Sickness is a peculiar state of being. Although there were times when sick people were killed,15 illness has always meant an existential-functional change. One is justified in believing that the illness arrived from outside (as with the plague that the gods unleashed on humans in the Iliad), but at the same time, since it is oneself that has fallen ill, one is compelled to blame oneself: one is at one’s own mercy. Disease-induced changes are not purely external lesions suffered by a body but are signs of the unstoppable deterioration and fatigue of existence manifesting in and through the body, the best proof of which is being at one’s own mercy. In illness, the previously unnoticed becomes clear: life is merely a moment in the fulfillment of being, which eclipses life and brings annihilation. Illness is, at one and the same time, a physical and a metaphysical phenomenon: the individual being sickens, and yet a universal fate is fulfilled; an “injury” befalls the person, yet that is also a speeding up of inevitable disintegration. What is a lack there is fulfillment here: in illness, one always surpasses one’s own healthy self (even when one evaluates the illness as “arrears”), since it makes one aware of what one is otherwise concealing: one’s ability to be annihilated. Illness is therefore not a pure operational fault — or if it is that, then so too is existence, of which we cannot even establish the standard by which to measure failure. Would there be any illness, one wonders, if existence were flawless?
Heidegger demonstrated that death is not only an exitus in the medical sense, as with an animal, but an essential appurtenance of life itself, and irrespective of the body’s biological dispositions, it may be slowed down or speeded up, and the relationship that is developed with it determines the conduct of life (death is not just an egress — an exitus—from life, but also an “ingress”). Disease can likewise be interpreted only from such an approach. To quote Thomas Mann: disease “has an intellectual and cultural side, connected with life itself and with its enhancement and growth, a side which the biologist and physician never fully understand”—and later on, speaking about possibilities inherent in sickness that few can draw on, he continues: “Certain attainments of the soul and the intellect are impossible without disease, without insanity, without spiritual crime, and the great invalids are crucified victims, sacrificed to humanity and its advancement, to the broadening of its feeling and knowledge — in short, to its more sublime health” (“Dostoevsky — in Moderation,” xiv — xv). In illness, life as it were blooms: the physician Victor von Weizsäcker, with a boldness befitting a philosopher, appraised diseases of organs as achievements of the organism. One should look on disease as just as fundamental a state of being as health, regardless of how it is assessed. Illness is regarded by most people as not just a bad but an inferior state, a subspecies of health. The medieval approach reechoes in this: illness is a consequence of sin, and sin can be based only on the existence of non-sin, that is, sin is of a lower order than good. Evil is not an essential ingredient of existence, but pure negativity (in St. Augustine’s wordplay, not a causa efficiens but a causa deficiens), and, mutatis mutandis, disease is not a substance but an accident: it is of a lower order than health. In sickness, man cannot dispose of himself, and this is a reminder of man’s creatureliness. Sickness makes the chasm between God the Creator and created man unbridgeable. The everyday usage of the concepts of health and disease reflects the view of the Middle Ages: for us to really understand disease, it is necessary to eliminate the chasm wedged by the Middle Ages not only between the existence of the creature and the creator, but also between body and soul. From that point of view, Philosophical Inquiries into the Essence of Human Freedom by Friedrich Schelling is exemplary. Although not concerned with human illness, it nevertheless exchanges its central concept of sin for the word “disease.” It is worth quoting at some length from this work; a new approach to disease emerges here, and Schelling expands the interpretation of melancholia.
“After the eternal act of self-revelation,” he begins his discourse,
everything in the world is, as we see it now, rule, order and form; but anarchy still lies in the ground, as if it could break through once again, and nowhere does it appear as if order and form were what is original but rather as if initial anarchy had been brought to order. This is the incomprehensible base of reality in things, the indivisible remainder, that which with the greatest exertion cannot be resolved in understanding but rather remains eternally in the ground. The understanding is born in the genuine sense from that which is without understanding. Without this preceding darkness creatures have no reality.
(Schelling, Philosophical Inquiries into the Essence of Human Freedom, 29)
The essence of man, according to Schelling, is the yearning and aspiration to get out of that darkness into luminosity, but rootedness in the dark also belongs to that essence. For that reason, the root of evil is not lack, privation, or defect, as the early Church Fathers or the scholastics believed: “For the simple reflection that only man, the most complete of all visible creatures, is capable of evil, shows already that the ground of evil could not in any way lie in lack or deprivation. . The ground of evil must lie, therefore, not only in something generally positive but rather in that which is most positive in what nature contains” (36–37). Picking up an argument by Franz von Baader that is in much the same spirit, he continues: “If one asks from whence comes evil, the answer is: from the ideal nature of creatures to the extent that it depends on the eternal truths that are contained in the divine understanding, but not on the will of God” (36). Therefore, “we deny that finitude for itself is evil” (38). The finite, animal, physical part of man is held to be the root of evil by those who find freedom exclusively in intelligence and accordingly deny the freedom inherent in evil. “As it is, however, in no way the intelligent or light principle in itself that is active in the good but rather this principle connected to selfhood, that is, having been raised to spirit, then, in the very same way, evil does not follow from the principle of finitude for itself but rather from the selfish or dark principle having been brought into intimacy with the centrum; and, just as there is an enthusiasm for the good, there is a spiritedness [
Begeisterung
] of evil” (39–40). Schelling explains this boundless, Romantic tolerance as follows: “God as spirit. . is the purest love: there can never be a will to evil in love just as little as in the ideal principle. But God himself requires a ground so that he can exist; but only a ground that is not outside but inside him and has in itself a nature which, although belonging to him, is yet also different from him” (42). Evil is comprehensible from this doubly committed nature: “For evil is surely nothing other than the primal ground [
Urgrund
] of existence to the extent that this ground strives toward actuality in created beings and therefore is in fact only
the higher potency of the ground active in nature” (44). The ultimate cause of evil is nature as understood in the nonempirical sense, which, as a foundation, contains the divine essence, but not as a unity. Sin derives from the state that is outside God and yet related to God, for sin is manifested in the fact “that man transgresses from authentic Being into non-Being, from truth into lies, from the light into darkness, in order to become a self-creating ground and, with the power of the centrum which he has within himself, to rule over all things.” He adds, “In evil there is the self-consuming and always annihilating contradiction that it strives to become creaturely just by annihilating the bond of creaturely existence and, out of overweening pride [