Contemplation of the Unity that is the Person

Maybe we can get closer to the mystery of what it is to be human, a person, contemplating the nature of our experience in this moment.

The experience we are having here, right now is a whole: the monitor in front of us, thoughts, keyboard, words flow into one another within a single consciousness that cannot be defined, but contains various elements having different qualities.

Let’s focus on one system or structure: the physical. This monitor is physical as are the colors and letters it displays. The visual experience exists for us because of neural processes that communicate with one another – from the cells in our retinas to the neurons in our cerebral cortex. If any part of this is disturbed, we will be blind – the display as it exists in our visual world will disappear. Consider that the functioning nervous system that we can imagine out there, part of the physical world, is actually the phenomenon that is being experienced this moment. At the same time that this display is our nervous system, it is also the physical display itself. Within this experience there is a unity of what we are and what we are observing. 

This leads us to consider a second system of structure that constitutes this experience: that of mind. What is happening, although it relates to physical processes that can be chemically analyzed and otherwise measured and described, includes seeing, thinking and feeling. Through our senses, we enter into a relationship with the world around us. Mind brings our world into existence as the frame of reference giving us our particular understanding of the universe. The “information/data/input” is cognitively organized; the world we experience is shaped through learning that occurs through direct contact and societal teachings. So I am whomever, living wherever, working as whatever. (This is pretty amazing stuff.) The monitor in front of us is perceived and understood as an object having particular components, out there, being observed by us in here. The mind generally makes sense of things in terms of what it knows, but can see things afresh. We note that body and mind do not control one another – moving the physical entity that is the keyboard and the perception of its movement exist as a unity, they are a whole. Thinking also takes place as neurons fire in particular patterns. One person, two ways of understanding him/her.

This of course leads us to the spirit. We exist, understand, know beauty and goodness; we act and our actions/lives have meaning. The wholeness that is this experience that we each are experiencing individually, is situated in the now, a now which is finite, in that it does not encompass the All, but has no dimensions. It is ever still, as time, events and experiences pass through it. It is God’s breath, making this moment be. The tiny dot that skims the page and gives life to these words, gives them meaning, emerges from He whose Being is within all, encompassing all time and space, eternal. We can therefore love Him and love each other, perceive and participate in the creation of what is beautiful. We can exercise our will in accordance to His wish for us: the Good, Himself. We can also choose otherwise. 

An Existential Understanding of Matter

Matter exists; it is a form of being. An atom, itself exists as a whole, exhibiting specific properties that arise from its constituent parts, particularly protons and electrons, The number of protons define it as a specific element, having a place on the periodic table.

Science long ago separated compounds into elements that exhibit individual properties. Elements have been reduced to the smallest unit that exhibits the elements properties – the atom. Atoms and other forms of matter and energy have been broken down into quantum events. Subatomic events such as the photon, we have discovered, can exist as individual particles or merged, in this case as a light beam, where they behave as waves.

The simplest atom is that of Hydrogen, which fuses within the sun to form  heavier elements. Atoms come together as molecules. These forms of matter, atoms and molecules, interact by means of their electromagnetic properties, the electrons and protons of which they are constituted. These interactions have an associated shape. The Carbon atom has a tetrahedral shape. This allows for the complexity that is found in the myriad of different organic molecules.

Proteins are one type of organic molecule that provides for the structures and functions that make up living organisms. The role that a particular protein plays in a living organism has to do with the particular shape that is formed by its electrostatic forces. Proteins provide structure such as the toughness of skin or sturdiness in bones, allow for movement in muscles, carry out communication between organ systems, as hormones and transmitters, transport nutrients such as oxygen in red blood cells, assist in the balance of fluids by drawing and maintaining water in blood vessels, and protect the body from disease as antibodies.

The complexities of matter in time and space grow as the events, from the smallest to the largest, coalesce. The subatomic allows for existence of atoms, which join to form molecules, combining as intracellular organs, making possible cells, which are specialized to make possible organ systems, all of which together constitute the bodies of animals. Diverse animal species are possible as a result of their particular physical make up.

In addition to their material structure, living things exhibit behavioural characteristics, which are beyond the basic and elemental forces of nature. We can describe the over-all organization of matter as a particular soul that makes a cat, for example, a cat.

Even if catness were an illusion rather than a revelation of a kind of living thing, it would be a feature of mankind’s soul or existential being, an attribute that brings together the matter, which we are and to which we relate on the outside, through our senses. To varying degrees and in different ways we manifest the human capacity to understand the world’s physical and moral foundations, and act upon that knowledge. Our physical being includes that of matter at each level described above, subsumed by the human soul, which allows for all those processes to express that humanity in time and space.

The Unconscious

Just as with the physical dimension of the person-in-the-world, where an infinitely complex series of material events are involved in the production of each moment, there are patterns of mental functioning which are not available to reason. Each action, thought or feeling is the product of a complex network of meanings which involves the totality of the person and stretches back beyond her birth and out into her family, community and the world in its entirety. An action affects the other who in turn is changed by that interaction and who then goes on to affect others. Just as all particles in the universe exert some influence on all others, persons reverberate to each other’s actions. The person is clearly unaware of the myriad of events that have come to play in even the most trivial of experiences.

Included in the unconscious are elements that we actively do not wish to acknowledge. In the service of self-preservation, at early stages of emotional development, dangerous and unacceptable ideas, impulses, and feelings were dealt with in such a way as to prevent them from becoming conscious. Remaining unconscious, these childish wishes and fears are unable to mature; they remain untouched by experience and continue to seek their infantile aims. According to the Psychoanalytic topographic model, therapy permits growth by rendering the unconscious, conscious.

One’s perceptions and actions are determined by factors that are not immediately evident to one’s rational mind. There is an unconscious aspect to the mind. At this moment one may have a series of opinions regarding this statement. What one thinks of the idea of the unconscious and other concepts does not exist as a static reality but rather emerges as a series of associations. One realizes how one feels about a subject by contemplation. One comes to know one’s thoughts, attitudes, and reactions toward given phenomena by allowing oneself the opportunity to ponder them. The reality of oneself is revealed as one (acts/thinks/?) in the world.

The Person: A Spiritual, Psychophysical Unity, Suffering and Healing

Stothard, Thomas; The Fall; Glynn Vivian Art Gallery;

The person can be described as multidimensional. The person firstly exists and does so as an individual participant within the larger universe. The fact of her existence would be a concrete, living truth which is a creative and dynamic unity. Ultimately a person becomes who one is through the free expression of their will. One’s actions make the potential a reality. The person participates in their creation from a universal basis which is the spiritual, existential reality of their being a psychophysiological unity. This unity is relational with the person as a separate, individual participant in the world. The separateness of our reality is felt as aloneness and in the experiences of anxiety and despair. We are anxious of the possibility of, and despair at the realities of death, condemnation, and meaninglessness. Our ills have physical, psychological, and ultimately spiritual dimensions. They are ultimately spiritual because suffering involves the totality of the person and brings us to a recognition of our existential aloneness. Healing’s aim is to re-establish the wholeness of the person in the world, involving the right relationship with it. Physically this means an intervention involving matter: surgery, pharmacotherapy, prosthetic devices and so on. Psychologically, it involves a recognition and resolution of conflicts. Spiritually speaking, healing involves the development of an attitude of acceptance and thankful dependence. In psychiatry these three separate healing roles are adopted through the administration of medication and the “talking cure” both of which are carried out in an atmosphere of understanding as two persons share their solitude.

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.

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.

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

We’ve looked at the person in terms of his structure and his being. Perhaps we can say a few brief things about the person as mind.

Firstly, it would appear self evident that we are symbolic entities. We move about in a web of socio-cultural interrelationships providing us with a wealth of experiences and the framework for heroic action. We are able as intellect, to speculate about reality and to reflect on ourselves. We emotionally need and hunger for one another. We hate and love, achieve greatness and suffer profound remorse. This is a world of meanings and magic. In the case of currency for example, what might otherwise be thought of as specially fabricatated paper bearing a leader’s likeness, is a source of power within the social network. Such meanings are agreed upon and are also imposed on us. They are like spirits having no substance in themselves and no separate consciousness, but enormous power. The strife in the Middle East, Northern Ireland, South Africa and so on attest to the negative impact and force of symbols on people’s lives. 

The works of Freud, Jung, Kohut, and numerous others in the field of psychiatry are attempts at describing the nature of psychological entities.

Psychic events, perceptions, symbols, emotions are expressions of the person; they in fact, are the person. One is happiness or sadness. These feeling states, though they may seem extraneous events that happen to oneself, are who one is at a particular moment. When one is joyous hungry or in despair, the feeling state permeates the entirety of his being in the world. Psychological phenomena, in the psychophysiological unity of the person, are also physical events. The other aspect of the paradoxical entity which presents itself on one hand as a mental event is also stuctured along the lines of brain physiology. For this reason mental phenomena can become distorted or lose their connection withon another. The person’s structure can be influenced by symbolic phenomena as well as by changes in neural structure or brain chemistry.

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

We should perhaps at this point briefly review what science tells us about the physical dimension of the psychophysiological unity which we are. We can speak of ourselves as being essentially matter undergoing the four interactions of nature which are weak and strong intranuclear, gravitational and electromagnetic forces within relative space-time frames of reference.

From this basis, the Carbon atom is possible. Because of the Carbon atom, biochemistry is possible and hence biology. Within the basic structure of the universe lies the possibility of evolution and hence ourselves. Wether this is interpreted to mean that life is a chance occurance, or the converse, that there is a meaning, destination which was set at the beginning of time, it remains a valid fact that the structure of Carbon makes possible the process by which increasingly complex molecules combined in a primordial soup covering the earth and formed the first cells.

The double-helix DNA structure makes possible the production of cellular proteins in addition to its own self-replication. Cells, complex collections of biochemical reactions, reproduce as long as they can incorporate new material within themselves and overcome destructive elements. With increasing specialization of cell function , increasingly sophisticated organisms were possible and we ourselves emerged.

This diagram describing some of what is known of the physiology of inter-neuronal communication, illustrates the complexity that has been achieved in the evolutionary process.

We can imagine one-celled creatures meeting and avoiding physical elements in the environment by undergoing membrane and intracelluar changes on contact. Just as the single cell “feels” its surroundings, we “feel” our’s, though with infinitely more sophisticated and specialized means. We are able to react to a greater range of stimuli and with a greater repertoire of behaviour.

Looking at behaviour patterns, we note greater malleability as we progress through the evolutionary hierarchy. Fish, for example, are able to move in unison probably because they perceive and react to the same stimulus in the exact same manner. Anything more than the most basic kind of learning in these schools would be disasterous for the group as each fish would go its own way based on its own experience. With us it is our families, our culture which directs what is to be perceived and how we are to react. Our perceptions and behaviours are malleable and must be learned. Because of this, we are more adaptable an more in need of one another than other animals. Here we see again the psychophysiological unity of the person: culture is possible because of biology and biology is possible because of culture.

The experience of this paper, for example, would appear to include the paper and an infinitely complex array of neurological events. All these elements are inherent in the experience which constitutes a unity.

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.

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

Because we are expressions of and centred on the eternal Now of Being with which we unconsciously identify, we have a sense that time passes while we remain still. You may look at the clock and find that you’ve spent the last hour or so reading. There is a sense that the time has gone while you were sitting taking in and thinking about these words. Time is not really external to us however. The person is a historic being; she exists at a particular time. In fact the person or collection of persons is the actual time in history. Our actions, our being at a certain moment in the context of the past and future defines that historic moment.The person is a condition of transformation, of becoming. Nonbeing then is withus not only in projected form as an everpresent and unavoidable possibility, but in every act and in the surrender of each moment to the next.

Though the person makes himself whom he becomes, he does so only in a finite way; he does not generate himself in relation to the larger whole on which he continues to depend for both physical and emotional nurturance. Necessity makes us eternal children, dependent on family, friends, society, and the larger universe. The anxiety of dearh would include not only theeventual demise which our aging process relentlessly pursues, but also the weak and dependent position that we are in and which puts us at the mercy of the fates and other people.