The significance of relatedness in healthcare

Abstract

The tradition of anthropological medicine in the first half of the twentieth century regarded medicine first of all as a relational activity. Its aim was to develop medicine as a science of human beings, building on the ideas of phenomenology, existentialism and philosophical anthropology (Ten Have 1995). Rather than applying the findings of scientific disciplines such as biology, genetics, chemistry or physics to human beings, following strict methodological rules or operating as a practical art, anthropological medicine emphasized the personal qualities of the healthcare professional and acknowledged the subjectivity of patients and doctor, medicine being in between science and art. How to create a genuinely humane medicine and physiology was the major challenge for Buytendijk (Dekkers 1995). Crucial notions in his work are ‘relation’ and ‘relatedness.’ Medicine essentially is a relational activity. It is basically characterized by what we nowadays would call connectivity. Another basic notion for Buytendijk was ‘encounter.’ Like his German colleagues Von Weizsacker and Von Gebsattel he wrote extensively about the doctor-patient relationship, which he did not simply regard as the interaction of health provider and health consumer. Rather it was the expression of the more fundamental situatedness of human beings in general. Our bodily existence is always situated in our ‘life-world.’ Existence means connecting to others, exceeding one’s individual boundaries. The notion of relationship therefore has a more fundamental significance. It is constitutive for human existence since it would not be possible without relatedness to other beings. But it is also the primordial phenomenon for the theory and practice of medicine, since the plea for help of someone in need constitutes the enterprise of medicine, establishing a relationship between the ill and needy and professionals who respond with help and care (Von Weizsacker 1951; Welie 1995). Thus medicine’s point of departure is—in a manner of speaking—‘‘relational ontology’’ (Martinsen 2013, p. 65). The significance of relatedness is exemplified in the anthropology that characterizes this philosophical tradition. It assumes, what Dekkers calls the ‘‘indissoluble relationship’’ between person, body, consciousness and world (Dekkers 1995, p. 20). Human beings cannot be separated into a physical and mental component, into body and self. In addition, the dualism in the scientific epistemology between object and subject must be challenged. We generally assume that there is an objective real world independent of an isolated individual subject. The anthropology of relatedness rejects such a distinction because it prevents that scientific methodology can grasp what is typical for human beings. If they are dissected, disintegrated and disconnected through abstract analytic approaches, they cannot be comprehended and approached as persons. The coherence and interrelationships that are defining living beings are lost. In this way, medicine cannot fully understand disease and illness. According to Von Weizsacker (1951) being ill is a way of being a human person, an existential mode. Having a disease and being ill are two sides of the same coin. Similarly, human beings do not only have a body but at the same they are their body. In other words, organic life (fxg) and biographical life (bio1) are intrinsically related. This connectedness explains the emphasis on passivity in the anthropological tradition. Human beings are not only characterized by activity and control, but they are also subjected to experiences and possibilities. Everyday life has, in the words of Von Weizsacker, a ‘pathic’ nature that cannot be eliminated by interventions. H. ten Have (&) B. Gordijn Pittsburgh, PA, USA e-mail: tenhaveh@duq.edu