Thursday, February 12, 2015

On the Materiality and Phenomenality of the Body

Levi Bryant has presented the case for the importance of materiality in philosophical discourse in much of his work, but he has just posted an interesting short version on Larval Subjects , "Critical Reflections on the Humanities and Social Sciences." In a brief response, I suggested that Heidegger has already begun the work of maintaining a distinction between materiality and phenomenality, but Levi balked at this assertion, and reaffirmed the primacy of materiality, while maintaining the validity of experience. From an example he provides, Levi concludes that the "material body is not the phenomenal body" and that a "substantial transformation of our concept of phenomenality" is called for. I have always found Levi an original and provocative thinker (our acquaintance began several years ago on a YahooGroup on Lacanian psychoanalysis), and even more-so lately. He is the author of the fascinating Democracy of Objects and other works in the 'object oriented ontology' field of inquiry. I have written what I have written on Larval Subjects in response to Levi's recent post, and my purpose here is not to engage his thesis any further, but instead take his conclusion as noted above as a point of departure for this blogpost.

I do not take the distinction between 'materiality' and 'phenomenality' as some irreducible dualism. That strategy is dead in the water and does nothing to release the event harbored in the application of these terms to the human body. I do want to interrogate how medical therapeutics ('medicine' henceforth) approaches materiality and phenomenality in the management of diagnoses. Let us look at cancer from this perspective.

While cancer presents itself as symptomatology within the experience of the patient, it also acts upon the material body by invading tissue and causing a cascade of biochemical occurrences that conduct the appearance of the symptoms which the patient experiences as disease. At first blush, 'cancer' has both its material and phenomenal dimensions that conspire in its appearance. Symptoms are said to be subjective (what the patient experiences and communicates) and Signs are said to be objective (what the investigator observes). These terms are not construed to be in competition.

I cannot fathom a scenario in which any method worthy of its name would privilege one term over another. If materiality and phenomenality are even temporarily placed in binary opposition, the 'bar' would regardless be the locus of treatment. The oncologist (cancer specialist) diagnoses the particular cancer affecting the patient and directs treatments determined to be effective in eradicating or controlling the cancer process with an eye to symptom resolution as the cancer milieu dissolves under treatment. The experience of symptoms such as pain, fatigue, depressed mood, shortness of breath resolves as their causes are quelled.

For patients whose cancers are cured symptoms may still persist. Survivorship medicine is based on the need to address symptoms that can no longer be traced to an existing materiality. Pain, which during the active disease process traces its materiality to the cancer milieu, persists in phenomenality in the absence of materiality. This pain is certainly a consequent of the materiality now absent, but its appearance is located only in its own phenomena. It is purely subjective (pain is solely determined by its subjective presence by definition). Some oncologists are reluctant to treat that which has no objective reality in materiality. The subjectivity of pain has not changed from the active cancer milieu to the survivorship phase. What is the diagnosis?

Similar observations can be made for disease processes other than cancer. But a certain kind of pain might drive home my point more dramatically. "Phantom pain" is a deafferentation pain many patients locate in amputated limbs. Barring from the discussion that patients still experience pain located in limbs that no longer exist (they have been incinerated), just what kind of pain is this? The experience of the pain is of burning, lancinating, electrical sensations in the space where the limb 'was.' All materiality of the body-part is gone, only the symptom of the diseased limb presents itself to the experience to the patient. Here the diagnosis is 'neuropathic pain,' and the treatment is an appropriate dose of an anti-convulsant drug, most often the drug 'gabapentin,' but also 'pregablin' and 'duloxetine' within a program of rehabilitation and interdisciplinary support and management.

Some neuroscientists, armed with their functional MRIs, suggest that such pain has its locus in the play of neurotransmitters in neural tissues, and that the subjective experience of such 'phantom pain' is all a function of mind. Such a conclusion at least tends to collapse phenomenality into materiality, or the converse. I resist the reduction of the body to the mind in this scenario, though I am open to further elucidation, even if this entails Levi's call for a transformation of the concept of phenomenality.

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