Hermeneutics is generally defined as the art or theory of interpretation. The term has wide usage across a variety of disciplines (film, photography, theater, art history, English and/or literature, analytic philosophy, law, sociology, anthropology, political science etc.) The fact that the term itself seems to be interdisciplinary (or at least is used "interdisciplinarily") might naturally cause the able reader to suspect that it might be of relevance to the medical humanities, and I will try to tease out just such a connection in this post.
So, hermeneutics refers to interpretation. So? Why is this of consequence? One way to come at this question is to introduce the notion of the hermeneutic circle, as developed by Hans-Georg Gadamer and Charles Taylor (among many others, of course). The hermeneutic circle refers to the notion that we are in a sense irreducibly "trapped" in a circle of our own interpretations. How, for example, can one get outside his/her own subject, and/or step outside of his/her own interpretations?
The Stanford Encyclopedia of Philosophy, which has an extensive entry on hermeneutics, explains that
[a]t the end of the day, Gadamer claims, it is not really we who address the texts of tradition, but the canonic texts that address us. Having traveled through decades and centuries, the classic works of art, literature, science, and philosophy question us and our way of life. Our prejudices, whatever aspects of our cultural horizon that we take for granted, are brought into the open in the encounter with the past. As a part of the tradition in which we stand, historical texts have an authority that precedes our own. Yet this authority is kept alive only to the extent that it is recognized by the present. We recognize the authority of a text (or a work of art) by engaging with it in textual explication and interpretation, by entering into a dialogical relationship with the past . . .
The idea, for Gadamer, is that text and reader are "co-determined," as the Encyclopedia puts it, in a kind of hermeneutic circle. The act of interpreting the text, if it constitutes a search for an objective, timeless, uniquely correct meaning of the text, is the quintessentially fruitless quest. Interpretation, under this view, is not the search for any such objective, certain semantics of a text. There are no meanings to texts that exist wholly outside of the practice of interpreting them (if the able reader is detecting Wittgenstein here, I admit that my Wittgenstein Filter is designed to allow large chunks to pass through).
The Stanford Encyc. of Philosophy entry notes that
[a]s important as the interplay between the parts and the whole of a text is the way in which our reading contributes to its effective history, adding to the complexity and depth of its meaning. The meaning of the text is not something we can grasp once and for all. It is something that exists in the historical interplay between past and present.
Of course, these observations, like Gadamer's thought itself, remain deeply controversial in many fields, and I am most familiar with these controversies in the context of law. If there are no uniquely objective meanings of, for example, the U.S. Constitution, then one might correctly infer that a veritable host of problems and implications tumble forth (*Shameless plug: yours truly has actually written on this subject -- I shan't post a link as that would be too self-aggrandizing even for me, but I will furnish a copy to anyone who actually wants one). If all is simply interpretation with no objectively correct meanings, how are we to judge which interpretations are sounder than others? (I think there are many plausible answers to this question, but that is not to deny the importance of the question).
Nevertheless, if we take seriously the notion of the hermeneutic circle, of the importance of interpretation as a practice, then the next question is, 'how/why is this relevant to the medical humanities?'
There are many possible answers to this question. At the outset, it may be worth pointing out that entering the term "hermeneutics" into a PubMed query produces 238 hits, which may suggest that at least some commentators deem the concept itself to have some relevance to the culture of biomedicine.
Quite simply, if the notion of the hermeneutic circle has some validity, it would seem to follow that those who practice medicine do just that -- they practice medicine. If medicine is actually practiced, then those who practice it would be epistemic interpreters along with the rest of us. The practice of medicine would be an ineluctably interpretive endeavor, with the intersubjectivity between provider, patient, care team, and caregivers being largely determinant of the meanings and interpretations that structure the illness experience (and, of course, the treatment experience).
Now, I daresay that almost anyone who has taken a patient history might giggle at all of these high-falutin' terms and concepts, because the notion that that history-taking is -- my word!! -- interpretive would seem obvious and trivial. However, if the practice of medicine is irreducibly interpretive, if there are no objectively correct meanings and interpretations of any particular patient's illness and experience, I tend to think some of the implications of this premise are neither obvious nor evident.
Part of the common criticisms of medical experiences (in the West) is that they are remote, with little attention paid to the particular subject being treated. The practice is objectified and technologized. Indeed, in some non-trivial sense, the methodology of medical practice is objectification, to discern the "objective" disease or affliction troubling a given patient, and to apply the treatments that have "objectively" been established as most therapeutic.
(Note: this is not to suggest that the objectifying aspects of medical practice should be tossed out; rather, the point is to suggest some of the consequences of relying so heavily on an objectifying methodology, which, quite obviously, has done a world of good).
The notion that medical practice is interpretive, that there is an irreducibly subjective aspect to the practice itself, is, I tend to think, an important premise with far-reaching implications.
Thoughts?
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