Page 55 - Contribution To Phenomenology

48 RICHARD M ZANER

contextual and strictly co-relative to the particular interests and pursuits,
or to what Schutz terms the "cognitive style'* of any province of meaning
or activity ([29, I], pp. 25-28). Husserl remarks, "the trader in the market
has his market-truth,*' relevant to his specific province of concerns—so
too, we must add, the scientist, the physician, and the patient ([12], p.
278).
The patient experiences and interprets her own condition—^which
harbors complex meaning for her. She has her own "truth" no less than
the trader or the physician. Her experiences and interpretive meanings
are quite legitimate within their own context, even if she needs help in
improving her understanding (perhaps in the light of a better understood
sense of what is *Vorthwhile" to her, as well as diagnostic data, etc.). To
paraphrase Husserl, simply because the physician works from within a
different framework (with its appertaining meanings, evidences, methods,
and truths) does not mean that the patient's views are inappropriate or
should be regarded as suspect Some physicians may still view the
patient's understanding, if not also her experiences, as suspect—as some
have emphasized ([3]; [16]; [20]; [22]; [32]), and as was clear of the
couple in our case when they were trying to understand statistical matters
regarding their fetus's probable diagnosis and future.
She has to reach an accurate and adequate understanding of her own
situation and condition. That crucial task, moreover, may require that
physicians and other providers (including the ethicist) help. Precisely
because of the specific asymmetry of the relationship, providers have the
responsibility of initiating candid conversations to ensure trust (even if
only temporary), so as to help patients and their families (and significant
others) understand and talk about the patient's condition. As Arthur
Kleinman emphasizes, "patients order their experiences of illness—^what
it means to them and to significant others—as personal narratives." Thus,
he continues, a "core clinical task is the empathetic interpretation" and
"reconstruction" of these narratives so as to help them take account of
what the clinician knows, and thus reach a more valid understanding
([16], pp. 49, 227-236). As people are compromised and often demoral-
ized by impairment, the clinician's work is an effort to "remoralize" their
circumstances—the principal means for which is "an experiential
phenomenology" that requires "the first and essential, great leap into the
world of the patient" ([16], p. 232), which in turn requires the physician
to understand and appreciate the patient's experiences, understanding, and
narratives.