Forthcoming in Inquiry

Ian James Kidd

Department of Philosophy
Durham University
50 Old Elvet
Durham
DH1 3HN
E: i.j.kidd@durham.ac.uk

Havi Carel has recently argued that one can be ill and happy. An ill person can positively
respond to illness by cultivating adaptability and creativity. I propose that Carels claim
can be augmented by connecting it with virtue ethics. The positive responses which Carel
describes are best understood as the cultivation of virtues and this adds a significant moral
aspect to coping with illness. I then defend this claim against two sets of objections and
conclude that interpreting Carels phenomenology of illness within a virtue ethical
framework enriches our understanding of how illness can be edifying.

In recent writings, Havi Carel has argued that one can be ill and happy.1 An important part of
her argument for this ostensibly paradoxical claim is that ill persons can develop positive
responses to illness, especially in the form of adaptability and creativity. This paper
develops and expands Carels account by interpreting it within the framework of virtue
ethics. I argue that the positive responses to illness which Carel describes are best understood
in terms of the cultivation of virtues: illness can afford opportunities to cultivate virtues and
can therefore be edifying.
This virtue2based interpretation extends and enriches Carels account by emphasising its
latent ethical aspects, affording illness a meaningfulness and moral value it might otherwise
lack. Discussions of the moral significance of illness can be found in a range of philosophical
traditions from ancient times onwards, many of which are treated later in the paper.
Interpreting Carels account of illness and happiness using virtue theories deepens her
account and proves useful new connections to other relevant debates within philosophy.
After outlining Carels phenomenological account of illness, I outline my edificationist
position. I argue that illness offers multiple possibilities for the cultivation of virtues.
Although illness is not a unique source of edification, it is an especially salient one for ill
persons, especially those who are terminally or chronically ill. An appeal to virtue theories is
advantageous for three reasons. First, it emphasises the moral achievement inherent in the
positive responses to illness that Carel describes. Second, both Carels phenomenological
account of illness and virtue ethics are holistic insofar as they stress the interconnected
practical, psychological, and social aspects of illness and virtue respectively. Thirdly,
edificationism also offers new contacts between the philosophy and phenomenology of
illness and philosophical ethics. My aim is to establish the plausibility of the claim that illness
can be edifying, leaving the further questions of how the process of edification works for
another paper.
I conclude that an edificationist approach helps to capture the multiple, complex ways in
which ill persons can positively respond to illness and successfully pursue the good life.
Two caveats should be mentioned. The first is that my discussion does not pertain to mental
illness, and, second, it largely avoids the connections between illness, virtue and religion.
Both mental illness and religion raise specific problems which merit sustained discussion in
their own right, hopefully a task for future work.

Carel criticises contemporary clinical and philosophical theories of illness and disease. The
predominant theories of illness are broadly naturalistic, the most representative being those of
Christopher Boorse.2 Naturalistic theories, argues Carel, are premised upon a detached, third2
person approach to illness which excludes and neglects the actual experience of the ill person.
Such theories maintain that illness is primarily, perhaps solely, a loss of biological function,
thereby excluding the deep existential aspects of illness, such as the loss of agency,
personhood, and the sense of possibilities that illness also entails. Carel does not oppose the
inclusion of biological considerations in the definition of illness, but insists that such
accounts must be augmented by the inclusion of the actual lived experience of ill persons. As
she says, the biological body is central to any conception of illness. What I am contesting is
the possibility of understanding illness only through the biological body, while ignoring lived
experience (Carel 2007, p. 98).
Carel proposes an alternative phenomenological approach to illness which takes as
primary the experiences of the ill person, using a distinction, introduced by Husserl and
Merleau2Ponty, between two conceptions of the body: the biological and the lived body.3

The biological body is the proper object of medical examination and treatment and is
conceived in terms of physiology, biochemistry and the like. By contrast, the lived body is
the embodied person himself or herself; that in and through which they engage with the world
and which is constitutive of ones self. The lived body must, therefore, be understood in
deeply and intimately subjective terms, requiring both phenomenological inquiry and
sensitivity to anecdote, emotion, and autobiographical and testimonial accounts.4
Illness involves a disruption of the relationship between the biological and the lived
bodies. For a healthy person, these two bodies are perfectly aligned with one another. The
biological body affords no resistance to the lived body, but in illness, this seamless
relationship is ruptured. As Carel puts it, illness splits apart the biological and the lived
body. In place of their ordinarily flawless correspondence, one finds that the biological
body suddenly behaves oddly; it exhibits strange symptoms and becomes unpredictable, its
transparent silent function is gone as it becomes the subject of anxious attention and
medical scrutiny (Carel 2007, p. 99).
This insight sits at the heart of Carels phenomenology of illness. Illness is primarily
experienced as this schismatisation of the biological and lived bodies. It involves an
estrangement or alienation from ones biological body, including a consequent frustration of
ones familiar activities and engagements with the world. The ill person can no longer easily
climb stairs, play football, or run for a bus in the way that they previously could. Illness
disrupts our familiar activities and routines and generates intersubjective anxieties; one now
worries about holding back ones healthy friends, about being unable to participate in social
activities and fears may arise about social stigmatisation and stereotyping. Personal autonomy
is compromised as one becomes dependent, to a greater or lesser extent, upon others, whether
family or friends, or carers and medical personnel, and even strangers (for instance, if one
collapses in the street). Illness also creates new and unwelcome possibilities for
embarrassment, indignity, fear and disappointment, possibilities whose negative character is
amplified by the fact of their unpredictability and, in many cases, untreatability. Furthermore,
illness constrains the possibilities available, for instance for professional advancement,
having children, engaging in certain activities (like sport), or by imposing practical
constraints (concerning mobility, say).
A phenomenological perspective on illness exposes aspects of the suffering of ill persons
which naturalistic theories miss out. Although this expands our understanding of the
detrimental impact of illness upon human beings, it also has positive aspects. Carel
emphasises that a phenomenological approach has both cognitive and clinical value. On the
cognitive side, illness provides a rare opportunity to perceive the gap between the
biological body and the experience of the lived body, a gap that remains hidden in health
(Carel 2007, p. 99). Using phenomenology to explore the relationship between the biological
and lived bodies can, therefore, contribute to philosophical understandingof embodiment,
for instancebut also inform clinical practice. Carel proposes that medical practitioners can
utilise phenomenological methods to provide the concepts and ideas essential to
understanding the experience of illness (Carel 2007, p. 109).
Central to the clinical value of phenomenological approaches is the capacity to enable
positive orientations towards illness. By highlighting features of the lived experience of
illness which otherwise go unexplored, phenomenological medicine can open a space for the
creative adaptability that can enable a good life even within a context of illness (Carel 2007,
p. 109). Enabling such health within illness involves reintegration of the biological and
lived bodies. Carel suggests that, by consciously utilising a phenomenological approach, one
can achieve a transformed body and thereby attain health within illness. After the initial
dislocation of the two bodies, one can, through a variety of creative responses, achieve a
reintegration of ones biological and lived bodies.

This reintegration may not consist of a perfect restoration of the prior unity, although that
may be possible in some circumstances. It is more likely to consist in a new sort of
integration; certain relationships between the biological and lived bodies may be partially
restored, but other novel ones will be created. In such cases of recovery, the biological body
that was transformed by illness is now reunited with the lived body and the ill person can
thereby achieve a modified but nonetheless rich texture of life even without a medical
resolution of the disease (Carel 2007, pp. 1082109).
Carel uses the idea of reintegration of the biological and lived bodies as the basis for her
positive proposals. Repairing the rupture between the two bodies requires, she argues, two
positive responses, namely adaptability and creativity. These two positive responses
encompass multiple modes of experience, as befits the phenomenological insistence on the
holistic character of the experience of illness. Illness opens up two sorts of gap, those
between the biological and lived bodies, on the one hand, and between the social and physical
world, on the other. Restoring or replacing these interactions require[s] significant
adjustment and creativity, and therefore illness, properly conceived, induces adaptability
thereby becoming a source of creative responses to it (Carel 2007, p. 104).
It is worthwhile giving some examples of such adaptability and creative response. There
are ample instances available from both the academic literature and popular discourse
concerning illness. For instance, Carel notes that there is a familiar idiom of adjustment,
coming to terms and acceptance of illness, which, though vague, does help to capture
something of the adaptive, creative nature of responses to illness. Adjustment, for instance,
requires a capacity and willingness to change certain features of oneself, or of ones physical
or social environment in order to minimise the obstacles they pose to ones transformed
capacities for action. Although such responses will necessarily betray a negative fact (that of
ones impaired mobility, say), Carel stresses the highly personal and creative dimension of
adaptability (Carel 2007, p. 105). In this example, the person may develop a whole range of
creative adaptations, including adapt[ing] her walking speed, gait, time allocation, level of
physical activity and so on, depending upon the particularities of the illness. These responses
also require an enhanced awareness of the physical aspects of ones activities and of ones
body.
The positive aspect of such adaptive and creative responses is obvious. Indeed, Carels
choice of those terms betrays their positive valence; it is a good thing to be adaptive and
creative, and conversely it is a bad thing to be inflexible and uncreative. Adaptability and
creativity are also mutually reinforcing. Being able to find new ways to perform familiar
tasks (such as showering) in the light of lost or diminished capacities requires the exercise of
creativity, imagination, and the like. It also demonstrates the plasticity of behaviour and the
human capacity to adjust to change (Carel 2007, p. 106).
There is a further, psychological aspect to adaptability and creativity. It is not enough for
the ill person to find new ways to perform old tasks; she must also be capable of
psychological adaptation. Carel writes that the ill personespecially those who are
terminally illmust be able to provide a new meaning for their experiences, to seek
explanation for her suffering and limitations, to create a new approach to ones future.
More broadly, psychological adaptation involves the successful development and
employment of mechanisms of coping, normalisation [and the] strategic mobilisation of
resources (Carel 2007, p. 98). The need for psychological adaptation is obvious. It is not
enough for an ill person to be able to simply replace one set of strategies for daily life with
anotherfor instance, to adjust her routines and press on with life. She must also be able to
cope with those changes, including the range of existential and intersubjective changes, and
so demonstrate the continued exploration of self and creation of meaning against an adverse
background which illness can provoke (Carel 2007, p. 106).

The positive responses to illness that Carel describes encompass a set of changes to ones
attitudes and orientations. Reintegrating the biological and lived bodies and adjusting ones
comportment within the social and physical worlds each require adaptive and creative
responses. Carel stresses that successful reintegration may take a great deal of time and
effort; however, it is a creative achievement which requires both the successful cultivation
and exercise of new capacities and, most likely, the enrichment of existing ones (Carel 2007,
p. 109). A person could become more creative as a response to illness, or see their existing
creativity developed in new and hitherto unanticipated ways. Because such creative
adaptation is challenging, its success leads to a sense of achievement satisfaction
[and] improvement in quality of life (Carel 2007, p. 106). And there are other rewards, such
as an ability to live in the present and a capacity to understand the fragility and transience
of life and nonetheless appreciate it (Carel 2007, p. 108).
Illness can therefore provoke us to become adaptable and creative. Carels
phenomenology of illness offers an enriched understanding of how persons experience
illness. Her account of positive responses deepens our understanding of how ill persons can
respond to, and cope with their illness. However, her account can be developed further by
developing its latent virtue ethical potential. More specifically, Carels account of positive
response to illness can be better articulated and developed by interpreting it within a virtue
ethical framework.
I justify this claim on three grounds. The first is that a vocabulary of virtues is present
throughout Carels Illness. Aside from certain explicit references to the virtues of others,
there is an implicit invocation of virtues throughout Carels book. For instance, Carels
references to her newfound awareness of, and responses to her bodily limitations reflects the
virtue of humility.5 Indeed, she often remarks that her illness has made her, for instance, more
patient, aware of the need for discipline in my illness management, encouraged her to open
myself to the knowledge that other people suffer too, and to cultivate optimis[m] (Carel
2008, p. 33).
The second is that the theme of learning is a central feature of Carels account. She often
writes of how much she has learned from her illness, attesting to its edifying potential. Carel
reports that she has learned more about my embodied existence, about peoples attitudes
towards illness and disability, about the inability to speak of important things (Carel 2008, p.
6). The educative potential of illness is central to the edificationist claim. By affording novel
opportunities for the cultivation of virtues, illness can, properly conceived, be instructive,
both ethically and cognitively. Carel reports her conviction that I view illness as a life2
transforming process, in which there is plenty of bad but also, surprisingly, some good
(Carel 2008, p. 12). Such remarks are wholly intelligible as a latent edificationism, especially
in conjunction with the pervasive appeals to virtues (and vices).
The third grounds for the virtue ethical interpretation is the fact that the idea that illness
can be edifying finds extensive support from the history of philosophy, as later sections of the
paper will indicate. In section three, I provide an account of the edificationist conception of
illness and explain how illness can be conducive to the cultivation of virtues. Then in section
four, I develop my account further by considering some objections, before concluding in
section five.

Carels account of positive responses to illness emphasises the role of adaptability and
creativity. These are both virtues, understood in the classical Aristotelian sense of excellences
of character and the purpose of this section is to make good on the virtue2based interpretation
I gestured to. A persons responses to illness not only invite description using a vocabulary of

virtues, but also tend to incorporate the theme of learning from illness (though not in every
case, a point I return to in section four), especially in the case of Carels account.
Before offering an account of the edifying potential of illness, it is worth noting a few
more general advantages to a virtue2theoretic interpretation of experiences of illness. The
idea that illness can be edifying can enrich our understanding of how ill persons can cope
with their illness, and also emphasises the moral achievement inherent in the cultivation and
exercise of virtues via illness. A person who is edified by illness has not simply developed
effective coping strategies, but can also claim a legitimate moral achievement. Moreover,
both illness and virtues are holistic, involving the psychological, practical and social aspects
of a persons being. These are advantages of an edificationist conception of illness which are
independent of, but complementary to, Carels own account of positive responses to illness.
The idea that illness is edifying is a familiar one. Certainly it has both intuitive and
idiomatic appeal, a fact attested by the moral rhetoric of the pathographic literature, for
instance the idea of coping with illness (though such rhetoric is often challenged, as
discussed in section four). There are also longstanding connections between virtue theory
and medicine, especially biomedical ethics, including a growing literature on the virtues of
physicians and patients.6 Finally, many thinkers, including many from the ancient world,
understood health and virtue to be conceptually and causally related, though that claim is far
from uncontroversial (see Sloan 2011).
It is not difficult to see how virtues enable an ill person to better cope with their illness.
Consider a series of typical virtues. An adaptable and creative person can better respond to
their illness than an inflexible, uncreative person, especially if they are also patient and have
fortitude. Conforming to drug regimens and exercises requires discipline, while engaging
with healthcare professionals invites trust and honesty, as well as hope concerning
possibilities for future health and gratitude for what health one does have. Other virtues could
be emphasised or added as one wishesthis sketch is illustrative, rather than schematic.
Such virtues are not isolated response to particular environments or situations. Instead, one
virtue tends to activate others, such that they enjoy a holistic character; as Socrates said, the
virtues tend to pull together, in a mutually2enabling way.7 It is also worth adding that no
virtue ethicist would claim that cultivating virtues will necessarily or automatically deliver
one from pain or suffering. A person can be highly virtuous yet still experience frustration
and despair, or struggle to adapt themselves to their illness. But what the virtue ethicist would
affirm is that becoming virtuous will improve ones chances of coping, practically and
psychologically, with ones illness. As Jennifer C. Jackson neatly puts it, virtues are
enabling [and] vices are disabling, even if the question of which virtues are enabling, and
why, is likely to be contextual and dependent on the moral character of the ill person
(Jackson 2006, p. 16). Aristotles wise observation that ethics is an inexact science applies
very well here; no algorithmic account could be given specifying the value and priority of the
various virtues.8
Interpreting illness as an opportunity for edification has two values. The first is that it
improves the life of the ill person and the lives of those around them, such as family, friends,
and healthcare providers. 9 An ill person who is courageous and patient will likely be better
able to cope with their illness, and its treatment, and benefits are likely to be felt by those
who care for them. As Arthur Kleinman puts it, during illness one may be privileged to
discover powers within us which would enable us to amplify our capacity to contribute
to [our own] care (Kleinman 1989, p. xiii). The second is that edificationism affords illness a
moral value and meaningfulness. Since the practical and psychological value of
edificationism is obvious enough, it is the second value I will dwell on. However, the aim, in
both cases, is primarily to get well, rather than to be edified. An ill person can exploit its

edifying potential, but they should also strive to do all that they can to restore themselves to
healthan issue I return to in section four.
Ill persons often remark upon the apparent meaninglessness of illness. It is not often clear
what value or purpose, if any, illness could have. Carel testifies to this point: Why me?, she
asks, decades of joy and involvement with the wondrous world of children, all taken away
from me, unfairly, bluntly, with no compensation, no explanation and little to take its place
(Carel 2008, pp. 46247). Indeed, the meaninglessness of illness is often cited as an important
contributor to ones suffering: illness seems to have no positive function, it simply entails
disruption, pain, physical and mental suffering, alienation, and incapacity. Even if one adopts
a policy of enduranceof taking the pills and riding it outillness meaninglessness
contributes to the existential aspect of suffering. That existential concern is, of course,
amplified for those who are chronically ill, or for whom no treatment is as yet available.
Interpreting illness as edifying may offset its meaninglessness. A person could decide to
exploit their illness as an opportunity to cultivate or exercise their virtues, thereby lending it a
degree of practical or moral meaningfulness. (One makes something of it, if you like). That
does not, of course, detract from the pain and suffering their illness entails; however, it does
mean that such suffering is not in vain, insofar as some positive valuemoral or practical,
saycan be attached to it. I take it that this is what Carel means when she says, in a remark
quoted earlier, that illness is a life2transforming process which includes plenty of bad but
also, surprisingly, some good. The good that illness can include lies in its capacity to
enable a person to cultivate and express their virtues, either as a practicable response or
within the more ambitious ethical project of pursuing the good life.
Both illness and virtue ethics are also holistic in character. Carel emphasises that illness is
not confined to certain localised biological dysfunctions; instead, illness can have a global
impact across the range of a persons activities. Such holism is absent from naturalistic
accounts which respond only to biological dysfunctions, neglecting the social and
psychological aspects of illness. A key aim of Carels phenomenological account is to expose
the holistic character of illness, to demonstrate that the impact of illness is not only
physical but also psychological, social, cognitive, emotional, existential, and temporal (Carel
2011, p. 42).
Informing Carels point about holism is the corresponding claim that any adequate
response to illness must be similarly holistic. It is not enough to treat the body, or those parts
of it which are dysfunctional, if the impact upon ones personal relationships, dignity, and
sense of self remain neglected. This is where virtue ethics is especially relevant. Since
Aristotle, virtue ethicists have emphasised that the virtues are holistic, insofar as they
manifest throughout the activities, habits and attitudes which constitute a persons life. Ones
virtues should be manifested across the practical, psychological, and social aspects of ones
being, including ones gait, pose, tone, manner, and attitudinal outlook. Indeed, virtue
ethicists emphasise the holistic character of virtue ethics, especially to criticise the tendency,
evident in some moral theories, to confine the ethical to certain special situationsperiodic
moral crises, say.10
Virtue ethics and illness are both holistic. If this is the case, then virtue ethics can serve as
an effective framework for a moral interpretation of illness. One can preserve Carels
phenomenological insistence on the holistic impact of illnesspractical, psychological, and
socialand marry it to the virtue ethicists claim that our virtues are manifest in our actions,
attitudes, and interactions with others. To borrow a term from Pierre Hadot (1995), both
illness and virtuousness are a way of life, and, for some persons, virtuous illness is their
way of life. Integrating virtuousness and illness therefore deepens Carels claim that one can
be ill and happy, by enriching the meaning of that latter term.

An ill person can cultivate the virtues in response to their illness and thereby embrace the
positive moral project of edification. Interpreting illness in this way elevates their medical
management of illness into a moral achievement, as well as lending it a meaningfulness
which it might otherwise lack. An ill person who positively responds to their illness is not
simply coping well, but is also participating in the noble project of cultivating the virtues
and pursuing the good life.
Some further practical points about the edificationist conception of illness should be
emphasised. The edificationist potential of an illness will depend on at least three factors: the
nature of the illness; the prior ethical character of the person; and their social environment. I
will take these in turn.
First, the edifying potential of an illness will depend upon its nature, intensity, duration,
and the cognitive impairment it might entail. A brief case of flu may afford little potential
for edification, since it is a brief, minor, non2fatal illness, whereas skin cancer is, in most
cases, serious, prolonged and potentially life2threatening. Some illnesses also entail cognitive
impairment, such as Alzheimers Syndrome, and it is likely that edification is impossible for
those with serious cognitive impairment. Judging the edifying potential of an illness will
likely require a case2by2case judgement by the ill person. A person with a brief case of the
flu may legitimately neglect its edifying potential, whereas a person diagnosed with skin
cancer perhaps ought not to (although later in the paper the question of whether ill persons
are obliged to exploit the edifying potential of illness is rejected on moral grounds).
Second, a persons prior ethical character will affect their willingness and ability to
embrace edificationism. A temperamental pessimist is less likely to regard illness as an
opportunity to cultivate their virtues.11 It is unlikely, however, that any strict causal link could
be established between prior ethical character and a capacity for edification. It is wholly
possibleindeed, examples could be givenof morally disciplined persons who go to
pieces during serious illness, or, conversely, of ethically vicious persons who are morally
transformed, for the better, by illness. I return to this point later, but will note, for now, that
philosophical analysis of how and why an ill person may go to pieces as a result of their
illness will require the resources of both moral philosophy and empirical psychology.12
Third, the social environment of the ill person affects their capacity to seek edification
from their experiences of illness. Carel herself discusses the social world of illness in
chapter three of Illness and emphasises the powerful effects that other persons can have upon
an ill person. Indeed, the chapter opens with the poignant remark that empathy is the human
emotion in greatest shortage, that of all the many terrible things about illness; the lack of
empathy hurts the most (Carel 2008, p. 37). When one considers the multiple ways in which
illness can disturb, even destroy a persons life, the force of this observation is considerable.
The social environment of an ill person can affect their capacity to be edified in at least
two ways. The first is that instances like that one just reported can damage the ill persons
confidence, for instance, by causing them to break down, shattering their fragile emotional
and psychological comportment. A cruel word or a nasty look can be devastating, especially
if one is ill. The second is that the cultivation of virtues requires a supporting social
environment. Aristotle, for instance, closes the Nicomachean Ethics by discussing the role of
education and political theory, on the grounds that the cultivation of virtues is difficult, if not
impossible, in the absence of a social environment which is receptive to that ethical project.13
A supportive social environment will therefore also affect an ill persons capacity to
recognise and exploit the edifying potential of their illness.
Carel discusses the role of social environment in the context of healthcare. One aim of her
phenomenology of medicine is its potential capacity to reform healthcare practice, especially
in the United Kingdom.14 Incorporating phenomenological insights into healthcare practice is
necessary, she argues, because the neglect of the lived experience of illness compromises the

adequacy of healthcare provision. Indeed, there is a substantial literature on the virtue of care
in nursing which includes generous appeal to Heideggerean phenomenology (see Johnson
2000). One can therefore use phenomenology to help to establish systems of healthcare
practice reflective of ethical virtues such as fundamental human empathy and compassion
(Carel 2008, p. 44).
The edifying potential of illness is contingent upon the nature of the illness, the prior
ethical character of the person, and their social environment. Those factors are too potentially
diverse to admit of algorithmic generalisation, in line with Aristotles remark that ethics is an
inexact science. The particularist nature of the edificationist conception of illness does not
undermine it, however, and in fact testifies to its applicability to a range of experiences of
illness. In particular, it preserves Carels insistence on the first2person lived experience of
illness and its holistic character, while also developing and enriching the latent role of
virtues and learning in her account.
I conclude that a virtue2ethical framework, of the sort sketched here, contributes to Carels
project of providing a phenomenology of illness which simultaneously includes and
illuminates the context, experience and relations of the ill person, of how illness affects the
rich texture of life (Carel 2007, p. 109). Edificationism adds new moral and existential
valence to those experiences and relations, and enriches the texture of life of the ill
person.
In the next section I will develop my account of the edifying potential of illness by
considering a series of objections to it. Responding to these objections will clarify the precise
meaning of the claim that illness can be edifying and also usefully indicate some antecedent
figures who have proposed edificationist accounts of illness. I then conclude the paper in
section five.

In sections two and three I argued that illness can be edifying. I now consider two sets of
objections to that claim, in order to develop and clarify my account and to identity some
historical antecedents for the edificationist claim. The first set of instrumentalist objections
concerns the claim that edificationism confers upon illness a value that renders it a desirable,
even good state to have. Illness can have instrumental moral, cognitive and existential
value. The second set of objections relates to the concern that edification imposes intolerable
burdens upon ill persons which it is unfair, even cruel to impose. I consider these two sets of
objections in turn, before concluding that an edificationist maintains that the primary aim of
an ill person should be to return to health, insofar as that is possible given the nature of their
illness and the medical resources available to them. Even if new and powerful sources of
edification become possible with illness, one should always strive above all to become well.

An instrumentalist argues that illness is desirable because of its unique moral, cognitive or
existential valuethough those three will often, of course, run together. Illness can afford
potent opportunities for moral development, insight and understanding and self2development
which, for the instrumentalist, make it desirable. Indeed, some strong instrumentalists, like
Nietzsche and the Cynics, insist that certain forms of human good are only available through
experiences of illness. The disturbing possibility therefore arises that an instrumentalist may
propose that it may be desirable to become ill in order to exploit its edifying potential, or
even to prolong or exacerbate ones illness.
Before considering examples of instrumentalism, it should be emphasised that it is, in fact,
a form of edificationism. Both the edificationist and the instrumentalist agree that illness can
be edifying, but whereas the edificationist does not interpret that as an imperative to seek out

illness, the instrumentalist does. That difference offers an important distinction: although the
instrumentalist is an edificationist, his normative valuation of illness, and the corresponding
imperative to seek it out and value it, represents a step too far. The instrumentalist positions
discussed in this section are, then, objections to certain strong or radical forms of
edificationism which are, in my judgement, untenable.
Let us start with moral instrumentalism, for which the Christian tradition offers instructive
examples. In City of God, Augustine, for example, argues that, illness is a consequence of the
frailty of our mortal flesh, but one which may contribute to our benefit if one makes wise
and appropriate use of it. Such utilisation of illness demands insight [and] staying power
and may also exercise our humility, thereby edifying us (Augustine, City of God IX: 22,
quoted in Larrimore (2001, pp. 55 and 56). Similarly, Boethius argues in Consolation of
Philosophy that illness brings [one] to self2discovery by affording us opportunities to assess
our fortitude and courage. A person who is excessively afraid of suffering, for example,
may discover their endurance, while, for others, illness may puncture the conceit of those
who are full of scorn for suffering they cannot in fact bear (quoted in Larrimore (2001, p.
74). Augustine and Boethius both affirm the morally improving potential of illness, but stop
short of affirming that illness is therefore desirable.15 They are therefore edificationists rather
than instrumentalists: each allow that illness may be positively responded to, in Carels
sense, but deny that this entails that illness is intrinsically valuable, or that one should seek to
become ill, or to prolong or exacerbate ones illness. It is not good to be ill, although good
can come of being ill.
A rare example of moral instrumentalism of the strong sort I reject is offered by Cynic
philosophy. The Cynics, such as Antisthenes and Diogenes, affirmed that illness, and toil
[and] hardship more generally, were necessary to human moral development. Their
conception of ethical formation centred on the idea of asksis, or training of the self, for
which exposure to, and endurance of hardships was essential (quoted in Diogenes Laertius
6.104 and 7.122). The biographies of the Cynics include many instances of self2imposed
physical suffering and social exclusion, each deliberately sought out and exacerbated, thereby
pushing their edificationist into the stronger, radical forms represented by instrumentalism.
The Cynics offer three points relevant to the moral value of illness. The first is that the aim
of their ethics is a life in accord with nature, including indifference to artificial social
conventions which distort our judgements about value. Since our nature likely includes
alternating periods of health and illness, and, towards the end of ones life, prolonged periods
of increasingly serious illness, the Cynics urge us to resist the premium placed by society on
health. Illness is a natural part of life and should be accepted as such.
The second is that the Cynics urge caution regarding conventional social valuations of
health as a good. Although health is naturally desirable, the tendency of societiesboth
theirs and oursto afford it intense moral valuation obscures the fact that a good life, a
virtuous life, is possible for ill persons. Indeed, Cynic ethical practices were intended to
provoke people to take seriously the possibility that they might live radically different lives
from those prescribed by social convention, including lives of serious illness (Mazalla 2007,
pp. 26229ff).
The third point that Cynic ethics offers concerning illness is the role it affords to virtue.
Central to asksis is the embrace of hardships, as evidenced by biographical anecdotes of
leading Cynics, such as Antisthenes and Diogenes, walking barefoot in snow, living vagrant
lifestyles, and so on. Enduring hardships enables one to achieve self2sufficiency
(autarkeia), which Diogenes defined as a capacity to adapt [oneself] to circumstances
(quoted in Diogenes Laertius 6.21). A self2sufficient person can adapt to changing
circumstances, such as the onset of illness, without clinging to their health as social norms
dictate. Such adaptability is, of course, wholly consonant with Carels account of positive

response, but where Carel only proposes that an ill person ought to become adaptable, the
Cynics go further, insisting that cultivating such adaptability requires one to become ill. The
state of profound self2sufficiency they seek is extremely difficult to achieve and requires
intense moral self2discipline, for which wilful embrace of toil [and] hardship are absolutely
prerequisite.16
The Cynics also identify social exclusion as a source of moral edification. That claim is
wholly consonant with the stringency of their conceptions of ethical training and it is quite
possible that certain persons may be edified by their wilfully excluding themselves from
society. Epictetus, for example, reports that the Cynic ought to be free from distraction,
even to the point of avoiding or abandoning relationships which he cannot violate, such as
marriage or parenthood (quoted in Navia 1996, p. 135). However, it seems likely that most
persons would not regard social exclusion as conducive to moral edification, especially in
states of serious or prolonged illness, and so social exclusion of the sort recommended by the
Cynics goes beyond the socially2supported forms of edification defended in this paper.
Instrumentalism as a form of radical edificationism also applies to existential concerns.
The edifying potential of illness helps one to cultivate not only their virtues, but also their
self. Illness affords unique opportunities for self2discovery and the formation of self, and is
therefore of existential value. Carel remarks that an ill person has a rare insight into, and
understanding of the fragility and transience of life, while Nietzsche declares that illness
helps to expose ones horizon[,] energies [and] impulses and thereby makes us deeper
(Nietzsche (1974, 120; Preface 3). An ill person enjoys insights into their selves which are
otherwise unavailable, obscured as they are by our health.
The existential value of illness is a familiar idea. Many persons report that experiences of
illness and injury have enabled them to better understand their limits and potencies,
disclosing, perhaps for the first time, their true mettle. Certainly the formative power of
experiences of illness is widely attested to, either insofar as illness tests ones virtues or offers
new forms of understanding and insight. The instrumental existential value of illness is
closely related to its cognitive value, the claim that being ill affords the ill person novel
insights, experiences and forms of understanding which would be either unavailable or less
efficiently achieved in the absence of illness.
The core contention that illness is potentially cognitively valuable is not in dispute,
especially since accounts like Carels are premised upon the cognitive value of illness. The
cognitive value of illness might include literary and artistic inspiration, philosophical
understanding, or a desire for empathy with ill persons of their acquaintance. However, the
objection from cognitive instrumentalism arises when a person claims that being ill is thereby
a desirable thing, especially if they thereby seek out illness as a cognitive resource. Once
again, the instrumentalist, like Nietzsche, adopts a radical edificationism, owing to their
insistence that such value can only be granted by illness, which is thereby rendered desirable.
Nietzsche defends the instrumental cognitive and existential value of illness. In The Gay
Science, Nietzsche describes illness as a transfiguration which can give birth to our
thoughts out of pain (Nietzsche 1974, New Preface 3). These claims are not suppositional,
since Nietzsche himself was ill throughout his life, a fact which informed his claims about the
value of illness. In an 1875 letter, he bemoans the fact that he was in a good physical state
because, without the prospect of sickness, his future as a writer is almost hopeless
(Nietzsche 1996, p. 130).
Nietzsches instrumentalism is indicated by his clear implication that the cognitive value
afforded by his illness could not be equalled by other experiences. Illness has a distinctive,
perhaps unique cognitive value. Indeed, elsewhere in The Gay Science, Nietzsche makes the
striking claim that cognitive ideals, like the pursuit of truth, are premised upon the cognitive
exploitation of illness. The great question, he suggests, is whether we can really dispense

with illness, if one maintainsas he clearly doesthat our thirst for knowledge and self2
knowledge in particular require[s] the sick soul as much as the healthy (Nietzsche 1974,
III, 120).
The cognitive value of illness is especially relevant to Carels project. The philosophical
and clinical value of a phenomenology of illness is premised upon the cognitive claim that ill
persons, like Carel, have distinctive insights into illness. And presumably Carel herself agrees
that illness is cognitively valuable, since otherwise the value of phenomenology of illness
would seem obscure. Indeed, a cognitive instrumentalist might embrace the perverse claim
that becoming ill would better enable them to understand illness, hence instrumentalisms
status as a stronger or more radical form of edificationism.
The three forms of instrumentalism described are closely related. Illness affords a person
powerful opportunities to cultivate and express their virtues, thereby contributing to the
depth of their character. That process of moral and existential development is cognitively
valuable in itself, since one learns more about oneself, but also arguably enables new insights
into the worldinto the nature of living, death, illness, and so on. If that is so, then illness is
desirable, perhaps even necessary, if human beings are to live fully moral and meaningful
lives.
Instrumentalism can be challenged by appeal to the plurality of possible edifying
opportunities. Consider, for instance, the claim that illness is valuable because of its capacity
to cultivate the virtues. An edificationist concurs that illness can be edifying, but denies that
illness is a sole or privileged possibility for successful edification. Being ill is not a
precondition for edification, since a healthy person still has very many possibilities for the
cultivation of virtue available to them, none of which could legitimately be judged inferior.
There are always multiple possibilities for the cultivation of virtue, including everyday social
interactions, ones professional life, religious observance, philosophical practice, or engaging
in art or even gardening.17
The fact that there are alternative opportunities for edification besides illness does not, in
itself, provide an automatic reason not to seek out or induce illness. Further argumentation is
needed to secure the claim that a person seeking edification should not induce illness, for
otherwise it may seem a person seeking edification could just as well induce serious illness as
take up gardening or watercolour painting. One appropriate consideration is the fact that
seeking out or inducing illness would constitute a failure of the virtue of prudence. A person
who seeks edification by taking up gardening or watercolour painting is not being imprudent
because, except in rare occasions, the practices and social relationships which those activities
entail do not entail the risk or certainty of physical injury, mental distress or serious financial
loss. Illness, of course, does, with due qualifications for the kind and extent of illness one has;
therefore it would be imprudent to seek it out, especially since alternative opportunities are
available which would not entail a failure of prudence.18
Considerations of prudence can therefore provide a means of selecting between the
various opportunities for edification available to a person. The involuntary nature of illness
may mark it out as a distinctive form of opportunity for edification, but that is wholly
compatible with the insistence that the restoration of health ought to be the primary aim of the
ill person.19 Illness should not be regarded as the sole or privileged edificatory opportunity,
and on pain of imprudence one should not therefore deliberately seek it out. A person who is
ill can be edified, but that does not entail that one should, or must become ill in order to be
edified. It is of course preferable that one be able to choose the sort of activities through
which one seeks edification, but illness does not afford that luxury. As Montaigne very
clearly puts it, I am glad not to be sick; but if I am, I want to know I am; and if they
cauterize or incise me, I want to feel it (quoted in Hartle 2003, p. 32). The ill person, in such
cases, is faced with the simpler or starker choice of whether to explore the edifying

possibilities of their illness, a judgement of course influenced by the factors which determine
that potential.20
The cognitive instrumentalist claim merits a different response. Illness has cognitive value,
for sure, but a healthy person does not need to deliberately become ill in order to derive
cognitive value from illness, for two reasons. The first point, perhaps a trite one, is that many
persons will likely become ill at some point anyway, even if we grant that they exercise and
live healthily. Even in modern societies with advanced healthcare systems and good nutrition
and public health, illness is inevitable at some point, and that fact holds even for the most
prudent persons who take care to eat well, exercise, and so on. The second is that one need
not become ill oneself to derive cognitive benefit from illness. Participating in the care of ill
persons (aged family members, say) or reflecting on autobiographical and literary accounts of
illness, such as Carels, can all offer a healthy person cognitively valuable insights into the
experience of illness. A person need not become ill to gain cognitive value from it, as long as
prudential alternative possibilities for deriving that value exist.
Indeed, Carels Illness itself attests to the fact that healthy persons can derive cognitive
value from testimonial accounts of illness. As Mikel Burley has argued, Carels
phenomenological description of her experiences grants receptive readers a capacity to
empathetically contemplate the possible effects of those symptoms upon the experiential life
of the ill person (Burley 2011, p. 43). The cognitive value of Carels account includes
enabling readers to imaginatively relive the experience of, say, intrusive interrogation about
ones health (Burley 2011, p. 42). Although I do not and have never had a chronic lung
disease, my reading of Carels own account has been cognitively valuable for me, affording
me understanding of and insights into the experience of serious illness. I can say the same of
the literature on, and television programs and films about, illness that formed part of the
research for this paper.
Neither the moral nor the cognitive value of illness requires one to be or become ill. The
fact of prudent alternative possible edifying opportunities offers other ways of cultivating
ones virtues, and the cognitive value of illness can be capitalised upon by, for instance,
literary works and phenomenological accounts by ill persons. However, the instrumentalist
may raise an epistemological problem for this defence, namely that the full cognitive and
existential value of illness can only be realised through first2person experience.
Autobiographical accounts of illness like Carels may be cognitively valuable, but not as
much as actually being ill oneself.
That objection is especially relevant to the existential instrumentalist charge that illness is
an essential resource for self2development. In The Gay Science, for example, Nietzsche
vacillates on the question of whether illness is necessary for our transfiguration, eventually
concluding that it is. A soul who craves to have experienced the whole range of values, he
argues, must enjoy great health, which Nietzsche defines as something one acquires
constantly [and] gives it up again and again (Nietzsche (1974, III, 382).21 Illness is, on
these terms, necessary to our moral, cognitive and existential development and furthermore
this value is realised fully only through personal experience. A person who has known only
health may be admirable, but by having never been ill that person is experientially
impoverished. Nietzsche even affirms that our understanding of certain concepts, like health
or illness, requires more eyes, different eyes to be complete (Nietzsche 2008, III, 12).
Understanding the value of life, in particular, cannot be estimated by the living
because, in Nietzsches striking remark, they are an interested party (Nietzsche 2008, II,
2).
How can one respond to the insistence that the value of illness is fully realised only by
personal experience of illness? For Nietzsche that of course requires not only the cheerful
embrace of illness, but repeated cycles of health and illness, pursuant of his oft2cited claim,

apparently taken from Goethe, that whatever does not kill a person makes them stronger.22 I
offer two responses. The first is that Nietzsche and the Cynics are being hyperbolic in their
insistence on the absolute necessary of individual suffering. The plurality of alternative
edifying opportunities ensures that a healthy person has many opportunities for moral,
cognitive, and existential development available to them. The emphasis on intense hardship is
biographically and philosophically intelligible for Nietzsche and the Cynics, but arguably
relies upon an overly austere conception of ethical formation, one a modest edificationist has
no obligation to adopt. The second is that if illness is construed as edifying then it makes no
sense, on virtue ethical terms, to seek out and embrace illness because by doing so one
sacrifices the virtue of prudence (and likely others, too). That person would have grossly
misunderstood the edificationist position if they premised their efforts to cultivate virtue on
the gross violation of the central virtue of prudence.
Therefore the claim that one should and must become ill in order to capitalise upon its
moral, cognitive and existential value ought to be rejected as hyperbolic, ethically misguided
and imprudent. It is for that reason that the stronger or radical forms of edificationism
reflected by instrumentalism ought to be rejected.
!
The second set of objections to edificationism pertains to claim that it imposes intolerable
burdens upon ill persons. I call these the novel demand, failure, and Medusa objections
and they come as a set of ascending objections, centred on the ethical and psychological
demands that edification imposes upon an ill person.
The novel demand objection begins with the point that edification is morally and
psychologically demanding. It is almost clichd to say that cultivating the virtues is difficult,
but in the case of illness it is especially relevant. An ill person has enough demands upon
their time and energy, including managing their illness medically, psychologically and
socially in the way detailed by Carel. Therefore, imposing the further demand of edification
adds to their burdens in a way which is unfair, cruel, or plain perverse. In Simone Weils
vivid image, a severely ill person has been stuck by one of those blows that leave a being
struggling on the ground like a half2crushed worm, leaving them in no state to help anyone
at all, and they are almost incapable of even wishing to do so (quoted in Larrimore 2001, p.
335).
Indeed, even healthy persons find edification demanding. As Geoffrey Scarre notes,
stories of moral achievementof outstanding courage, saycan be both curiously
inspiring and daunting: inspiring because they indicate the heights of moral excellence of
which humans are capable, yet daunting because they offer a model of virtuous endeavour
which many of us may feel to be utterly, and distressingly, beyond us (Scarre 2010, p. 1).
The cultivation of the virtues is a difficult enough project even for those in states of good
health, so to insist that ill persons embrace edification seems unfair at best, perverse at worst.
The novel demand objection is amplified by the failure objection. Edification is a process
which demands effort [and] imagination and therefore its accomplishment is neither easy
[nor] immediate (Cooper 2010, pp. 63264ff). Since successful edification is not assured, to
insist that ill persons strive to embrace it, despite the risk of failure, is intolerable. The
objection here is not simply that failure is possible, for that is true of many of the challenges
one is called to face in life. Instead, the worry is that since illness is a challenge one must
inevitably face, adding the further burden of the risk of failure constitutes a further,
intolerable stress upon ill persons.
Many persons also fail to be edified by their illness. It is often the case that a person fails
to be morally improved by their illness; indeed, some persons come out of their illness the
worse for it (they become less patient and tolerant, say). As the psychotherapist Kathlyn

Conway writes, I hate hearing that cancer has made someone a better person. Its only
making me a worse person (Conway 1997, p. 193). Indeed, edificationist rhetoric is a cause
of palpable alarm for some ill persons. The cancer patient Christina Middlebrook offers the
striking remark that, if edificationist talk is correct, then it turns me ugly as Medusa
(Middlebrook 1996, p. 274). The concerns of those who fail to be edified by illness are
wholly understandable, since it may seem that such persons are morally impotent, imperfect,
or incapable. The edificationist in fact seems to run the risk of morally condemning such
persons, adding a moral aspect to their suffering.
The novel demand, failure, and Medusa objections are related to one another. Each can be
met using one of the following responses. Firstly, few, if any persons demand edification
from ill persons. Often the explicit policy of edification goes unrealised, and, if it is, neither
healthcare professionals nor family members generally insist that the ill person embrace it.
Secondly, the edifying potential of illness is qualified by the nature of the illness, the prior
ethical character of the person, and the social environment. Each experience of illness affords
a different possibility for edification; some illnesses will offer rich possibilities for
edification, others less so, and still others none at all. Thirdly, the Stoics were surely right to
insist that, in matters concerning the cultivation of virtue, what matters is not that one is
successful, but that one tries. Counter intuitively, what matters is, perhaps, that the ill person
tries to realise the edifying potential of their illness, not that they in fact succeed in doing so.
If they succeed, so much the better, but since their capacity to succeed is contingent upon
factors beyond their controlsuch as the development of their illnesssuccess can be
neither presumed nor guaranteed. Fourthly, an ill person could seek edification from any
number of other activities and experiences other than their illness, such as their professional
life, artistic interests, and so on. Using these four responses, the objections from novel
demand, failure, and Medusa are rebutted.
The edificationist proposal that illness can be valuable does not entail that illness should
be viewed as a moral, cognitive, or existential resource. Those forms of value become
possible for an ill person, who may perhaps then have an obligation to exploit them if
possible (an issue I return to later in the paper). However, the fact that illness can have moral,
cognitive, or existential value does not warrant the proposal that one should seek out illness
in order to attain that value for oneself. It would hardly merit the virtues of prudence and
respect, of oneself or others, to deliberately seek to deliberately become ill. Although the
pursuit of virtue is itself meritorious, it should not proceed in ignorance of the circumstances
of the moral agents in question and cases like illness offer legitimate exemption from the call
to edify, at all costs.
My claim that edification can be protected from the novel demand, failure and Medusa
objections can be strengthened by an appeal to Stoic ethics. The Stoics argued that neither
health nor illness is good in itself, since both can be used well and badly, depending upon
the character of the person (Long and Sedley (2003, p. 354, section 58A). Although health is
generally enabling, and illness disabling, the moral value of those states is determined by
ones response to them. For the Stoics, a person who is healthy but fails to exploit that time to
cultivate their virtues and live well is bad, whereas a person who falls ill but seizes its
edifying potential is good. No necessary connection exists between health and virtue, nor
illness and vice.
Cicero rather graphically emphasises that no one, given the choice, would prefer to
have all the parts of his body defective or twisted, but since that choice is rarely, if at all
available to ill persons, the sensible response of a wise person to illness is to strive to restore
to oneself what Cicero calls understanding regularity and harmony of conduct (Long
and Sedley 2003, p. 360, section 59D and p. 35425, section 58D). Seneca develops this claim,
insisting that a wise person should ensure above all that they do not fall into a state of affairs

which is disturbed, powerless, subservient to another and worthless to oneself (Long and
Sedley (2003, p. 423, section 66C). This remark seems especially resonant with Carels
phenomenological account since it acknowledges the potential of positive responses to
illness. Just as Cicero and Seneca affirm that illness is compatible with a regular,
harmonious and virtuous life, so too Carel maintains that one can be ill and happy.
Carel and the Stoics agree that there is an important conceptual and evaluative difference
between health and happiness, or virtuousness. Autonomy, self2respect, virtuousness and
flourishing are available to the healthy and the ill person alike. Other writers concur. Oliver
Sacks, for instance, suggests that one can transform an ill person in a hopeless state into a
humanly, spiritually active one by encouraging them to become deeply attentive [to] what
constitutes and determines personal being (Sacks 1987, p. 39). In Stoic language, Sacks
urges the use of reason, art communion [and] the human spirit to enable philosophical
reflection on illness as a means of edification. Indeed, Carels account of health in illness
would, with requisite philosophical and terminological modification, surely be wholly
intelligible to the Stoics. When Carel remarks that an ill person can still engage in activities
whose results include honouring the self, creating opportunities, celebrating life and
transcending the self, the Stoics would surely applaud (Carel 2007, p. 103).
Despite the agreements between them, however, Carel and the Stoics disagree on a
fundamental question concerning any edificationist conception of illness: namely, is an ill
person obligated or otherwise required to explore the edifying opportunities afforded by their
illness? Carel and the Stoics agree that no one should desire illness, but the Stoics, unlike
Carel, insist that an ill person should strive to benefit from it by exploiting its edifying
potential.23 Epictetus, for instance, conceded that Socrates was ethically and intellectually
exceptional and so insisted that his achievement was both the proper aim of human life and
therefore within the scope of our ambition (Epictetus (1995, 1.2.33237). So too with
illness; although it can place great demands upon us, we are all obliged to strive to transform
it into a means of moral improvement. For the Stoics, then, although success in edification is
supererogatory, the imperative to engage in it is not; one may fail to be edified by illness, but
one must try (with appropriate qualifications for the edifying potential of the illness, as
discussed in section two).
The question of whether ill persons are obligated to exploit the edifying potential of their
illness is a complex one. It is important to take seriously Conways and Middlebrooks
concerns that edificationism should not be presented as a normative demand. Issuing such
normative imperatives may be easy to do from the detached vantage point of good health:
indeed, it may be too easy. Carel is surely right to argue that a phenomenological approach to
illness can restore the missing first2person perspective and so enable healthcare
professionals and others to understand the transformation of the world of the ill person
caused by illness (Carel 2008, p. 45). An important aspect of such understanding is
recognition and appreciation of the fact that illness imposes its own physical, psychological
and social demands upon a person. Such understanding is also likely to include other virtues,
such as compassion and empathy, each of those being virtues whose importance is stressed
by Carel. Therefore the edificationist account of illness, at least as I have developed it here,
should not include the strong normative claim that an ill person is, by the fact of their illness,
thereby placed under an obligation to exploit the edifying potential of their illness.
Edification is a possibility rather than an obligation for an ill person.

Carels phenomenology of illness can be enriched and expanded by interpreting it within a

virtue2ethical framework. The positive responses to illness she identifies are best
understood as the cultivation of virtues, such as adaptability and creativity, which lend

meaningfulness and moral significance which experiences of illness otherwise lack. I also
argued that the edifying potential of illness is contingent upon a range of factors, relating to
the illness, the person, and their social environment. Therefore any judgements about the
edifying potential of specific experiences of illness must be made on a particularist basis.
To develop the edificationist account, I also considered a range of instrumentalist
objections to edificationism, but judged that each can be rebutted. The fact that illness can, at
least in certain cases, have edifying potential does not make it valuable, nor does it sponsor
the proposal that illness should be sought out, prolonged, or exacerbated. Indeed, a persons
ability to identify if and how their experiences of illness can be edifying would itself require
the cultivation and exercise of virtues, most obviously prudence.
The connections between the phenomenology of illness and virtue ethics are more
extensive and complex than this paper has been able to address. Outstanding issues include
the religious significance of suffering, the question of whether edification should begin
during or after illness, the history of edificationist conceptions of illness, and the possibilities
for implementing edificationism in contemporary healthcare practice. I leave those for
another time. A more urgent set of questions concerns the mechanisms of edification. How
does the edifying process operate? When does it begin? What moral, cognitive and
psychological processes are involved? How is the process of edification structured by
interpersonal considerations? Those questions are topics for another time. My aim in this
paper was to establish the plausibility of the claim that illness can be edifying in order to
prepare the way for a sustained enquiry into the details of that claim. Hopefully this paper
will go some way towards inspiring and enabling discussion of edificationist conceptions of
illness.24
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Sacks, O. (1987) The Man Who Mistook His Wife for a Hat (New York: Harper and Row).
Scarre, G. (2010) On Courage (London: Routledge).
Sloan, R.P. (2011) Virtue and vice in health and illness: the idea that wouldnt die, The
Lancet, 377, pp. 8962897.

See Carel (2007), (2008), (2011).

See Boorse (1975), (1976), (1977); though see R. Cooper (2002).

Merleau2Ponty (2002).

See Burley (2011) for a discussion and defence of the use of anecdote and emotion in

philosophy, with specific reference to Carel.

5

See, for instance, Carel (2008, pp. 627) on loss of bodily capacity and surrendering

vanities.
6

See, for instance, Pellegrino (2007), Pellegrino and Thomasma (1993) and Putman (1988).
See Protagoras 329c62d11 and, for a discussion of the unity of the virtues thesis,

Devereux (2006).
8

Indeed, one could argue that certain virtues may be disabling, rather than enabling. Hume

(1960: p. 286), for instance, described humility as painful because it involved a recognition
of ones deformities (roughly, ones physical and psychological imperfections). In such
cases, humility would be disabling, rather than enabling. That said, such humble awareness of
ones limitations could also be a positive experience, for instance if it is interpreted as a
liberation from otherwise excessive demands.
9

This claim, as I will develop it, is distinct from Marcums (2009) proposal that clinicians

should be epistemically virtuous.

10

Many recent writers have therefore welcomed the revival of larger, and more exciting

conceptions of ethics than those which were current amongst many early2twentieth2century
philosophers, such as Ayer (1936, Ch6) (D.E. Cooper, 1998, p. 2).
11

It may also be the case that, for some persons at least, edification becomes easier or more

achievable if they are acquainted with the relevant philosophical theories; however, that is a
moot point, and one which many ethicists may question. Certainly many persons are quite
virtuous despite little if any knowledge of or engagement with the literature on philosophical
ethics, so such acquaintance is hardly a sine qua non of successful edification.
12

See Campbell and Swift (2000) and Broom and Whittaker (2004).

13

This principle is evident elsewhere, for instance in the form of gym buddies and students

revising together; my father attends biweekly physiotherapy classes and reports that the value
of those classes is partly social, insofar as the members can share and discuss their
experiences and seek solidarity and understanding with one another.
14

See further Carel (2011).

15

Augustine and Boethiuss restraint arises because their metaphysics of illness identify it as

a symptom of our corrupt, fallen nature, so for that reason it cannot be valuable. Illness, as
an evil, is a privation, and thus a particular subsection of the problem of evil.
16

Cynic ethics also emphasises parrhsia, a freedom of speech or frankness or freedom to

speak the truth (Piering 2006, 3b). A self2sufficient person is able not only to cope with
lifes changing circumstances, but also can freely and frankly speak the truth about the
social conventions which distort most peoples moral reasoning. This, of course, entails that
the Cynic will often, if not always, speak truths which are upsetting or disturbing because
they challenge presumed conceptions of what is good and valuable. Carel arguably offers a
contemporary instance of parrhsia, both by exposing occluded features of the experience of

illness and, in turn, by challenging presumptive social valuations (such as the idea that one
cannot be happy, or that medical professionalism entails emotional detachment).
17

See, inter alia, McGhee (2003), Goldie (2008), and Cooper (2008).

18

I thank an anonymous referee for this journal for stressing the role of prudence.

19

An anonymous referee has pointed out to me that illness can also be voluntarily induced.

Although I do not wish to discuss cases of voluntarily induced illness here, an edificationist
response to such cases would likely focus upon, first, the motivation a person has for
inducing illness and, second, the nature of the illness they are inducing. Sustained study of
cases of voluntarily induced illness would offer an interesting future line of development for
the sort of edificationist position I defend here.
20

Or, to use a rather crude popular idiom, construing illness as edifying is the best that one

can make of a bad situation.

21

22

Compare with Nietzsche (1974, III, NP3 and 120.

That phrase appears in both Ecce Homo (Why I Am So Wise, section 2) and Twilight of

the Idols (Arrows and Epigrams, section 8). See Nietzsche (2005, pp. 77 and 335).
23

In private correspondence, Carel confirmed that she does not think that an ill person is

obligated or otherwise require to seek edification.

24

I am very grateful to Havi Carel for reading and commenting on an earlier draft of this

paper, which also benefited from the comments and suggestions of Alan Bowden, George
Boys2Stones, David E. Cooper, H Martyn Evans, Mihretu Gupta, Simon James, Collette and
Alan Kidd, David Kirkby, Jane McNaughton, Andreas Pantazatos, Ana Espinal2Rae,
Geoffrey Scarre, Hannah Shand, and Benedict Smith, my parents, and an anonymous referee.