Existential Health Psychology by Patrick M. Whitehead

Author:Patrick M. Whitehead
Language: eng
Format: epub
ISBN: 9783030213558
Publisher: Springer International Publishing

Keywords

MedicalizationIatrogenesisIvan Illich

As we have seen already, the existential dimension of human being is not as tidy as the objective dimension. Existentiality cannot be neatly summarized or publicly verified the way that objectivity can. For example, the personality and lifestyle changes by which clinical depression is diagnosed by the DSM-V (APA 2013) are achieved only through subjective assessment—first through their description by the patient, and second through the attending clinician who either does or does not believe the patient’s account. A great leap is made when the attending clinician categorizes the unique transformation of the patient as depression. The many possible nuances of change that the patient has observed in herself are reduced to one psychiatric development. To categorize the patient’s experience in this manner is an instance of abstraction: to generalize something that is by its nature singular. The alternative would be to make a unique clinical observation for every patient who presents with symptoms that include anhedonia and working each as a separate case with separate recommendations. Given the many-thousand insurance codes that already exist for medical treatments, this is an unlikely direction for psychiatry to turn.

The use of abstractions is helpful in the practice of medicine—it allows providers to use a single category for the many-thousand possible combinations of the symptoms of depression. But there are a few problems that follow this practice. It implies, for example, that depression may be treated homogeneously—despite its many possible combinations of symptoms. The problem that I will spend the rest of the chapter discussing is what happens when the abstraction begins to hide the unique characteristics of the singular case in question. This problem has been called, variously, “vicious abstractionism” by the American philosopher William James, the “fallacy of misplaced concreteness” by the English philosopher Alfred North Whitehead, “abstractification” by the American sociologist and psychoanalyst Erich Fromm, and “hypostatization” by the German philosopher and phenomenologist Edmund Husserl.

The experience of chronic lower-back pain is not localized to the small of one’s back but extends into the suffering person’s life. Consequently, a father who can no longer hold his daughter will have a very different experience of this pain than the brick mason who cannot work as quickly or for as long as he once could. To homogenize these lifestyle transformations as “chronic lower-back pain” misses their unique impact on each person and thereby obscures the helpful course of rehabilitation (or intervention, if necessary). Moreover, it is assumed that each man has some physiological, neural, or orthopedic problem that is in principle localizable and measurable, even though chronic pain is defined by the absence of any objective problem. Each person suffers in a way unique to him or herself, and this uniqueness is camouflaged by the generalized medical category. That which is lost through this process of abstraction are the qualities of concreteness: the chronic lower-back pain as it is experienced by each man. One cannot lift his daughter and hold her close, and is thereby impotent in his role of father-as-protector. The other cannot exhibit his work-ethic—that upon which his reputation has been based.

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