EXISTENTIAL MEDICINE

 translated by Peter Wilberg 

 

The enterprise of introducing psychology into medicine … has to do with the question of whether every illness, whether of the skin, lungs, heart, liver and kidneys has a soul character.

In other words we’ve touched on a hot iron. It is not simply a question of whether one adds psychology (Seelenkunde) and psychiatry to the reliable teachings of physics, chemistry, physiology and pathology. No additional multiplication of specialisms is implied, but rather a change in these specialisms themselves, and that on the basis of the recognition that the material substance of the human organism is quite different to what physiology has taught to far. 

We do not mean to explain all illnesses psychologically. Angina remains angina. Yet if one explores how organic illnesses are embedded in an outer and inner life story, then one is astonished how to often illness appears at the sharp end of a dramatic peak, how often it prevents or seals a catastrophe, how regularly it give the course of a biography a new turn.

… lung infections, diabetes, heart afflictions have to do with our struggles as human beings and with being human …

… [on the one hand] natural-scientific medicine does not reach the soul … on the other hand theology, religion and moral teachings don’t reach the body.

Insofar as the ill person reflects on how their illness has grown out of his life history, the whole direction of causal thinking is reversed … if out of the suffering that befalls him from his gall bladder or lungs it follows that nothing will come of his hopes – that’s the fault of the illness. Yet it is just as right to say that because he senses that nothing will come, or because he loses motivation ….he becomes ill.

We should see that our suffering is no manoeuvrable machine but has a type of soul, is a being in the human being, often an enemy, but also a friend, often unteachable, but also something that teaches us.

The turning that in this way is completed, brings forth, like the embryo in the mother’s womb, an alter ego, an ‘I’ within the ‘I’, a being that I both am and am not (One could say, a strengthening of the feminine principle.)

One sees now, that psychology in medicine brings forth an unexpected result. It does not only bring knowledge of the soul, but illuminates the body in such a way as to let it appear in a new light. The body is no longer what is seemed before, and what anatomy and physiology teach. 

 The ill person says: “This is where it hurts” … but then “It feels to me as if something has knotted itself up” or “I feel as if there’s a stone in me”, or “as if my heart was in my belly”, or even “as if drops are falling into me”. Now the psychologically schooled doctor begins to seek a deeper meaning in these words, whereas the purely physiologically educated doctor turns away with phrases like “sense delusions” or “fantasies”. We however, have found that such expression of ill people contain truths, for indeed their inner sensations are senses of self.”

A psychological medicine … obviously comes into conflict with the technological development of medicine, which has already become an Über-technology.” This development is itself closely connected with modern economic structures, with industry, with the income sources of physicians, with the gigantic need for patients – and others – to be deceived. 

These then, are the connections that lead us to the ‘Illness Camp’ of so-called modern culture.

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It is not true that I can objectively determine if a person does or does not have a headache; it is not true that I can objectively judge if he is therefore capable or not capable of work …

I can therefore not myself know … the pain that he has.

I cannot seize it, but I can be seized by it!

Turning towards the pain of the other – that is the matter of the doctor’s profession.

Nothing organic has no meaning; nothing psychical has no body.

The human being in his community and the human being with his ‘I’ is no different than the human being with his body: one cannot divide him up.

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Illness can be experienced as this – that through a bodily occurrence a development in awareness is created.

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Nature explains itself, if one allows it. One doesn’t need to teach it, only to let ourselves be taught by it,

The illness should at first appear to the doctor as to the ill person themselves, not as hypothesised by familiar clinical pictures and according to the laws of pathology.

A faculty says “I am philosophy”, another “I am theology”. Physics, physiology and psychology also speak in this “I” form, as if such a thing existed in nature, when actually it is only all about institutions, staffs and managements, agreements over methods etc.

A pain or a fear forces us to think … The doctor, medicine, science all immediately involves themselves in this work of thinking. And let us say it straightaway, for the most part this thinking is in vain. It has do with a way of thinking that is in itself ineffective.

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…psychosomatic medicine … is at the most a preparatory work that still stands before a crisis. To begin with we find that the crisis expresses itself politically … in the inseparability of power, money and science. The situation is so serious that the system cannot be altered through any of these three. And it is also clear that no individual dare hope to alter the whole through individual acts.

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We understand as body [Leib] something unconsciously ensouled. We have good grounds to think of all cells of the body as ensouled. We want to understand every liver cell, every ganglion cell, every blood cell as unconsciously ensouled.

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The greatest goal would be to understand how in every case, in what way an illness is just a muted final thought, a still insufficiently [fufilled] creative act.

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One used to say that science was the foundation of medical practice and the academics were comfortable with this. Today we can be clear to ourselves that science presents us with just one specific human comportment among others, that it is not a ray of divine light from above demanding special reverence.

…let us ask ourselves seriously to what extent scientific objectivity is not sacrosanct, when natural science is a form of domination over nature, objectivity a way of annihilating subjectivity.

…no answer sounds forth to the question as to why, in its application, such unwanted things were done. If the knowledge was good, how could its application be so bad? (1949)

Is so-called psychosomatic medicine in a position to lead to the reform of medicine which conscience demands, which people need? From its perspective: yes, if it succeeds in decoding the meaning of functional disturbances and organ speech. We are not a long way from that … but when someone measures vasomotoric reactions to artificially induced shock or pleasure he is only in the business of psychophysiology … as with a form of exact natural science he seeks to rule out the question of what meaning shock and pleasure have in such an experiment. The experiment serves science and that will do

If however, someone seeks to understand what meaning a particular shock or what value a particular pleasure, let he has let in and acknowledged the human subject.

Although psychosomatic medicine is not full-grown Hercules, but a baby, it still has to fight the snake of Asclepius.

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Cells interact with cells, organs with organs, species with species, souls with souls, with themselves and with others, man with woman, parents with children, groups and peoples with one another. What is ownmost encounters otherness. All these types of interaction give rise to disturbances which we call illnesses.

… it is remarkable that whilst natural laws are granted universal validity, the soul is granted the laurel of individuality … so that in fighting epidemics and researching genetics one lost sight of the pathology of the family, of upbringing.  

So it came to be that today marriage problems, problems to do with having children,  work problems appear in the clinical consultation like foreign bodies, although we know that such conflicts can be pathogenic … The relation of the one to the other, of the few to the many is also a basic problem for an anthropological psychosomatics.  

For the bureaucratic state health is at the same time any arbitrary form of exploitation, for example through conscription, earning a living, employment… This is a notion I reject.

What is better? The bureaucratic state or human fulfilment?

Here also psychosomatic medicine has a helping word to say … The deciphering of organ speech [Organsprache] is its business, its translation into the understandable word of the soul its soluble task. What effort has been put into this so far and what is the problem?  Let it be emphasised to begin with that the backwards relocation of this problem to some specific anatomical structure, namely the nervous system is of no help … the nerves are supposed to be ill, not the soul. Now it is mostly the ‘glands’.

Either ‘only’ the soul or ‘only’ the body is ill. The unity of medicine is thereby destroyed. [But] then comes the turnaround: with regards to psychoses it is now the brain … that is supposed to be ill. Odd with what certainty some colleagues believe this, as if they knew it to be true. 

Here belongs a word on the so-called ‘psychogenesis’ of organic diseases … when one speaks of psychogenesis, one should mean by it only a historical genesis [not a causal one] in the course of which bodily changes occur which take the place of psychological processes …

The boundaries of psychosomatics have been pushed forward from ‘conversion hysterias’ to ‘organic neuroses’ and from there to infections, metabolic, circulatory, hormonal illnesses and so on and so forth.  A fundamentalist ‘thus far but no further’ physician is not to be seen – and how little has so far been researched.

[But] there are other things that worry me ladies and gentlemen … On the one hand one sees a continuous ignoring of psychosomatics … on the other hand, types of ‘psychosomatic’ thinking based on a most primitive [“almost barbaric”] psychology. 

No doubt the relation of Psyche and Soma has changed for modern man, and that in such a way as to be inauspicious for the spread of psychosomatic medicine.

A large portion of the public is alien, indifferent, resistant or antipathetic to psychosomatic explanations. For them only ineffective chemical-physiological treatment is clear. A lot of doctors, including the younger, share in this rejecting resistance.

That illnesses have meaning, can lead those affected to the meaning of their lives – this  is the insight that natural-scientific medicine has fundamentally impeded.