Healing the Sick Person: an Existential Approach to the Art and Science of Psychiatry: The Person

The primary concern in Psychiatry has to be the person. We don’t treat mental illness per se, but rather attempt to alleviate the individual’s suffering by intervening in the appropriate manner. There is no mental illness outside of the person so that if we are battling Schizophrenia, for example, we may end up battling our patient.

But what is a person? It seems we will always fall short in attempting a complete description. The answer is simple on the one hand; you and I are persons. Here and now, this is the reality of a person. Yet what am I? Searching for an answer, the solid becomes nebulous. One may turn to books, analysts, to Gurus on the other side of the globe, to find what is closest- oneself. Though we seek a rational explanation, we find ourselves not as descriptions, not as solutions to a problem, but in the act of being ourselves. Understanding, science and knowledge in this light become a form of art, a creative activity, a personal relationship with the world and an expression of oneself in the world.

In attempting to describe what a person is, we can begin by noting that we can understand him in terms of different dimensions. There is one person but we can talk about his existence, his structure, his physical and his psychological properties.

The person clearly exists and he does so as a dynamic creative unity. Vision, hearing, touch, thought, and feeeling are manifestations of the person, elements of his totality.

Though fate determines various innate qualities in addition to the time, family, and culture he is thrown into, it is his will that determines which direction he takes and hence the choices that are open to him in the future. Though he does so in a limited, finite way, the person willfully creates himself and his place within the larger structure.

When we try to understand the person as a structured being, we assume that there are basic events whose interplay is responsible for the complexity of phenomena. Our reason tries to elucidate their nature and views them as universal principles. If we view being and structure as fundemental aspects of the person and hence the universe of which the person is an expression, the relationship between them can be pictured as a ground of being from which the structure is eternally created. Perhaps this can be made clear by describing my speaking here. Clearly this experience is the latest of links that constitute the chain of my history. In one sense I am here because of things that happened in the past. This explanation is not sufficient however. My being here is generated into existence at this moment. My life might be likened to a wheel with being at the centre, creating me at each particular time. This image may convey a sense of how the structure might be seen as a manifestation of being which is at the heart of all things. Focussing strictly on the structure, we can observe that it has physical and psychological aspects. We are biological entities made up of the same stuff as the rest of the universe and not merely subject to its laws or solely expressions of these laws; in fact, we are the physical laws. We are not only physical beings but have an additional mental dimension as well. We go about in a world of symbols. We can describe the experience of being here in terms of biological processes which are part of the material universe or as psychological phenomena which are manifestations of the world of the psyche. In order to understand the person more fully, each of these dimensions, including those of being and structure, are necessary. None is sufficient however; and ultimately too, all explanations must fail to reach and encompass the person who is the explanation itself.

The intellect is finite: we get only fragments of who and what we are. Ideas of wholeness, of being, of free choice and so on tend to be ignored by scientific disciplines to a large part. This is true of psychiatry as well; the focus is on structural elements which can be predicted and manipulated. Observations and conclusions involve the isolation and organization of events. Distortions occur when we forget that the understanding we have is only one aspect of whatever totality it is we are studying. In that case we must consequently be ignoring other possible attributes that belong to the object of investigation. For example, in medical school we learn about the human body partially through the dissection of cadavers. Something of the gross structure of a human being is preserved as proteins are denatured and the natural process of decomposition is unable to procede. While the dissection lab provides us with an opportunity to develop mental images of muscle and organ, structure and functioning, in the end we are studying neither life nor death. In histology, the slides we pour over endlessly have about as much to do with living tissue and the person as does, say a rock from the pertrified forest with wood and the original tree. Though these methods are necessary in providing us with information about ourselves as physical beings, they can affect one’s view of what constitutes a person. It is easy to imagine that the cadaver is a human being, that those remains were once inhabited by a person. The person has in fact died; the person was the totality of the living body in the world.

In Psychiatry we are learning more about ourselves now that we can do receptor assays and P.E.T. scans, and with increasingly sophisticated statistical studies. Otherwise undetectable patterns are made visible by such techniques. However, because the technique only focusses on certain variables, the understanding that evolves will be only one among many. Distortions occur when one adheres to only one aspect as representing the whole. In effect, the person, the relationship between oneself and the other

is a fountainhead of sensations, impressions, feelings, and ideas. The person is a mystery, the more we know the more profound the mystery.

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