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

L.F. Canella M.D. F.R.C.P.(C). (1988)

Within the field if Psychiatry one finds a wealth of information and a variety of often conflicting approaches. This diversity reflects differences in the way we integrate the material into a meaningful system for our selves. The particular orientation would be an expression of one’s own background and interests.

As I have neared the end of my residency program, I have felt it necessary to pull together the facts and information I have been accumulating. These rounds offered an incentive to organize my thoughts and clarify the field of psychiatry for myself. During the course of the next forty-five minutes I would like to share with you some ideas on what it means to heal the sick person.

In doing so, I will be taking what might be termed an existential position. It is existential in that a basic premise holds that “the essence of man is his existence.” What this means to me is that the truth about us isn’t merely intellectual, but is rather a living truth. We are too concrete to be grasped in our entirety, by the rational mind. We find ourselves, we become ourselves not so much through the analysis of our actions but rather in the choices we make, in what we do, which includes thinking. In a finite sense, it can be said that we create ourselves.  We are centred on being from which our structure emerges. No matter what the distortions in the structure, that which makes us human remains. These ideas form the basis of what follows.

Though the basic premise I quoted is from Sartre, from what I understand of his works, he probably wouldn’t go along with many statements I will be making. The Existential writer that has been most influential on my thinking would have to be Paul Tillich.

The title “Healing the Sick Person” suggests three questions that have been with us since humankind first began to reason. They are: What is human nature? What is the nature of the ills that befall us? and What can be done about the situation?

In formulating a response, I will be elaborating on the central idea of the person. The view that I would like to present is this, that the person is a dynamic unity and a living truth which is centred on being and possesses a structure which is a manifestation of being.This structure can be described along the two dimensions of mind and matter. Like other paradoxical phenomena in nature, our totality presents as only one aspect at a time to our finite reason. The person is an individual participant within a larger structure, which is in turn an expression of infinite creativity and freedom.This creativity is finally manifested as the finite expression of free will. There is a structure, but the person is not static; the person is someone whom she becomes as a result of what she does. The intellect cannot reach the person; being who she is, doing what she does, the person is illumined by being revealing itself.

In discussing sickness, I hope to make an argument for the view that suffering is ultimately a state of spiritual alienation having physical and psychological dimensions. Whatever the illness, suffering ensues because a person is affected. The illnessreveals her existential finitude. If it is valid to describe illness as affecting us physically, psychologically, and spiritually, then it follows that healing involves three types of intervention. The task in healing is ultimately to bring about a new wholeness of the person within the world. In itself, this might be described as a priestly function. The healing that brings the ill person back to physical health is that done by the physician. The Psychiatrist provides a third type of healing which assists the patient with his psychological problems: his conflicts, his irrational fears, his maladaptive patterns, and so on. Though listed last, the Psychiatrist is probably most likely to take on all three roles. Unfortunately with rising trends towards an organically oriented psychiatry, we run the risk of perpetuating the illusion of a mind-body split and in the process perhaps doing away with our discpline altogether. Unless our focus is on the totality of the person, we as psychiatrists will either be absorbed into physical medicine as a sort of pharmaconeurology or into religion or other organized systems of belief such as psychoanalysis.

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