) and the spoken word, the law (
), are linked. Pathology in a broad sense is knowledge built up about suffering, or rather, since suffering is not objectifiable, that is, an adequate knowledge of it cannot be gained, it is the knowledge that emerges from suffering. It is not just a play on words if, moving beyond knowledge, one also discerns in the notion of logos the Christian interpretation of that word: Logos is the son of God, that is, Jesus Christ (1 John 1:14), whose sufferings involved the acceptance of bodily torment as well as the transfiguration that emerged from that. His suffering not only referred to life, as against death, but also showed that suffering was inseparable from life. Man does not suffer by accident, but for one reason or another; suffering, which appears suddenly, signals the original fragility and unresolvable endangerment of human existence. Like disease, which is its most elemental manifestation, suffering does not arrive from outside but is latent in man, ready to burst out at any moment. Therefore, to deprive man of his suffering, however benign the hope, is to pronounce a death sentence (only in death is there no suffering). In Hölderlin’s precise formulation: “Nothing causes greater pain. . than riddling on our suffering” (Death of Empedocles, act 1, scene 4).19
If medicine seeks to clear up the existential notions of illness and suffering instrumentally, it forgets that technology itself cannot be defined technically. This once more raises the problem of infinitude and incommunicability, which the technophile outlook wishes to reject. One way or another, every sick patient is a mystic, Victor von Weizsäcker declared; they pose problems for which physicians are unprepared. In the vast majority of cases, however, medical science does not hear the question, or, to be more exact, it hears only the questions that it is able to answer. (Unlike pathogenesis, etiology has been a neglected area of medicine to the present day.) Questions implied by the answer are not questions, however. That is doubly true in the case of illness because it is not possible to give unambiguous answers to the real questions relating to disease, just as human existence cannot be exhausted in a logical game of questions and answers. A physician wants to understand a disease, but it is precisely in the conceptual apprehension that a restriction presents itself, which was described by Kierkegaard in the following terms: “The secret of all comprehending is that the very act of comprehension is higher than every position which it posits. The concept posits a position, but the fact that it is comprehended means precisely that it is negated” (The Sickness unto Death, bk. 2, 3). Conceptual-logical understanding results in the same kind of split in the human phenomenon as the distinction between body and souclass="underline" the physician implicitly treats disease as an object to be explained, which seems like an external blow in its “objectivity,” regardless of the position in life of both physician and patient. The relationship between comprehension and the object awaiting comprehension, however, is far from external; indeed, the fact that the two do not exist independently of each other indicates an inner relationship. It is a commonplace that the precondition for human understanding is some kind of profound identity between subject and object,20 which means that the person wishing to acquire knowledge must possess some sort of foreknowledge, or to be more precise, a conjecture of the object to be known. “All knowledge is caused by means of a likeness,” writes St. Thomas Aquinas. “The likeness of a thing known is not of necessity actually [sit actu] in the nature of the knower; but given a thing which knows potentially [in potentia], and afterwards knows actually [in actu], the likeness of the thing known must be in the nature of the knower, not actually, but only potentially” (Summa theologica, I. 75, q. 1. a. 2.). The modern idea and experience of the self-creation of man proved that man was, and the objective world could not be, separated into “contemplating subjectivity” and “neutral objectivity,” independent of everything. It was not just the problem of body and soul that was radically reformulated but also, in close relationship to it, the question of knowing and understanding. The insight that man is a self-creating being who makes his own history goes hand in hand with the aforesaid transformation of the concept of reality. The “objective” reality waiting to be recognized is always a reality related to man and existing for him — the reality about which man knows nothing is, strictly speaking, unreality. The reality about which he knows, however, is a historical-existential existent resulting from his acquisitive activity (history), that is, even if it turns antihuman, it is never without humans. The relationship of man to the world (which includes the system of man-made institutions as well as nature and the cosmos) is determined historically and existentially. If I want to interpret and get to know reality, then I become part of the interpretation as an object and, at the same time, a subject: the understanding of a so-called objective phenomenon, if I press ahead consistently with my questions about revealing the being of the phenomenon, will eventually lead to understanding myself: I cannot acquire information about something without also gaining knowledge about myself and the life situation that defines the act of cognition. (Admittedly, truth is not just a substance but also a subject, phenomenology teaches; and the understanding of a chemical effect, although an “objective” process, suggests that the phenomenon depends on human interpretation.) “According to pre-dialectical logic, the constitutum cannot be the constituens and the conditioned cannot be the condition for its own condition,” says Adorno. “Reflection upon the value of societal knowledge within the framework of what it knows forces reflection beyond this simple lack of contradiction. The inescapability of paradox, which Wittgenstein frankly expressed, testifies to the fact that generally the lack of contradiction cannot, for consistent thought, have the last word, not even when consistent thought sanctions its norm” (introduction to Adorno et al., The Positivist Dispute in German Sociology). Returning to Schelling’s earlier thought: man is incapable of taking possession of the precondition of his own existence — hence the dejection that one might call the connective tissue of existence.
Technically minded medicine aims to eradicate all contradictions, and although efforts to cure result in insoluble problems every day for physicians and patients alike, strictly somatic medical science puts this down to an insufficiency of the conceptual and technical apparatus, not noticing that in practice insoluble cases are often due to the ultimate insolubility of human existence. (Toothache may seem mundane, death mysterious, and yet the case of Thomas Buddenbrook, who died of a toothache, shows that even an apparently ordinary event may have the potential for mystery.) The categories of cognition and the stockpiles of technical apparatus wish to fix unfixable human reality, and what could be more typical of the obstinacy of the objectivist spirit than the fact that in defense of its own tools, it seeks to force dynamic human-historical reality into its own closed, technically defined notion of reality. The categories of cognition and the reality examined do not coincide (human reality does not coincide with anything), but they can be approximated to each other. The precondition for doing this is to open up, which was in fact done by dynamic psychiatry and psychosomatically oriented medical science: cognition has to be linked with understanding, since, after all, the “object” of medical knowledge, human existence, is indissoluble from self-interpretation, following from historicity.21 Understanding points to the way out of the apparently irresolvable conflict between technical dogmatism and an insoluble life situation. “Comprehension,” writes Sartre, “is none other than my true life, that is to say, the totalizing movement, which contains my fellow human beings, my good self, and the neighborhood in the synthetic unit of in process” (“Search for a Method”). It is in understanding that the questioner and the questioned, the physician and the patient, recognize each other; it is only there that the infinite horizon is unfolded in their dialogue, the horizon that makes the concept of disease open, infinite, and, despite its insolubility, promising. The appropriate approach to a disease is the task of unraveling in practical conversation, since in the end every disease ought to direct attention to a particular individual’s way of life. That means, on the one hand, that in every patient one can follow the individual structuring of a concrete human situation; on the other hand, that in every disease one is confronted by human existence in general. The two viewpoints twist spirally around each other: at each step, empirical medical science and the philosophical understanding of life have to recognize each other. Drawing on some words of Martin Heidegger: