patient as the starting point of interpretation. Hence, founded upon the existential projection of care (Sorge), nursing practice, when it takes on the reflexivity of thought in philosophy, has a unique Sache which differentiates itself from the academic hermeneutic practice in the humanities, which preoccupies itself almost exclusively with texts both ancient and modern.

Hermeneutics and universality – part one

In Being and time Heidegger sets out to elevate the traditional, metaphysical understanding of being as a universal to a higher level that lays the ground for his important insight of ontological difference: being is not just any being, nor is it simply “every possible determination existent in a being” (Heidegger, 1996, p. 38). The starting point of Heidegger’s fundamental ontology is that “being is not a genus of beings” (ibid.). Heidegger differentiates being (Sein) from beings (Seiende), even if the latter is in every instance appropriated by the former in the Ereignis of fundamental understanding. Being transcends beings – but Heidegger is careful not to repeat the metaphysical understanding of transcendens as koinon, but to ground it in what he calls the ecstatic-temporal unity of the hermeneutic horizon that allows us to think being beyond beings (ibid., marginal remark). Given that the hermeneutic circle is, methodologically speaking, the interpretative consequence of ontological difference, its circularity has a universal structure embedded in the nature of understanding. Understanding itself has the universality of transcendence in that every understanding has understanding of being (Seinsverständnis) as its ground.

The being of care (Sorge) in nursing is the patient – the sick as distinct from the healthy. Resonating with Heidegger’s fundamental ontology in method and in structure, a hermeneutic nursing theory is grounded not in the koinon of patient care, which is the brute fact of the sickness of patients, but in the specific being-with (Mitsein) of nurse and patient that allows for the universality of hermeneutic circle to be grounded through dialogue and communication, which necessarily involve understanding and interpretation. In existential terms, both nurse and patient are thrown (geworfen) together into a situation where there is an implicit understanding of healing or, in the case of terminal illness, palliative care. However, given that the patient is not an object but a person, i.e. a Dasein capable of uncovering the meaning of its being, the situation in nursing care is necessarily hermeneutic. What a hermeneutic nursing theory does is to make this ontological facticity explicit.

For Heidegger, experience places Dasein in a hermeneutic situation in that on the primordial level, it concerns itself with the understanding of being as the uncovering of the truth of being of Dasein, so that the meaning of being of Dasein can come within its horizon of comprehensibility. In contrast to the mood of French existentialism, the affliction of disease is not absurd, but has a meaning waiting to be interpreted and integrated into the whole or holon of the patient’s being. The suffering and possibly shortened life expectancy brought about by disease, whether acute or chronic, places the being of a patient in a situation where there is a sense of urgency in making sense of how to continue with life.