Page last updated at 08:43 GMT, Saturday, 10 May 2008 09:43 UK

A philosophical approach to illness

By Jane Elliott
Health reporter, BBC News

Havi Carel
Havi's condition has deteriorated

Havi Carel loves her life and is determined to live every minute to the full.

She is just 37 but knows that she may not live to be 45.

Two years ago Havi, from Bristol, was told that she has an incurable disease called lymphangioleiomyomatosis (LAM).

LAM is a very rare lung disease which only affects women (mostly of child bearing age) and currently has no treatment, except for lung transplantation.

But because of an acute shortage in organs for transplantation, it is difficult to know how long Havi will have to wait until a match is found - or whether a donor will be found in time.

Diagnosis problems

Havi said that at first her symptoms left doctors mystified as her lung capacity plummeted to just 47% of that expected.

"I noticed that I would get very breathless doing everyday tasks, like walking up a flight of stairs," she said.

This was particularly worrying as Havi had always been so fit.

I skimmed and got to the bottom where it said: Prognosis '10 years from onset of symptoms'
Havi Carel

"In the beginning I tried to exercise more, but eventually I got breathless very easily. So even while walking and chatting to people I would notice a problem," she said.

"Initially, I saw a consultant in the UK who thought it was 'unusual asthma'."

But in April 2006 doctors diagnosed her with LAM.

"I was on holiday in Israel, where my dad runs a medical centre. He was worried about me and arranged for a CT scan," said Havi.

"On the day I was due to get the results he went in to talk to the radiologist and my mum and I waited in the car. When he was not back after 20 minutes I knew something was wrong and went in.

"The radiologist told me to sit down and instead of telling me what was wrong handed me a diagnostic manual.

"He said, 'I will let you read about what you have got' and handed it to me.

"I remember reading all the terms that I did not know at the time, like pneumothorax (presence of air in the pleural cavity, between a lung and the chest wall).

"I skimmed the document and got to the bottom where it said: Prognosis '10 years from onset of symptoms'."

Life after diagnosis

Havi was devastated. After her diagnosis her physical capacities deteriorated rapidly, until she could no longer cycle and had to start using oxygen.

I think that there is a huge role for philosophical reflection as a way of changing our attitude towards events over which we have no control
Havi Carel

"It is always traumatic getting a diagnosis like this," she said.

"I went from thinking there was something a little bit wrong with my lungs to thinking that I am going to die within the next 10 years. My life was altered completely and permanently."

But Havi, a lecturer in philosophy, is determined not to allow her illness to overwhelm her.

"I don't have a choice about being ill, but I do have a choice about how I am going to live with my illness," she said.

"When you are faced with serious illness you can let it take over your life, or you can learn to co-exist with it, to make peace with how things are.

"I began to see that I had the option of leading a good life despite my illness. I felt I had to confront what was happening to me and take responsibility for my well-being.

"Physical health is only one aspect of well-being and I learned to cultivate other aspects and find substitutes for things I was no longer able to do.

"I am a philosopher and I use philosophy to make sense of my illness.

"Philosophy was traditionally a practical aid to life, a set of arguments and ideas designed to help humans improve their well-being. It is an aid for coping with issues such as death and loss and questions such as how can I make sense of a finite life? Can a limited life still be a good one?"

New book

Havi has used her experience to write a book, "Illness", which examines how philosophy can deal with illness.

The book deals with big philosophical questions but also offers practical suggestions for living with illness.

"I think that there is a huge role for philosophical reflection as a way of changing our attitude towards events over which we have no control," said Havi.

"We all get ill, we all die. We have to learn to make sense of a finite life".

Dr Simon Johnson, reader in respiratory medicine at Nottingham University Hospitals, said there were treatments that could ease LAM although there is no cure. But he said patients ultimately needed a transplant.

"The prognosis is very variable. Some patients stay stable for many years and others get progressive decline in lung function.

"But after 10 years from the onset of symptoms most of the patients have significant breathlessness and 10-20% of them will have died," he said.

"Illness" will be out in September, published by Acumen.


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