Healing the Sick Person: an Existential Approach to the Art and Science of Psychiatry: The Person as a Unity of Mind and Matter within and Estranged from the World

Perception and understanding require not only the objects being studied but also our intact nervous system. One can there fore describe any experience as the universe, in the microcasm of the person, reflecting back and understanding itself.

Even though one can talk about unity and wholeness, the very real fact remains that one is separate. One doesn’t, in a state of everyday consciousness at least, experience oneself and the world from its foundations in being. The reality that ideas about psychological forces, atoms, and molecules relate to, though it is who and what one is, remains a mystery.

Perhaps the entire process is unconscious because of its total involvement in the moment. One would continue to be frustrated in finding oneself and the ground of ones ground because the reality of oneself would lie not in the image that develops but rather in the act of thinking itself. Whatever the answer, though I read, speak, move my hands, I remain impenetrable darkness which my intellect cannot illumine.Theories and ideas are all very fine, but who and what am I really?How and why does this occur? The abyss surrounds me.

We exist in a state of estrangement from ourselves and the world. The reality of the person is for the most part unconscious; this unconsciousness  may be understood as a manifestation of an aspect of being which might be termed separation. This separateness is not a consequence of underlying physical forces, but is an irreducible aspect of reality; we are separate to the core of our being.

Consciousness is a totality of sensation, perception, thought, and so on. It is not a force in the dimension of the physical that weaves psychoneurological events into this cohesive unity with aspects of the material and syymbolic worlds. Likewise no physical law explains how the beingness of one’s individual world is cut off from the rest of the universe.

Separateness is integral to individual existence; it defines the person who is alone in thought action and death. The greatness of humankind lies in the individual’s separation from the whole. Becaus of this one is able to know and love the other; one has a separate and hence free will which makes possible heroic action. We exist as ourselves ultimately because we are separate from the rest. Though we are chance occurances in other respects, our aloneness gives us infinite significance. The person’s life is unique; it is irreplaceable, to be lived by that person alone and never again.

This condition of separateness or finitude, though miraculous and at the root of who one is, this fact of existential aloneness is also the ultimate horror.

Separation is the source of anxiety and despair, the demons and monsters that guard the gates to one another and ourselves. Anxiety and despair arise from the encounter with nonbeing. We become anxious and afraid when faced with the possibility of losing something we love, something which is a source of meaning be it a person, a position or role, an object, or parts of ourselves such as our minds, our capacities to act effectively, or especially ourselves in our entirety. When the possibility of loss becomes reality, when we are brought face to face with the reality of separation from the beloved,we enter into the state of despair. Anxiety and despair involve us totally. Emotionally, we are in turmoil, in pain; things are confused; we want to retreat. Physically, our hearts race; we breathe heavily. There is on cure to anxiety in the sense that if we balance the chemistry or the psychic forces, the source of anxiety will be abolished. What there is , is the challenge of heroic action. It is when our attempts have all failed, when the possibility becomes reality, that we enter into a state of despair. We have reached our limits; we are vanquished. Nonbeing is victorious. Helpless, we  see the days stretch ahead empty. With the loss of the loved object, one’s ties to the world are cut; other loves cannot lift the emotional weight of one’s existential aloneness. One longs to die but can’t. As long as reason is intact, suicide is no option. It offers no victory over the fates that have driven one to this point. There is no victory over death, no escape from guilt. To bring about one’s own death is to merely hurt others, there is not even the satisfaction of a last heroic act of rebellion against God. Suicide is madness; there is no escape. This is the existential reality of despair whose approach is signalled by anxiety. These are conditions of spiritual malaise which the person becomes as he is confronted by his finitude.

Neurotic anxiety, we understand as a signal of unconscious conflict. What this means is that we are free, that we can act in any manner. The rigid patterns need not be adhered to. These patterns, this character armour was conditioned and continues to operate in an attempt to avoid anxiety, the awareness of finitude, and the possibility of despair. Neurotic anxiety is psychopathological in that it is, as Freud stated, a private suffering. Anxiety in neurosis can be seen as existential anxiety which has been associated with an idea, memory, situation or object in order to have something which the person can control or avoid and thereby continue to otherwise function as normally as possible. One is able to avoid despair by manipulating its symbolic representation. At the point that the patient comes to us, the patient is acutely aware that her strategies have failed; somethging is not right. Nonbeing threatens and the result is neurotic and characterological symptomatology.

Anxiety as a state in which we are faced with our finitude, manifests itself in three forms: the first, perhaps foremost, is the anxiety of death; the second is related to our will, our actions, and is an anxiety associated with the possibility of final condemnation; thirdly is the anxiety that emerges when a sense of meaning to our lives is threatened.

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