SOME BASIC CONCEPTS FOR AN INTERACTION WITH THE SUFFERER
It is easier for truth to emerge from error than from confusion.
Francis Bacon *
Miguel Angel Materazzi
Summary: This paper is aimed at a three-fold objective: understanding what does an
interaction with the sufferer mean; defining what such thing is transdiscipline, and
defining the psychocentered health criterion.
Introduction
We can see that the basic relationships any person sets up with the world comprehend
the widest limits within which any relationship is understandable. In other words, any
instances that are set up within the limit that is generated when a person cannot get
further than his/her own body are going to become the 'limit situations' without which
you cannot 'understand'.
Every human being faces four unavoidable limit situations: the relationship with the
cosmos, the relationship with Nature, the relationship with other people, and the
relationship with one's own future. These relations can only be achieved through a
culture-assisted process: any person is the response culture gives us. So, a person has
two options: he or she can set up a 'conventional' relationship with the said limit
situations –that is, without abiding strictly by the significances that science offers.
Sometimes, significances are integrated in our experience because significances already
existed before our experience in, and with, the world: in other words, this is a
relationship that has been made partial (a lot-like relationship, so to speak). That was the
first option. The second option lies in setting up a relationship at the comprehensive,
and triggering level when, either above or under the conventional realm, beyond the
relationship the scientific plane reveals to us, we face a most distressing dimension –a
dimension appearing before us in determined moments, whenever we put the
conventional between epojé 1 , and we totalize our relationship with all the limit
situations involved.
From my point of view, any interaction with the sufferer, can be described as follows:
this is a body of hypotheses and conceptualization aimed at understanding either
pathologic or non-pathologic behaviors by listening adequately to either a person or a
concrete community in a state of crisis, within a determined social-historical context
transdisciplinarily assisted.
*
It should be noted that the author worked with translations in the Spanish language. Thus, this, and any
other quotation hereof are backtranslations to the English language (Translator's Note).
1
Epojé: (Gr.) to put something between brackets
Let us breakdown the said definition: a body of hypotheses and conceptualization
includes:
a) The concept of structure
b) Polycausality
c) A phenomenic expression
a) The concept of structure
This concept could be defined as any durable agreement, grouping, model, articulation
of parts aimed at forming a relatively stable system or totality. This concept challenges
either the concept of function or the concept of process –even though both concepts may
be endowed with a structure, the concept of structure proper is associated to shapeless
things, and things that change either temporarily or quickly.
Gestalt is a word pointing out to a whole. System is a word pointing out to the
rationality of the arrangement at stake. Organization is a word pointing out to
determined parts in accordance to their roles or functions. These differences are not
inflexible –so, the three words are interchangeable frequently.
Structure and Gestalt elements are almost perfect synonyms: let us recall the so-called
'law of the good form': the whole is more than the sum of all parts. That is, the whole
gives characteristics to the parts –in turn, the parts have a significance within the
structure of the whole.
b) Polycausality
1. The genetic-structural factor (genotype and phenotype)
2. Child experience (the triangular primary situation, and the primary group a person
belongs to).
I am convinced that the Gordian knot of humans lies in being able to love, and being
loved.
Love is what gives musicality and color to life. If love is not experienced, any person
will become a dull individual lacking every intellectual interest no matter how many
material successes he or she had achieved.
Points a) and b) together constitute the predisposition field.
3. In accordance to the said field, a person builds up child, adolescent, young adult, and
adult experiences gradually.
4. Finally, the unleashing factor would be the sparking trigger, the last straw that breaks
the camel's back.
c) A phenomenic expression
A synopsis of persons can be worded as: the inner area, the Mind; the middle area, the
Body, and the outer area: the External Milieu.
We must recall what is the area in, or through, which an individual expresses
himself/herself, besides taking into account the pledge to Totality.
This is why I wish to present the following reflection which, above all, is aimed at the
young professionals.
According to the socio-economic situation we are living in, the Latin American
professionals working at the admittance area of public institutions must remember that
they are not living in developed countries –instead, they are living in a very limited
milieu as far as resources are concerned. At such institutions, the way patients expressed
themselves should be recorded phenomenically: that is, a common mistake, such as
recording presumption-based diagnoses should not be made because what should be
logical becomes dangerous insofar as a given patient is sent to a service where there are
no adequate resources and, generally speaking, that patient keeps on with his/her
presumption-based diagnosis that, in many a case, must be corrected, on the one hand.
On the other hand, medication is used in an indiscriminate way –that is, medication is
used lavishly in order not to bother the doctor on duty instead of being used to the
service of the patient who is thus sealed, so to speak.
Understanding
Understanding is different from the empathic comprehension of phenomenology. To
understand means to reel off a subject's conflicts which appear together with what is
manifest. Thus, we must work like facilitators in that sense that we must be able to
cause what is latent, engraved in the unconscious, to erupt through, and reflected in
words, reason for which we have to be very good at listening to patients.
A person must go through a field of existential needs, and define himself/herself by
his/her project.
An approach to the philosophical substratum that supports hermeneutics 2 will be
attempted so that we can understand the concrete person in crisis.
The relationship between the person and the other is established by means of an
encounter which constitutes the presence which, in turn, constitutes a first level of
knowledge: the level of value. Value pertains at the pre-reflexive consciousness. The
field of value covers all that is referent to the body, and sets up what the other feels for
the other. Thus, it is a sensitive intuition marked by the immediate relationship of the
presence. The image (i.e. the presence of an absence) is supported by the level of value
which constitutes a second level: the level of the reflexive consciousness, endowed with
a higher comprehensive grade of the inter-human relationship, and the relationship with
the world. Either the sign, the word or the representation surge. The sign is supported on
the image. From the sign, the plane of the discourse is attained. The sign has a multivocal character: it goes past the subjective to the objective, past the individual to the
collective: it makes up a third level of knowledge, the level of the symbolic
understanding which allows a greater capture of the world.
Supported by the presence, the image, and the sign there bursts the concept out which is
attained by means of the definition, besides being aimed at setting up the essence of the
2
Hermeneutics: the method, the path, the system to do research.
object. The concept has a univocal character: whenever the concept gets intertwined
with all the foregoing factors it constitutes a fourth level: the level of structure, system,
or scientific knowledge, a level possessing the greatest comprehensiveness in the world.
No level is either true or false: at least, it is either coherent or incoherent. Any attempt at
looking for the truth means pacing to and fro from the plane of structure to the plane of
presence.
The constitution of significances is ascendant. Its verification, however, is descendant –
so, from science it is possible to reach the individual field, so that its relationship with
the world can be changed. Thus, we can see how people who are parts of a whole
attempt at embracing the whole. Hence, we are allowed to enter the operative, reference,
conceptual outline through which we operate, based on a process using the innerness to
know the world –this process consists in recognizing how inseparable are the conflicting
factors as well as acknowledging the principle of their union into a totalizing, superior
category.
Crisis
We must distinguish various types of crises. Vital crises are like a transformation model
connecting us with the origin of both the feeling of identity and the thinking process.
The vicissitudes the Ego endures during the first year of life evidence the same logic
stages that any vital crisis goes through. This crisis is taken into a context of creation:
any vital crisis that has been satisfactorily overcome improves the subject's quality of
life the main trait of which lies in having, and exercising a creative ability within a
supportive co-participation.
From another point of view, crisis, as a word can be united to the meaning of danger,
and the meaning of opportunity –that is: a "crisis" can connect us with anything
threatening us, anything unknown… but, also, a "crisis" is likely to give us the
opportunity to produce something new.
We could say that "crisis" means that we get either stopped, frozen or crystallized at a
determined moment while we are shaping our existence project. That is, we have two
possibilities: a) crisis is a stopover for us to reflect on things, re-elaborate them –thus,
any crisis contributes to development. It is one of the growth crises that allow us to take
a quantitative and qualitative leap with regard to our project, or: b) crisis causes us to go
to pieces, to sink into regression –hence, into a psychopathological decompensation.
The concrete person
"Concrete" can be defined as either "the synthesis of the multiples" or the "unity of
things diverse" (G.W.F. Hegel).
This is a thought that forces us to think that we cannot try to understand humans from
some viewpoints only –i.e. either only through the biological, only through the social, or
only through the psychological because, if it was so, we would fall into an abstraction:
in other words, defining the whole by the parts thereof. In other words the "concrete"
concept helps us not to fall into the reductionism on the one hand, and making up all the
perspectives on the other hand.
The social-historical context
This is a variable which has always to be kept in mind. One example? Trying to
understand homosexuality in Sicily –where it is condemned, is not the same thing as
trying to understand it in London where it is socially accepted or trying to understand
how it was considered in Greece, when the cult of ephebes was in favor during
Pericles's Golden Century.
Making health plans and devising health programs under authoritarian administrations
(when carrying on any preventive work in the community is forbidden because
authorities consider it to be potentially subversive) is not the same thing as making
those plans and devising those programs under democratic administrations.
Transdiscipline
To discuss transdiscipline, it is useful to recall what are multidiscipline, and
interdiscipline first.
- What such thing is multidiscipline? It is the grouping of different professionals who
work in their own 'watertight' departments relevant to their respective areas. For
example: an Argentine HMO 3 as well as a great majority of health care Argentine
institutions.
- What such thing is interdiscipline? It is a group of professionals who interact in search
for a confluence space, and a common code so that they are able to work with either an
individual, in a community or in any other social group. Thanks to this interaction,
professionals enrich themselves while fulfilling the obligations relevant to their own
specialties.
- What such thing is transdiscipline? In an interdisciplinary group of professionals, each
one of them has somewhat resigned his or her own role due to the enrichment he/she has
stored up through interacting with the other professionals thus going beyond his/her
specialty.
3
It should be noted that the Argentine system called "Obra Social" is more complex and more
comprehensive than an HMO: not only health care but social aspects related to workers are also covered,
such as loans, vacation planning, distribution of items needed by schoolchildren, retirement homes, etc.
That is, lots of different professionals are involved.
A criterion for psychocentered health
Taking into account this interaction to understand people, we can infer what is the
criterion we must put forward with regard to Mental Health.
We are going to use the Mental Health concept just by way of didactics because,
actually, we should mention Health only, just not to fall into the mind-body dichotomy.
In other words, if we talk about Mental Health, it could be understood that there exists
"another" health –the physical one. Now that this has been cleared up, we must also
point out that we disagree with the most common definition of health, namely: it can be
said that a person is in good state of health if he or she enjoys a bio-psycho-social
equilibrium –a definition, however that has been a breakthrough with respect to the
previous definition stating that health was the absence of illness.
From my perspective, such a definition falls into the following errors: a) considering
that there exists a category of humans called "the normal ones", that is people
unaffected by mental disorders; and b) the mention of equilibrium leads us to think that
health could be something ideal, most Nirvana-like.
From my perspective, now I have to define the person who tends to the Psychocentered
Health. First of all, I start from the criterion of structure with respect to the psychic
alterations. So, from this criterion, any person who tends to health finds himself/herself
into a neurotic structure –the slightest part of it, however. So, if this person tends to
health he/she must be based on the following triad:
1. Psychological plasticity,
2. Creative contribution,
3. Participation
- What does psychological plasticity mean? This is an attitude humans have, that allows
them to enter the changeable scenes life offers to them: so they adapt themselves
actively. That attitude counters the stereotyped mood that leads humans to either a
severe psychic disorder or to a passive adaptation.
- What does creative contribution mean? Creativity allows a person not to accept
passively whatever his/her milieu proposes to him/her massively. So, the creative
contribution allows this person to go beyond the "here-and-now" context, shaping
whatever does not exist as yet… but could be, and, ultimately making the essential
visible, thus leading this person to a dialectic interplay with plasticity.
- What does participation mean? It means that a person participates actively in his/her
crises, and the context crises as well. It is clear that whenever we are the furthest away
from health, the lesser we are going to participate in our crises –that are "deposited", so
to speak, outside, not to mention the crises of the context. Indeed: is any stereotyped
person –a passively adapted, and non-creative person, really interested about whatever
is likely to happen to either his/her neighbors or the social context?
Translator: Françoise M.S. de Pérez Fernández
General reference
MATERAZZI,M.A et al.: Salud mental, un enfoque transdisciplinario, Buenos Aires,
Salerno, 1999.
Other references can be requested to the author at: materazzi@arnet.com.ar