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Medical discernment and dialogical praxis: treatment as healing oneself


This essay investigates the hermeneutic idea of health and the resulting formative notion of treatment. In its first part, the essay diagnoses, based on some texts of the German philosopher Hans-Georg Gadamer, the increasing technologization of contemporary professions and, specifically in the case of medicine, the risk of disappearance of self-treatment that this technologization causes. In addition to medicine, it also briefly takes psychoanalysis and pedagogy to exemplify the risk of over-specialized professionalization. In the second part, the essay seeks to doubly ground the hermeneutical idea of health: on the one hand, in the heritage of Hippocratic medicine that supports Gadamer's point of view and, on the other hand, in dialogical praxis, considering it the core of philosophical hermeneutics itself. Still in its second part, the essay interprets three aspects of the Gadamerian dialogue, translating them into medical professional practice. Finally, in the third and last part, the essay shows that hermeneutically-understood medical treatment leads to self-treatment, which is an indispensable, but not sufficient, condition of the patient's cure. In summary, when patients are mobilized by the dialogical praxis of medical discernment, they are more able to understand the importance of their taking treatment as self-treatment.

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  1. 1.

    On how Gadamer innovates hermeneutics tradition, especially regarding Heidegger's philosophical phenomenology, see Grondin (2001).

  2. 2.

    Therefore, the medical or teaching activity needs to be supported by the ethics education of the subject, which has been a source of concern since classical antiquity. Michel Foucault shows this with ease in his penetrating course L’herméneutique du Sujet (The hermeneutics of the subject), given at Collège de France, in 1981 and 1982. This Foucault course also serves to understand how deeply united philosophy and medicine are in antiquity through a shared ethical problematic.

  3. 3.

    Research into the relationship between physis and techne is a core point for understanding ancient medicine, especially the notion of health of Hippocratic medicine. The essay collection organized by Flasha (1971) offers a good problematizing introduction to this relationship from different interpretative perspectives; for a more detailed presentation, focusing especially on the notion of physis, see also Entralgo (1970).

  4. 4.

    Here Gadamer refers specifically to clinical cases in which patient recovery is possible; he does not ignore all the situations in which the patient, being terminally ill, no longer has a medical cure.


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Correspondence to Renata Maraschin.

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Dalbosco, C.A., Filho, F.C.d.S., Maraschin, R. et al. Medical discernment and dialogical praxis: treatment as healing oneself. Med Health Care and Philos (2020).

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  • Philosophy
  • Medicine
  • Health
  • Treatment
  • Education