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01-03-2016 | Scientific Contribution

Heidegger, ontological death, and the healing professions

Author: Kevin A. Aho

Published in: Medicine, Health Care and Philosophy | Issue 1/2016

Abstract

In Being and Time, Martin Heidegger introduces a unique interpretation of death as a kind of world-collapse or breakdown of meaning that strips away our ability to understand and make sense of who we are. This is an ‘ontological death’ in the sense that we cannot be anything because the intelligible world that we draw on to fashion our identities and sustain our sense of self has lost all significance. On this account, death is not only an event that we can physiologically live through; it can happen numerous times throughout the finite span of our lives. This paper draws on Arthur Frank’s (At the will of the body: reflections on illness. Houghton, Boston, 1991) narrative of critical illness to concretize the experience of ‘ontological death’ and illuminate the unique challenges it poses for health care professionals. I turn to Heidegger’s conception of ‘resoluteness’ (Entschlossenheit) to address these challenges, arguing for the need of health care professionals to help establish a discursive context whereby the critically ill can begin to meaningfully express and interpret their experience of self-loss in a way that acknowledges the structural vulnerability of their own identities and is flexible enough to let go of those that have lost their significance or viability.

There has been a great deal of discussion on the meaning of death in Heidegger’s thought in recent years. Some of the more influential interpretations can be found in Blattner (1994, 2006), Carman (2003), Guignon (1983, 2011), Haugland (2000), Hoffman (1993), Mulhall (2005), Thomson (2013), and White (2005). For a concise overview of leading Anglophone interpretations of Heidegger on death, see Dreyfus (2005).

This interpretation is supported by the fact that Heidegger’s discussion of the myriad ways in which we cover over and evade the ‘mineness’ of death is clearly influenced by Leo Tolstoy’s The Death of Ivan Ilych, a story that provides what is perhaps the definitive existentialist account of death (e.g. Heidegger 1927/1962, 254n12).

For a comprehensive account of why Heidegger avoids an analysis of the body in Being and Time, see Aho (2009).

For a rich account of the relation between fear and anxiety as it pertains to being-towards-death, see Thomson (2013).

Understanding world-collapse as a structure of Dasein helps explain what Heidegger means when he says, “The ‘nothing’ exhibits itself as that in the face of which one has anxiety, this means that being-in-world [or Dasein] itself is that in the face of which anxiety is anxious” (1927/1962, 187).

This is why Heidegger can say that ontological death is both ‘certain’ and ‘indefinite’. The public world “covers up what is peculiar in death’s certainty—that it is possible at any moment. Along with the certainty of death goes the indefiniteness of its ‘when’.” (1927/1962, 258) Death is certain in the sense that the self-interpretive activity of being human is structured in a way that is always vulnerable to collapse; but it is indefinite in the sense that we have no idea if and when this collapse will happen.

I am indebted to Charles Guignon for pointing this out. For more on the ambiguous etymology of Entschlossenheit, see Stambaugh (1987).

Heidegger explains, “The rarity of the phenomenon [of anxiety] is an index that Dasein… remains concealed from itself… because of the way in which things have been publicly interpreted by ‘the Anyone’” (1927/1962, 190).

Heidegger also mentions that “anxiety is often conditioned by ‘physiological factors’” (1927/1962, 190), which may suggest that those individuals equipped with an especially strong or resilient nervous system may be shielded from ever experiencing their own structural vulnerability.

The data in Charmaz’s study comes from “73 in-depth interviews with 57 chronically ill persons in northern California who have various diagnoses such as cardiovascular disease, diabetes, cancer, multiple sclerosis, lupus erythematosus and so forth” (1983, 171).

Frank writes, for instance, of the ways in which his nurses focused only on his physical suffering, how they refused to use the word ‘cancer’ around him, referring to him merely as the “seminoma in [room] 53,” and how they frequently cited other patients as being much “much worse off” than he was (1991, 100–101). Indeed, the only way he could get his surgeon to talk meaningfully to him about his experience of suffering was by refusing to sign the consent form.

This does not mean Heidegger is promoting a kind of postmodern dismissal of selfhood. The interpretive activity of Dasein provides for a relatively cohesive and unified sense of self as a whole. The problem arises when I confuse the cohesiveness of my narrative identity with permanence and become convinced that the interpretation I have of myself is the ‘real me’.

It is important to note that Heidegger rejects the existentialist (e.g. Sartre’s) conception of the radical or absolute subject who creates her identity ex nihilo. This is because the meaning and significance of any identity Dasein commits to in the wake of ‘ontological death’ has already been established and interpreted by the public world. In short, Dasein, whether authentic or inauthentic, is never ‘world-less’. This is why Heidegger says, “Resoluteness, as authentic being-one’s-self, does not detach Dasein from its world, nor does it isolate it so that it becomes a free-floating ‘I’. And how should it, when resoluteness as authentic disclosedness, is authentically nothing else than being-in-the-world? Resoluteness brings the self right into its current concernful being-alongside what is ready-to-hand, and pushes it in solicitous being with others” (1927/1962, 298).

Aho, K. 2009. Heidegger’s neglect of the body. Albany, NY: SUNY Press.

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Title: Heidegger, ontological death, and the healing professions
Author: Kevin A. Aho
Publication date: 01-03-2016
Publisher: Springer Netherlands
Published in: Medicine, Health Care and Philosophy / Issue 1/2016
Print ISSN: 1386-7423
Electronic ISSN: 1572-8633
DOI: https://doi.org/10.1007/s11019-015-9639-4

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