Mending the Broken Frame: Self-Narration in a Constructionist Framework

The communal construction of mental illness makes recovery a daunting challenge since society largely perceives the psychiatrically ill as ??deficient??. Not only does one have to deal with the illness itself, one additionally has to deal with the perpetual stigma associated with the labeling, increasing the personal consequences of these illnesses. In my own journey through mental illness, I have repeatedly tried to construct for myself those structures which would help me become stable and empower me from within rather than rob me of my sense of self. This paper is a small expression of that narrative.     

A Multimodal Approach in Dealing with Chronic Epstein-Barr Viral Syndrome

Chronic Epstein-Barr Viral Syndrome (CEBV) is a puzzling and controversial disease with a variety of symptoms that frequently include depression and emotional debilitation. The following article describes CEBV, offers some diagnostic signs, and suggests a possible treatment strategy based on the multimodal approach. I am writing this letter in an attempt to try and explain the way my life has changed due to an illness called Chronic Epstein-Barr Viral Syndrome, or CEBV. I was not diagnosed at first. … I saw doctor after doctor and (had) test after test before being diagnosed … all of this began three years ago. I started getting weak, fatigued, headaches, swollen glands, sleep disturbances, light-headed and having pain and weakness in my joints. I soon was unable to perform at work or in my various sports activities. I sought help medically … he (the physician) put me in the hospital and ran numerous tests, all showing normal … this did not help either, I was still sick.     

Man on Wire: Walking the Therapeutically Transformative Tightrope of the Analyst’s Cancer

Almost nothing was clear to me when I was diagnosed with pancreatic cancer. I knew that I intended to inform all of my patients about my illness. But how could the focus remain on their needs when my mortality was so at risk? Unexpectedly, I discovered that I coped with my fears most effectively in my office. It was the one place where I could maintain a grasp on a holistic sense of myself and hold conflicting intense emotions. Additionally striking was the corresponding capacity of my patients to remain in treatment while addressing the unpredictable dyadic changes generated by my sickness. In this paper, I address this point of intersubjective transformation—the interactive contributions that generated each treatment’s unique rhythm. I also discuss the temporality of illness and how my continuing reconfigurations of self-experience impacted my ability to maintain authenticity and analytic balance both during and after treatment.     

The virgil role

The referral of a patient for subspecialty consultation and examination is but one facet of the primary care physician's involvement with his patient. Using examples from my practice, I argue that the term "gatekeeper" is an inadequate term for describing what the primary care physician does, or should do, for his patient. "Virgil Role" is offered as an alternative expression based on a proposed parallel between Dante's passage through the Inferno accompanied by his mentor-guide, Virgil, and a sick person's journey through his personal Hell of illness and the labyrinthine medical care system, guided by his physician.     

Owning It

What is the distinction, if any, between who we are as people and what we believe and how we practice as psychoanalysts? For me, art played a vital affirmation that there was a world full of larger ideas and feelings in contrast to the desiccated environment my parents had created. From grade school, through my training as an analyst to the present, art has not only elucidated who I am but expanded my sense of being a creative individual. From the procession of viewing art and engaging with it, to making and acquiring art pieces, the discovery was not only that I owned these pieces but that their impact challenged the ‘who’ I thought I was if I was willing to own up to it. The information that informs our personal beliefs and practice in psychoanalysis comes from such an openness to new experiences from many directions in our daily lives, and challenges who we believe we are. Art adds to analytic knowledge, not by giving us an interpretation for our lives, but by stimulating the genuinely creative process of self-reflection.     

Clinical Commentary

Abstract

This paper is the narrative of a first-time father with a son born seven weeks early by Caesarean section. Against the anxiety and trauma of his infant's birth and his wife's illness, another inner darker drama is being relived. Michael shows all the wounds of a battered child. He asks two awesome questions - Will I be to my son as my father was to me? Will my son be to me as I was to my father? Fearful and at first unvoiced questions, the developing interviews gave them a voice. We respected Michael's sharing of the early and fearful days and nights when his infant first came home. We sometimes found it hard to empathize with his running away to hide in work, until we understood what he was hiding from. Most poignant was his struggle with his anger and hurt with his father and his desire to understand, ‘Why?’, so that he would not be like this to his son. We saw a sensitive revelation of life being born inside him anew, as he made contact with his real infant and his psychic infant within. Of particular interest was the therapeutic use of the research interview space and the interviewer.     

In Retreat

I use Thich Nhat Hanh's books in ethics courses at Montana State University to stretch the minds of my generally conservative, traditional students. When I saw that Thich Nhat Hanh was offering a retreat in Colorado, I attended. The five-day retreat allowed me to witness Thich Nhat Hanh and his community of nuns and monks in action. It also provided me with ample time to ponder the phenomenon of human belief and practice. I learned much to share with students, such as the art of eating silent meals and the practice of hugging meditation. But I also learned a great deal from the imperfections and shortcomings that I encountered at this mindfulness retreat.     

On Disability and Illness. A Reply to Edwards

This paper is a reply to an article by Steven Edwards in a previous issue of Theoretical Medicine and Bioethics. In this paper Edwards discusses two types of problems which he finds to be inherent in my theory of disability, mainly as presented in my On the Nature of Health, Kluwer 1995. First, Edwards discerns a tension in my basic definition of health, a tension between my “subjectivistic” and my “objectivistic” aspirations in the definition. Second, he finds that my theory of disability does not allow for a distinction between disability due to illness or injury and disability which has no such (at least not immediate) background. In my answer to Edwards's arguments I claim that his first criticism must be due to a misunderstanding of my intentions. I find his second criticism to be more to the point. It raises important issues in the theory of health which partly concern our interpretation of the notion of illness. Edwards introduces the notion of capacity in order to separate between disability due to illness or injury and disability without such a background. In the last part of my paper I argue that this distinction, however, will not fulfil its purpose. This revised version was published online in August 2006 with corrections to the Cover Date.     

Sartre and the Doctors

Abstract

This paper considers how the experience of illness fits within Sartre’s account of embodiment in Being and Nothingness. Sartre makes some remarks about illness, but does not develop a full account. I show that the anti‐naturalistic ontological framework in which Sartre’s discussion of the body is placed, which opposes my ‘being‐for‐Others’ to my ‘being‐for‐myself’, imposes a revisionary account of illness, and how Sartre’s model of interpersonal relations affects his view of doctors, and their role in the illness experience. I note and discuss the connection Sartre draws between illness and bad faith. I also point out that recent phenomenologically inspired criticisms of the medical establishment that draw on Sartre’s account of the body are limited by their failure to engage with Sartre’s ontology.     

Moving on From the Suburbs

This is an account of my development as a psychoanalyst beginning in a safe but very unquestioning culture of a London suburb. Some unusual features of my childhood, as well as a natural curiosity, made me need to question the apparent certainties of my surroundings. I describe how a number of events—the death of my father, my illness as an adolescent, and an unlikely encounter with psychoanalysis shortly after, set me onto a rather slow road toward becoming a psychoanalyst several years later. I describe the influences that were important to me. I have always been most inspired by those who could explain complex ideas in a simple and straightforward way, and this has become important objective for me.     

WHY I BELIEVE IN AN EXTERNAL WORLD

Abstract: I claim in this article that if my experience is such that it seems to me that there is an external object before me, then I have reason to believe that there is an external object before me. The sceptic argues that since my having the experience is compatible both with there being and with there not being an external object before me, I have no reason to believe that the former possibility obtains and not the latter. I respond that the sceptic has ignored a relevant difference between the two possibilities: I can make sense of the former possibility but not of the latter. I examine two broad categories of sceptical possibilities (dreams and hallucinations), explain why I cannot make sense of them, and explain why my inability to make sense of them gives me reason to believe they do not obtain.     

Reasons,rules and the ring of experience: Reading our world into Carlos Castaneda's works

Don Juan said that my body was disappearing and only my head was going to remain, and in such a condition the only way to stay awake and move around was by becoming a crow ... He ordered me to straighten up my head and put it on my chin. He said that in the chin were the crow's legs. He commanded me to feel the legs and observe that they were coming out slowly. He then said ... that the tail would come out of my neck. He ordered me to extend the tail like a fan, and to feel how it swept the floor ...I had no difficulty whatsoever eliciting the corresponding sensations to each one of his commands. I had the perception of growing bird's legs, which were weak and wobbly at first. I felt the tail coming out of the back of my neck and wings out of my cheekbones. ...When don Juan directed me to grow a beak, I had an annoying sensation of lack of air. The something bulged out and created a block in front of me. But it was not until don Juan directed me to see laterally that my eyes actually were capable of having a full view to the side... (Castaneda, 1968, pp. 172–174)An earlier version of this paper was presented at a meeting of the International Society for the Sociology of Knowledge, New York, 1976. I am grateful to Kurt H. Wolff and Mary E. Rohman for their comments and continuing encouragement through several drafts of this paper.     

Reflections for Clinical Pastoral Education Students in Psychiatric Settings

This article focuses on Donald Capps’s books on mental illness. In doing so I highlight three key insights from Capps that I have applied in my own ministry with persons with mental illness in various psychiatric hospitals. These insights, together with my own experience as a chaplain, lead to three practical lessons for clinical pastoral education students in psychiatric settings. I provide some context for my interest in mental illness and my friendship with Capps, as well as some background regarding how Capps’s writings on mental illness fit with certain broader themes in his own work as a pastoral theologian. This essay is personal throughout.     

Survival

This article describes the trauma and subsequent struggle of surviving a serious car accident. It deals with the physical efforts to keep me alive as well as the emotional impact and suffering. I was an "active sixty-three" when my life changed drastically. The car I drove en route to a vacation unexplainedly swerved, landed in a ditch and rolled over. I became QUADRIPLEGIC in one instant-paralyzed from the neck down, permanently confined to a wheelchair. I spend several unforgettable months in a Florida hospital, hooked up to life supports, hovering between life and death. I was then flown to New York for rehabilitation. A devoted medical team and supportive family taught be to become somewhat independent with the help of high-tech equipment, preparing me to face the world as a "QUAD." Six years have passed and I still mourn my "body beautiful," but I have accepted my limitations and found new challenges in life.     

Working with psychosis Part 4: Therapy online – ending by email

This is the fourth and concluding paper from a series about psychotherapy with a man suffering from a psychotic illness. The paper describes the ending of the therapy which was precipitated by my decision to leave the country. News of ending was extremely disturbing for my client and stirred fears that he would again break down and need re-admission to hospital. Six weeks before the ending he stopped attending but continued to stay in contact by email. I decided to reply to his emails during the session times, and we developed what he came to call his ‘email therapy’. This online technology provided a means for my client and me to separate, to find a third perspective and to begin to mourn this ending without him losing his mind and breaking down. Following James Fisher's ideas about ‘mourning in the presence of the loved object’ I understand aspects of this email ending as enabling a relinquishing of projective identification used to possess and control, a recognition of the freedom of the other and of the need to mourn omnipotence. I discuss some of the problems presented by premature ending with a vulnerable client – problems which can be seen in my difficulty of mourning and working through the ending reflected in the long time it has taken to finish writing this paper.     

JUSTICE AS INHERENT RIGHTS: A RESPONSE TO MY COMMENTATORS

The critical comments by my fellow symposiasts on my book, Justice: Rights and Wrongs , have provided me with the opportunity to clarify parts of my argument and to correct some misunderstandings; they have also helped me see more clearly than I did before the import of some parts of my argument. In his comments, Paul Weithman points out features of the right order conception of justice that I had not noticed. They have also prodded me to clarify in what way rights are trumps; and both his comments and Bernstein's have prodded me to clarify certain aspects of the theistic account of human rights that I offered. Attridge's comments lead me to see that I was perhaps over-zealous in emphasizing the objective aspects of the semantic range of dikaiosunê as used in the New Testament and downplaying the subjective aspects. And O'Donovan's comments have provided me with the opportunity to make clear that my account of rights is not an immunities account that presupposes nominalism, and to emphasize the ways in which it is not an asocial individualistic account.     

Narrative (Re)Righting: Recovering and Rebuilding a Life Rocked by Trauma

In this paper, I write about and through my recent brush with death to narrate myself out of fear and desperation and into hope and acceptance. Storytelling helps me sort through the rubble and make sense of my life repeatedly rocked by trauma. Narrative reframing takes me a step further, empowering me to rebuild and reinvent my life through the stories I choose to tell as I move forward. Through this work, I am reminded rebuilding is temporary, continual, and precarious; and not only possible, but important and necessary.     

Grounding Recognition: A Rejoinder to Critical Questions

It is always great good fortune for an author to have his writings meet with a receptive circle of readers who take them up in their own work and clarify them further. Indeed, it may even be the secret of all theoretical productivity that one reaches an opportune point in one's own creative process when others' queries, suggestions, and criticisms give one no peace, until one has been forced to come up with new answers and solutions. The four essays collected here, in any event, jointly represent an ideal form of such a challenge: I am now compelled to make further theoretical developments and clarifications that lead me to a whole new stage of my own endeavours, well beyond what I initially had in mind in The Struggle for Recognition . For this reason, I will not concentrate here on interpretative issues regarding my earlier work but will instead take up the problems and challenges that have occasioned several revisions on my part. For this reason, it makes sense to begin (in section I) with the points that Carl-Göran Heidegren makes, in terms of a history of social theory, regarding my proposed theory of recognition. The issues that still motivate me today can best be expressed via an engagement with the conscientious interpretations he offers. The core of this rejoinder is based on Heikki Ikäheimo's and Arto Laitinen's suggestions and corrections, which they have used to develop my initial approach further, to the point where the theoretical outlines of a precise and general concept of recognition come into view. It is primarily these two contributions that helped me develop a productive elaboration of my originally vague intuitions (section II). By way of conclusion (in section III), I take up the penetrating questions raised by Antti Kauppinen regarding the use of the concept of recognition in the broader context of social criticism; he has compelled me to take on several extremely helpful clarifications, and they give me the opportunity, in conclusion, to summarize my overarching intentions.     

Can I Be Ill and Happy?

Can one be ill and happy? I use a phenomenological approach to provide an answer to this question, using Merleau-Ponty’s distinction between the biological and the lived body. I begin by discussing the rift between the biological body and the ill person’s lived experience, which occurs in illness. The transparent and taken for granted biological body is problematised by illness, which exposes it as different from the lived experience of this body. I argue that because of this rift, the experience of illness cannot be captured within a naturalistic view and propose to supplant this view with a phenomenological approach. The latter approach accounts for changes in the ill person’s relationship to her social and physical world. These changes, I argue, cannot be captured by a naturalistic perspective. I then propose the notion of health within illness as a useful concept for capturing the experience of well-being reported by some ill people. I present empirical evidence for this phenomenon and assess its philosophical significance. Finally, I suggest that adaptability and creativity are two common positive responses to illness, demonstrating that health within illness is possible. The three elements combined – the transformed body, health within illness and adaptability and creativity – serve as the basis for a positive answer to the question posed above.