Biomedical Engineering Reference
In-Depth Information
in this attitude is often called the
meaning
of experience. Lived experience,
on the one hand, and the theories and results of natural science, on the
other, are meaningful in entirely different ways; suffering from the ravages
of an illness, for example, is something altogether different from coldly
cataloguing the characteristics of a disease.
8
Science, as a human activity that
strives to solve puzzles and produce new results, is no doubt meaningful,
but the manner of explanation particular to science, with its focus on causal
relations within nature, is not directly tied to the everyday world. The
meaning that phenomenology investigates is not found within the causal
patterns of the world studied by science (the brain in the case of SSRIs), but
in the subjective perspective the person develops on herself and the world
around her in everyday life.
Phenomenology, which started out as a philosophical tradition - the most
famous names are Edmund Husserl, Martin Heidegger, Maurice Merleau-
Ponty, Jean-Paul Sartre, Paul Ricoeur and Hans-Georg Gadamer - found
quick response in other disciplines, such as aesthetics, psychology, sociology,
ethnography and pedagogy, and developed into a vast fi eld of different
research programs. In the last three decades, phenomenology has also
gained some attention within the discipline of medicine (Toombs 2001), and
particularly so within psychiatry (Spitzer
et al
. 1993). My phenomenological
approach in this chapter should be understood as a conceptual, philosophical
analysis, rather than as a piece of qualitative, empirical research, but the
analysis is nevertheless linked to interviews with doctors and patients about
SSRIs, and to different fi ndings in empirical disciplines about depression and
medication.
9
What should we expect from a phenomenological analysis of the SSRI
revolution? Which questions does the analysis need to address to make us
better understand the issues involved? One pressing question is the one
concerning
normality
. When an SSRI is prescribed this seems to indicate that
the patient is suffering from an illness. How is the border between health
and ill-health to be drawn regarding the kind of suffering associated with
SSRI medication? The phenomenologist addresses this question on the life-
world level (illness), and not on the level of biological functioning of the
brain (disease). That this approach is particularly fi tting in the case of SSRIs,
even though the drugs in question, of course, have a biological impact on
the serotonin level in the brain, becomes clear when we turn to the models
of psychiatric diagnosis. There are no diagnostic tests for serotonin levels
in the brain (so far) to be used on patients; instead, doctors rely on clinical
experience and diagnostic manuals in their judgments on treatment.
10
The psychiatric diagnosis
A brief look into one of the two psychiatric bibles for diagnosis, DSM-IV
(2000) (the other one is ICD-10 [2004]), reveals what kind of questions
and observations are supposed to be made by the doctor in order to decide
