Monday, June 14, 2010

Amazing May 6

The Inexactness of Diagnosis


One of the aspects of mental illness in its many various incarnations that has both alarmed and intrigued me is its “fuzziness” with respect to diagnosis. As a sufferer from endogenous depression, it took some ten years for an accurate diagnosis to be made. I have also met several others whose experience has been the same. This is not surprising as it is very easy to examine physical lumps and lesions and other physical effects of very visible diseases. Now the invisible world of the mind is a quagmire. As to what the mind is no one is too sure. It more than likely “exists” somewhere in the brain, though it most certainly is not synonymous with it. Then, what is a healthy mind has to be defined, as well as an ill one. How does one decide what is “normal” and what is not with respect to some “entity” we are not 100% sure as to what it even is?

I have written the foregoing paragraph as a result of reading the brief case history of Ellen West who sadly went on to take her own life. This lady had attended two psychiatrists and several psychoanalysts in an effort to get to the root of her problem. Her case was one reviewed by Dr Ludwig Binswanger long after she had died. It interests me because of the different diagnoses and methods given and used by the medical and helping professions. Kraepelin, one of the first great psychiatrists diagnosed her with melancholia, while Bleuler, the inventor of the term, diagnosed schizophrenia. Then the two psychoanalysts she attended attempted to help her on the level of instincts and drives only. Now, obviously both psychiatry and psychoanalysis were in their infancy in the early twentieth century, and we cannot find fault with their valiant attempts to help this deeply disturbed woman. In 1983, with the 20-20 vision of hindsight, and with the advances in psychiatric and psychotherapeutic interventions, Rollo May can diagnose that Ellen West in all probability suffered from anorexia nervosa.

However, while important, the accuracy of diagnosis is not at issue here, I believe, and I also believe this to be Rollo May’s suggestion. What is important is the absence of treating Ellen West as a whole entity or being or reality in herself, not just as a collocation of symptoms or as a target for various techniques of psychoanalysis. This again links in with my reading of Dr Ronnie Laing who questioned way back in the early sixties the overuse of diagnoses of schizophrenia to categorise one whole amorphous area of mental health, without ever treating the patient as a real whole human being in the existential sense. His Sanity, Madness and the Family written with colleague Dr Aaron Esterson, which dates back to 1963/4 was a study of families of schizophrenics, a work which showed that mental health was a family rather than an individual issue. It also threw doubts on the view of schizophrenia then current and suggested that many of the symptoms shown by those poor diagnosed souls might have been no more than the tortured ruses of people struggling to live in unliveable situations. I mention all of this just to give the reader a flavour of what a quagmire the whole mental health area is in itself.

The Tortured Mind of Ellen West

I return now to the case of Ellen West. This poor lady was indeed tortured in her own mind. I am reminded here of a comment made by one of the Special Needs Assistants on one of her charges whom I was later to teach that he was a “tortured soul.” She was a sensitive human being who picked up the tortured nature of this poor child. This kid has been diagnosed as Asperger’s with ADHD. He only ceased being as tortured as that outlined above when a recent medical intervention was made. As a person diagnosed with endogenous depression and who has successfully been on medical treatment for some twelve years now, I am certainly not anti-psychiatric in my thoughts on this whole area of mental health. I believe that mental health to maintain its balance needs both medical and psychotherapeutic interventions. Some patients will need either one of these interventions and many will need both. The question is the judicious and monitored use of either or both. As an existentialist myself, my concerns like those of the radical Ronnie Laing and those of the more measured Rollo May is that the patient be taken as a whole entity, as a being in his/her entirety as a thinking, feeling and willing unity. If the “tortured soul” is to be treated it must first be met with complete compassion. That is essentially what Ellen West needed and what those who suffer from mental illness most need today also.

The compassion of Existentialism

Existentialism strikes this writer as being the quintessence of compassion because it takes the suffering “tortured soul” of the patient seriously. Nothing less is needed. Binswanger, a great existentialist psychiatrist, following in firm existentialist footsteps saw Ellen West as “a vivid example of Kierkegaard’s description of despair in Sickness unto Death.” (Op. cit., p. 42) Kierkegaard, long a “tortured soul” himself would deeply understand Ellen West’s predicament. With May, I can only marvel at Binswanger’s brave wrestling to make some sense of West’s predicament. This is the very compassion of existentialism, I firmly believe.

I was also much taken with Rollo May’s contention that the existential movement in psychiatry and psychology arose precisely out of a passion to be nor less but more empirical. In this regard I wish to finish this post with a longer quotation from May:

Binswanger and others were convinced that the traditional scientific methods not only did not do justice to the data but actually tended to hide rather than reveal what was going on in the patient. The existential analysis movement is a protest against the tendency to see the patient in forms tailored to our own preconceptions or to make him over into the image of our predilections. In this respect existential psychology stands squarely within the scientific tradition in its widest sense. But it broadens its knowledge of man by historical perspective and scholarly depth, by accepting the facts that human beings reveal themselves in art and literature and philosophy, and by profiting from the insights of the particular cultural movements which express the anxiety and conflicts of contemporary man.” (Ibid., p. 45)


Above and to the right a cartoon like copy of Edvard Munch's famous painting, The Scream.

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