Hermeneutics and health: reflections on the thinking of Hans-Georg Gadamer

Abstracts

Este artigo tem como objetivo contribuir para a utilização da hermenêutica de Gadamer na prática de enfermagem. Reflete acerca da incorporação do paradigma conceitual sobre a saúde, o cuidado e o diálogo terapêutico. Na primeira parte, apresenta a discussão dos conceitos Gadamerianos da obra Verdade e Método, a filosofia hermenêutica proposta pelo filósofo e finaliza com a articulação do conceito de saúde apresentado na obra O Caráter Oculto da Saúde, que propõe o cuidado mediado pelo diálogo terapêutico e sua utilização pelos profissionais de enfermagem.

Assistência à saúde; Cuidados de enfermagem; Filosofia em enfermagem

THEORETICAL STUDY

Hermeneutics and health: reflections on the thinking of Hans-Georg Gadamer

Hermenéutica y salud: reflexiones sobre el pensamiento de Hans-Georg Gadamer

Janieiry Lima de Araújo^I; Elisabete Pimenta Araujo Paz^II; Thereza Maria Magalhães Moreira^III

^IMS in Clinical Care in Health, State University of Ceará. Professor, State University of Rio Grande do Norte, Advanced Campus Professor Maria Elisa de Alburquerque, Nursing Program. Pau dos Ferros, RN, Brazil. [e-mail]

^IIPhD in Nursing. Professor, Federal University of Rio de Janeiro, Anna Nery Nursing School, College of Nursing, Public Health Nursing Department. Rio de Janeiro, RJ, Brazil. [e-mail]

^IIIPhD in Nursing. Professor, State University of Ceará, Graduate Programs in Clinical Care in Health and Public Health. ⁴ Director of the Policies, Knowledge and Practices in Health Research Group. CNPq Research Fellow. Fortaleza, CE, Brazil. [e-mail]

ABSTRACT

This article has as its objective the desire to contribute to nursing practice with the use of Gadamer's hermeneutics. It reflects on the incorporation of the conceptual paradigm of health, care and therapeutic dialogue. In the first section the article discusses the Gadamerian concepts of the work Truth and Method, the hermeneutics philosophy proposed by the philosopher, and it concludes with the articulation of the health concept presented in the work The Hidden Character of Health, which proposes care mediated by therapeutic dialogue and its use by nursing professionals.

Descriptors: Delivery of health care; Nursing care; Philosophy, nursing

RESUMEN

Este artículo tiene como objetivo contribuir a la utilización de la hermenéutica de Gadamer en la práctica de la enfermería. Reflexiona sobre la incorporación del paradigma conceptual sobre la salud, el cuidado y el diálogo terapéutico. En la primera parte, lleva a la discusión de los conceptos Gadamerianos de la obra Verdad y Método, la filosofía hermenéutica propuesta por el filósofo, y finaliza con la articulación del concepto de salud presentado en la obra El Carácter Oculto de la Salud, que propone el cuidado intermediado por el diálogo terapéutico y su utilización por parte de los profesionales de enfermería.

Descriptores: Prestación de atención de salud; Atención de enfermería; Filosofía en enfermería

INTRODUCTION

The hermeneutics or the art of interpretation represents an important strand of philosophical thinking and of human and social sciences in the 20^th century. It presents itself as a methodological possibility to enhance mobility (movement) and epistemological attitude in research in the health and nursing fields. Hence, the art of understanding does not deal only with interpretation of texts, as hermeneutic studies are usually conceived. On the contrary, the process of understanding is present in the entire process of life experience in which written, spoken or symbolic language demonstrates aspects of human reality⁽¹⁾.

Etymologically, interpreting means judging intent, explaining or clarifying the meaning of each word, text or gesture⁽²⁾. Beyond this definition, hermeneutics has the meaning of something to reveal, to be discovered and also to unveil meanings hidden in a text or language. Its use permits one to understand the human being, his/her world, and history, human existence itself. Interpreting is related to the human being's nature and is a creative task that influences human beings in their particular and also public scopes, in relationships the self establishes with another⁽³⁾.

Hermeneutics [in fact] starts as a procedure or technique used to interpret sacred and classic texts. Interpretation involves more than a philosophical investigation of the historical origins and meanings of words, it can be seen as an element in the process, the act or event of the understanding itself. (...) all understanding is interpretation, showing that hermeneutics is involved in all understanding acts (...) it is universal: what happens when we interpret a text is what happens when we seek to understand anything in our sociocultural world, be it the meaning of life or a more common interpretation of daily objects, ideas and situations⁽⁴⁾.

Hermeneutics has achieved expressiveness and recognition in modern times due to the contributions of the German philosopher Hans-Georg Gadamer (1900-2002) who was influenced by the thinking and work or Plato, Aristotle, Hegel, Husserl, Heidegger, and Nietzsche, among others^(1,5). In his philosophical hermeneutics, Gadamer is interested in the ethical and human. He states that the core of his discussion concerning Truth and Method lies in the rupture with the instrumental mind, strongly present in modernity, and in the need to elaborate more appropriate methodologies for different objects in the face of an authentic dialog⁽⁵⁾.

GADAMER'S PHILOSOPHICAL HERMENEUTICS

Gadamer is considered an intellectual of broad thinking; the central idea of his writings is that all understanding, or acts of understanding, is essentially processed from dialog and that is in light of a deep study concerning the reality in which we acquire knowledge, while its practical applicability, the praxis, occurs by a experiential historical process^(4,6).

The philosopher is not concerned in asking what the conditions of possibility of knowledge are; he is not concerned to determine which method he will follow to achieve such knowledge. What matters is to ask what happens when one understands something, because this act of understanding arises as an event of determination of truth⁽⁷⁾. Gadamer's philosophical proposition is not based on destroying the validity of the scientific method but on justifying the view that the art of dialog is more appropriate than the technique of dissecting themes and problems when philosophizing⁽⁵⁾.

In the 1960s, he published his masterpiece Truth and Method, fundamental features of a philosophical hermeneutics in which he consolidates his critique of the experience of searching for the truth and establishment of a scientific criterion. His ideas are presented in three modes: (1) the experience of art as a path and way of being for hermeneutics; (2) the understanding as a basis-category of discussions of historical sciences of the mind, as when Gadamer analyzes hermeneutics from the perspective of Schleiermacher, who classified it as an ancillary discipline subordinate to dialectics, from the historicism and historical conscious of Dilthey and the phenomenology of Husserl and Heidegger, who introduce the guideline of hermeneutics of facticity; and (3) the development of the philosophy of language as human experience toward the construction of thought⁽⁷⁾.

Hence, for Gadamer, hermeneutics

(...) in the face of the incomprehensible challenge and through it is brought to the path of questioning and required to understand. Therein lies not in any way a previously established enthronement of everything that is meaningful. On the contrary, this is much more a response to the challenge of the ever-renewing not being able to understand something that shows itself as something startlingly other, alien, obscure - and perhaps something deep that we need to understand⁽⁸⁾.

The effort of hermeneutics consists in clarifying what we want to say when we talk to each other and what we would like to show to each other - so we learn by ourselves when we talk to each other⁽⁸⁾. It thus consists of unveiling the meaning of the written or spoken word, but which is processed in a singular manner in dialog and in the construction of language.

Gadamer was influenced by his professor, Martin Heidegger, who sought to explain the meaning of the being we all are, or as he calls it, Dasein. Daisen is in its existence the only being who can question, question the meaning of oneself, and understand a search about oneself. Heidegger used to say that Existing is interpreting and more than that, a previous understanding of oneself also belongs to being. Hence, we are interpretation and understanding in the world of existence and experience in the world.

From Gadamer's encounter with Heidegger's philosophy, we perceive the mutual interest in Aristotle's philosophy. For Heidegger, Aristotle precedes the discussion concerning Being and anticipates the perspective given by Husserl's phenomenology. In this context, (...) is not so much about a return to Aristotle's philosophy, but rather a journey through him⁽⁸⁾. Therefore, the Being is what lies before us. It is in the essence of the being, that which is not an entity, that truth is revealed and clarified.

The being is understood or conceived or thought of. (...) S/he is spoken, that is, it is how one talks about it. (...) Everything designates language and what language says. (...) The logic of tradition [that] is transformed in vitality of a reality connected to the world of life. This logic comes to us as language⁽⁹⁾.

But what would be language in this sense? Why is it essential that we live in constant dialog with each other, with the objective to understand ourselves and our relationship with the world? In response, Gadamer goes beyond Heidegger's interpretation and states that⁽⁸⁾:

The language of philosophy and its conceptualization belong everywhere to the vital connection of language respectively spoken. Hence, this language takes part in the role that language in general performs while accessing the world. (...) Language, while language, is veiled because it always has intent each time. Language is only true when there is dialog, that is, interaction, and it is in fact mysterious how it is as a working process. Interaction is our vital situation and being in sync with the interaction is a task for each of us.

Therefore, the phenomenon's interpretative act occurs when the human being seeks in his/her daily life to understand him/herself, also in the relationships established with another, in a movement consisting of construction of subjectivity and inter-subjectivity. Concerning this understanding of one with oneself, and one with another, Gadamer indicates that even in another and among a diversity, one can experience a type of encounter with oneself. The task of learning to recognize what is common in another and in otherness becomes more urgent than ever ⁽⁹⁾. Hence,

(...) we do not seek dialog only to understand other people better. On the contrary, we are ourselves much more threatened by the rigidity of our concepts when we want to say something and when we seek acceptance in another. (...) The problem does not lie in not understanding another, but in not understanding ourselves. We need it when we try to understand another, we make the hermeneutic experience that we need to breakdown resistance in ourselves, if we want to listen to another while they are another. This is certainly a radical and essential determination of the entire human existence and it dominates even our so-called self-understanding⁽⁸⁾.

The notion of understanding is central to the development of Gadamer's hermeneutics, while such an epistemological attitude is not limited to the behavior of objectification in the face of a given object. Understanding is a movement of belonging, of the subject to the being of what is understood⁽⁷⁾. In the hermeneutic philosophy, data assumes another definition. When being asked what data was, Gadamer stated that only who does not answer to what one can measure and open up to this question will know what hermeneutic philosophy is⁽¹⁰⁾.

From the hermeneutic perspective, reading is interpretation, looking at is interpretation, thinking is interpretation, touching is interpretation, feeling is interpretation; hence, these are aspects of the human understanding concerning the world, science, and philosophy - concerning our existential and social life. At this point, language assumes the role of giving fundamental meaning to the set of interior history of thought. In its essence resides the enigma of the denomination and meaning of a name. From this perspective, word and thing seem, at a first view, united one to another in an indissoluble manner, but they are not⁽⁸⁾.

The best word chosen has the function of triggering speech, which in turn has the purpose of enabling dialog, that is, understanding. The words have their own familiarity and obviousness. They evoke something as a name, which designates a call⁽⁸⁾.

(...) to perform its signification, a word needs to be understood; and when it comes to meet us in the context of discourse, it serves as an agreement in relation to what is not only a word that says. (...) The true of what is said is not what the word aimed to but the disclosure of what was found in the discourse. (...) What is mysterious in language is the fact it allows one to see, so that something is presented (something close) of what I called the truth of the word⁽⁸⁾.

In this context, philosophical hermeneutics refers to interpretative processes of possible understandings concerning human experience, contained in the word, in language, in tradition and daily routine. This 'understanding' occurs within dialog among individuals, of the self with itself (subjectivity) and the self with another (inter-subjectivity), that is, in the joint pre-ordinated growth of socio-cultural relationships among individuals in linguistic coexistence (dialog). It is in dialog that the self is constantly confronted with another, the diverse, the foreign, the new. This communicational confrontation precisely occurs

(...) Because we are not any people who are in any place, but we are ourselves what we are, it makes us, for the first time, effectively aware of who we are and of what may happen to us⁽⁹⁾.

Hermeneutics is not a methodology exclusive to the human sciences but an attempt to understand what is truly human science beyond its methodological self-consciousness, what connects us to the totality of our human experience⁽⁷⁾. To better clarify it, we have that:

Hermeneutics is the art of understanding. It seems especially difficult to understand the problems of hermeneutics, at least as unclear concepts of science, criticism, and reflection dominate the discussion. That is because we live in a time in which science increasingly dominates nature and guides the administration of human co-existence, and this pride of our civilization, which tirelessly corrects a lack of success and constantly produces new tasks of scientific investigation where progress, planning and removal of damage is based on, and develops the power of a true blindness. In the hardening of this path toward a progressive configuration of the world through science, a system is perpetuated in which the individual's practical awareness either blindly and resignedly submits itself or rebels against, and it means, no less blindly⁽¹¹⁾.

Hermeneutics is not non-methodical or anti-methodical. It works from another methodological perspective, apart from scientific methodology⁽⁸⁾. A critique of the instrumental mind of modernity resides in the basis of its thought. However, the philosopher is not opposed to knowledge of natural sciences; this is a false interpretation of his thinking; Gadamer respects modern science. The fact is that scientific research has its limitations because the [scientific] method is not unique and universal, nor is it one of knowledge, or of truth⁽⁵⁾.

The concepts of philosophy^(7,11-12) connected to the hermeneutic understanding of reality are: Comprehension and understanding; The logic of question and answer (seen in an interactive process); Reestablishment of tradition, authority and preconception (in regard to the pre-reflective involvement concerning human phenomena); Effective historical awareness (or effectual history); Temporality (comprehension problems occur in the attempt to understand the past based on the present because time is not chronological, but experienced): Fusion of horizons (in the attempt to dialogically unite perspectives or views of the world) and the concepts of health, disease, care and treatment, discussed in texts under the title The hidden nature of health⁽¹²⁾.

Comprehension, in principle, means individuals understand each other. From the hermeneutic perspective, human beings, most of the time, understand each other or make an internal and relational movement (mobility) with another, seeking acts of understanding or consensual agreements. It is not understanding and interpreting but also applying [since] understanding oneself is part of the hermeneutic process⁽⁵⁾.

The interpreter understands meanings based on his/her own comprehension, pre-structure; the interpreter belongs to a certain field of knowledge and culture. S/he did not arrive empty, s/he came with experiences, and conditioned by the historical being s/he is. The interpreter addresses the text with his/her preconceptions, prejudice, questions and assumptions, and a perfect dialog, called the fusion of horizons, occurs between the interpreter and the work⁽¹³⁾.

Strangeness is required for one to reach understanding, that is, understanding occurs based on the onset of a disorder, which is concretized in a question that assume openness, but also a delimitation⁽⁷⁾. Hence, the way to understanding begins with the exercise of denial, strangeness (from whom wants to know) because the words and speeches say much more than what is in the appearance of what is said. The one who interprets needs to take into account the contextualized individualities of linguistic manifestations, that is, the puzzle that is hidden in the construction of thought and which is materialized through language and dialog.

The rule of hermeneutics is the experience of asking, since if we want to clarify our understanding, the paths of knowledge will be found in the essence of question. To ask, one needs to want to know, that is, be aware that one does not know⁽⁷⁾. Therefore, questions takes the lead, built on thinking, on the restlessness of wanting to understand, the art of asking is open to dialog, to meeting with another, in the search for what is common to all of us, understanding.

In relation to the logic of question and answer, we find that the precedent of hermeneutic is based on the experience of asking. The concept of questioning is the key to hermeneutic philosophies; the question should make sense, be relevant, a meaning that refers to the guidance of assumptions about potential answers. The meaning (direction) of asking consists of making open what is asked in its questionability. It [the meaning] has to be put on hold so that pros and cons are balanced⁽⁷⁾.

Still, in this path of understanding human thought (subjectivity and inter-subjectivity), the German philosopher readdresses issues in his work in which he proposes re-establishing tradition, authority and preconception. Based on these concepts, Gadamer⁽⁷⁾ constructs his critique of modern thinking and demystifies pejorative interpretations of what these propositions are.

Thus, authority can be seen as opposed to reason and freedom. It has nothing to do with blind obedience to commands, but rather to knowledge and recognition of these commands, mediated by the pedagogical process. Having authority over something means to have knowledge, and this knowledge is reached and recognized in tradition. One cannot forget that we are part of what we want to understand and there is no single path to truth. The hermeneutic tradition rejects the unitary world of knowledge. What we have are truths, differentiated aspects of the same reality, constructed based on authority and tradition⁽⁷⁾.

The word tradition comes from Latin traditio whose verb tradere means given in or hand over and refers to the process of passing on something, some teaching, a gerational movement. Tradition goes beyond the rational basis and in large part determines our institutions and attitudes. Its rehabilitation is justified because it is an important notion of social and cultural theory. It keeps the activity of transmitting knowledge, tradition. Accordingly, it is a vital force embedded in the culture of men and the transmission of knowledge from generation to generation is a reflective action, for tradition is language and we can never escape from it, since we are always there.

Discussing the concepts of tradition, preconception and authority from Gadamer's perspective:

Tradición e autoridad son dos categorías inherentes a la conciencia da la experiencia humana en cuanto ella es sorprendida por la razón en su dinamismo completo, encarnado e histórico. La descalificación sumaria de ambas as categorías prevalece allí donde un afán metódico apriorístico se instaura como un cualificador del análisis de la experiencia humana. La a-historicidad y el espíritu de ruptura del la filosofía del Cogito epistemológico halla su ocasión en factores contextuales no siempre examinados en cuanto tales, pero se determina desde o presupuesto de constituir el sistema completo y autónomo del saber. Se busca una clave de seguridad analítica, no tanto para comprender las cosas misma, sino para descartar los significados que impiden un control del conjunto de la experiencia, bajo el axioma de que sólo se conoce lo que se produce. (...) Gadamer coloca su empeño teórico en las experiencias antropológicas básicas que preforman ulteriores aproximaciones epistemológicas y regulaciones de la vida práctica, sin prescindir del estatuto previo e fundamenta de la cuestión del ser que cualifica a todo intento filosófico (...) La pré-compréncion práctica do Dasein, en lugar de ser recolectada en su integridad y llevada a su instancia auto-consciente, más bien si encierra sobre alguna de sus posibilidades derivadas, circunstancialmente más plausible: p.e., como subjetividad, vitalidad, psiquismo asociativo, emotividad, etc⁽¹⁴⁾.

Herein lies the basis of Gadamer's critique of instrumental human reason: overcoming all harm or prejudice of modern life manifests itself as harm or prejudice against the experience. Reviewing it opens up a path to appropriate understanding in the essence of our being, that is, of our historical consciousness given the reality experienced, on the grounds of culture and tradition⁽¹⁴⁾.

When Gadamer⁽⁷⁾ proposes the existence of effective historical consciousness, he argues that understanding is essentially historical: it always occurs against a backdrop of previous historical understandings and involvements. He considers understanding acts to be effective because these influence our own existence. This term is used to demonstrate that historical consciousness always exists as an effect of the past on the present, reflecting on the future. Concerning the present, he states that this now is not just a point in time in the continuous sequence of nows that follow each other. On the contrary, it contains its past and its future⁽⁹⁾.

It is possible through hermeneutics to realize the possibilities of understanding human finitude based on the sciences of the mind, having the responsibility to place the end of it in the locus of the existential context of communication to seek its understanding⁽¹⁵⁾. Hence, historical consciousness is present in an interpretative process concerning something experienced in human life, which leads us to understand that there will always be an unveiled truth; the past influence the present and reflects on the future, the temporality of living and existing.

In regard to temporality, he points out that such a concept does not lead us to think about changes in human life as something chronologically determined, but as changes that take place in the time lived, relational and interactive with human experience, a union of perspectives or horizons of life⁽⁷⁾.

The horizon is not fixed. When we apply it to mind, we can talk about the limitation of horizons, of the likely expansion of horizons, of opening new horizons. It assumes the encounter of different ways of seeing the world, a result of the process of acculturation mediated by the use of language and tradition. It suggests that the perspective of the horizon lead us to enlarge our view of the world and of things in the world⁽⁷⁾.

To have a horizon is to have a perspective of the view concerning the world experienced. This view leads us to the use of language, thus, a horizon can be placed in a meeting with another horizon, in a fusion process, that is, of linguistic arrangements. Therefore, all understanding of the present occurs based on a horizon interconnected with the past, envisioning a future. This is the character of the transition in itself: the different ways of looking at the world are composed of past, present and future.

THE CONCEPTION OF HEALTH AND CARE ACCORDING TO GADAMER'S APPROACH

In his work entitled The Enigmatic Character of Health, Gadamer⁽¹²⁾ discusses how hermeneutic thinking brings important contributions to the field of the production of knowledge in the field of health sciences. This discussion is one of the concerns in the current world, in which modern science and its biotechnological advancements have two faces: one face is positive, perceived by the advancement in production and scientific discoveries in the field of problems and health care, and the other face represents negativity, which reduces knowledge in health to simple measurable variables and care of human beings to physiopathological aspects. For Gadamer, (...) the matter is to achieve balance between the ability to do, want and responsible practice that consists of care in health⁽¹²⁾.

Hence, conceptual understanding concerning health makes us think about the care practices of health professionals, among them, nursing care⁽¹²⁾.

For the philosopher, the act of care involves the ability to do, want and responsible practice⁽¹²⁾. In these three circumstances reside the possibilities and limits of our decisions concerning evaluation, planning, and the execution of integral health care. To better understand what health is, Gadamer states it is associated with a state of balance. Hence,

Balance is like the absence of gravity since weights compensate for each other. Disturbance of balance can only be overridden by a counterweight. But with every attempt to compensate a disturbance with a counterweight, there is a threat to a new reverse loss of balance. [Hence], (...) the maintenance of balance is a very instructive model (...) that shows there is danger in every intervention. There is always the threat of doing too much. (...) [Health] (...) it is the rhythm of life, a continuous process in which balance always stabilizes⁽¹²⁾.

Health depends on many factors. At the end of the search for re-establishing balance and harmony, one finds not only health, but also the reintroduction of the patient into his/her former position in everyday life. This is what we look for when a more appropriate treatment is developed mediated by therapeutic dialogue, one's full recovery, the extent of which is not only the result of the competence of health professionals. The person in a state of unbalance (illness) also needs to act toward recovery⁽¹²⁾.

Based on this concept, illness would be the expression of disturbance to the state of balance, leading individuals to seek measures to correct it, such as, for example, seeking the help of a physician or nurse from a health service. The discourse of care practice with Gadamer's bias indicates that the health of people reflects moments of balance and unbalance. Becoming healthy is then returning to vital ways that lead in themselves to recovery⁽¹²⁾.

If balance is disturbed there is suffering manifested as disease or injury in the biological or social body. For the philosopher, we are not always healthy and not always ill. The mechanism of existence favors one or another state, which will determine our vitality in the face of life.

Health is presented as a state of balance and, as such, something based on the experience of the 'being' in the face of the world of life, which is his/her everyday life, constructed from which elements are brought by culture, inter-subjectivity and language. This way of being in the world brings to health professionals the possibility of opening up new conceptual horizons concerning health and care, moving toward the understanding of individuals in the face of complex manifestations of their health-disease continuum⁽⁵⁾.

It is this openness to a new conceptual understanding concerning unbalanced health and disease that will allow the construction of care that differs from knowledge in biomedicine, because this openness is directed to another, based on a common space, which is the care routine. Hence, concepts such as balance, harmony, dialogue, and integrality will be valued to facilitate understanding health and constructing therapeutic care projects consonant with the heath needs of individuals and collectives^(5,12).

Accordingly, care is something present in the operational reality of health services, since it can be assumed in its different aspects, that is, in the promotion, protection, maintenance and rehabilitation of individual and collective health and should be processed in the rhythm of life.

Care primarily indicates the need to converge on diagnosis, more appropriate treatment, dialogue and the collaboration of users in this existential moment, which is the experience of disease. Herein consists therapeutic dialogue, not only a dialogue centered on human inter-subjectivity, but also the linguistic meeting required to understand one another⁽¹²⁾.

Therapeutic dialogue goes beyond its specificities by having an objective to be achieved and because it occurs between the self and another, who have roles to play: the health professionals and the human being experiencing the situation of being ill. Therapeutic dialogue assumes a primary purpose, which is the surveillance of health to obtain the effectiveness of health care. What one seeks in the dialogical meeting is to re-establish one's lost balance in health, the being who experiences a moment of disturbance in his/her world of life⁽¹²⁾.

Therapeutic dialogue renders decision-making shared in regard to treatment more appropriate to the situation experienced at the time. The situation that requires intervention involves an individual who experiences disharmony in their health, which is expressed as a disorder, a disease. The health care centered on therapeutic dialogue considers the patient's existential experience given his/her condition. In this dialogical encounter between professional and client, the therapist's knowledge will guide therapeutic decisions appropriate to the rhythm of healthy life for human beings, toward recovery of harmony, that is health, enabling individuals to resume routine tasks⁽¹²⁾.

From the statement that health cannot be measured emerges a discussion of the precepts of modern science, which sees disease as the center of biomedical care⁽¹²⁾. On the contrary, health is linked to the individual being, in an existential and subjective perspective of human experience in the face of the world of life, where disease is manifested as a disturbance. Such situations of experiencing disease are individualized and unique, thus requiring that the art of healing goes beyond the biological dimension of the act of instrumental care.

FINAL CONSIDERATIONS

The health care of individuals or population groups requires attitudes of co-responsibility among the diverse actors involved (health professionals, in particular, nurses, users, families, community). Every treatment starts with the hands, with touching, with the meeting of the self with another. It is through touch and an attitude of curiosity to identify the experience of living with disease, to examine an unknown body, that the distance between the professional and user is abolished.

Considering such an assertion, nurses, whose object of work is care, should realize that all their behavior and attitudes should, in essence, be endowed with healing (in Heidegger's philosophical meaning) and guided by a dedication toward re-establishing health balance, affected by disturbances accruing from situations of disease that affect individuals⁽¹⁵⁾.

Being guided by Gadamer's thought permits the possibility of interacting with health, grounding a way of thinking and doing nursing. By acting openly with another willing to listen, nurses permit themselves to dialogue with users who come and seek their care services. Gadamer calls attention to an important point in establishing therapeutic dialogue: there is no dialogue if only the professional with his/her technical-scientific knowledge concerning health and disease conducts the meeting with the patient. The nurse who does not allow the patient to express his/her life project and glimpse his/her intimate modes of care hinders the treatment and re-establishment of balance.

Nurses have greater opportunities to conduct an encounter with health service users using the essential elements of therapeutic dialogue: hearing and listening, seeking understanding and knowledge of the individual experiencing a health disorder, mediated by language. It is from the patient who talks about the experience of living with a disease that one can find 'tips' to decide on the most appropriate treatment.

We all know how hard it is to dialogue in today's world, in which understanding each other became one of the main difficulties of mankind. But we should try because in the field of health and nursing, we always stand by our patients⁽¹⁶⁾, making an effort to understand them in their dynamics of life and health, enabling a care practice that favors the other person in his/her existence.

All behaviors and attitudes are endowed with healing and guided by a commitment⁽¹⁷⁾. Cure is what belongs to the human presence while living. Gadamer insists that one needs to think in terms of concern, occupation, and dedication as cure, which means it may be found in every behavior and situation of human life. Cure in Heidegger's view can be enabled by an efficient care that favors the human being having a life project, assuming his/her own being, becoming free to recognize and choose one's own possibilities. For those with a mental disorder, cure may be achieved when the individual experiences his/her disease in an authentic manner, recognizing that it is necessary to self-care and become responsible for him/herself in order to enjoy a good quality of life. As opposed to what many say about hermeneutics, it is not merely the art of interpreting but the art and ability to understand^(7,11).

When we think of nursing care in the context of health, we specifically refer to the care practices performed by nurses in the routine of primary health care services in coexistence between the self and another⁽¹⁸⁾. The self and another are us, nurses and patients, we place ourselves in constant dialogue, whose purpose is therapeutic care that favors better health conditions to patients who are under our care daily.

In this context, dialogue only causes the patient to envision the possibility of awakening his/her own internal activity, which is called 'collaboration'⁽¹²⁾, without however becoming disoriented again. Hence, nurses should collaborate with the re-establishment of balance in health, returning to patients their abilities to live with their condition of being ill, work and relate with other people, be happy and self-care.

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Correspondence addressed to:

Publication Dates

• Publication in this collection
  20 Mar 2012
• Date of issue
  Feb 2012

History

• Received
  04 May 2010
• Accepted
  11 July 2011