“Biography, pathography and the recovery of meaning” by John Wiltshire . [essay, medicine]
I find Bion’s concept of a ‘container’(the caretaker, the mother) that receives the emotions (normally distress) of the ‘contained’ (patient, child) and regurgitates them, after processing them, in a way that makes it possible for the contained to accept them, very interesting. I normally have trouble finding people who know how to contain me and have to be comforted by their intentions, since their processing is subpar. I wonder if I fail to thruly fix things for others as much.
29.10.12
6.05.13
[Spoiler (click to open)]
· As Elaine Scarry puts it: If pain is 'the unmaking of the world' then mortal illness or medical crisis represents the world's unmeaningness, its chaotic and incoherent quality... illness narratives are processes of meaning-creation.
· And this articulates a common effect of such narratives. Their topic is the breakdown not of selfhood, but of the 'normal' separations between people. In pathographic narratives the balance between self and other, between carer and patient is upset, undergoes all sorts of mysterious transmutations or reconfigurations.
The pathography itself can be understood as a container, and the writing of a pathography as a means through which the caregiving is endured.
“Disease, then, is something an organ has; illness is something a man has.” - Eric J. Cassell, 1978 1
These two words are often used interchangeably. However, it would be helpful for everyone: researchers/ scientists, doctors/ healthcare professionals, and patients/ clients - if the two terms were distinguished more clearly. 2, 3, 4, 5
Without further delay, let’s define them:
Disease - best refers to an abnormal condition affecting an organism. This abnormal condition could be due to infection, degeneration of tissue, injury/trauma, toxic exposure, development of cancer, etc. This is what needs to be ‘cured’, especially if it’s life-threatening.
Illness - best refers to the feelings that might come with having a disease. Feelings like pain, fatigue, weakness, discomfort, distress, confusion, dysfunction, etc. - the reasons people seek healthcare - and usually the way people measure their success with treatment.
Quotes:
of biomedicine, the shorthand term for a medicine in which technological interventions (tests, examinations,
organ replacements) are critical instruments for the treatment of disease.
Biomedicine is commonly dated to the invention of the kidney dialysis
machine in the 1960s and to the problems of triage, or the rightful
distribution of scarce medical resources, which this instigated. So that with
biomedicine was born bioethics, a realm of thought in which respect for the
'autonomy'of the patient is reiterated as a kind of unavailing mantra, as it
seeks to supplement its more powerful twin's disregard of the personal or
experiential.7
Patients write memoirs, of their own illness or of their father's
or daughter's or husband's, as an act of protest, as a recall to the fact that
one is not only a body, and to rescue the whole experience of illness and
medicalisation from the narrower definitions of the clinic. The
pathography then is certainly a critical patient narrative - a critique of
medicine - but it has a broader agenda than simply, like the postcolonial
subject, to'write back' to the conquering imperialism of biomedicine,12 and
other issues are involved than those which, in a post-Foucauldian milieu,
are likely to be formulated solely in terms of inequities and modalities of
power.
. If pain, as Elaine Scarry put it, is 'the unmaking of the world',14 then mortal illness or
medical crisis tends to represent the world's unmeaningness, its chaotic and
incoherent quality, and this is a condition faced (though with differences)
as much by the care-giver as by the patient. In the broadest sense, illness is
the evacuation or stripping of meaning from both person and event. Under
this duress, and challenged by this contingency, illness narratives are
processes of meaning-creation.
. The intimacy of care-giver and patient mimics the relation
between mother and child, or rather presents such a relationship in a
distorted, reconfigured, or transposed form. In this sense it is analogous to
the relation between analyst and the person in psychoanalytic treatment.
Indeed, post-Freudian'object relations' psychoanalysis seems to offer useful
tools for thinking about this realm that is occupied together by patient and
narrator. Object relations pays particular attention to the 'two-person
field', in which the boundaries between subjectivities, between self and
other, become less distinct. And, as it happens, this psychoanalysis may
even throw some light on the nature of the meaning-creation that I am
suggesting is the essential endeavour of the pathographer.
'17 The point of this moment is not that de Beauvoir goes to pieces; it is her discovery that
her mother and herself are not utterly separate identities.
In pathographic narratives the balance between self and other, between
carer and patient is upset, undergoes all sorts of mysterious transmutations
or reconfigurations.
Donald Winnicott wrote of the immature
infant's ego needing the help of the mother's ego to survive.18 The mother's
ego is thus envisaged as a form of surrogate or prosthetic selfhood that
serves the infant until it acquires the capacity to 'go on being' by itself. In
many ways the relation of care-giver and sick person recreates this in
another form.
becomes a substitute ego or thinking apparatus for, the other.
Perhaps Bion's most famous contribution to psychoanalytic theory is his
paradigm of the container and contained. These terms depend, in large
An understanding mother is able to experience the feeling of dread that
this baby was striving to deal with by projective identification, and yet
retain a balanced outlook.
Containing then is that capacity to take in the anguish or pain of the
other, to bear with it, to moderate and return it to the other person so that
they can bear with it too, instead of being overwhelmed or consumed. Bion
distress to another, and he or she, far from brushing this off, or saying
'Don't worry about that', lets themselves experience the misery, and, in
experiencing, allows it to be moderated by their own other emotions. In an
Bion perhaps suggests what the absence of alpha function
means when, in a later paper, he describes 'people who feel pain and will
not suffer it and so cannot be said to discover it'.23
The usefulness of this idea to the understanding of the pathography is
twofold. In the first place it describes the psychological events that may
occur within the narrative. Nursing might be defined as the lending of one's
body as a prosthetic supplement for what the other's body is temporarily
unable to achieve. Care-giving is this and more: the offering of one's self,
putting one's ego at the service of the other, and ideally, 'containing' the
other's distress.
he present tense in which, like so many pathographies, the narrative is inscribed has
the effect of concealing this activity of recording, but that is nevertheless
the crucial goal towards which the narrator's energies are bent. One thus
sees that the narrator's relative composure in the life-world has a close
relation to his acts of composition.
Perhaps it could be said that these activities represent something
analogous to Bion's beta-elements, pre-thought, preconceptual modalities
that require reverie to complete them.
'The comfort I give Iris
depends on my ability to lead this inner life', he remarks
Bayley's, then, is a process of meaning-creation, and I have likened it to
Bion's notion of alpha function. This is the task of the care-giver, but it is
also the general function of the illness narrative, which must recognise the
destructive elements in its material, even as it contains them.
2012, #essay, #non-fiction, 2012: essay in english, @read in english, *read for university, *author: male, +medicine, [quotes], [quotes] books/non-fiction