In this book Gadamer discusses the transformations in human self-understanding, focusing on the achievements of modern medicine.
1. Theory, Technology, Praxis.
2. Apologia for the Art of Healing.
3. The Problem of Intelligence.
4. The Experience of Death.
5. Bodily Experience and the Limits of Objectificaton.
6. Between Nature and Art.
7. Philosophy and Practical Medicine.
8. On the Enigmatic Character of Health.
9. Authority and Critical Freedom.
10. Treatment and Dialogue.
11. Life and Soul.
12. Anxiety and Anxieties.
13. Hermeneutics and Psychiatry.
Apologia for the Art of Healing
We still possess a treatise from the age of the Greek Sophists where we find the art of medicine defended against its detractors.1 And it is certainly no accident that traces of a similar argument can be pursued even further back than this. For the art exercised in medicine is a strange one that does not correspond at every point with what the Greeks called techne, and what we call either applied art or science. The concept of techne is a peculiar creation of Greek culture, of the spirit of historié, the free-thinking investigation of things, and of the spirit of logos, the search for the explanatory grounds of everything we hold as true. The discovery of the concept of techne and its application to medicine marked a first decisive commitment towards everything that essentially characterizes western civilization. The physician no longer appears as the kind of medicine man mysteriously shrouded with special powers that we find in other cultures. He is a man with a body of knowledge. Aristotle specifically uses medicine as his standard example for the transformation of the purely practical accumulation of skill and knowledge into a genuine science. Even if the physician proves inferior to the experienced dispenser of cures or the wise old woman in a particular case, his knowledge possesses a fundamentally different character: he grasps the universal. He knows the reason why a particular form of healing meets with success. And he understands its effectiveness because he pursues the interconnection between cause and effect itself. That sounds very modern, and yet there is no question here of applying natural scientific knowledge to the practical goal of healing in our contemporary sense. For the opposition between pure science and its practical application as we are familiar with it has been shaped by the specific methods of modern science and the application of mathematics to the knowledge of nature. The Greek concept of techne on the other hand does not signify the practical application of theoretical knowing, but rather a special form of practical knowing. Techne is that knowledge which constitutes a specific and tried ability in the context of producing things. It is related from the very beginning to the sphere of production, and it is from this sphere that it first arose. But it represents a unique ability to produce, one which knows what it is doing, and knows on the basis of grounds. Thus it is a characteristic of this knowing ability from the outset that an ergon, or work, emerges from it and is released, as it were, from the activity of production. For production consummates itself in the fact that something independent is actually produced, that is, is given over for the use of others.
Now within the parameters of a concept of 'art' which still stands before the threshold of what we call 'science', it is obvious that the art of healing occupies an exceptional and problematic position. For here there is no 'work' produced by art, and no 'artificial' product. Here we cannot speak of a material which is already given in the last analysis by nature, and from which something new emerges by being brought into an artfully conceived form. On the contrary, it belongs to the essence of the art of healing that its ability to produce is an ability to re-produce and re-establish something. This signifies a special modification of what 'art' means, and one which is unique to the knowledge and practice of the physician. One can indeed say that physicians 'produce' health by means of their art, but this is not a very precise way of speaking. For what is produced in this way is not a work, an ergon, something quite new that comes into being and confirms the original skill. Rather it involves the restoration of the health of the sick person, and whether this is actually the result of medical knowledge and ability cannot be directly observed from the restored state of health itself. The healthy individual is not simply someone who has been 'made' healthy. Thus it must always remain an open question just how much the successful restoration of health owes to the experienced treatment of the physician and how much nature itself has assisted in the process.
This is the reason why from time immemorial there has always seemed something special about the art of medicine and the standing it enjoys. The literally vital significance of the art of medicine lends a particular status to physicians and their claims to knowledge and skill, especially when life is in mortal danger. On the other hand, and particularly when the danger is past, to this standing there always corresponds a certain doubt about the existence or the efficacy of such healing skills. Tyche and techne, fate and art, stand in a particularly tense and antagonistic relationship here. What is true for the positive case of successful healing is no less true for the negative case of failed treatment. What part was played by the negligence of the physician, we may ask, or was it perhaps the omnipotent stroke of fate which brought about the unlucky outcome? Who could decide such a thing, and especially those who do not possess the requisite skills? An apologia for the art of healing is more than a defence of a particular profession or a special art against other sceptical or unconvinced individuals; it also represents a kind of self-examination and self-defence on the part of the physician which indissolubly belongs to the peculiar character of medical skill itself. Physicians can no more prove the worth of their art to themselves than they can to others.
The characteristic ability which distinguishes the art of medicine in the context of techne stands, like all techne, within the broader context of nature. All ancient thought conceived the domain of what can skilfully be produced by human art in the light of nature. If techne was understood as the imitation of nature, then this principally signified that the artful capacity of human beings exploits and fills out, as it were, the open realm of possibilities which have been provided for us by the forms of nature itself. In this sense medicine is clearly not an imitation of nature, for there is no artificial product involved. What is supposed to emerge from the exercise of the physician's art is simply health, that is, nature itself. And this is what leaves its peculiar mark on the art of healing as a whole. It is not an art that involves the invention or planning of something new, of something which does not already exist as it is and which someone could go about producing in an instrumental fashion. On the contrary, it is from the beginning a particular kind of doing and making which produces nothing of its own and has no material of its own to produce something from. The expert practice of this art inserts itself entirely within the process of nature in so far as it seeks to restore this process when it is disturbed, and to do so in such a way that the art can allow itself to disappear once the natural equilibrium of health has returned. Physicians cannot stand back from their work in the way any artists, artisans or fabricators can, in such a way, that is, that they might in some sense retain the product as their own. Of course it is true in all cases of techne that the product is given over into the use of others, yet the product still remains one's own work. The work of physicians on the other hand, precisely because it is simply the health which has been restored, does not remain theirs in any way, and indeed it never was there. The relationship between the doing and the deed, the making and the made, the effort and the success is here of a fundamentally different, more enigmatic and elusive character.
In ancient medicine this can be seen among other things in the fact that an express effort had to be made to overcome the old temptation of only intervening and demonstrating one's skills where there was a chance of success. Even the individual who is fatally ill and who offers absolutely no hope of spectacular medical success still has to be an object of the doctor's concern, at least where there is a mature awareness among the medical profession, an awareness which goes hand in hand with philosophical insight into the logos. In this more profound sense the techne which is in question here is clearly integrated into the course of nature in such a way that it can make its contribution within the natural process as a whole and in all of its phases.
Now one can certainly recognize all these features in the modern science of medicine as well. And yet there has also been a fundamental transformation. For nature as the object of modern natural science is not the nature into which the medical skills, and indeed all the skills of human 'art', once felt themselves to be integrated. Indeed the peculiar character of the modern natural sciences lies in the fact that they understand their own knowledge precisely as a capacity to produce effects. The mathematical-quantitative isolation of laws and regularities in the natural order is directed towards the isolation of specific contexts of cause and effect which allow human action various possibilities for intervention which can be repeated under exact conditions. The concept of technology which is connected with the idea of science in the modern era thus takes on specifically intensified and increased possibilities in the field of medicine and its healing procedures. The capacity to produce desired effects makes itself independent, as it were. It permits the control of local...