July 27-28, 2024 in Andalusia, Alabama  –  “Energetics, Somatics and Sensory Experiencing” with Thomas, Mel and jim mcdonald now enrolling!

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The Phenomenology of Illness

When we fall ill, our taken-for-granted relationship with our body is disrupted. The body, once a silent partner in our daily lives, becomes the source of discomfort, pain, or dysfunction. This experience of bodily dysfunction can profoundly alter our sense of self and our way of being in the world. As Havi Carel, a philosopher who has written extensively on the phenomenology of illness, notes: “Illness is not just an event that happens to the body, but a way of being that permeates all aspects of life.”

In illness, the body becomes the focus of our attention, demanding to be noticed and cared for. Simple tasks that were once performed with ease may now require great effort or may be impossible altogether. The ill person may feel a sense of betrayal by their body, a loss of control, or a disconnection from their former sense of self. These experiences can be accompanied by feelings of vulnerability, fear, and isolation, as the ill person navigates a world that is often not designed to accommodate their needs.

Moreover, the experience of illness is not just about bodily sensations, but about the meanings we ascribe to those sensations. A pain in the chest may be experienced as a minor annoyance, a sign of overexertion, or a terrifying indication of a heart attack, depending on the person’s beliefs, knowledge, and past experiences. The meaning we give to our symptoms can significantly shape our emotional responses, our coping strategies, and our overall illness narratives.

The phenomenology of illness also highlights the social dimensions of embodiment. Illness can disrupt our ability to fulfill social roles and meet expectations, leading to shifts in identity and relationships. The ill person may face stigma, discrimination, or lack of understanding from others, further compounding their sense of isolation and distress. At the same time, illness can also open up new forms of connection and solidarity, as people bond over shared experiences and challenges. This solidarity can be a powerful force for advocacy and social change, as seen in the disability justice movement.

Disability justice is a framework that emphasizes the intersectionality of disability with other forms of marginalization, such as race, class, gender, and sexuality. It recognizes that people with disabilities, including chronic illnesses, face systemic barriers and oppression that cannot be addressed solely through individual accommodation or medical intervention. Instead, disability justice calls for a fundamental transformation of society to ensure equal rights, access, and inclusion for all people, regardless of their health status or disability. One of the key tenets of disability justice is the importance of community building and collective action. By sharing their stories and experiences, people with disabilities can challenge dominant narratives of illness and disability as solely medical or personal issues, and instead situate them within a broader context of social and structural inequity. This can foster a sense of pride, empowerment, and solidarity among people with diverse health experiences, and create opportunities for mutual support, advocacy, and resistance.

The Phenomenology of Health

While the phenomenology of illness has received significant attention, the phenomenology of health is equally important to consider. Health, from a phenomenological perspective, is not merely the absence of disease, but a positive state of vitality, resilience, and well-being. When we are healthy, our bodies often recede into the background, allowing us to engage fully with the world and pursue our goals and aspirations.

However, the experience of health is not just characterized by the absence of bodily dysfunction. There are moments when we are acutely aware of our bodies in positive ways – when we feel a surge of energy, a sense of strength, or a rush of endorphins. These experiences of bodily vitality and joy are an integral part of the phenomenology of health.

Consider the experience of “flow” – a state of complete absorption in an activity, where time seems to disappear and the body moves with ease and grace. Athletes, artists, and musicians often describe experiences of flow, where they feel a sense of unity between their body and mind, a dissolution of the self into the activity at hand. These experiences of bodily mastery and integration are not just mentally pleasurable, but are felt viscerally, as a sense of aliveness and connection.

Similarly, experiences of physical pleasure, such as the warmth of the sun on one’s skin, the rush of endorphins after exercise, or the sensual delight of a massage, are all part of the positive phenomenology of embodiment. These experiences remind us that our bodies are not just instruments for achieving tasks, but are sources of joy, creativity, and connection.

The phenomenology of health also includes experiences of resilience and adaptability. When we face physical challenges or stressors, our bodies have a remarkable capacity to adapt and recover. We may feel a sense of pride and confidence in our body’s abilities, a trust in its wisdom and strength. These experiences of bodily resilience can contribute to a positive sense of self and a greater capacity to navigate life’s challenges.

The Therapeutic Relationship and Experience

At the heart of effective healthcare lies the therapeutic relationship, a dynamic partnership built on trust, empathy, and collaborative care. Far more than an exchange of information or a means to deliver treatment, the therapeutic relationship is a dynamic, co-creative process that has the power to profoundly shape an individual’s experience of illness and their journey towards well-being.

At its core, the therapeutic relationship is built upon a foundation of empathy, trust, and open communication. When a practitioner meets an individual with genuine compassion and a willingness to understand their unique story, a deep bond of trust can form. This trust is essential, for it creates a safe and supportive environment where the individual can openly share their fears, hopes, and vulnerabilities without fear of judgment or dismissal.

Empathy, the ability to step into another’s shoes and see the world through their eyes, is a key component of a strong therapeutic alliance. When a practitioner empathizes with an individual’s suffering, they convey a powerful message of validation and understanding. This empathic connection helps to alleviate the sense of isolation and alienation that so often accompanies illness, reminding the individual that they are not alone in their struggle.

Through active listening and attentive presence, the practitioner can gain a deeper understanding of the individual’s unique experience of illness. This understanding goes beyond symptom reporting, encompassing the emotional, social, and existential dimensions of the individual’s life that are impacted by their health condition. By holding space for the individual to share their story, the practitioner can help them to find meaning and coherence in the midst of the often chaotic and fragmenting experience of illness.

The therapeutic relationship also provides a context for collaborative decision-making and personalized care. Rather than adhering to a one-size-fits-all approach, the practitioner and individual work together to develop an interventional plan that aligns with the individual’s values, preferences, and goals. This collaborative process empowers the individual to take an active role in their own healing, fostering a sense of agency and self-efficacy.

When an individual feels heard, understood, and respected within the therapeutic relationship, they are more likely to engage in self-care practices and are more motivated to work the interventional plan. They may also feel more comfortable discussing any concerns or side effects they experience, allowing for timely adjustments to their care plan. This open, two-way communication is essential for building trust and ensuring that the individual receives the most appropriate and effective care.

In the face of serious illness, the therapeutic relationship can be a powerful source of emotional support and resilience. A compassionate and attentive practitioner can help create a container to hold the individual’s anxiety, fear, and grief, providing a stable and reassuring presence in times of uncertainty. By offering empathy and validation, the practitioner can help the individual to process their emotional experiences and find healthy ways to cope with the challenges of their illness.

This emotional support can be particularly valuable for individuals facing chronic or life-threatening illnesses, who may grapple with existential questions of meaning, purpose, and identity. The therapeutic relationship can provide a space for exploring these deeper concerns, helping the individual to find ways to maintain a sense of wholeness and connection in the face of profound disruption and loss.

Beyond offering emotional support, the therapeutic relationship can also serve as a catalyst for personal growth and transformation. By approaching the individual with unconditional positive regard and a belief in their innate capacity for healing, the practitioner can help to nurture a sense of hope and possibility. This hopeful, growth-oriented stance can be especially important for individuals who have internalized a sense of helplessness or despair in the face of chronic illness.

As the individual begins to see themselves through the eyes of a caring and supportive practitioner, they may start to challenge limiting beliefs and expand their sense of what is possible for their health and their life. The therapeutic relationship thus becomes a crucible for change, a space where old patterns can be released and new perspectives can emerge.

Within the context of herbal medicine, the therapeutic relationship takes on additional dimensions of richness and depth. Herbal medicine, with its roots in traditional ways of knowing, recognizes the inherent wisdom and healing capacity of the body. By working with plant allies to support and strengthen the body’s own resilience, the herbal practitioner becomes a partner and a guide in the individual’s journey towards balance and well-being.

The use of herbal medicines can also foster a profound sense of connection and intimacy within the therapeutic relationship. The acts of preparing and taking herbal remedies can be imbued with ritual and intention, creating a shared sense of purpose and meaning between practitioner and individual. As the individual engages with the sensory qualities of the herbs – their tastes, smells, and textures – they are invited into a direct and embodied relationship with the plants themselves.

This multisensory engagement with herbal medicines can be deeply grounding and nourishing, helping the individual to feel more connected to their own body and to the larger web of life. This sensory engagement with herbal medicines takes on a deeper significance when viewed through the lens of the predictive brain framework. As discussed earlier, our subjective experiences of health and illness are profoundly shaped by the brain’s predictive models, which are constantly updated based on sensory input and the meaning we assign to these experiences. By introducing new sensory experiences and promoting a sense of connection and coherence, the therapeutic relationship and the use of herbal medicines can help to shift these predictive models, facilitating a more positive and empowering experience of health and healing.

In this context, the therapeutic relationship becomes not just a means of delivering care but a powerful tool for reshaping the individual’s predictive models and, by extension, their subjective experience of illness. By providing a safe and supportive space for exploring new sensations, emotions, and ways of understanding, the practitioner can help the individual to develop new narratives and expectations around their health, fostering a greater sense of agency and resilience in the face of challenge.

The therapeutic relationship in herbal medicine also provides an opportunity for education and empowerment, helping the individual to become more attuned to their own body’s needs and rhythms. This learning process can be deeply empowering, as the individual gains a greater sense of autonomy and self-sufficiency in their own health and healing.

As the individual learns to work with herbal allies for self-care and symptom management, they may feel a greater sense of control and mastery in the face of illness. This sense of empowerment can ripple out into other areas of their life, fostering a more proactive and resilient stance in the face of life’s challenges.

Ultimately, for Herbalists, the therapeutic relationship is a living, breathing embodiment of the interconnectedness of nature.  By creating a space of safety, trust, and collaboration, the practitioner and individual can co-create a healing journey that honors the full complexity and potential of the human experience. This journey is not always easy, and it is not always linear. There may be setbacks, frustrations, and moments of doubt along the way. But the therapeutic alliance can create the possibility that these challenges can become opportunities for deeper understanding, growth, and transformation.

As practitioners, we have the profound privilege and responsibility of stewarding these therapeutic relationships. This stewardship asks us to cultivate not only our skills and knowledge but also our own capacity for empathy, presence, and self-awareness. It invites us to engage in ongoing self-reflection and personal growth, recognizing that our own healing journey is inextricably linked to our ability to hold space for others.

By committing to our own self-work and cultivating a compassionate presence, we create a space that is primed for transformation – not just for our clients, but for ourselves as well. The mutual growth inherent in the therapeutic relationship reminds us that we are not separate from the individuals we work with, but are fellow travelers on this journey we call life.

The Phenomenology of Herbal Medicine: Reconnecting with Traditional Ways of Knowing

Five decades ago, Christopher Hedley, a much loved and respected U.K. Herbalist and teacher, developed a unique approach to engaging with medicinal plants through blind tea tastings. In his classes, he had students focus intently on their direct sensory experience of herbs, noting their taste, smell, and felt sense in the body. This practice, Hedley argued, was not merely a novel educational tool, but a way of relearning and reconnecting with the sensory language and concepts that lie at the heart of many traditional systems of medicine. This practice was formalized at the Scottish School of Herbal Medicine, and was spread, in various forms and formats, far and wide by students of Hedley.

I incorporated blind plant tastings into my school’s curriculum from its inception in 2010, but it took me years to understand the practice of blind plant tastings as a form of phenomenological plant knowledge that is foundational to traditional systems of medicine. When we look at the Materia Medicas of traditional systems, we find a wealth of descriptive language that captures the sensory and experiential dimensions of medicinal plants. The taste, smell, texture, and felt qualities of herbs are described in great detail, using terms that evoke a direct, embodied sense of the plant. Though poetic, these descriptions are not just poetry, but are seen as essential guides to the therapeutic properties and actions of the herbs.

In many traditional systems, the experiential qualities of an herb – its flavor, its temperature, its moisture, its vitality – are understood to reflect its medicinal potential. An herb that is bitter and cooling is seen as having different actions and indications than one that is sweet and warming. The modern herbal practitioner’s skill lies not just in their knowledge of these qualities, but in their ability to perceive and interpret them directly, through their own senses and embodied experience.

This way of knowing stands in contrast to the conventional biomedical approach, which tends to prioritize objective, quantifiable data over subjective, qualitative experience. In the biomedical paradigm, the efficacy of a treatment is typically measured by its ability to alter specific physiological parameters or disease outcomes. The subjective experience of the patient, while not ignored, is often seen as secondary to these objective measures.

However, when we understand the goal of herbal medicine as the alleviation of suffering and the promotion of well-being, rather than solely the elimination of disease, the experiential dimension takes on a central importance. The way a patient feels, the meaning they ascribe to their symptoms, the sense of vitality and resilience they experience – these are not just incidental side-effects of treatment, but are the very essence of the healing process.

This understanding has profound implications for how we evaluate and validate herbal interventions. The standard of evidence in biomedicine, the randomized controlled trial, is designed to isolate the specific, causal effects of a treatment by controlling for all other variables, including the subjective beliefs and experiences of the patient and practitioner. If we remove the limitations on the concept of healing imposed by the curative hypothesis of biomedicine, and embrace it as a relief of illness, often accompanied by a return to health,  these variables are not noise to be isolated and eliminated, but are active ingredients in the healing process.

Importantly, this does not mean that we must abandon the idea of evidence and efficacy in herbal medicine. Rather, it calls for a broadening of our understanding of what constitutes evidence, and a recognition that the experiential dimension of healing must be studied and validated on its own terms. This could involve the systematic collection and analysis of qualitative data from patients and practitioners, using methods from phenomenology, ethnography, and other human sciences. It could also involve the development of new outcome measures that capture the subjective dimensions of well-being and transformation.

Some may argue that this approach lacks the rigor and objectivity of biomedical science. But I would argue that the study of subjective experience, when approached with methodological discipline and intersubjective validation, can yield knowledge that is just as rigorous and actionable as the study of objective physiological processes. Indeed, in the context of a holistic, person-centered medicine, it may be even more relevant and essential.

By embracing the phenomenology of herbal medicine – by recognizing and honoring the experiential dimension of healing – we are not rejecting science, but expanding its scope and relevance. We are reconnecting with traditional ways of knowing that have guided the use of medicinal plants for millennia, and integrating them with the insights of modern research and clinical practice.

This integration is at the heart of the Five Realms model, which seeks to understand the healing process in all its dimensions – physiological, experiential, social, and spiritual. By grounding our approach in the lived experience of the patient, and by recognizing the transformative power of subjective meaning and perception, we arrive at a model of medicine that does not just treat diseases, but treats people in all their complexity and individuality. It is a medicine that recognizes that the journey towards health and wholeness is not just a matter of adjusting biochemical parameters, but of facilitating a profound transformation of the human experience.

Seen in this way, the experiential approach to herbal medicine is not just an abstract theory or technique, but a moral and compassionate necessity. It is a way of respecting the profound significance of the healing relationship, and of putting the patient’s subjective experience at the heart of the healing journey. By cultivating this approach – through practices like blind tea tasting, through the study of traditional systems of medicine, and through the development of new research methodologies – we can not only deepen our understanding of medicinal plants, but also our understanding of what it means to heal and be healed. We can create an herbal medicine that is not just evidence-based, but wisdom-based – a medicine that draws on the best of both traditional and modern ways of knowing, in service of both nature and the human being.

The Predictive Brain and the Experience of Health and Illness

Our subjective experiences of health and illness are profoundly shaped by the brain’s predictive mechanisms, a central insight from the field of predictive processing and the work of neuroscientists like Anil Seth. This perspective challenges the traditional view of perception as a passive reflection of objective reality, proposing instead that our conscious experiences are active constructions generated by the brain’s predictive models.

The predictive brain is continually generating hypotheses and models about the causes of sensory inputs, using these models to anticipate and make sense of incoming information. The very nature of our felt experience of being alive and aware may arise from these same predictive mechanisms. Our perceptions of health and illness are fundamentally shaped by the brain’s interpretive processes and the meaning it assigns to embodied experiences.

For example, the experience of pain is not just a simple reflection of tissue damage, but is shaped by the brain’s predictive models about the causes and consequences of that pain. For instance, breaking a hand is painful for anyone, but for a pianist the potential consequences of the injury often amplify the experience of pain. Likewise, a person with chronic pain may have a brain that has become highly attuned to pain signals, generating predictions of pain even in the absence of actual tissue damage. Conversely, a person with a history of positive experiences of physical resilience may have a brain that predicts a rapid recovery from injury, shaping their subjective experience of the healing process.

The predictive brain framework also sheds light on the role of meaning-making and narrative in shaping the illness experience. Our brains are constantly seeking to make sense of our experiences, generating explanatory models and narratives that help us navigate the world. In the context of illness, these narratives can have a profound impact on how we perceive and respond to our symptoms.

For instance, a person who has grown up with a cultural narrative of illness as a sign of weakness or moral failing may have a brain that predicts shame and isolation in response to bodily dysfunction. In contrast, a person with a narrative of illness as a journey of growth and transformation may have a brain that predicts opportunities for personal development and connection in the face of health challenges.

The predictive brain framework also highlights the social dimensions of illness experience. Our brains are exquisitely attuned to social cues and expectations, and our predictive models are shaped by the cultural and interpersonal contexts in which we live. The experience of illness can be profoundly influenced by the reactions and expectations of others, from the stigma and discrimination faced by those with certain conditions to the support and validation offered by caring communities.

Importantly, the predictive brain framework does not imply that illness experiences are purely subjective or “all in our heads.” The brain’s predictive models are constantly being updated and refined based on sensory inputs from the body and the world. Actual tissue damage, physiological dysfunction, and environmental stressors all play a crucial role in shaping the brain’s predictions and the resulting subjective experiences.

However, the predictive brain framework does suggest that there is a complex and dynamic interplay between the biological realities of illness and the subjective experiences of those who live with it. By understanding the role of the brain’s predictive mechanisms in shaping these experiences, we can develop a more nuanced and compassionate approach to supporting those who are navigating the challenges of illness.

For herbal medicine practitioners, the predictive brain framework offers valuable insights for working with clients in the Realm of Experience. By recognizing the power of meaning-making and narrative in shaping illness experiences, herbalists can support clients in exploring and transforming their explanatory models and stories about their health. This may involve working with clients to identify and challenge limiting beliefs or expectations, or to cultivate new narratives of resilience, growth, and possibility.

The predictive brain framework also highlights the importance of attending to the sensory and embodied dimensions of herbal medicine. The tastes, smells, and felt experiences of herbal preparations can provide novel sources of sensory stimulation, acting as powerful tools for reshaping the brain’s predictive models and generating new experiences of healing and vitality. By inviting clients to engage mindfully with the sensory qualities of herbs, herbalists can support them in developing a more positive and empowering relationship with their bodies and their health.

It’s important to acknowledge that while our predictive models shape our experience of health and illness, they are largely operating outside of our conscious control. We don’t choose our expectations or interpretations in the same way that we choose our actions. They are the product of our individual histories, our biology, and our social environments – factors that are often beyond our individual control. Many people’s predictive models have been shaped by experiences of trauma, adversity, and systemic injustice. Recognizing this helps us to avoid the trap of blaming individuals for their illnesses and instead fosters a more compassionate, contextual understanding.

While we have some ability to influence our predictive models through practices we are about to explore, this ability is not unlimited. Healing is not simply a matter of willpower. It’s a collaborative process that involves working with the brain’s predictive models, not trying to override them through sheer force of will. The therapeutic relationship is about finding a shared understanding, one that recognizes the patient’s autonomy and expertise about their own experience.

Moreover, we must be careful not to slip into a facile mind-over-matter voluntarism that would blame the ill for their suffering. While the predictive processing framework highlights the role of the mind in shaping our experience of illness, it in no way suggests that people choose to be sick or that they can simply think themselves well. The reality is far more complex. Our predictive models are deeply ingrained, shaped by factors like genetics, early life experiences, and social conditions that are often beyond individual control.

Chronic illness, in particular, can reshape the brain’s predictive models in ways that perpetuate suffering. The experience of persistent pain or chronic illness can give rise to sub-conscious predictive expectations of more pain and illness, creating a self-reinforcing cycle. Breaking out of these patterns requires more than just a change of mind – it requires a fundamental rewiring of the brain’s predictive architecture, a process that is often slow, difficult, and dependent on external support.

Effective interventions then are not about convincing patients that their illness is “all in their head.” Rather, it’s about working collaboratively to identify and reshape the predictive models that are contributing to their suffering. This is a delicate process that requires deep empathy, patience, and respect for the patient’s lived experience. It involves not just changing thoughts, but also changing environments, relationships, and embodied patterns of perception and action.

In this way, the predictive processing framework invites us to approach illness with a spirit of humility and compassion. It moves us away from a simplistic blame game and towards a more nuanced, contextual understanding of the multiple factors that shape health and disease. At the same time, it offers hope by highlighting the brain’s remarkable capacity for change and adaptation. With the right kind of support, even deeply entrenched patterns of illness can often be transformed.

Ultimately, by integrating the insights of predictive processing and phenomenology, we arrive at a more holistic and humanistic model of medicine – one that treats people as embodied, meaning-making beings striving for vital normativity.

Realm of Illness Conclusion

As I reflect on the profound insights and transformative potential of the Realm of Experience, I’m reminded of why this aspect of the Five Realms model has become so central to my own practice as an herbalist. By attuning to the lived experience of those who seek our care, and by recognizing the power of the therapeutic relationship to shape the healing journey, we open up new possibilities for compassionate, person-centered care.

I know that many of you reading this are already deeply committed to these principles, even if you may not have encountered them through the specific lens of the Five Realms. My hope is that by naming and exploring these ideas in a fresh way, this model might help to crystallize and validate the wisdom you’ve gained through your own experiences, while also sparking new insights and connections.

If you find yourself resonating with the Realm of Experience, I invite you to consider how you might weave these insights into your own practice, in a way that feels authentic and aligned for you. This does not mean abandoning the insights and tools of modern biomedicine, nor the traditional practices of health and vitality building, but rather weaving them seamlessly with an attunement to the experiential dimensions of healing. It means cultivating a therapeutic presence that honors the patient’s unique reality, their fears, their hopes, and the profound meanings they ascribe to their symptoms and struggles.

In practical terms, this translates to a practice grounded in empathy, authentic connection, and a willingness to work collaboratively with each individual on their journey towards well-being. It might involve incorporating rituals and practices that tap into meaning making such as mindful tea ceremonies or embodied plant attunements. It could mean engaging in deep, non-judgmental listening to understand the patient’s subjective experience, and then co-creating a shared narrative of healing that resonates with their lived reality.

Ultimately, embracing the Realm of Experience is a call to reclaim the sacred art of “caring” – of tending to the whole person, not just their physical ailments. It is a recognition that the true measure of our success as practitioners lies not solely in our ability to eradicate disease, but in our capacity to ease suffering, instill hope, and facilitate profound shifts in perception and well-being.

As we move forward, embracing the Realm of Experience and the phenomenological approach to herbal medicine, we have the opportunity to reshape the very landscape of healthcare. We can create a space where the subjective experience of the patient is not merely an afterthought, but the central focus of our efforts. We can weave the threads of modern knowledge and ancient wisdom into a tapestry of care that celebrates the innate resilience and beauty of the human spirit.

In doing so, we not only serve others more fully, but we also reclaim our own sense of purpose and meaning as practitioners. For in tending to the Realm of Experience, we tend to the very essence of what it means to be human – to suffer, to transform, and to find wholeness amidst the fragility and wonder of our embodied existence.

As we move from the Realm of Experience to the realm of sociocultural context, we expand our lens even further to consider the broader social, economic, and political forces that shape health outcomes and illness experiences. While the realm of illness focuses on the individual’s subjective experience of being unwell, the realm of sociocultural context recognizes that these experiences are always embedded within larger systems of meaning, power, and inequality. In this realm, we explore how factors such as race, class, and access to resources influence health disparities and the delivery of care.

Next in this series: Part 6 – The Ream of Eco-Sociocultural Political Context

 

The botanical illustrations used in this post were created by Annie SewDev.