Illness, Inauthenticity and the Uncanny

Illness, Inauthenticity and the Uncanny

Table of Contents:

Introduction...p.4

Dasein...p.8

Inauthenticity...p.13

The Uncanny...p.21

Inauthenticity and the Uncanny...p.31

Average and Minimal Health...p.47

Conclusion...p.58

Bibliography...p.61

In this thesis I put forward a hybrid phenomenological account of illness which borrows from the work of Medard Boss and Frederick Svenaeus. Each author writing under the influence of Martin Heidegger, the key concepts supplied in his work Being and Time are first outlined and their utility for the question of health and illness specified. Then, after summarizing Boss’ account of illness as inauthenticity, and Svenaeus’ account of illness as the uncanny, I work towards their combination. First, where Svenaeus accuses Boss of restricting his account to mental and psychosomatic health, I accuse Svenaeus of restricting his own account to somatic health. And I further argue that were Svenaeus to extend his account beyond somatic health, the opportunity to find a role for authenticity in attenuating experiences of the uncanny would be provided. This I demonstrate, by outlining the way in which authenticity, by satisfying an individual’s unique mental and bodily needs, may function as a condition for what I call optimal health – a state in which experiences of the uncanny arise as little as possible. For although Svenaeus denies its relevance, rather than merely restrict an individual’s “freedom”, inauthenticity can be shown to underwrite such unpleasant experiences. Having therefore achieved an account of optimal health through the combination of Boss with Svenaeus, I then turn to discuss what I call average and minimal health, the former being underwritten by inauthenticity, and the latter by the complete absence of others in one’s life. Notwithstanding the extension of my account which this discussion enables, the nature of average and minimal health also helps clarify the central role the satisfaction of needs, particularly the social need to belong, plays in health. As accurate as I understand Svenaeus’ phenomenological description of illness to be, therefore, a return to Boss’ focus on the authenticity-inauthenticity axis nonetheless deepens and nuances his account, providing an insight into the interrelation between illness, inauthenticity and the uncanny.

To begin, we should demarcate the boundaries of our discussion about health and illness. As should already be clear from the above summary, the focus of this thesis will not be on the concept of disease but on that of illness, a distinction made by Boorse (1975).1

This distinction is one between the theoretical and practical senses of health. The theoretical sense includes the technical aspects of health couched in third person causal and functional terms for scientific research purposes. Boorse calls this ‘disease’ – that which physicians investigate, and philosophy’s umbrella-term for all bodily ailments. The practical sense of health, by contrast, includes the evaluative aspects of health, specifically the negatively evaluated subjective sensations often intrinsic to the first person experience of disease. Boorse calls this ‘illness’ – that which patients experience and communicate. As illustration, simply consider the two possible descriptors for a cardiovascular event: there is the practical “myocardial infarction” (a disease) or the evaluative “heart attack” (an illness).

It has historically been disease, as the compromiser of health, which academic research has taken as its primary object of study, health only becoming an object of empirical science within medicine during the nineteenth century. Boorse’s (1975, 1976 & 1977 p.63) biological-statistical theory serves as a recent paradigm example of such a disease model of health. According to it, health is the absence of abnormal biological functions within the body. In the absence of any first-person, evaluative terminology, this is clearly an account of disease prioritising the point of view of the pathologist, rather than an account of illness prioritising that of the patient. A more recent theory, however, comes closer to the first person account this thesis favours, Nordenfelt (1987, 1993) defining health as the “ability to realize one's vital goals given standard circumstances”. His focus, then, is a holistic one, accommodating the experiences, ambitions and abilities of the patient interacting with an environment that both enables and thwarts their activities. Health, here, is evaluatively characterised as something like ‘success’, and illness as resembling ‘failure’. Nonetheless, although the focus is indeed holistic, Frederik Svenaeus argues it is not holistic enough. There are “other dimensions of human existence than action, such as understanding, language, feeling and embodiment” 1 Though see also Scadding (1967), Barondess (1979), Jennings (1986) and Schramme (2000).

(Svenaeus 2000, p.75) all of which he argues can only collectively receive the attention they require within the integrative perspective phenomenology makes possible. This, Svenaeus provides in assorted articles and also in his book The Hermeneutics of

Medicine and the Phenomenology of Health (ibid.), a theory we shall consider in

comparison to Medard Boss’ Daseinanalytic theory as presented in Psychoanalysis and

Daseinanalysis (1982) and Existential Foundations of Medicine and Psychology (1983). In

this way, we will be able to move beyond defining health and disease in science to explicating the meaning of health and illness in experience. Phenomenology, offering a valuable perspective on the subject’s perception of phenomena, serves this function well within the philosophy of medicine (see Gergel 2012 for a review). We should therefore clarify what this branch of philosophy is.

Phenomenology is founded on the writings of Edmund Husserl, and should, for our purposes, be primarily understood as aiming at uncovering the universal structure of experience. That is, phenomenology takes consciousness – the origin and seat of experience – as its focus, defining itself as a philosophy of self-explication: “a philosophy turned toward the subject himself” (Husserl 1931, p.2). Central to Husserl’s findings was that consciousness unfolds in a series of intentional acts – not intentional in the purposive sense but in the sense that they are all directed towards, and are ‘about’, objects. No thought, for instance, is without an object, or we would otherwise be thoughtless. This structure is made visible by the phenomenological epoché (suspension), a process of ‘stepping back’ from one’s natural attitude in which consciousness functions as one’s transparent means of accessing intentional objects, and focusing instead on the intentional acts themselves. Through this focus, the meaning of experience itself is uncovered through an analysis of the ‘conditions of possibility for consciousness’ – an analysis of the universal structure of the transcendental ego.

This Husserlian phenomenology brings us closer to the account of illness (contra disease) we would like because, where Nordenfelt restricts himself to a merely mechanistic analysis of the patient’s actions, phenomenology clarifies the nature of their intentional experiences. However, Svenaeus (2000) appeals to the work of Hans-Georg Gadamer in order to illustrate certain important shortcomings Husserl’s approach is

weakened by. Gadamer argues that the “conscious awareness of health conceals itself”, and is manifested simply as “a feeling of wellbeing [which] means that we are open to new things, ready to embark on new enterprises and, forgetful of ourselves, scarcely notic[ing] the demands and strains which are put upon us” (Gadamer 1993, pp.143-144). That is:

Health is not a condition that one introspectively feels in oneself [as it is made available to one through the epoché]. Rather it is a condition of being there (Da-Sein), of being in the world (In-der-Welt-Sein), of being together with other people (Mit-den-Menschen-Sein), of being taken in by an active and rewarding engagement with the things that matters in life [...] It is the rhythm of life, a permanent process in which equilibrium re-establishes itself. This is something known to us all. Think of the processes of breathing, digesting and sleeping for example (ibid. pp. 144-145)

Though this might be interpreted along the ability-based lines of Nordenfelt’s theory (“active and rewarding”) or indeed the function-based lines of Boorse’s (“equilibrium”), Martin Heidegger, whose terminology Gadamer uses, is in fact a phenomenologist, and one whose theory Svenaeus argues is better suited than Husserl’s for clarifying what illness is. This is because it captures health as something “we live through rather than

towards” (Svenaeus 2000, p.80, original italics). Husserl’s transcendental ego might live

towards illness in the same way it is directed towards its intentional objects, however, this misses certain crucial aspects of illness. Svenaeus identifies three: the unpleasant attunement of illness as experienced whilst nauseous, dizzy, feverish and so on; the role embodiment plays in structuring and texturing experience as opposed to simply kinaesthetically orienting consciousness around objects; and the way prethematic actions – actions “lived through” rather than consciously directed towards objects – break down in illness. None of these, as Gadamer says, can be introspectively felt within oneself as intentionality is, but can only be actively undergone. As Gadamer states: “conscious awareness of health [or illness] conceals itself” (Gadamer 1993, pp.143-144). An introspective, transcendental analysis of a static consciousness can therefore only provide limited insight into the experience of illness, meaning the broader context of the

patient’s dynamic (or ek-static), engaged existence, which Heidegger’s ‘existential analytic’ provides, is required. A Heideggerian, and not Husserlian, phenomenology is better suited to inquiry into the nature of illness.

This thesis therefore examines two Heideggerian accounts of illness and attempts a rapprochement between them. Svenaeus’ account of illness as uncanny unhomelikeness has much to be said in its favour, and my own additions to it ultimately detract little from its central features. Thus, Svenaeus’ emphasis on the unpleasant experience of illness as a certain kind of alienation from one’s being-in-the-world, and the inability to coherently project forwards within it, is retained. Nonetheless, my additions to this account, inspired by Medard Boss’ own Heideggerian account of illness as inauthenticity, are not without import. Renewed focus on Dasein’s state of authenticity, first of all, clarifies the distinction between mental and somatic illness which Svenaeus struggles to reject. Authenticity and inauthenticity being associated with Dasein’s non-bodily existentials of understanding and discourse, they are also more readily associated with Dasein’s non-bodily mental health (though I also argue for the existence of a bodily form of authenticity and inauthenticity). And this renewed focus also makes possible, for the first time, the distinction between three different forms of health: optimal, average and minimal. Optimal health accompanies Dasein’s state of authenticity because, when the attunement of anxiety which Heidegger argues precedes authenticity, Dasein is made more familiar with the uncanny aspects of its being-in-the-world. That is, as Svenaeus illustrates as being central to health, the optimally healthy Dasein is more ‘at home’ in its world. Average health accompanies Dasein’s state of inauthenticity because it is less at home in its world than if it were optimally health, but familiar enough with that world insofar as its fundamental need as a Mitsein for social belonging is satisfied. And minimal health accompanies the absence of either authenticity or inauthenticity, arising and severely compromising Dasein’s health when the need for social belonging is neglected. In effect, then, though I retain Svenaeus’ account of the unpleasant

experience of illness, my hybrid account also specifies the background conditions for

existential analytic of Dasein Being and Time is required, before Boss and Svenaeus’ theories are discussed in that order.

Dasein

In his magnum opus, Being and Time (1996), Heidegger takes Descartes’ conception of the world as one of external objects from which we, as subjects, are distinct as anathema to his own project. Descartes’ ontology famously posits that the subject is contained within an ‘inner theatre’ of private ideas, and dispassionately observes an outer, mind-independent world – a perspective which ultimately leads one to retreat from that world through a process of sceptical doubt. Radically opposed to this subject-object divide and its attendant sceptical problems, Heidegger counters that human beings are not mere observers or ‘knowers’, but are ‘doers’, immersed in the world and the numerous projects therein. Heidegger’s is therefore a manifestationist view of human agency, humans being identical with their manifest activity, rather than any allegedly hidden essence. The world, in turn, is not disclosed as an abstract, three-dimensional space filled with foreign objects, but is disclosed and constituted by our understanding actions, thoughts and feelings. It is a ‘lived world’ ordered by human interests and purposes into a structure of significance consisting of ‘ready-to-hand’ tools. Heidegger therefore called human being

Dasein (‘being there’), consciously countering the notion that humans are distinct from

their environment and emphasising instead that, from an immediate phenomenological perspective, humans only come into focus through the world into which they are ‘thrown’ and engage with in practical activity. Dasein therefore forming a unity with, rather than division from, the world, Heidegger chose the compound term ‘being-in-the-world’ to describe it, the compound reflecting that unity. This claim, rather than the intentional consciousness Husserl focuses on (inspired by Descartes), is Heidegger’s starting point. But like Husserl, and consistent with the general project of phenomenology, Heidegger is concerned with the deeper, universal characteristics of human existence as opposed to its empirically available, surface features. In his own terminology, therefore, an analysis

of Dasein should focus on Dasein’s ‘ontological existentials’, not its ‘ontic categories’ (Heidegger 1996, p.12).

Heidegger identifies three ontological existentials: attunement, understanding and discourse, all always intertwined in Dasein as an attuned, understanding and articulating being-in-the-world. The first of these, attunement, constitutes the central way Dasein finds itself always already thrown into a certain mood. “Da-sein is always

already brought before itself, it has always already found itself [...] as one finds one's self in attunement” (ibid. p.128). Moods are an inescapable condition of its thrown being-in-the-world, disclosing Dasein’s determinate facticity. But they also open up the structure of significance of its world, disclosing or concealing its multifarious regions as meaningful. Consider, for instance, how fear discloses the threatening aspects of one’s assailant – their weapon or formidable size – and not, say, their beautiful aspects like their eyes or hair. Attunement therefore makes possible and influences Dasein’s transcendence in the world – in this case one’s immediate options to fight or flee. Attunement discloses “how one is and is coming along” (ibid. p.127), “how one is” being Dasein’s throwness, the colour and structure of the world it finds itself in, and “how one is coming along” being the manner in which Dasein projects out of that throwness.

This projective ability is in fact Dasein’s second existential – its understanding as that which allows it to seize on a possible way of actively existing, and in so doing, transform its throwness into a project (Dasein is usefully characterised as a ‘thrown-project’, ibid. p.139). Attunement and understanding are therefore indeed intertwined, or “equiprimordial” (ibid. p.126), each attunement shaping Dasein’s understanding which in turn shapes its next attunement and so on. Understanding orients Dasein in its being-in-the-world, not by providing it with a cognitive awareness of its physical environment, but by providing it with the ‘know-how’ to engage with its throwness and competently manoeuvre, or project, towards the goals it sets itself. Thus, as another example, my attunement of quiet concentratedness discloses the keyboard in front of me as a keyboard which I can operate insofar as it is relevant to the possibility I have of being someone who writes. It is not disclosed – as it would be to a detached Cartesian ego – as

a mere jumble of pads bearing symbols. To reiterate, Dasein is a skilled ‘doer’, not a detached ‘knower’.

The third and final existential is discourse, also intertwined with the other two existentials as one which articulates and confirms the meaning structures first disclosed by attunement and operated by understanding. Most importantly found in language, discourse makes Dasein’s being-in-the-world transparent, allowing Dasein to comprehend its existence by thinking and talking about it. Thus, in addition to the implicit meanings which imbue Dasein’s attuned understanding, discourse imbues these existentials with explicit meaning – an importantly different dimension it can share with its co-beings-in-the-world. My two above examples of Dasein’s attunement and understanding may be taken as real-time convenient illustrations of this existential in that they made explicit the general structure of Dasein as a thrown-project.

Taken together, all three existentials make up the structural whole of Dasein as

care, Dasein’s “being-ahead-of-itself-already-in (the world) as –being-together-with

(innerworldly beings encountered)” (ibid. p.180). This deepens Heidegger’s analytic of Dasein since, as care, Dasein is characterised as concerned with its existence. ‘Being there’ not only means being always already situated there – to be thrown – but also means to question the meaning of being there. Dasein is self-interpreting – “related to its being as its truest possibility” (ibid. p.40) – and therefore responsible for itself and the projects it chooses to undertake. A stone cannot choose to be or not be a stone; however, I as a Dasein could stop writing and go for a walk instead. This captures the nature of Dasein as not only a ‘being there’ but also a ‘being possible’ – a “being-ahead-of-itself” (ibid. p.188) – which has potentialities to be or not be something other than it is. This recalls Heidegger’s distance from the Cartesian worldview, a worldview trapped in the present as a sequence of indifferent ‘nows’. By contrast, Heidegger emphasises the being of Dasein as temporal, its temporality being the “unfolding and coming forth of his existence” (Boss 1982, p.45). Dasein ‘stands out’ in the past, present and future as an

ek-stasis rather than a mere present-bound stasis. It comes back to itself as a picking up

of the possibilities of its throwness (the past), which it transcends in understanding (the future), and makes present through its articulations (the present).

Crucially, the manner of Dasein’s standing out is as a ‘being-toward-death’, meaning that Dasein is a finite thrown-projector. This raises a central theme in Heidegger’s analytic of Dasein: the difference between its authentic and inauthentic modes of being. As understanding, Dasein typically ‘falls prey’ to an inauthentic mode of absorption in the world whereby it is disclosed as a mere collection of objects independent from oneself. This results from Dasein being a Mitsein, a “being-with” (Heidegger 1996, p.107). As Mitsein, Dasein’s world is a shared one in which it is open to and aligns itself with other Dasein as a member of an anonymous generality. This generality, which inducts its members into its all-encompassing social practices, is das

Man, or ‘the one’, or ‘anyone’ (ibid.). Das Man dictates how ‘one eats’, ‘one sleeps’, and

so on. That is, it articulates its world for it, overriding its individual disclosure of the world as personal and dependent on its own activity, instead disclosing the world as a collection of impersonal, independent objects corresponding only to das Man’s public activity. Das Man alienates Dasein from itself as a unique being-in-the-world. Each inauthentic member of das Man therefore forgets their past (when not needed for successful conformity with das Man), expects their future (a utilitarian attitude whereby das Man’s acceptance is pursued), and makes present the entities around them (collecting entities which reflect das Man’s acceptance). Dasein becomes immersed in the merely conventional ways of understanding, being attuned and discoursing with others imposed on it, falling prey to a generic identity. Blind routine as opposed to clear-eyed self-interpretation prevails as Dasein ‘lives away from itself’ in others, irresponsibly allowing those others to project forwards for it.

Yet Dasein has the potential to achieve individualised, authentic self-understanding, that is to say, understanding of the meaning structures of the world related to its own unique being – not the undifferentiated being imposed by das Man. On this basis, Dasein, not das Man, projects itself forwards into the future, an option made possible by the mood of anxiety provoked – returning to Dasein’s above mentioned finitude – by its facing up to the fact of its being-towards-death. This fact is that the public world cannot protect me insofar as death signals the complete cessation of all my projects and the extinction of my entire being-in-the-world. “Death is the possibility of

the absolute impossibility of Dasein” (ibid. p.232), the one thing das Man cannot take over from me or which I can step out of, stand over against or live through as I do the deaths of others. Matching the unrealizability of death then, Dasein is thrown into the similarly objectless mood of anxiety, a destabilising and deeply uncomfortable state throughout which the mattering of all the structures of significance of the world are extinguished and become alienating and uncanny. “The totality of relevance discovered within the world of things at hand and objectively present is completely without importance. It collapses. The world has the character of complete insignificance.” (ibid. p.174). Unlike other attunements which disclose only certain regions of the world (joy, for instance, only disclosing its joyful regions), anxiety discloses something threatening, not

within the world, but about the world as a whole. It discloses its utter contingency and

groundlessness, bringing Dasein to the nothingness at the heart of Being. Rather than maintain Dasein within the shared world that facilitates its projection, the anxiety provoked by Dasein’s “ownmost” (ibid. p.232) being-towards-death throws it out of that world and isolates it within a disengaged perspective upon it.

This is the gateway to authentic self-understanding. Dasein mustn’t flee from anxiety, back into those tranquilising innerworldly things handed down by das Man, but, from its disengaged perspective, must realise its unbounded freedom to select its own way of life. The world’s groundlessness and Dasein’s mortal vulnerability eclipses das Man’s pressing expectations and ready-made solutions, therefore freeing it to take up, modify or even abandon those solutions in its individualised, authentic transcendence. Dasein can achieve “anticipatory resoluteness” (ibid. p.280): resoluteness meaning facing up to the unique, “factical situation” (ibid. p.284) in which one finds oneself as opposed to a ‘state of affairs’ anyone could confront, and anticipatory meaning being ready, willing and able to embrace the particular and fragile set of possibilities within that situation. That is, Dasein, by no longer ignoring the finitude and particularity of its being-in-the-world, becomes the author of its own projects. The difference between the authentic and inauthentic Dasein plays itself out in temporal terms: the authentic Dasein repeats its past (acknowledging its own throwness), anticipates its future (facing up to its own death) and organises its present in a ‘moment of vision’ (opening itself fully to

present realities). It does not bequeath ownership of its temporal existence to das Man. And importantly, Dasein being a temporal “being-ahead-of-itself” (ibid. p.180), no achieved state of authenticity is final. The authentic Dasein accepts its nullity – its lack of positive essence – and resolves to “take itself back" (ibid. p.284) by continually renewing its commitments. The authentic life is one of sober joy, lived decisively, intensely and presciently.

The tone of Heidegger’s treatment of authenticity and inauthenticity – belying the professed neutrality of his existential analytic – is widely regarded as favouring the authentic life. This, as Medard Boss does, perhaps makes the association of authenticity with health, and inauthenticity with illness, tempting.

Inauthenticity

Medard Boss’ Psychoanalysis and Daseinanalysis (1982) and Existential Foundations of

Medicine and Psychology (1983) both analyse illness – specifically mental and

psychosomatic illness – in explicit contrast to the mechanistic (read Cartesian) theory of psychoanalysis whose “speculative superstructure” (Boss 1982, p.284) Boss sees as an unwarranted departure from the evidence of everyday experience. Heidegger remaining loyal to that experience, Boss (like Svenaeus and myself) finds his existential analytic a suitable framework for an account of illness.

Central to that account, first of all, is the nature of Dasein as a basic openness to the world and therefore as the source of all meaning within it. The world is that in which meaning unfolds without reaching – as it does in God – self-unity, and it is Dasein which does the unfolding insofar as it is itself unfolding – drawn along by its lack as a finite, self-interpreting being. Dasein is “primarily of the nature of illuminating, of disclosing and understanding the meaning of what he encounters” (ibid. p.34). To remind ourselves of the above, Dasein encounters the world as a structure of significance which includes the thoughts, feelings, perceptions and tools within it. Freeing things from unintelligibility, precisely through tool use for instance, Dasein moves in an understanding of the

“being-ness” of all entities in the world, exhibiting “the still more fundamental understanding that there is something at all, against the possibility that there might be nothing at all” (ibid. p.35). Thus, without Dasein as the realm of illumination, be it an ill or healthy Dasein, there would be nothing to shine forth in its being.

As should be clear from the previous section, “[t]hings can come forth into its openness only in consonance with Dasein’s actual attunement, or ‘pitch’” (Boss 1982, p.41). And as also previously indicated, this temporal openness is most fully apparent the mood of anxiety. For here, Boss argues, when the world is disclosed in its totality, and when Dasein can take authentic responsibility for its mortal openness by rejecting handed down ways of life, beings in the world may manifest themselves in more complete and complex ways. Where das Man’s superficial understanding of beings reduces these to mere instruments for achieving contingent ends, Dasein’s freer, authentic understanding allows those entities clearer self-expression. As Zimmerman (1993) argues, in inauthentic understanding the das Man-like, restrictive subject-object picture of the world according to which I, as an ego, have a permanency which transcends the impermanency of the objects surrounding me, takes over. These objects are then enlisted to the fulfilment of my narrow ends. But when the nothingness at the heart of my existence is acknowledged, the being of those objects unfolds of its own accord. A more authentic understanding of the integrity and interrelatedness of all beings emerges and Dasein’s structure as care – concern and solicitude towards all encountered beings – flourishes:

This means that man must responsibly take over all his possibilities for world-disclosing relationships, so that whatever may show itself in the light of these relationships can come forth into its being to the best possible extent. (Boss 1982, p.47).

Dasein, as the ‘shepherd of Being’, must illuminate everything in its world-openness, a task Boss says it is set by the “call of conscience” (Heidegger 1996, p.249). This call tells Dasein of its guilt, and like being-towards-death, provokes anxiety. I, as Dasein, am guilty insofar as I am, my throwness being saturated by a ‘nullity’. Dasein is a

“being-the-ground for a being which is determined by a not – that is, being-the-“being-the-ground of a nullity” (ibid. p.261). Two things are meant by this. That insofar as I am, I exist within a contingent throwness which I did not instigate nor can ever master (one lack), and also that at every moment I fail to project out of that throwness in an individualised way (another lack). To be the “ground of a nullity”, therefore, is to be the reason I am not what I am not. I typically fail to choose an authentic existence and therefore also fail, as Boss puts it, to illuminate everything in its world-openness. To address that nullity and its indebtedness to the world, Dasein must free itself from conformity and face up to the task of its existence in ‘anticipatory resoluteness’ before death. Dasein must open up to its life-possibilities.

This is the central focus of Boss’ account of illness, Boss equating Dasein’s authenticity with its freedom from guilt, and its health. As he puts it, the inauthentic, unfree Dasein is necessarily ill because it cannot unfold its full potentiality of being – it is precluded from the “full capacity for work and enjoyment” (Boss 1982, p.68) which Freud identified as the goal of therapy. “What is actually impaired in a given illness is the ill person's ability to engage in carrying out these particular potentialities as free behavior toward what he encounters in his world” (Boss 1983, p.199). This “free behavior” is the freedom to disclose as many beings in the world as can be – that is, to be open and to therefore adopt the many possibilities of relating to the world available to one as an individual. For Dasein not to be open is for it to narrow its existence and risk falling prey to das Man’s instrumental, superficial mode of disclosing the world. It is for it to merely function or ‘get by’, and fail to take a stand on any individual course of action. It is for it to be ill. And depending on the manner of that falling prey – depending on which existential Dasein fails to fulfil – that Dasein has one or another illness. Yet common to all of them is the ill Dasein’s confinement to a limiting, impersonal present; contrasting with the healthy Dasein’s ability to carry its past into the future and open up its own present and therefore realise all of its potentialities. In keeping with Svenaeus’ early stipulated criterion, then, this account of illness does indeed characterise it as something “we live

through rather than towards” (Svenaeus 2000, p.80), authenticity and inauthenticity

Daseinanalysis therefore seeks to restore the inauthentic Dasein to optimal world

openness, through a process in which the patient is “absolutely honest and truthful with himself and the analyst”, meaning that “all those possibilities of awareness, all feeling, thinking, imagining, dreaming, and acting relationships with the world” are “accepted, realized freely, and appropriated with responsibility as constituting one's own existence” (Boss 1982, p.61-2). Boss’ example of an adolescent girl whose parents censor all references to sexuality, a possibility of being developing within the girl and yet hampered in its expression by that familial intolerance, illustrates this idea. The girl finds herself attracted to a gardener who she often walks past on the way to school, but she one day falls over in front of his garden, her legs paralysed. Absent any physically identifiable cause, Boss argues that the girl’s illness is psychosomatic, and therefore related to her having inauthentically fallen prey to the restrictive attitudes of her parents. By being closed to the reality of her attraction to the gardener, the only way she knew of carrying it out was by counterproductively “warding off her moving closer to him” (ibid. p.118) – by performing the obscure somatic gesture of paralysis. Any other, more direct and willed way of relating to him was closed off in her being. “The paralysis of this girl's legs thus shows that she was so little her own and independent self as yet that she was not even able to think reflectingly about the gardener, so that the blocked relationship in which her existence was so completely absorbed could occur only within the bodily sphere of her existence—in the form of the paralysis of her legs” (ibid. p.119). Hence her ill-health as a Dasein. Only once helped to mature into a full and free authentic understanding of the world will an open relation towards the gardener, and the cessation of her ‘hysterical’ psychosomatic symptoms be achieved, she must shed the parental “protective dependencies” (ibid. p.122) fallen prey to and disclose more fully what she encounters within her being-in-the-world.

Elaboration on Boss’ account of illness (and revealing his psychoanalytic background by repeating his outdated terminology), we can distinguish the ‘neurotic’ and ‘psychotic’ ways of falling prey and therefore ill. The neurotic falls prey as the paralysed girl did – to entities within the world. In the girl’s case this was the repressive attitudes of her family, in another patient’s case it might be feminine ideals of beauty as thin, and in

another’s a bully’s hurtful insults. Whenever an entity is fallen prey to in such a way that ‘problems in living’ arise – the girl becomes paralysed, another begins to starve herself, the victim self harms – then that Dasein is ill. In each case, a problematically narrow segment of the world is disclosed in Dasein’s openness as Dasein, and the nature of its being-in-the-world is altered accordingly. Boss’ Kierkegaardian example of the ‘melancholic’ (the depressed patient) in fact reveals a direct link between illness and inauthenticity. This link exists because the melancholic falls prey to persecutory feelings of guilt – those feelings only inauthentic Dasein experience when alerted to their potential for authenticity. Having fallen prey to these feelings, however, the melancholic’s being-in-the-world enters a negative spiral. Unable to respond to the call to be authentic, their sense of indebtedness to the world only increases, in turn strengthen the call and so on. The melancholic is, as it were, plagued precisely by the call and their own inauthenticity. As Boss diagnoses, “[f]rom a very early age, each of them relegated the significance of his own inborn possibilities so far below that of the dictates — actual or imagined — of the surrounding world that they were not able to gather their existence into a reliable, genuine self and carry it to fulfillment.” (Boss 1983, p.220). By becoming authentic and rejecting das Man’s dictates, the flourishing of these inborn possibilities of world-disclosure frees the melancholic from their suffering.

The psychotic, by contrast, does not disclose the world in the ‘realistic’ but restricted way the neurotic does. Rather, it discloses entities in a qualitatively different way altogether – in a way inaccessible to das Man’s common experience. The psychotically ill Dasein therefore does not fall prey to the entities das Man discloses within the world, but withdraws from its state as Mitsein and falls prey to its own experiences. The “psychotic's existence is no longer open only to the sensory perception of those phenomena which present themselves in a physically tangible way to average people during their waking hours” (Boss 1982, p.212). Unrestricted by das Man, the psychotic Dasein’s openness surpasses that seen in healthy, authentic openness, and is overextended, revealing Dasein as “unable to sustain or maintain that open worldly realm” (Boss 1983, p.255). Consequently, the psychotic Dasein accesses distressing, otherworldly entities and “what he encounters engulfs the schizophrenic; it destroys his

selfhood” (ibid. p.255). A more detailed account of a similar process is given by Ratcliffe in the final section on average and minimal health.

Boss also interprets health and illness, not only along the dimension of authenticity and inauthenticity, but along that of maturity and immaturity. As he states, the ill Dasein’s arrested world relation, plays out in problematic ways, by being “limited to modes of disclosure and behavior similar to a child's” (Boss 1982, p.124). Boss argues children fall prey far more readily and deeply to others, namely to their parents. In infancy, “the child dwells wholly outside itself in the maternal Da-sein” and is “dependent on, and dissolved in, his parents' existences” (Boss 1983, p.243). The child’s being-in-the-world is not yet autonomously differentiated from their parents’. Consequently, their germinating abilities to engage with the world are heavily determined by the abilities their parents and the social world at large impart upon them. Give too little or too much of that help and support and the development of the young Dasein’s existentials falls out of step with its chronological age. As already seen, the neurotic girl who falls prey to an overly prudish way of relating with others somatises her urges, the school boy who falls prey to the bully’s hurtful treatment enacts that hurt against himself by self-harming, and similarly, the psychotic, “basically a small child” (ibid. p.126) and therefore more sensitive to perceived threats, engages in bizarre behaviour in order to alleviate her paranoia. Just like “children are said to live entirely in the present, not yet having access to a past or a future” (Boss 1983, p.214), so the ill Dasein lives in the present. But it is a painful one, for unlike the child, the ill adult Dasein typically lacks the guidance required for growth. Provide guidance and the future “begins to stamp the present with increasing force for children as their curiosity grows” (ibid., p.214). The same obtains for the ill adult Dasein, medical or psychological treatment helping their own “curiosity” (read openness) find the means to unfold itself.

Before this final treatment aspect of Daseinanalysis is reviewed, however, the later section on average and minimal health will be clearer if the nature of Dasein’s growth from infancy to adulthood is elaborated upon. Hatab (2014) describes childhood as the “ontogenetic ‘origin’” (ibid. p.381) of mature Dasein’s tacit understanding of Being, childhood being that period in which enculturation into social practices and

language use takes place. Expanding on the few passages in which Heidegger discusses childhood (his 1928/29 lecture course Einleitung in die Philosophie) and describes it as a “twilight” condition of Dasein and a “helpless deliverance in the world” (Heidegger 1975, pp.125–26), Hatab emphasises the importance of language use as signalling the child’s individuated emergence out of the twilight state in which its being-in-the-world forms part of an undifferentiated whole with that of its primary caregiver and other worldly entities. This emergence is into a clearer, reflective understanding of Being, language qua discourse being of a world-disclosive nature as determined by other, older Dasein already open to Being. Language use for Hatab, therefore, promotes the development of Dasein’s world-openness. Importantly, however, language promotes additional growth insofar as it enables children to incorporate Being’s “ineluctable blend of positive and negative forces [into] the meaning structures of their world” (Hatab 2014, p.389). This is through the “yes” and the “no”, and the mixture of praise and blame they receive from their parents. And it is also through the separation anxiety the child experiences when unexpectedly separated from its primary caregiver and forced to monitor and regulate its needs alone. Citing research in developmental psychology (Fleshback & Bloom-Fleshback 1987), Hatab emphasises how important such anxiety is for human development, its affective force sharpening the child’s experience of its being-in-the-world, and therefore bringing it, as it were, to a fuller understanding of Being. That said, growth therefore also depends as much on the withdrawal of Being, as it does on its presence. Indeed, we shall recall that the most positive change to Dasein accompanies the most negative recession of meaning. That is, authenticity is accompanied by anxiety, a process we see paralleled throughout childhood.

Heidegger does after all conceive of “Not-being-at-home [...] as the more primordial phenomenon”, and states that it “always already latently determines being-in-the-world” (Heidegger 1996, p.177) and its meaning. This is clearly apparent in early-life experience. The growth of world-openness therefore requires the, as it were, periodic disappearance of the world. “A life without estrangements and losses would be a life without meaning and growth. Yet too much estrangement can lead to disintegration, trauma, incapacitation, or perhaps excessive attachments as a refuge from finitude”

(Hatab 2014, p.390). Combining Boss and Hatab’s views, then, in order to reach optimal openness Dasein must experience “a parent-child relationship [...] whose openness is sufficiently in accord with all of the child's genuine nature” (Boss 1982, p.207). Its early attachments must not be prematurely ruptured – or never ruptured at all – so as to avoid the risk of a restricted world-openness. Similarly, in order to treat the ill Dasein, the analyst must meet the analysand on their level: that of a child. “The analyst must be mature enough to permit the patient to unfold in an atmosphere of complete security, in a relationship comparable to that of a mother with an unborn child” (Boss 1982, p.245). Meeting the patient at the level at which their development was interrupted, therapy “cast(s) aside the pathological obstructions to the free carrying out of all possible ways of relatedness with what is encountered” (Boss 1983, p.255) and restores, or secures for the first time, the patient’s health. The therapist’s openness safeguards against the dismissal or compartmentalisation of the patient’s fragile, developing being. The patient is then enabled to develop into full openness, a process which may take place on an articulate, verbal level, a childish behavioural level, or any level in between. Such is Boss’ complete Heideggerian account of illness, one we will revisit and alter in combination with Svenaeus’ account.

The Uncanny

Prior to presenting his own Heideggerian account of illness in The Hermeneutics of

Medicine and the Phenomenology of Health, Svenaeus states: “[t]hat authentic

understanding in Heidegger's sense could be of great help in matters of health is one thing, but to say that it is necessary for health or identical with health is in my view far too strong a claim” (Svenaeus 2000, p.91). This criticism is directly aimed at Boss whose account, if formulated a certain way, states that the lack of identity and freedom present when inauthentic always constitutes illness. In effect, Boss claims that the life of das Man is unhealthy. This does indeed sound like too strong a claim, for is it really plausible that only inauthentic Dasein could suffer from minor illnesses such as the common cold? That

is, do all illnesses, whatever their severity, constitute such an important restriction on Dasein’s authentic world-openness that in order to be classified as authentic no illness whatsoever must affect it, or could Dasein be authentic and ill, or inauthentic and healthy? In the absence of a clear and rigid distinction between authenticity as health and inauthenticity as illness, Boss’ account does not seem able to prevent such marginal cases contradicting his central claim. Indeed, as Svenaeus argues in a related article, “authenticity and inauthenticity in Heidegger’s phenomenology are two complementary modes of understanding – philosophical understanding and unreflected, everyday understanding – rather than two different life forms” (Svenaeus 2000b, p. 128). There therefore seems to be no neat way in which Boss can associate the philosophical understanding of authenticity exclusively with the freedom of health, or the everyday understanding of inauthenticity with illness. And, moreover, Svenaeus also criticises Boss for seemingly ignoring how inauthentic understanding “provides the necessary background for authentic understanding, by being precisely that which is thereby explored as a pattern of meaning” (ibid. p.128). There is presumably no similar need to explore illness when healthy, the different “forms of life” that are health and illness being perfectly intelligible in the absence of any association between the two. Svenaeus’ criticisms on these points should be taken seriously. However after our discussion of Svenaeus’ alternative account, my own account of illness will borrow from both his and Boss’ and present a more nuanced role for authenticity as the condition for optimal health, not, it should be noted, as somehow identical with it.

Instead of a lack of freedom, authenticity or autonomy, Svenaeus equates illness with the sense of unhomelikeness experienced in anxiety. As Heidegger puts it:

In Angst one has an "uncanny" feeling. Here the peculiar indefiniteness of that which Da-sein finds itself involved in with Angst initially finds expression: the nothing and nowhere. But uncanniness means at the same time not-being-at-home. (Heidegger 1996, p.176)

As previously noted, Heidegger conceives of “Not-being-at-home [...] as the more primordial phenomenon”, and states that it “always already latently determines

being-in-the-world” (Heidegger 1996, p.177). Svenaeus echoes this, saying “[t]he being-at-home, being-in-the-world of human being-there (Da-sein) is always also a not-being-quite-at-home in this world” (Svenaeus 2000a, p.7). And in illness, like in anxiety, it is this otherness of the world, as it is shared with other people and with a nature that resists understanding, which arises as uncanny. Heidegger may indeed have been alluding to disease in the following suggestive passage about nature: “Objectively present things encountered through Dasein can, so to speak, run against its being, for example, events of nature which break in on us and destroy us” (Heidegger 1996, p.142). Regardless, illness, on this account, involves a certain attunement which discloses the alienating and the threatening. Ratcliffe (2008) concurs, proposing that in illness a “falling away from the security of the familiar world” (p. 117) takes place and it becomes strange, bewildering and distant. Authentic anxiety is therefore not, contrary to Boss, involved in health, but as the alienation of unhomelikeness, quite the opposite is in fact the case. It is the omen for illness, rather than the catalyst for health. The alienation of anonymity which Boss focuses on is therefore not the alienation of unhomelikeness Svenaeus takes to be important, but is incidental to the true nature of health. Thus, if we imagine the

Augenblick of anxiety stretched across several moments – be it minutes or years –

Svenaeus’ phenomenological account of illness can be understood. Given this focus on attunement, the nature of Boss’ ‘problems in living’, which arise when one falls prey to das Man, are better explicated by Svenaeus, and the evaluative sense of the term “illness” receives a more thorough treatment.

Recalling Gadamer’s earlier characterisation of health as a “rhythm of life, a permanent process in which equilibrium re-establishes itself” (Gadamer 1993, p.94), we have the background to Svenaeus’ theory which, it should also be recalled, identifies health as something “we live through rather than towards” (Svenaeus 2000, p.80). Svenaeus views health as an active process of balancing, much like the act of balancing on one’s bike. When cycling well, a sense of flow and homelikeness pervades one’s being-in-the-world, a sense which needn’t be articulable but which remains in the background, providing the framework for other, more intrusive moods. When one loses one’s balance, however, that homelikeness is interrupted, and an uncanny feeling one

seeks to get away from by regaining balance arises. The failure to regain it constitutes illness. A shift occurs, whereby the entire pattern of one’s being-in-the-world, including the physical activity one may attempt, the equipment around one and the language one uses, changes at a rate faster than one can adjust. The uncanny attunement of illness therefore, like all attunements, affects one’s projective understanding, rendering it incoherent and thwarting attempts at regaining balance. The sense that something is required to adjust to this new, unpleasant being-in-the-world and return it to a coherent, homelike state gains urgency. But unlike the attempts to restore homelikeness when one’s understanding fails as part of an expectable rhythm or balance within one’s being-in-the-world (daily tiredness, or a twice-yearly cold), our responses to illness are very different in meaning.

Before expanding on this, it is worth pointing out that Nordenfelt’s comments on children cohere with Svenaeus’, as well as those of Boss and Hatab summarised above. Addressing the apparent dilemma that children are not able to realize their vital goals, yet are not considered ill because of this, Nordenfelt introduces the notion of “standard adult support” (1987, p.104), a system which takes over the realization of those vital goals. Boss, as already seen, equates this notion with his own notion that children require assistance in the absence of a mature, individualised, authentic understanding of the world. And Svenaeus echoes this idea too. As he says “infants are not immediately but only gradually thrown into the intersubjective meaning-patterns of being-in-the-world” a process which “demands support and teaching”. This is turn means “[t]he transcendence and coherence one demands for a child to be healthy would therefore gradually increase” (Svenaeus 2000, p.103). Consequently, though a child’s projective understanding may be incoherent, adult support safeguards against this constituting illness. Nordenfelt, Boss and Svenaeus therefore agree that immaturity and illness have features in common, an agreement which we shall revisit when discussing average and minimal health.

Pursuing Svenaeus’ account, emphasis is placed on embodiment. Criticising Heidegger’s neglect of this in Being and Time (see also Aho 2009) Svenaeus argues that “[t]o place the limit of the meaning-patterns of the world at the surface of the biological organism would be to proceed from a materialist perspective, and not from the

phenomenological point of view which Heidegger adopts in this work” (Svenaeus 2000, p.108-9). The lived body (as Leib, as opposed to the living, biological body as Koerper), therefore, constitutes a “nodal point in the meaning-pattern of the world” (ibid. p.109), a theory most famously defended by Merleau-Ponty in his Phenomenology of Perception (1945). One’s experiences are the body’s experiences, a coincidence which is neither causal nor conceptual, but one of identity. The body is one’s perspective on the world – one’s vector of existence – opening up and structuring the world according to its perceptual capacities and movement. Heidegger did in fact seem to acknowledge this after writing Being and Time, saying in a seminar organised by Boss: “[i]n contrast to a tool the living domains of existence cannot, however, be released from the human being. They cannot be stored separately in a tool-box. Rather they remain pervaded by human being, kept in a human being, belonging to a human being, as long as he lives” (Heidegger 1994, p. 293). The body therefore belongs to the “projective power of the self” (Svenaeus 2000, p.109) making existence a “bodying forth” (ibid. p.110) into the world’s structures of significance. Svenaeus therefore qualifies embodiment as Dasein’s fourth existential alongside attunement, understanding and discourse.

Illness, therefore, is the body announcing itself as uncanny. This echoes the various theories of illness propounded by Zaner (1981), Leder (1990), Toombs (1992), and Carel (2008), all of whom articulate a way in which “despite its evident 'intimacy', my own body is as well the experiential ground for frustration, anguish, pain, fear, dread [...] and ultimately of death, my own ceasing-to-be” (Zaner 1981, p. 52). As Carel (2008) formulates it, in illness the body as Leib becomes painfully misaligned with the body as

Koerper, the latter betraying the prereflective expectations and habits of the former and

therefore painfully protruding in awareness where it was previously transparent. The otherness of the body presents itself, that is, beyond the normal rhythm of health which includes the body’s routine autonomic functions and familiar limitations. The body is central to illness as that which interrupts coherent transcendence into the world, an especially uncanny experience because the “lived body is the primary home of Dasein” (Svenaeus ill unh, p.), an existential that cannot be left behind unlike the other tools one uses. Compare, for instance, the confusion and distress experienced when one’s hand as

opposed to the hammer it holds ‘breaks down’. The hand, being much more fundamentally me than the hammer is means that the distress is greater, possibly to the extent that it renders me ill.

So far, it might that Svenaeus’ characterisation of illness only accommodates somatic illness. Tool use is made possible by embodiment and compromised by ‘somatic illness’, but Dasein’s being-in-the-world also involves the appreciation of art, language use, society formation and so on, all of which are compromised in ‘mental illness’ (Svenaeus 2013). Cognisant of this, Svenaeus therefore argues that, despite the fact that illness as unhomelikeness primarily arises in the existential of embodiment, his account can extend beyond somatic illness. As he reiterates, no clean distinctions exist between the existentials, for they “permeate each other in an unravellable way” (Svenaeus 2000, p.112), meaning that illness affects a Dasein’s entire being-in-the-world insofar as no incoherent transcendence is entirely somatic or entirely mental. Consider, for instance, that if one is unable to communicate using language (discourse), one can still ‘express’ things using bodily gestures (embodiment). Or simply recall the equiprimordiality of attunement and understanding. Consequently, the terms ‘somatic’ and ‘mental’ “are applicable only on the psychological and physiological level - to diseases - not on the meaning-level of health and illness” (ibid. p.112).

Svenaeus (2005, 2013) elaborates on this, citing Thomas Fuchs (2002) who locates the root of all illness in malfunctions of the body, drawing a direct link between the existentials of embodiment and attunement. By his theory, Dasein’s openness, as widened or narrowed by its attunement, rests on a “bodily resonance” determined by the bodily scheme in which one’s sense modalities work in a ‘primal unity’ (Gallagher 2005). This resonance is determined by physiological changes such as hunger or disease, and like one’s ears pick up a tune, it is also determined by the picking up of ‘free-floating’ atmosphere-like moods (see Schmitz 1989). The body opens up a ‘mood space’ in which Dasein’s being-in-the-world develops within a specific spectrum of moods over time. This bodily resonance, importantly, may be healthy and pick up a wide spectrum of moods, it may be idiosyncratic and favour certain moods over others, or it may be unhealthy and pick up an uncanny spectrum such that one’s transcendence becomes incoherent and

the world becomes unhomelike. And fortunately, or unfortunately, “once attunements have been established by a situation, it can take hold of the self, which will in turn attune new situations in a corresponding manner” (Svenaeus 2005, p.207). Depression, for instance, traps one in an attunement of boredom and sadness as one’s body becomes, as it were, increasingly stiff and unresponsive to the call of the world. One’s engagement in the flow of things diminishes and one is forced back on oneself, restricted to a painful present. The bodily attuned dialogue of the self (as Leib) with the variable ‘atmospheres’ of the world breaks down. Hence Svenaeus’ account is not restricted to ‘somatic’ illness, so called ‘mental’ illnesses (or at least ‘mental’ illnesses which affect one’s attunements) implicating Dasein’s embodiment as Fuchs specifies. Hence, also, the effectiveness of pharmaceutical drugs in treating psychiatric conditions (Svenaeus 2007, 2009) which, by chemically altering the makeup of the body as Koerper, bring about “alterations of bodily resonance – alterations that make new forms of transcendence to the world possible”(Svenaeus 2007, p.152), therefore alleviating the distress of illness.

Is this enough, however, for Svenaeus’ claim that all illnesses as uncanny, both somatic and mental, implicate the body? Is it primarily the body which shows up as uncanny in mental illness, or is the uncanny aspect of one’s being-in-the-world sometimes more neatly locatable in the wider, non-bodily dimensions of the self? As Svenaeus states, the self “is not identical with the lived body, but stretches out into dimensions of emotions, thoughts and language that go beyond bodily being in a narrow sense” (Svenaeus 2000a, p.337). And as he also states, whilst the lived body forms the “centre of the self”, the self has other 'mental' dimensions encapsulated by the existentials of understanding and discourse (Svenaeus 2000, p.117). It might therefore be that dimensions of the self not contained by the body as a resonance tool, but extending beyond the body through Dasein’s immersion in the world, can show up as uncanny. This is certainly consistent with Heidegger’s existential analytic, Dasein’s self not being a mental of bodily substance but an activity, changing with the course of the temporal nature of its existence. Svenaeus is therefore right to caution “in cases of mental illness, the deformation of the self, leading to difficulties in being-in-the-world of the person, is harder to track down to its bodily roots” (ibid.).This contradicts his earlier

stated claims. As we now investigate the nature of Dasein’s mental illness, the notion that authenticity and inauthenticity might be implicated in health and illness will then be made more plausible.

Svenaeus in fact gives examples of non-bodily illnesses. Consider: “The loss of a beloved could lead to an attunement of illness if he formed an irreplaceable part of the person’s self” (ibid. p.109). Similarly, being imprisoned could result in illness depending on the way in which that person is thrown into the world and projects out of it (ibid. p.117). Here, illness is associated by Svenaeus with something other than the body. The unhomelike grief provoked by the beloved’s death could be due to the uncanny nature of an empty family home. Or if we imagine the prisoner as a professional mountaineer, the walls of their confining prison cell, rather than their body, could present as uncanny by blocking access to the more homelike mountains outside. And as Fuchs qua Svenaeus further admits, illness being a defective self-world dialogue, the world as uncanny as well as the body as uncanny affects one’s health: “the perspective of the lived body does not exclude the world but points logically to it, and to the people who inhabit it” (Svenaeus 2005, p.210). Thus, by Svenaeus’ own lights, those numerous dimensions of the world constituting the broader dimensions of the self, as opposed to the set of bodily features constituting the narrower dimensions of the self, becomes unhomelike. This more worldly nature of mental illness2 _{might indeed explain the greater variability of experiences}

amongst the mentally ill as opposed to the physically ill, the world, containing substantially more regions, including those regions disclosed by understanding and discourse.

Svenaeus’ (2014) interpretation of anorexia nervosa, a psychiatric diagnosis, in fact addresses the role uncanny understanding and discourse might play in illness, (though he frames his discussion as a means of exploring the relation of the ‘body uncanny’ to mental illness). He takes the following hypothetical case study. A given pubescent or pre-pubescent girl experiences her body as alien, it not conforming to 2 This will also include some cases of somatic illness, Svenaeus pointing out that the blind woman’s walking stick “belongs to the region we would identify with the self rather than the world” (Svenaeus 2000b, p.130) given the central role it plays in her bodying forth. Regardless, whether the body is understood as ending either at, or beyond, the boundaries of the skin, I argue such somatic cases could be distinguished from other instances of ‘mental’ illness which extend more conclusively beyond the body.

certain cultural ideals of beauty. This experience is exacerbated by the changes her body undergoes during puberty, to which she responds by controlling her eating in order to control her body. Crucially, the dietary and exercise routines she develops escalate into a pathology of their own. That is, the girl attempts to construct an ideal identity for herself through her body, but the body remains uncanny throughout. Therefore, the identity construction being futile, the routines she persists with become uncanny in themselves. The latter point is significant, for as Svenaeus says, anorexia, when it has “established itself, takes on a kind of life of its own as an uncanny pattern of experiences and ‘musts’” (ibid. p.14). As is often noted to happen in mental illness, the anorexia – consisting of the girl’s altered moods, thoughts and behaviours – takes over and a foreign will dominates her old self.

Is anorexia therefore simply a case of the body uncanny, or does it also involve alienation from the broader dimensions of the self? I argue the latter. The anorexic’s body may well be uncanny, but more significantly, her existentials of understanding and discourse – as manifested by the “uncanny pattern of experiences and ‘musts’” – are as well. Alongside her bodily attunement in the world, her projective understandings and discursive articulations of her situation are also alienating in the manner of a foreign will. Consider how her intrusive “experiences and ‘musts’” concerning food make the anorexic, for example, weigh herself obsessively (understanding) or discuss nothing but weight loss (discourse), modes of being-in-the-world she would not inhabit were that world more homelike. Once again, therefore, it is not primarily the body which shows up as uncanny and renders understanding incoherent. Nor is it even necessarily one’s attunements. Rather, it can be understanding and discourse, the homelikeness or not of the anorexic’s body notwithstanding. Granted, it is difficult to determine from case to case the extent whether the patient’s bodily attunement, as opposed to their understanding or discourse, is the more uncanny. For instance, in anxiety disorders, is it the hyperventilating body or the racing thoughts which is the most uncanny during a panic attack? That is, could the racing thoughts be so uncanny as to provoke uncanny hyperventilation, or is the opposite the case? In other conditions, however, that determination might be easier, cases of auditory verbal hallucination, for instance, less

obviously implicating uncanny embodiment than uncanny discourse (see Ratcliffe (2017) discussed below). Svenaeus in fact considers this, calling it the “mind uncanny” (Svenaeus 2000a), a concept he traces to Freud’s 1919 essay Das Unheimliche (the unhomelike) which addresses the sensation of being taken over by an alienting, demonic power, a sensation Freud later conceptualised in terms of the unconscious mind (and not the body), working beyond one’s control. This is not phenomenological, however psychoanalysis’ emphasis on the uncanny ‘mental’ aspects of Dasein’s self is nonetheless similar to the emphasis I am trying to make, and which Svenaeus, his appropriation of Fuchs to the contrary, appears to be making as well.

It seems superficially correct that Svenaeus objects to Boss equating illness with inauthenticity, this equation ignoring the highly plausible role the unpleasant experience of the uncanny plays, and committing the category error of identifying that experience, as a form of life, with a form of understanding. Boss ignores the concrete experience of illness and mistakes it for a lack of freedom. However, I have argued Svenaeus focuses too much on the ill Dasein’s throwness as bodily attunement, and not enough on its non-bodily attunements, discursive activities, and the manner of its understanding transcendence. As we saw in the examples of grief and imprisonment, non-bodily attunement may sometimes be the primary source of the uncanny. Also, again in cases of mental illness, there is room to argue, that Dasein’s understanding and discourse, more than its embodied attunement, becomes uncanny in the sense of not being Dasein’s own. This was seen to be the case in anorexia, and it seems intuitively to be the case in such conditions as schizophrenia, whose symptoms, whilst of course indicating uncanny attunements and embodiment, are also indicative of uncanny behaviours, thoughts and verbalizations. Again, given this extension of Svenaeus’ account of illness beyond uncanny embodiment, attempting to determine which other existential is the most uncanny is likely to be difficult in view of their intertwinement. I nonetheless argue it is a necessary extension. Shifting focus onto the other existentials, mental illness is better accounted for, and new room for Boss’ account of illness as inauthenticity is created. This I will show in the next section in which I combine both Boss and Svenaeus’ accounts.

Inauthenticity and the Uncanny

Keeping the above extension in view, I will now combine Svenaeus’ and Boss’ accounts and present a hybrid Heideggerian theory of illness. As it shall be illustrated, illness involves both inauthenticity and a sense of the uncanny, inauthenticity structuring one’s being-in-the-world such that far more within it is likely to show up as uncanny. To explain this, I begin with a non-clinical example and I then address mental and physical illness. To immediately clarify why this division of illness into mental and somatic types makes room for authenticity and inauthenticity within a theory of illness – unlike Svenaeus – I take it that mental health and illness as associated with Dasein’s non-bodily existentials, existentials which authenticity and inauthenticity are also customarily associated with. That is, in the same way that mental health and illness implicate Dasein’s transcendence in the world more than its concrete bodily state do, so authenticity and inauthenticity implicate the more active than passive aspects of Dasein’s existence. For, as we saw, authenticity involves “anticipatory resoluteness” – resolving upon new understanding actions and therefore achieving new discursive articulations – not the mere acceptance of new bodily attunements. Thus, the focus on ‘mental’ states made above constituted a first step towards enlisting Svenaeus to a Bossian understanding of illness as inauthenticity. But as will also be seen, the customary association of authenticity and inauthenticity with the non-bodily existentials should not in fact be taken so seriously. For once the discussion turns to the particularities of somatic illness, the notion of bodily authenticity will be introduced, and Boss’ own confinement to mental and psychosomatic illness overcome. Before this, however, some groundwork is required so as to circumvent the problems Svenaeus sees in Boss’ equation of authenticity and inauthenticity with health and illness.

One form the role of inauthenticity in illness could take is as follows. If we recall, authenticity makes possible Dasein’s individualised transcendence into the world whereby it lives in anticipatory resoluteness: Dasein resolves upon facing up to the unique, “factical situation” in which it finds itself, and it anticipates a specific and fragile