We talked about the phenomenological Approach in philosophy I thought it be interesting to look at it in a different form.
Keywords:
- phenomenology;
- Merleau-Ponty;
- perception;
- intentionality;
- embodiment;
- nursing research
Abstract
Abstract
Phenomenology has proved to be a popular methodology for nursing
research. I argue, however, that phenomenological nursing research could
be strengthened by greater attention to its philosophical
underpinnings. Many research reports devote more page space to procedure
than to the philosophy that purportedly guided it. The philosophy of
Maurice Merleau-Ponty is an excellent fit for nursing, although his work
has received less attention than that of Husserl and Heidegger. In this
paper, I examine the life and thought of Merleau-Ponty, with emphasis
on concepts, such as perception, intentionality and embodiment, which
have particular relevance to the discipline of nursing.
How remote from their clumsy pride was the task which they considered insignificant and left in dust and must – the task of description – although the subtlest fingers and senses can scarcely be subtle enough for it. (Friedrich Nietzsche)
Phenomenological
research methodology is devoted to that ‘task of description’ of which
Nietzche spoke. When well written, the report of a phenomenological
study can move readers to tears. Such a report can take clinicians into
the lifeworld of their patients in a deeper way, often producing
astonishment as well as empathy and compassion. Nursing studies
conducted from a phenomenological stance have yielded compelling
descriptions of the lived experience of diverse disease conditions (e.g.
addiction, anorexia, arthritis, cancer) and symptoms (e.g. air hunger,
chronic pain, urinary incontinence), as well as more elusive phenomena
such as courage and caring (Koch, 1995; Carpenter et al., 1999).
I argue, however, that phenomenological nursing research could be
strengthened by greater attention to its philosophical underpinnings.
The work of Maurice Merleau-Ponty provides an excellent philosophical
base for advancing nursing research, and I seek to kindle excitement
about it among other scholars. I begin by describing my personal odyssey
as a researcher.
Discarding the mechanistic lens
For
much of modern nursing's history, medicine's mechanistic lens for
seeing phenomena also was nursing's lens. Patients’ bodies were viewed
as malfunctioning machines and their complaints as problems to be solved
using a linear hypothetico-deductive thought process. Likewise, nursing
research proceeded from specifying a ‘problem’ to operationalizing
discrete, measurable variables such as ‘stress’, to statistical testing
of the null hypothesis (Thomas & Pollio, 2002).
I became dissatisfied with this approach when my programme of research
began to focus on women's stress and anger. For example, no
questionnaire measures women's vicarious stress, which proved to be the
stressor of greatest magnitude for women in a study by my research team (Thomas, 1993).
Study participants had completed a well-validated and reliable stress
instrument, but an open-ended question ultimately revealed the
shortcomings of this instrument. The open-ended question, added almost
as an afterthought, permitted the women to describe their greatest
distress in their own words.
What most
troubled my study participants were events happening to their
significant others, such as the impending divorce of a son, job problems
of a husband, illness of a sister or friend. In these stressful
circumstances the women suffered empathically along with their loved
ones but had little or no control over what was transpiring. Vicarious
stress was not amenable to traditional stress management strategies
directed toward marshalling personal resources and gaining mastery. It
fuelled a chronic, impotent anger. I realized that the nature of this
stress, and the concomitant anger, of these women would not have been
revealed by any of the commonly utilized instruments. To understand what
they felt, I needed to plumb the complexities of their relational
commitments to partners, friends, and extended families. I needed to
invite them to describe their experience in an unfettered manner,
telling their stories of emotional distress with all the inherent
messiness that cannot be neatly operationalized and factor-analysed.
Experiences such as this led me to phenomenological methodology. Before the ink was dry on my first book about women's anger (Thomas, 1993),
based largely on quantitative research data, I had formed a new
research team and plunged into phenomenological investigation. I was
soon stunned by the realization that the quantitative project had
completely missed an essential dimension of women's anger experience:
the intermingling of deep hurt with their anger. Women often said, ‘I
don’t know if I’m more angry or hurt; I’m hurt and angry.’ (Thomas et al., 1998)
The hurt emanated from violations of an implicit relational contract
that women understood to be present between themselves and their
significant others. What women expected was reciprocity in their close
relationships. When others let them down, their emotional response was
an amalgam of painful feelings – feelings that were often
suppressed for fear of alienating intimates or causing relationship
termination. These research findings had significant implications for
extant cognitive-behavioural anger management interventions, none of
which addressed these complexly interwoven aspects of women's anger.
None of the ‘valid and reliable’ anger instruments had permitted
discovery of these findings.
So I became a
‘convert’ to phenomenology, but well aware of my limitations and hungry
for greater knowledge. Long a reader of existential philosophers such
as Kierkegaard, Camus, and Sartre, I felt comfortable with existential
tenets. But I had been trained solely as a quantitative researcher. What
did I know about qualitative research methodology? What did I know
about phenomenology? It is said that when the learner is ready, the
teacher will appear. I had actually taken a course in existential
phenomenology as a doctoral student and enjoyed my first dabbling in the
work of Merleau-Ponty (Merleau-Ponty, 1945),
but at the time I was thoroughly captivated by beta weights,
Bonferronis and significant Fs. As the years passed, sometimes I would
see my teacher around campus. He would ask what I was studying, and he
would gently suggest that phenomenological interviews might be
revelatory. Finally, I heard what he was saying. One day, 15 years after
the first course, I enrolled in his class again, and Merleau-Ponty now
made so much more sense. I experienced an epiphany. I was home. I have
been immersed in existential phenomenology ever since, at first a mere
novice in my professor's weekly research group, then a collaborator, and
finally a coleader. Our interdisciplinary group has been meeting weekly
for 12 years now. There is something very special about our Tuesday
afternoon meetings. About 15–20 faculty and students from nursing,
education, psychology, geography, exercise science and other disciplines
gather together for the reading of phenomenological interview
transcripts. Enthusiasm about our approach has been kindled in dozens of
colleagues and students, some of whom contributed to our 2002 book, Listening to Patients (Thomas & Pollio, 2002).
Why choose phenomenology for the study of emotion?
I contend that only within existential phenomenology has emotion been given a central place in human existence (Heidegger, 1927; Sartre & Frechtman, 1939).
Earlier philosophies tended to view emotion as inferior to reason;
being ‘emotional’ led to mistakes, madness and sin. Within existential
phenomenology, the various forms of being emotional are viewed as
diverse ways of being-in-the-world (Fischer et al., 1989),
and the phenomenologist is interested in their meanings. Sartre was one
of the first to offer an account of emotion, proposing that emotion is
the way consciousness changes the world from deterministic to magical (Sartre, 1939).
For example, an emotion like anger could be used strategically, to
achieve one's ends when faced with the struggles and difficulties of a
deterministic world. Emotions are gestalts that move us to action; they
cannot be reduced to physiological alterations or motor behaviours (Sartre, 1939).
Yet much contemporary research focuses on discrete aspects of emotion
such as changes in facial musculature or neurotransmitters. Pribram has
commented on this trend, ‘It was not so very long ago that I attended a
symposium on “emotion” at an international congress in Madrid. The
participants discussed factor analysis, limbic neuroanatomy, and operant
conditioning. Somewhere in the agenda emotions were hidden from view,
lurking in the dark alleys of our ignorance. No one even dared used the
term’ (Pribram et al., 1980,
p. 246). It is time to uncover the meanings of anger, stress and
depression from the first-person perspective of individuals experiencing
these feelings. Perhaps they have value and purpose. Existential
phenomenology offers a way to engage in respectful dialogue with people
and glean richly nuanced and contextualized descriptions of their
emotions. While other qualitative approaches employ a dialogical method,
what is unique here is the specific philosophical lens.
Choosing the specific philosophical lens for the study of emotion
To enable me to see emotional phenomena freshly, I chose a new lens derived from the philosophy of Maurice Merleau-Ponty (Merleau-Ponty, 1945).
I liked his antireductionist and antipositivist stance. I liked his
explicit rejection of Cartesian mind–body dualism. He contended that the
‘I’ which thinks is inseparable from his body and his lived situation; a
person is an indissoluble unity. In contrast to Heidegger, whose focus
was on the abstract nature of being, Merleau-Ponty was concerned with a
science of human beings (Cohen, 1987).
The specific aim of his phenomenology was to give a direct description,
not a causal explanation, of experience. Merleau-Ponty exhorted us to
examine the immediacy of experience before it is objectified by science.
He believed that true philosophy is relearning to see the world. Thus,
he urged us to be astonished by the world, to see it with open and
wondering eyes.
Merleau-Ponty (1908–61)
was a contemporary of philosophical luminaries such as Husserl, Sartre,
and Heidegger. In early 20th century Europe, immersed in the horror of
two world wars being fought in their own lands, it is not surprising
that these German and French philosophers were grappling with issues of
anxiety, death, freedom, responsibility and the very meaning of human
existence. A remote and abstract philosophy could no longer be
satisfying to them. Their personal experiences undoubtedly provided
impetus for their philosophical musings. Thus, it is important to note
that Merleau-Ponty served in the French army in World War II and
suffered imprisonment and torture by the Germans (Thomas & Pollio, 2002).
Just as we must seek to understand the situational context of our
research participants’– and patients’– experiences, so also we must
consider the writings of phenomenological philosophers in light of the
war-torn lifeworld into which they had been thrust. For that reason, we
will delve further into key events of Merleau-Ponty's life a bit later.
Origins and evolution of phenomenology
Phenomenology
had originated in German philosophy but soon gained adherents in other
European countries such as France, Belgium and Holland. The historical
evolution of the phenomenological movement has been ably traced by
others (Spiegelberg, 1981; Cohen, 1987; Reeder, 1987). The movement has been characterized as a ‘set of waves’ (Reeder, 1987) in a vast groundswell of ‘antireductionist and anticonstructionist’ thinking that had begun in the nineteenth century (Spiegelberg, 1981, p.
xi). No unity was achieved within this European intellectual movement,
although there was a common aversion to the prevailing mechanistic
research paradigm of the behaviourists. Much of the European work was
unknown for some time in the English-speaking world, including that of
Merleau-Ponty, whose work was first translated into English relatively
recently in 1962 (Merleau-Ponty, 1945).
Phenomenology in nursing
Articles on phenomenology began to appear in the nursing literature in the 1970s, with early treatises by Paterson & Zderad (1976), Parse (1981), Oiler (1982) and Omery (1983).
Over the ensuing decades, phenomenology has become quite popular.
Although a number of nurses now call themselves phenomenologists, there
is considerable diversity amongst us. According to Caelli (2000),
18 different forms of phenomenology have been identified. Dominant
within nursing literature have been Husserlian phenomenology,
Heideggerian phenomenology and variants of the ‘Dutch school’. What
nurses in America, Australia and other western countries are doing today
under the putative umbrella of phenomenology is very different from the
solitary reflections of twentieth century European philosophers. While Crotty (1996) accused contemporary nurse scholars of misinterpreting European phenomenological philosophy, Caelli (2000) contended that deliberate choices were made to develop new ways of applying phenomenological philosophy to inquiry. Drew (2001,
p. 16), speaking of the legacy of Husserl's ideas, reminded us that it
is the task of researchers to decide ‘how . . . philosophic ideas are
put into action’. Silverman (1987,
p. 6) commended the new generation of American phenomenological
researchers who are marking out ‘clear and original paths’. But clarity
regarding these ‘paths’ is lacking in many published reports of
phenomenological nursing research. To wit, the link between procedural
aspects of a study and its philosophical underpinnings is often unclear
to the reader. Despite the lip service paid to Husserl, Heidegger and
other philosophers by nurse researchers, many reports of
phenomenological research devote more page space to procedure than to
the philosophy that purportedly guided it (Porter, 1998).
There is no mention of the underlying philosophical perspective in some
research reports. For example, a researcher may speak of using
Colaizzi's ‘steps’ (Colaizzi et al., 1978),
making no reference to the Husserlian inspiration for his analytic
scheme. Especially popular within nursing has been this set of steps
developed by Colaizzi, a psychology graduate student, while doing his
1973 doctoral dissertation on learning at Duquesne (Colaizzi, 1973). Nursing's prolonged allegiance to Colaizzi is puzzling. Other than a book chapter in a 1978 text by Valle and Halling (Colaizzi et al., 1978),
I find no evidence that Colaizzi ever published anything else.
Apparently he did not remain active in phenomenological scholarship.
Six years ago, Porter (1998,
pp. 26, 27) called upon nurse scholars to ‘demonstrate allegiance to
our chosen philosophies rather than adherence to procedure’. She
described her own experience of ‘being inspired’ by Husserl. I have been
similarly inspired by the works of Merleau-Ponty. Elsewhere, with my
mentor Howard Pollio, I have written about procedural aspects of the
phenomenological research method that was developed at the University of
Tennessee (Thomas & Pollio, 2002) and first introduced by Pollio et al. (1997).
Here, I focus mainly on the philosophy that guides our work. I examine
the life and thought of Maurice Merleau-Ponty, with emphasis on the
material of particular relevance to my programme of research and to the
discipline of nursing. My hope is that this introduction to the man and
his ideas will stimulate other nurse scholars to seek additional
information. We begin by examining biographical data regarding the key
events and people who influenced his philosophy.
A brief biography of Merleau-Ponty
Curiously,
given his international prominence, there is no book-length biography
of Merleau-Ponty. The facts that follow were gleaned, bit by bit, from a
variety of sources. Maurice Merleau-Ponty was born on the west coast of
France in 1908. War touched his life early, as his father, an army
officer, was killed in action during World War I. Despite the loss of
his father, his childhood, spent living with his mother and one sister,
was said to be idyllic (McBride et al., 2001). He was educated in the French lycee
system and then studied philosophy at the Ecole Normale Superieure in
Paris, where he conducted postgraduate work on the nature of perception
and met Sartre, a profound influence on his life (Priest, 1998). The remainder of his life was spent as a teacher in the lycee
system and in various universities. Along with Sartre and other French
philosophers, he began his career studying the work of Husserl (Moran, 2000).
He heard Husserl lecture in 1929 and later travelled to the Husserlian
Archives to examine unpublished papers. Although he ultimately rejected
certain aspects of Husserl's thought, he retained Husserl's descriptive
approach to phenomena and combined it with an existential ground,
deriving, in part, from Heidegger (Thomas & Pollio, 2002). His existentialist ideas are also attributed to his close association with Sartre and Camus (Priest, 1998).
The relationship with Sartre has been the topic of numerous
essays. According to most accounts, the two men greatly enjoyed
matching wits in long intellectual discussions. While in agreement about
many points, Merleau-Ponty was more concerned with science than was
Sartre (Cohen, 1987).
Although some say that Merleau-Ponty was himself a behaviourist – having once uttered kind words about John Watson (Pollio et al., 1997) – his first book took issue with behaviourism. In The Structure of Behaviour (Merleau-Ponty, 1942),
he asserted that no piece of behaviour may be reduced to its alleged
parts. He pointed out the ambiguity of behaviour, contending that any
behaviour may be given various interpretations from the perspective of
the actor or the third person observer (Priest, 1998).
Ambiguity was to become a continuing thread throughout his work. Later,
he explained that ambiguity prevails both in perception and in
self-knowledge. Time itself is not an objective dimension of the world,
but is ambiguous.
In his most famous book, The Phenomenology of Perception (hereafter abbreviated as PP) (Merleau-Ponty, 1945),
Merleau-Ponty devoted painstaking attention to everyday human
activities and situations. This focus was divergent from traditional
philosophy. In PP, he sought to refute both empiricism and what
he called ‘intellectualism’, which is more commonly termed idealism.
Empiricism is flawed because it ignores the subjective; intellectualism
is flawed because things are only understood intellectually, and the
world is reduced to ideas. In the words of Merleau-Ponty, ‘empiricism
cannot see that we need to know what we are looking for, otherwise we
would not be looking for it, and intellectualism fails to see that we
need to be ignorant of what we are looking for, or equally again we
should not be searching’ (Merleau-Ponty, 1945, p. 28). We will have more to say about PP later.
The
outbreak of World War II disrupted Merleau-Ponty's research and greatly
affected his view of freedom and other people. He concluded that
everyone is compromised in war (Moran, 2000).
In his role as a second lieutenant in the infantry, he was required to
call for artillery barrages or air attacks on enemy positions. As noted
earlier, he was captured and tortured by the Germans. After the war, in Sense and Nonsense (Merleau-Ponty, 1948), he wrote movingly of the changes in his values that ensued from these experiences. In Humanism and Terror, he wrote about what it means to be a collaborator, a traitor, or a revolutionary (Merleau-Ponty, 1947).
In the early postwar years, he became involved in radical politics. In
1945 Merleau-Ponty and Sartre collaborated in founding a journal. In
Sartre's words, ‘We [were] hunters of meaning, we would speak the truth
about the world and about our own lives’ (Moran, 2000,
p. 397). Deploring capitalism's protection of privileged groups, the
two philosophers sought answers in Marxism and Communism. But
Merleau-Ponty began to view Sartre's support of Stalin with dismay. By
1952, significant differences between the two caused an acrimonious
split, with Merleau-Ponty resigning from the journal staff. One bone of
contention was the journal's propensity for taking what Merleau-Ponty
called ‘on-the-fly’ positions about political events. He felt that the
journal should maintain a more philosophical tone, i.e. ‘try to reach
the reader's head rather than heart’ (Belay & Davis, 2001,
p. 42). The immediate impetus for Merleau-Ponty's resignation, however,
was Sartre's stated intent to prevent the journal from publishing one
of his essays.
As Merleau-Ponty became
increasingly disillusioned with both Marxism and Communism, withdrawing
from the political fray, Sartre accused him of abdicating his
responsibility. Recently translated letters are illuminating (Belay & Davis, 2001).
In a 1953 letter, Sartre chided: ‘I blame you . . . for abdicating in
the midst of circumstances where you have to decide as a man, as French,
as citizen, and as intellectual – by taking your “philosophy” as an
alibi’ (Belay & Davis, 2001,
p. 35). In his response, Merleau-Ponty asserted, ‘I have never wavered
on my wish to do philosophy, and I told you so, one day around 1948,
when you asked me why I did not give up teaching. . . . I have decided,
since the Korean War, to stop writing on events as they happen’ (Belay & Davis, 2001,
p. 40). The split between the two men was emotionally painful for both,
as shown in their 1953 letters. Merleau-Ponty deplored the ‘glacial
tone’ and ‘irate tone’ Sartre used when making comments to him about his
recent lectures and essays. Sartre defended himself by saying, ‘If I
might have seemed glacial, it is because I have always had a sort of
shyness when it comes to congratulating’ (Belay & Davis, 2001, p. 56) and he admitted that ‘I am unhappy that we disagree’ (Belay & Davis, 2001,
p. 57). Interested readers may want to seek out this exchange of
letters between the two philosophers, which provide not only some
insight into what Sartre called the ‘emptying of the abscess’ in their
strained personal relationship (Belay & Davis, 2001, p. 55) but also a glimpse of the tensions in the world in the first phase of the Cold War.
In
1953, at the age of 45, Merleau-Ponty achieved the distinction of being
the youngest person ever to be elected the chair of philosophy at the
College de France. During the 1950s he was rethinking much of his
earlier work. According to Moran (2000),
he had become especially interested in the problem of reciprocal
relations and communications with others (intersubjectivity). In his
last book, The Visible and the Invisible, published posthumously, he showed a new interest in ontological questions, such as the ‘subject–object question’ (Merleau-Ponty, 1964).
Dissatisfied with language that perpetuated dualism and dichotomies, he introduced new terms, such as intertwining, which described the inseparability of subject from world, and chiasm,
which described the ‘place in the flesh of the world where the visible
flesh also sees, where the tangible flesh also touches, and so
on. . . . This only happens at the location in this fleshly element
where there is a person. The sculpture does not feel or see itself or
the other objects in the room around it. . . . Thus, perception and
sensation are a kind of doubling of the flesh of the world upon itself.
One could think of it as the wave when it breaks and curls over. It is
the place in the wave where the water touches itself’ (Young & Davis, 2001,
p. 114). Unfortunately, he did not complete this ambitious undertaking.
Before his sudden death in 1961, he had finished only a few chapters of
the book, although others were subsequently assembled from his notes.
As McBride notes, ‘I am sure that Merleau-Ponty's thought would have
developed in exciting new directions . . . that might well have
complemented some of the new directions taken by Sartre during the years
in which he outlived his former colleague’ (McBride et al., 2001, p.
73). In my searches of the literature, I have not found a cause of
death for Merleau-Ponty. The event of his death is tinged with irony, as
he collapsed while rereading Descartes in preparation for a class he
was to deliver the next day (Priest, 1998). He was only 53.
Key tenets of Merleau-Ponty's philosophy with relevance to nursing
Perception
The
nurse researcher who works within the Merleau-Ponty tradition seeks to
discover study participants’/patients’ perceptions of their lived
experience. Merleau-Ponty's philosophy was first and always a
phenomenology of perception. He felt that traditional philosophy
misunderstood the role of perception in the formation of awareness and
experience. It is perception that opens us to reality, providing a
direct experience of the events, objects and phenomena of the world.
This direct experience is to be contrasted with thinking and language,
which deal with ideas and representations of the world (Thomas & Pollio, 2002).
All knowledge takes place within the horizons opened up by perception,
and all meaning occurs through perception. Perception is learned in an
embodied, communal environment. Humans are born into a particular
sociohistorical and cultural milieu, and immediately embedded in what
Merleau-Ponty called a ‘knot of relations’ that includes ‘all those we
have loved, detested, known or simply glimpsed’ (Switzer & Davis, 2001, p. 283).
As
children grow, they readily absorb the norms and practices of their
culture. Because of shared cultural understandings, perception of a
given entity cannot be fully understood without knowing something of the
specific culture. For example, a Japanese wife may express her anger
toward her husband by creating a disorderly flower arrangement. The
husband's ability to perceive the symbolic meaning of that flower
arrangement is predicated on his understanding of the culturally
prescribed, precise way that flowers should be placed in their container
and the proscription against direct expression of a disruptive emotion
such as anger in Japanese society. An American husband seeing the same
flowers would not perceive them in the same way.
Phenomena
appear to us as meaningful wholes. But perceived things, according to
Merleau-Ponty, are always perceived as having a certain figure or form against a background (Moran, 2000).
To explain this principle, the familiar black-and-white illustration of
the vase and two faces is often used, in which a focus on the white
portion reveals the vase and a focus on the black portions on each side
reveals two faces confronting one another (Thomas & Pollio, 2002). Similarly, figure and ground
cocreate each other in human experiences: ‘There are no figures by
themselves: All figural aspects of (perceptual) experience emerge
against some ground that serves to delineate its specific experiential
form’ (Pollio et al., 1997,
p. 13). What stands out as figural or focal to a person cannot be fully
understood without consideration of many different existential grounds.
Thus, we must consider the major grounds: Body, Time, Other People, and
World (Thomas & Pollio, 2002).
Our research method seeks a complete and careful description of both
the figural and background aspects of the phenomenon we are
investigating. The emotion of anger, for example, cannot be understood
without a grasp of both its relational and cultural context. It is an
intense bodily experience as well. It is important to note, however,
that the researcher does not use a structured interview protocol to
probe for these contexts; instead, the angry person is asked, ‘What
aspects of the experience stand out to you?’
The
interviewee's narrative reveals what is figural to him. The bodily
aspects of a phenomenon may compel the attention of some respondents
while other aspects of the experience, such as Time or World, may be
indistinct or fuzzy. In a study of chronic pain, for example, patients
seldom talked about the World (Thomas, 2000). Pain had imprisoned them, creating separation from the world. They used terms such as locked off, roped off and caged off
to depict this imprisonment that created distance from other people and
the world. As one participant explained, ‘I feel like I’m on this
island all by myself’ (Thomas, 2000, p. 692).
Figure
and ground may ‘change places’ many times during repeated experiences
of a phenomenon. In the aforementioned study of chronic pain, searing
pain was sometimes figural, obliterating a patient's awareness of
everything but the hurting body (Thomas, 2000).
On other occasions, the pain receded to a dull ache; although constant,
it did not dominate consciousness (i.e. was no longer figural).
As the body became ‘ground’, the individual could emerge from the
isolation of the pain, go out into the world and connect with other
people again.
Intentionality
The literature indicates some confusion with the term intentionality as Merleau-Ponty used it.
What
he was referring to was not plans or planning, as in common parlance,
but relatedness to the world, the integral interconnectedness between
humans and the lifeworld in which attention of humans is always directed
toward specific events, objects and phenomena (Thomas & Pollio, 2002).
We are never simply passive before the stimuli in the lifeworld. We are
engaged ‘receptors’ of stimuli. All experience takes place in relation
to something other than itself. ‘Understanding the meaning of some
experience requires us to describe the intentional stance (or situated
perspective) of the event from the point of view of the experiencing
person’ (Pollio et al., 1997, p. 8). Thomas & Pollio (2002, p.
14) provide a maxim to help researchers grasp the concept of
intentionality: ‘What I am aware of reveals what is meaningful to me.
If, for example, I enter a room and notice only the furniture, I
probably am a very different person from someone else who enters the
room and notices only the children, the food, or the artwork.’Drew (2001)
recommends that researchers consider our own intentionality (i.e. what
we find meaningful, how we are connected to the topics that we study).
We accomplish this through the process of bracketing (Thomas & Pollio, 2002),
although Merleau-Ponty reminds that it is not possible to completely
bracket all of our personal interests, assumptions and presuppositions.
Bracketing is an ongoing process throughout the course of a study.
Embodiment
Of
Merleau-Ponty's concepts, embodiment has attracted the most attention
from nurse scholars. ‘Merleau-Ponty is possibly the single philosopher
who has done the most to draw our attention to the pervasive importance
of embodiment’ (Young & Davis, 2001, p. 101). As MacQuarrie (1973, p. 93) notes,
‘The reason for the neglect of the body in philosophy lies deep in the tradition of Western thought . . . From Plato to Descartes and modern idealism, the belief has been that the true self or the real man is somehow within, and that the body is an appendage or a framework of some sort’.
Descartes argued that
‘being able to think constitutes our essence; . . . that the mind is disembodied; and . . . therefore, that the essence of human beings, that which makes us human, has nothing to do with our bodies’ (Lakoff & Johnson, 1999, p. 400).
According to Lakoff & Johnson (1999),
these Cartesian tenets influenced not only philosophy but education and
popular culture, leading to the dissociation of reason from emotion and
the downplaying and devaluing of emotional life. Much of the
contemporary anger management literature exhorts readers to employ
rational thought to control – even banish – the emotion of anger. Anger
is branded as dangerous and irrational, especially for women. If
enacted, this advice would require us to ignore the wisdom of the angry
body. But anger is generated by significant violations of beliefs,
values, or rights. The body's arousal is powerful, a call to movement
and to words that will protect one's boundaries and defend one's rights.
When silenced, the angry body remains in turmoil. Women in our study
used terms such as simmering, stewing and festering
to describe the agitation produced by anger. As noted by one research
participant, the body hurts when anger is suppressed: ‘I can tell if I
hold anger for a while . . . my anger takes the form of stress in my
neck . . . it's hidden but my body knows’ (Thomas et al., 1998,
p. 315). The suppressed anger builds over time in the body. One woman
used the metaphor of ‘a big ball’ to describe its accumulation: ‘It's
like you build up so much anger inside . . . without really sitting down
and talking about the problem that it just rolls up into a big ball and
you’re not even sure what it's really about’ (Thomas et al., 1998,
p. 316). Study participants described a sense of powerlessness when
they did not express their anger but confined it within the body. Our
research suggests that instead of stifling anger, women must acknowledge
the wisdom of their bodies and act on their anger to achieve conditions
of justice and equity (Thomas et al., 1998).
To
return to the philosophy of Merleau-Ponty, the human body is not an
appendage or a thing in the Cartesian sense. The body is the fundamental
category of human existence; it exists before there is thought (Pollio et al., 1997).
The body is, of course, the unwavering vantage point of perception. The
body, however, not only perceives but also gestures and speaks. It
moves through a world of objects that it can use for its various
purposes. The body conveys qualities of objects, such as their weight.
It gives meaning to the space around itself. As the body grows, the
meaning of space becomes modified. What is high for a child is no longer
high for an adult.
Of particular
relevance to nurses is Merleau-Ponty's distinction between the ‘body
object’, the body of medicine, and the ‘lived body’ or ‘body subject’,
the body of personal experience. It is not surprising that medical
students come to perceive the body as ‘object’, because they begin
learning about it through dissection of cadavers. Watson (1999)
relates that one medical school professor actually introduced his
students to the human body by writing ‘dead mammal’ on the blackboard
the first day of class. In contrast to this dehumanizing and
objectifying stance, Merleau-Ponty reminds us of the sacredness of the
body. If we view the body as sacred, ‘it [is] impossible for us to treat
a face or a body, even a dead body, like a thing. They are sacred
entities’ (Moran, 2000, p. 415).
When
the relationship between body and world is disturbed, a person's
existence is profoundly shaken. Merleau-Ponty illustrates this
throughout PP with accounts of injured, disabled people, such as Schneider, who can no longer organize their world (Merleau-Ponty & Smith, 1945).
Schneider, a World War I veteran, is unable to make certain arm
movements in the research laboratory because of his wounds. However, he
is able to move his arm while doing factory work. Merleau-Ponty takes
the reader through a penetrating analysis of this paradox, showing that
neither a rationalist nor an empiricist explanation will suffice.
Merleau-Ponty's insights about the body are of great significance both
to philosophy, which has been slow to devote attention to the body, and
to nursing, which has intimate knowledge of the impaired body but seldom
pauses for philosophical reflection about it.
Relationships with other people: the ‘knot of relations’
Many
existential philosophers seemed to have a rather dark view of humanity,
espousing individualism and writing disparagingly of the ‘crowd, the
herd, the mass’ (MacQuarrie, 1973,
p. 122). In contrast, Merleau-Ponty saw the benefits of connecting with
other people. He reminded us that newborn infants are first orientated
toward their mother's face, not toward objects in the world; the first
‘objects’ the infant sees are smiles (Moran, 2000).
Life thereafter is spent in a ‘knot’ or network of relations. When
referring to the Other, Merleau-Ponty used terms such as ‘my double’ or
‘my twin’, indicating an egalitarian stance. Unlike Sartre, who saw in
the social world the potential for conflict ‘epitomized in the sweaty,
mundane, empirically describable boxing match’ (McBride et al., 2001,
p. 82), Merleau-Ponty saw the potential for dialogue, through which
persons receive recognition and affirmation. Unlike Heidegger, who
warned that other people distract from the pursuit of authentic being,
Merleau-Ponty did not see others as impediments, rather as fellow
travellers in life's journey (Pollio et al., 1997).
He spoke of the intersections of his path, and the path of other
people: ‘my own and other people's [paths] intersect and engage each
other like gears’ (Merleau-Ponty, 1945,
p. xx). Recently, the daily intersections of nurses and patients have
commanded the interest of several members of our phenomenological
research team and revealed some surprising – and disturbing – findings.
In
one study, hospitalized patients longed for deeper connection with
nurses and other caregivers, but more often they experienced
disconnectedness. For example, a study participant commented on the
timing and irrelevance of questions by a nurse when the participant was
in active labour. The nurse, focused on her task of filling in all the
blanks on an assessment form, was not attuned to the figural aspect of
the patient's experience (her uterine contractions):
She stood on that side at one point during my labour and was asking me questions. And it was like, ‘Have you had any stress in your life?’ I’m having a baby! I think she meant have you moved recently or changed jobs, blah, blah, blah. It was funny, she would ask me questions, and I would be in the middle of a contraction and I’d say ‘Can I answer that in a minute?’ (Shattell, 2002, p. 225)
In
this interaction between nurse and patient, common ground was not
achieved. Dialogue, as described by Merleau-Ponty, did not take place.
Merleau-Ponty asserted that ‘In the experience of dialogue, there is
constituted between the other person and myself a common ground; my
thought and his are interwoven into a single fabric. . . . We have here a
dual being, where the other is for me no longer a mere bit of behaviour
in my transcendental field, nor I in his; we are collaborators for each
other in consummate reciprocity. Our perspectives merge into each
other, and we coexist through a common world’ (Merleau-Ponty, 1945, p. 354).
In contrast to the disconnectedness in the previous vignette, Benner (2001,
p. 68) shared an example in which the nurse, despite her patient's
initial belligerence, did persist in gaining the patient's trust and
engaging her in dialogue:
I was making my rounds. And I walked in and I said, ‘Hi, I’m Sue. You must be Ann.’ And she said, ‘What the hell is it to you? I’m so goddamned mad.’ I . . . said, ‘Well, why don’t you tell me about it?’ I knew from the beginning that there was such pain under her vile language – such intensity, almost agony. And I didn’t even know her history. I didn’t know anything about her . . . and over the next month I found out about the agony and the pain.
These
phenomenological studies provide brief but fascinating glimpses of the
intersecting paths of nurses and patients. Further studies of the
relational aspects of nursing care would be especially timely, given the
emphasis on speedy execution of tasks in today's profit-driven health
care delivery system. Current nursing literature is replete with
articles about weary nurses burning out and frightened patients feeling
abandoned. Much remains to be learned about the meaning-laden situations
in which nurses and patients meet one another and establish a dialogic
connection – or fail to do so.
Time
Earlier,
we made reference to the ambiguity of Time in Merleau-Ponty's writings.
Time is a subjective experience, not ‘a system of objective positions
through which we pass but a mobile setting that moves toward and away
from us’ (Pollio et al., 1997, p. 160). Awareness of time depends on events that happen; events are subjective, not objective (Priest, 1998).
Merleau-Ponty spoke of the ‘bursting forth’ of time – by analogy with a
flowering plant bursting from its pod. In much of everyday life,
minutes and hours pass mindlessly; Time only periodically bursts into
consciousness. For example, a patient hearing a physician pronounce the
diagnosis of terminal cancer may have a sudden awareness of the brevity
of the life span. From that point on, he may engage in a frantic
struggle to ‘make the most’ of his remaining days or months. He may be
acutely aware of the choices and limits inherent in this quantity of
time. His focus may shift to a pain-free hour, or a few moments in the
sunshine, and it is often the nurse who provides these comforts during
the terminal illness. The unit of time most salient to Merleau-Ponty is
the present. In a letter to Sartre, he explicated the differences
between the two philosophers’ views of time: ‘You have a facility to
construct and inhabit the future that is all yours. I tend to live in
the present, leaving it undecidable and open, as it is. . . . My
relationship with time happens mostly through the present’ (Belay & Davis, 2001, p. 48).
Morality
One
can find pervasive references to ambiguity in Merleau-Ponty's work,
suggesting that his philosophy could provide no guidance regarding the
Truth or the Good. However, he once defined true morality as ‘actively
being what we are by chance, establishing that communication with others
and with ourselves for which our temporal structure gives us the
opportunity and of which our liberty is only the rough outline’ (Watson & Davis, 2001,
p. 201). I find this an astute guide for a moral and meaningful life. I
find it directly pertinent to the daily practices of nurses in their
local situations, wherever they may be.
I also find a distinctly moral tone in works such as Humanism and Terror (Merleau-Ponty, 1947),
in which Merleau-Ponty pointed out the hypocrisy of democracy, noting
that societies proclaiming respect for autonomy, dignity and property
rights ‘were themselves created by violent conquests and
insurrections . . . and maintained by ongoing violence against exploited
classes on foreign soils’ (Young & Davis, 2001, p. 129).
Merleau-Ponty
deplored all such violence, envisioning a humane social world in which
dialogue would take priority over violence (Madison & Davis, 2001).
As Madison has pointed out, Merleau-Ponty was an early critic of
totalitarianism – two decades before that position became fashionable in
France – instead espousing a politics of ‘mutual recognition and
solidarity [that] was in fact the direct anticipation of the politics of
civility championed in our times by Vaclav Havel’ (Madison & Davis, 2001, p. 174).
Assessment of Merleau-Ponty's contribution
If
one is trying to pin down Merleau-Ponty, the task is much like the
proverbial impossibility of nailing down jello. He rejects both
historical determinism and absolute freedom. He rejects relativism and
dogmatism as well. He rejects both realism and idealism. He tells us
that meaning is ambiguous, mixed up with nonmeaning. In his opinion, no
amount of investigation can dispel the ambiguity of the mysteries of
nature, the world, or God. This stance may create discomfort in nurses
who wish to have ‘right answers’ to their questions. On the other hand,
how exciting it can be to thoughtfully consider diverse interpretations
of clinical or research data, remaining open to the possibility of truly
novel ways of perceiving the familiar. Adherents to the Merleau-Ponty
view of human existence must approach the study participant/patient from
the humble stance of perpetual learner, not authority figure. With a
humility uncharacteristic of academics, Merleau-Ponty referred to
himself as the ‘philosopher who does not know’. Whereas Husserl wanted
to reduce scientific phenomena to their foundational prescientific
essence, Merleau-Ponty believed that the original phenomena lie buried
in darkness in such a way that they cannot be brought to light –
although we can always erect pointers in the darkness. Our task as nurse
researchers, then, is to erect these pointers. Porter (2000)
likens the phenomenological researcher to a heliograph, a device for
sending messages or signalling by flashing the sun's rays from a mirror.
By sending participants’ messages to practising nurses, the researcher
enables nurses to vicariously experience the lifeworld of patients with
conditions such as chronic pain.
Many scholars, both within and outside philosophy, are discovering, or rediscovering, the work of Merleau-Ponty (Priest, 1998; Wilde, 1999; Benner, 2000; Moran, 2000; Davis, 2001)
Some speculate that he never received the public attention accorded his
contemporaries because of his retiring personality and difficult
language (Moran, 2000). Priest (1998,
p. 224) judged him to possess ‘neither the literary talent nor the
political dexterity of Sartre’. Nor does it seem that he exhibited the
charisma of Heidegger. Interestingly, given his emphasis on description
of lived experience, he remained noncommunicative about his own life,
revealing little about himself (Davis, 2001).
For a time, his work was unfashionable in French intellectual circles,
although now he is viewed more favourably: He is actually considered to
have pre-empted some aspects of postmodern thought. Derrida, among
others, urges reassessing Merleau-Ponty's work (Davis, 2001).
Perhaps
it should not be surprising that it took a while for American scholars
to develop appreciation of Merleau-Ponty's work, because of the time lag
before many of his writings were translated. By the time PP was translated into English in 1962, Merleau-Ponty was already deceased. English translations of other books, such as Signs, Prose of the World and The Visible and the Invisible (Merleau-Ponty & Lingis, 1964; Merleau-Ponty & McCleary, 1964; Merleau-Ponty & Lefort, 1973), appeared even later. Lakoff & Johnson (1999, p. xi), in their recent book Philosophy in the Flesh,
paid special tribute both to Merleau-Ponty and John Dewey: ‘Any book
with the words “philosophy” and “flesh” in the title must express its
obvious debt to Maurice Merleau-Ponty . . . For their day, Dewey and
Merleau-Ponty were models of what we will refer to as “empirically
responsible philosophers” ’.
Wilde (1999)
noted that scholars from nursing, medicine, anthropology, education,
psychology and sociology have been exploring embodiment as a new area
for theory development. She predicted that phenomenological nursing
research will reveal the embodied practices that enable the chronically
ill to surmount the challenges of living with limitations and assistive
technologies. I believe this potential already has been demonstrated in Wilde's (1999)
study of individuals requiring long-term urinary catheterization and in
recent phenomenological studies of ventilator-dependent children (Sarvey, 2001) and patients whose bodies have incorporated implanted defibrillators (Krau, 2002).
In their day-by-day navigation of the lifeworld, such patients have
acquired valuable knowledge and innovative skills for coping. As we tap
the wisdom of their bodies, by asking them to describe their everyday
embodied existence, we can generate new middle-range theories and
nursing interventions to help other chronically ill patients manage
their conditions (Wilde, 1999).
Likewise, phenomenological studies of emotions such as anger are
revealing the intelligence of emotions, thereby mandating a new stance
on traditional therapeutic approaches that seek to medicate or banish
them.
Conclusion
In
writing this paper, I was once again reminded of the truth of
Merleau-Ponty's observation that ‘writers experience the excess of what
is to be said beyond their ordinary capacities’ (Merleau-Ponty, 1973, p. 57).
A
sense of urgency drove me to put these words on paper at a time when my
understanding is still incomplete. But, of course, my understanding
will always be incomplete. I urge others to join the rejuvenated
dialogue about the work of Maurice Merleau-Ponty. Clearly, I believe
that the ideas of Merleau-Ponty have abundant potential to advance
nursing research. But phenomenology is not just for researchers. I
believe that all nurses can practise it as ‘a manner or style of
thinking’ (Merleau-Ponty & Smith, 1945, p.
viii), learning to listen to patient concerns in a new way, alert to
what is figural in the perceptions of their patients yet ever-mindful of
their embeddedness in a particular sociocultural context. Being invited
by a nurse to tell one's story surely benefits the patient, who often
feels lost and alone in the juggernaut of the health care assembly line.
Hearing the story enriches the nurse as well, filling him or her with
awe regarding both the particularistic and the universal dimensions of
human lived experiences of health and illness. I find that phenomenology
is transformational for those who practise it.
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