Can you treat a person’s story? At present, amid the setting of the 14th International Philosophy and Psychiatry conference in Gothenburg, Sweden, I am not alone in trying to peer through the looking-glass, searching for the heart of the humanity in medicine, and for a treasure, that will surely tell us what we should find when we excavate the depths of our minds and our enquiring empathy?
So, the story unfolds. How do we define and classify who amongst us is a psychiatric patient?
When we use the term ‘psychiatry’, we are referring to the ‘medical treatment of the mind’; to heal. But is it not the case that sometimes pain is an exploration of who we are? When the mind is the heart, the emotional seat for pain, perhaps we can learn to understand who I am and who you are from such a unique vantage point? These questions, situated in the context of a philosophical reflection on psychiatry, on human experience, illustrates that there are different forms of pain; and to these, there needs to be a poetic; a language of the mind.
Psychiatry places the origins of pain in a dichotomous position, namely, the traditionally dualistic concepts of physical and mental. Pain is a physical sensation invoking suffering. Psychosomatic pain is classified as an expression of psychosocial stress, or as displaying medically unexplained symptoms. These are symptoms that are inconsistent with an identifiable medical diagnosis.
The causal model of medicine requires a physical origin of pain. Pain that is defined as psychopathological pain is considered to be a mood state. In somatization, it is imperative that the meaning and experience of pain is expressed and understood. Narration of people’s experiences of pain can reveal the organization and structure in which their symptoms manifest, enabling the “witnessing and helping to order the experience to be of therapeutic value” (Kleinmann 1989).
A psychic pain emphasizes the importance of constructing the narrative of a person’s experience of pain. In narratives, the meaning of pain is dispersed away from its origin, therefore annihilating the necessity for classifying pain as physical or mental. Instead, narratives need to be examined, as if they are the body of the mind, the revealer, and locus, of the relationship between the person and their pain.
An example of such healing is isibongo poetry by Sangomas (traditional healers) in South Africa. A poem is after all, in the words of Jonathan Culler, “not simply a series of sentences; it is spoke by a persona, who expresses an attitude to be defined” (2005). Such poetry permits incompatibilities between different types of pain – physical or psychosomatic – to be irrelevant, and consequently the sharing and recognition of pain is dispersed through the communication of verse. Psychosomatic pain transcends the boundaries of the individual through the development of poetry, offering a role in medicine to discuss medically unexplained symptoms independently of the categories of physical or psychosomatic pain.
In our concept of cure, we traditionally are looking for a terminus; a process whereby there is a telos of removing a possession or a ghost or resetting the actions of certain molecules or chemical levels.
However, the conference talks yielded insights into the intricacies of the mind’s voice; do we hear screams that are muffled in dissociative states; are delusions beliefs; are experiences external to the norms in social realms a pathology; is there a difference between the mind’s expression of a wish to die and the body’s ultimate physiological cessation; do all stories belong to the mind?
The finale of the questions I surmised during the conference reached their pivotal as it wound down for another year; what does a person’s story mean?
Why do we, as human beings, feel fear, paranoia, a fragmentation of reality? Why do we survive unimaginable horrors during times and territories of trauma? Where do our stories end? How can we function as part of the societal whole when our minds fail to order or recognise the demands and responsibilities that are required of us as relational beings?
So, to this end, I found myself concluding that sometimes our stories are void from The End; they will repeat, and sometimes be cyclical, and may flourish or deteriorate; they may isolate and they may unite; but overall they are our stories; they are who we are for our narrative is our self.