The language of disease versus the language of health
This paper was presented on Paper Panel V at the 1st GASi Online Symposium, “The Languages of Groups: the power to include and exclude” 4-6, September, 2020.
Abstract
The personal and social languages spoken in the group-analytic group (words, silences, gestures) might enhance or impede comprehension, insight and intercommunications. The discrimination between ‘health’ and ‘disease’ intensified nowadays, results in impeding interconnection and cohesion. Conversely, empathy and acceptance enable the members’ search for personal expression and identity in the group, leading gradually into integration of what is perceived as ‘disease’ to progressively healthier functioning. Instead of being restricted to the idea of ‘health’ and ‘disease’ one might commence by investigating and translating the symptoms’ semantic content hence supporting the group member to eventually adopt healthier life attitudes. The distinction among the scientific conception of ‘health’ and the patient’s apperception of his/her modus operandi may be unitized via the emphasis attributed to the variability of personality characteristics. The quest of an idiosyncratic language unfolding lustier aspects of one’s self within the group signifies that communication is not reached in terms of disease; it rather contributes to the translation of the disease’s message. Reflections on the symbolic meaning of the language system in the group both in the dimension of comprehending disease and seeking health are extremely valuable in the situation culminating in ameliorated management of the members’ difficulties.
Keywords: disease versus health; psychopathology and koinonia; language of communication and group analysis
Introduction
The Covid-19 pandemic questions the omnipotent human illusion of defeating disease, by virtue of medical achievements. We could consider it a narcissistic blow to humanity. We are now provoked to reflect upon our priorities, reassess our values and organize our choices into a different, more humane-centered hierarchy. We are challenged to explore different types of communication and adapt to the new after-coronavirus era.
Being ‘ill’ or being different?
It is important how we process the concept of difference in general, but also more specifically, in terms of disease within koinonia (de Maré, 1991) and inclusion of people suffering from mental health disease. We might consider disease as an escape from exclusion and rejection, if a person cannot find a healthier way to be included; a role undertaken subconsciously by the individual in order to be accepted in his/hers group of origin as well as in the other groups that s/he belongs. Symptom is a talking act, in a foreign language, awaiting to be understood and translated.
How personal and social languages might enhance or impede comprehension, insight and intercommunications in the group.
We enter the group bearing our beliefs, images, memories, relationships, dysfunctions, behaviours, fears, uncertainties and hopes. If we look not only for differences, but for similarities too, intercommunications, transactions and resonance will grow in the safe ‘container’ of the group, thus enabling therapeutic change. The relational nature of our existence provides the background where we can explore and experiment with our ways of attachment to others (Foulkes, 1990; Rippa, 2013; Urlic, 2010; Hadar, 2019; Dalal, 2004; Bion, 1962; Koukis, 2016).
The discrimination between ‘health’ and ‘disease’ results in impeding interconnection and cohesion
The gap between ‘health’ and ‘disease’ is deepened nowadays, as ‘disease’ is more or less unacceptable in our contemporary competitive, urging for success and happiness society. If the symptom is interwoven with the development of the ego and ensures a degree of functionality, a direct challenge might be perceived as a threat to the core of the member’s existence, activating defensive mechanisms. A member of the group-analytic group addressed as ill, may find refugee in denial, resistance and distrust, show minimized eagerness for disclosure, think that any effort might prove futile, thus wavering to get engaged in efforts of change and becoming overwhelmed with guilt, shame, stigmatization, disappointment, fatigue, estrangement, feeling trapped in the disease and silence, feeling dead inside.
How do we perceive ‘health’ and ‘disease’?
People often have their own conceptions about the meaning of health and disease, influenced by family, societal and cultural perceptions as well as beliefs linked to the social unconscious. The group task is to reveal these ideas, leading to the awareness of their dysfunctional consequences to the members’ everyday personal, family, work and social interactions. Wording instead of acting, helps the member to overcome the disease, using speech and not symptoms, to express difficulties and dysfunctions.
What about racism and stigma?
Perhaps we can consider an analogy between the racism connected with difference (Kinouani, 2019) and that towards illness. Any deviation from the norms evokes fear and distrust, as ‘uncanny’ (Freud, 1920) feelings and alienation emerge. Disease is intertwined with stigmatization, because it arouses the fear of death. In the group, it would be useful and effective to consider disease as a different state of existence, not as a stigmatizing sign. The patient that is considered to be not a ‘patient’, but a human being asking for help, is freed to speak for her/himself.
Does empathy and acceptance enable the members’ search for personal expression and identity in the group?
Humans seek for an empathetic comprehension similar to the imprint of their relationship to the primal maternal object, the primitive link. If this mother-infant relationship is re-experienced in the group-analytic group, a matrix of intercommunications and interactions is cultivated, providing the context for ‘ego training in action’ (Foulkes, 1948, 1990). The saliency of the variety among different persons’ idea of the world as well as the distinction between each person’s notion of hers/his place in the society and the reality of the koinonia (de Maré, 1991) pragmatic schemes, occurring in the group, enables the member to perceive a better balanced sense of his surrounding environments and gradually adapt more realistic attitudes and choices in daily life.
How is integration achieved?
The acceptance of the person regardless of the diagnosis, opens the channels of communication, liberates the member from acquired patterns of behaviours, and helps the member to observe, to understand, to explore difficulties, to re-examine how s/he functions, therefore hopefully managing to take alternative choices and to believe that this is feasible, that change is hard, yet worth trying. Listening to the symptom’s narrative enables the member to realize the dead end s/he is trapped in, thereby gradually adopting a different attitude and escape from this vicious circle. As a result, s/he is urged to assume responsibility for hers/his own treatment and welfare.
What is the value of investigating and translating the symptoms’ semantic content?
The group is assigned a task both delicate and complicated. Transference and countertransference phenomena, the fear of failure, the fear of mental disease, the need to ensure that every member will become ‘healthy’ with the strict norms imposed by science – whereas it would be adequate to acquire a certain degree of functionality in everyday life demands – might sometimes hinder group intercommunications. Our aim is for a person to function in a ‘good enough’ manner, meeting hers/his everyday life needs. The capacity to communicate with oneself by using symbols is gradually ameliorated (Bion, 1959) as the member talks about the symptoms and describes verbally perceived difficulties.
Can we escape from the dipole ‘health/disease’?
When the group faces the patient in a different, healthier manner, an alteration of the patient’s attitude also happens, resembling to the different positions that tennis players occupy during the game, responding to the other player’s location. Patients at risk of a deadening loss of meaning apprehend how to act with words instead of symptoms; instead of using symptoms as words, they gradually learn to use speech, they achieve phrasing, they are wording the unspeakable. The creation of a ‘transitional space’ (Winnicott, 1971) in the group via the acceptance of all discourses, especially the talking act that the symptom represents, enhances trust, self-disclosure and cohesion, leading to the translocation of the unconscious meaning of the symptom, thus resulting to increased awareness and transformation.
The variability of personality characteristics
Recent neuroscience research demonstrates the genetic and epigenetic variability between humans (Pantoja, 2020). The parallel and interrelated development of affective and cognitive systems, based on both genetic factors and psychodynamic systems, influence identity formation according to the perception of internal and external reality, as well as that of relations to others (Kernberg, 2014). People with mental difficulties need empowerment to modify their lives in directions meaningful for them (Cyrille, 2018). The concept of ‘health’ is therefore an individualized, personalized idea.
Are we ‘healthy’ or ‘relatively healthy’?
The intertwined relationships in the group help the patient to process internal conflicts, regaining self-limits and psychic balance. The three major constituents of personality (temperament, attachment, self-consciousness) manifest in the group shaping the communicative matrix and creating a therapeutic context where the member may revisit and process what is that the symptoms express (Foulkes, 1990; Karterud, 2019). The ‘personal language’ of the member’s symptoms, unfolds within the group enhancing resonance, shared feelings, discourses and interactions helpful in the adoption of more efficient behaviours (Cox, 1979). Hence, the effort to become ‘relatively healthy’ human beings, as far as it concerns both our relations with our selves and others, gradually maturates and succeeds (Pines, 2002).
Is communication reached in terms of disease or through the translation of the disease’s message?
Where is the truth? Where is the meeting point between each individual’s personal truth and that of hers/his social groups? Is the symptom the patient’s truth and what exactly does it declare in combination with hers/his social environment? Is it an absolute personal truth or it represents the relational truth as it is conceived by the patient as a member of hers/his surrounding groups? How does the discourse of the symptom reveal social unconscious elements (Coombe, 2017)? Is the language of the symptom used as a bond between the patient and the ‘Other’?
Is the symptom a struggle for meaning?
Is it possible to create zones of communication in the group-analytic group through the symptom’s subtext? What does the symptom reveal and conversely, what does it conceal? Is existence interwoven with the symptom? Does it express pain, trauma, fear, loneliness, emptiness, deadening, deficits, distortion, anger, aggressiveness, helplessness, shame, guilt, perversion and misunderstanding, question and wondering, difficulty to adjust and be included, omnipotence, effort for prominence, distorted attempt to communicate, learned behaviour? The exploration of subjective meaning in the group-analytic group contributes to the symbolic self-realization (Nitzgen, 2013).
Is the symptom related to a primary trauma?
The use of language as an ‘instrument of communication’ enhances group interactions and therapeutic progress (Foulkes & Anthony, 1965). Compatibility between trauma and expression in the first language, the mother dialect, is usually observed (Klavora, 2015). The vital importance of attachment bonds has been thoroughly described by Bowlby (1969). We might perhaps consider the symptom as an expression of primary trauma, of primal traumatic experiences related to the failure or insufficiency or partial inadequacy of early attachment.
Reflections on the symbolic meaning of the language system in the group
The mother connects to her infant’s unknown language, expresses her love and verbalizes its experience by reverie, not through physical channels of communication (Bion, 1962). ‘Group reverie’ promotes exchange, enables linking, permits reflections, induces empathy and enhances mental growth (Bion, 1962; Foulkes, 1964; Levin, 2017). The individual’s personal reverie concerning one’s self, one’s attitude, one’s life, creates novel pathways for self understanding, flourishing and maturation, resulting in a more articulated ability to confront the demands, not only of each one’s personal life, but also of the groups’ where the person belongs and is hopefully integrated.
The value of the symptom
In the group, we choose a unified language to describe positions and figurations, applying to the individual, group and social processes that facilitate therapeutic change (Liveras, 2019). A change of attitudes, behaviours and representations is required in order to achieve better adjustment and adaptation to the social environment. An interpretive phenomenological analysis of a group-analytic group showed that initially strong feelings of anger, competition and fear predominated, eventually leading to understanding, weathering and resilience, enabled by the provided support, safety and care, resulting in new learning, change of symptoms and improved relationships among the members (O’Beney, 2019). In a similar manner, we could estimate the value of the symptom as an expression of feeling, the exploration of which might prove helpful in order to produce benefits, such as resilience, mental growth and therapeutic change.
Concluding thoughts
It is time to reflect and reassess how we could apply our increasing knowledge of human nature and better understanding of psychic phenomena to the benefit and well-being of our patients. Repositioning our beliefs, restrictions and perceptions about ‘health’ and ‘disease’ may facilitate reinsertion, better functioning and inclusion. Freeing ourselves and our patients from the antinomy disease-health and viewing disease not as a problem to solve but as a different language to understand, may cultivate patterns of growth and maturation in the therapeutic group. The symptom is a characteristic attribute, a quality, not the person’s identity. Accepting that means not to regard disease as a normal situation, but to respect the patient as a whole human being with various traits, in an holistic approach. If we consider our patients not ‘ill’, but just co humans, we can persuade them to verbalize their difficulties instead of resorting to nonverbal communications. The goal of treatment is to become able to function in the community as our unique selves, to communicate with our own personal language, achieving inclusion in our groups and ultimately gain balance in our lives.
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Kalliopi Panagiotopoulou MD PhD
Allergist & Clinical Immunologist
Group Psychotherapist
panagiotopouloukp@gmail.com