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dialogic in nature; thus hermeneutics in its purest form is found in the living dialoguestaking place between people of real flesh and blood:In many respects, the discussion here is much too restricted to the special situation ofthe historical human sciences and “being that is oriented to a text.” Only in Part Threehave I succeeded in broadening the issue to language and dialogue, though in fact Ihave had it constantly in view; and consequently, only there have I grasped in a fundamentalway the notions of distance and otherness. 17In my study, The Hermeneutics of Medicine and the Phenomenology of Health: StepsTowards a Philosophy of Medical Practice, 18 I have tried to show in detail how thisdialogue-based hermeneutics is exemplary when it comes to elucidating not only thechosen interpretation (in the humanities), but also the interpretative structure of medicalpractice. The clinical encounter can be viewed as a coming-together of the two differentattitudes and lifeworlds of doctor and patient -- of their different horizons of understanding,in the language of Gadamer -- aimed at establishing a mutual understanding,which can benefit the health of the sick party. Doctors (as well as representatives of otherhealth-care professions) are thus not scientists applying biological knowledge, first andforemost, but rather interpreters, hermeneuts of health and sickness. Biological explanationsand therapies can only be applied within the dialogical meeting, guided by theclinical understanding attained in the service of the patient and his health. Gadamer’s philosophyof hermeneutic understanding, which has mainly been taken to be a generaldescription of the pattern of knowledge found in the humanities, might thus be expandedto cover the activities of health care, I argued.Gadamer’s late work, The Enigma of Health, supports this interpretation, addressing thearea of medicine and health care in a more direct way than the philosopher’s earlierworks. Medicine is here characterized as a dialogue (Gespräch) by which the doctor andpatient together try to reach an understanding of why the patient is ill:It is the disruption of health that necessitates treatment by a doctor. An important partof the treatment is that the patient actually discusses his or her illness with the doctor.This element of discussion is vital to all the different areas of medical competence, notjust to that of the psychiatrist. Dialogue and discussion serve to humanize the fundamentallyunequal relationship that prevails between doctor and patient. 19What is particularly obvious in the medical meeting is the asymmetrical relationbetween the parties. The patient is ill and seeks help, whereas the doctor is at home -- incontrol by virtue of his knowledge and experience of disease and illness. This asymmetrynecessitates empathy on the part of the doctor. He must try to understand the patient, not17Ibid., 311, footnote 240. “Wie vielfach in diesem Zusammenhange bleibt die Erörterung noch zusehr auf die besondere Lage der historischen Geisteswissenschaften und das “Sein zum Text” beschränkt.Erst im dritten Teil erfolgt die in Wahrheit ständig anvisierte Ausweitung auf Sprache und Gespräch – unddamit die grundsätzliche Fassung von Abstand und Andersheit.” Gadamer, Wahrheit und Methode, 316-317, footnote 240.18Fredrik Svenaeus, The Hermeneutics of Medicine and the Phenomenology of Health: StepsTowards a Philosophy of Medical Practice, 2d rev. ed. (Dordrecht: Kluwer, 2001).19Gadamer, The Enigma of Health, 112. “Die Störung der Gesundheit ist es, die die Behandlungdurch den Arzt nötig macht. Zu einer Behandlung gehört das Gespräch. Es beherrscht die entscheidendeDimension allen ärztlichen Tuns, nicht nur bei den Psychiatern. Das Gespräch trägt die Humanisierungder Beziehung zwischen fundamental Ungleichen, zwischen dem Arzt und dem Patienten.” Gadamer, Überdie Verborgenheit der Gesundheit, 144.175