The original edition of Carel’s book Illness: The Cry of the Flesh, published in 2008, made something of a splash. It was a raw expression-cum-examination of the experience of a life-changing, possibly life-ending, illness. Carel had received her diagnosis only two years before the publication of the first edition, and it showed in the uncertain ruminations of the book.  The reader was, at times, given the impression that what was being read were personal diaries, with all the feelings of reading that entails of reading something not meant for others.

Perhaps because of this very personal, at times almost visceral, approach found in the work, it divided the philosophical community, with some hailing it as an important contribution to the philosophy of illness, and others criticising it as little more than a personal expression of grief. The present edition doesn’t address this issue in any detail, but it does, I think, provide an implicit answer by aligning itself with those philosophers who argue that philosophy goes beyond explicit formal argumentation. It’s worth noting that this use of literature in aid of her philosophical/personal reasoning was anticipated by Mikel Burley in 2011 Cf. Mikel Burley, “Emotion and Anecdote in Philosophical Argument: The Case of Havi Carel’s Illness’, Metaphilosophy, Vol. 42, Nos. 1-2 (Jan., 2011), pp. 33-48. In including that addition, the present work goes some way to answering those critiques.

Regardless, it was, I think, precisely this personal aspect of the book that reached out beyond the confines of an academic audience and connected with people from all walks of life, whether doctors, patients, those who knew someone suffering, and those just plain interested in what philosophy has to offer in the way of therapeutic advice. In he preface to this third edition, Havi Carel enumerates some of the unexpected ways in which her book has had influence, leading to her running professional development sessions for doctors, nurses, and medical students, among others.

Clearly the work has struck a chord. But what, if anything, does this third edition bring to the table? In what follows I begin by giving a brief outline of the book, for those unfamiliar with earlier editions, before examining how this third edition advances the conversation.

In essence, Illness is a form of what Foucault refers to as ‘Self-Writing‘. Foucault observes that part of the role of writing within philosophy is as a kind of ‘test of truth’, in which the individual philosopher explores and expresses their lived experience through the lens of philosophy. The most well-known example of this kind of work is, of course, Marcus Aurelius’ Meditations, in which he explores the issues which concern him in a form of askesis, which is nevertheless equally valuable, though perhaps differently so, for his different readers.{Other examples of this include Boethius’s Consolations of Philosophy, Pascal’s Pensées, or the letters various of Seneca.) As a fine addition to this lineage of philosophical works, Carel’s work  is, therefore, necessarily personal, but, as with Aurelius’ Meditations or Boethius’ Consolations, this does not  detract from its philosophical content. On the contrary, its personal nature, like the lyrics of a pop song, are made all the more universal precisely because they so uniquely personal, laying bare a soul in the hopes of connecting with another. 

This connection is achieved across five chapters in the original book, with the third edition adding a sixth on the subject of organ transplantation.  Each chapter explores one aspect of life which is affected by the presence of an illness, roughly corresponding, it seems to me, to the order of experience. And so Chapter One considers how the body and our (if a Cartesian ego may be permitted) relationship to it is affected by the lived experience of a chronic illness. This changed relationship with the body must, of course, have a consequent effect on our relationship with others, and so the social effect of illness is the focus of Chapter Two. Chapter Three turns to what is perhaps the most-asked question surrounding the experience of serious illness, which is how this experience should be understood, and whether it is possible to life a good life within that experience. Although in terms of the expression of her own experience, this chapter is the least personal, its discussion of the possibility of ‘health within illness’ (pp. 95-99) is delicate and relatable, drawing on a number of philosophical resources without losing the connection to the concrete world of immediate experience. The natural question after this is one which has concerned philosophers since Socrates: the fear of death. It is fitting, then, that in addition to Carel’s ‘usual suspects’ of Merleau-Ponty and Heidegger, she draws heavily on the ancient philosopher Epicurus in this chapter. Indeed, the entire argument of this chapter has a very ancient world flavour to it, with its central theme – that the fear of death prevents a good life – calls to mind not just Epicurus but Seneca, Epictetus, Socrates, and countless others. 

Of course, for any ancient philosopher, the statement that fear of death can ruin life is an incomplete sentence. And here we come to an important change between the first edition of the work and its latest, third, edition. In the original book Chapter 4 flowed seamlessly into Chapter 5 (and is still called this in a typo on page 21), which presented the corollary to the statement of its predecessor: that, while the fear of death can prevent us from living, it is the awareness and acceptance of death as a reality that enables us to live in the moment, enjoying life more fully.  In the present edition this is now Chapter 6, with a new chapter on the subject of transplants occupying the place of Chapter 5. Carel’s justification of this shift is that transplantation ‘exists to prolong life and defer death’, and are ‘an option of last resort for those who would otherwise have  died.’ (p. 146). I take the point, but I can’t help but feel that on the surface something has been lost philosophically in separating the arguments of Chapter 4 and (now) Chapter 6. 

That said, the insertion of the new Chapter 5 where it is provides a perfect continuation of the mirroring of experience. After the fear of imminent death discussed in Chapter 4 gives way to a new lease on life in Chapter 5, which also incorporates an excellent analysis of Hans Christian Anderson’s The Shadow, in which a man’s shadow slowly takes over his whole life, eventually killing him as the shadow subsumes his existence– the analogy Carel draws between the shadow and illness (pp. 153-158) needs little explanation .But the possibility of a transplant suggests the possibility of overcoming the shadow, as Carel has herself done in the years since the first edition, regaining lung capacity and even becoming a mother, something she believed impossible in 2008. And so the hope (expressed, admittedly, in a kind of fear)of Chapter 5 in fact leads nicely into the present-focused mindset of Chapter 6.

Here we can see the contribution of this latest edition. Where the first edition was notable and laudable for its rawness, the passing of years has enabled the third edition to retain the descriptions of those experiences as authentic, but no longer so imminent. This gives the third edition a more reflective note, one which, I think, will make it easier, because less confronting, to relate to and understand the keen psychological and philosophical insights of the work. It is also, I think, noticeably more hopeful, and the more important for that very hopefulness. Where the first book was published in the immediate wake of diagnosis, so to speak, the third edition is calmer, happier, and permeated throughout by the lived experience of living with, in, and, in a sense, through, a diagnosis.  Where the first book uses the present tense to describe pain, suffering, even despair, this is (sometimes) re-phrased to indicate the situation has changed. Perhaps the most touching example of this is the change from ‘the children I would never have’ to, in the third edition, ‘the children I thought I would never have’ (p. 40). This simple change offers a hope for those suffering, and an inspiration for those who are not. 

The first edition was a book about suffering, but the third, to me, reads like a book on the philosophical and psychological experience of hope and suffering. This is best encapsulated in the work’s own closing words: 

I continue to ride my electric bike to work, go to yoga class, and see friends and family. I continue to walk my dog, listen to music, write. I continue to live. Sometimes my illness makes life hard. It often takes up more time and space than I would like it to. But it has also given me an ability to bew truly happy in the present, in being here and now. (p. 185)

The shadow is overcome. 

© 2019 Alexander Westenberg

Alexander Westenberg, PhD, Academic Research Officer to Archbishop of Sydney, Australia