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mandag, 17-01-2022

Camille Drach Hojaij: Stein and Empathic Fulfilment

 

Carlos R. Hojaij’s reply to Hector Warnes’ comment on his comment

 

 

        I need to thank Tom Ban for allowing a non-member, Camille Drach Hojaij, a Philosophy's bachelor, to come to the INHN arena and introduce one of the most important and challenging topics in psychiatry. It is also thanks to several philosophers from the late 19th century who complemented psychiatry’s strict biological view with a humanistic (existential) perspective. More than 100 years after the phenomenological and existential revolutions, current psychiatry well deserves another look into man’s essentiality.

        The ancient Greeks were wise enough to understand that a multitude of gods was necessary to encompass the infinite dimension of man. Only polytheism could alert them to their polyvalent set of feelings, ideas, behaviors and consequences. If Greek mythology initiated the formation of the ancient Greek, the subsequent tragedies consolidated the previous education, for by that time men were not only more conscious of their power, but equally ran the risk of raising tragedies themselves.

        I understand the main thematic and atmosphere of the Iliad is different from what we may find in Sophocles' Antigone (1978). In relation to the Iliad we clearly see a deadly match between men promoted by the gods; actually, it was a match between the gods using men as their pawns, as we see in chess. Achilles knew of his fate before he went to war, and he has chosen to be a hero; but, close to the inevitable end, he became sensitive to the meaning of life and man’s suffering, of his father and the father of his greatest enemy. By Zeus, he was bestowed with the distinction of compassion via empathy.

        In Antigone, however, there is a clash, maybe the first one, between the power of a State and the consciousness of a woman. Creon, the brother of Oedipus’ wife/mother, was the king of Thebes; his successors, Oedipus sons/brothers, killed themselves in a dispute over the throne. Creon represents the legitimacy of the State, concerned with the development and security of the people of Thebes and by maintaining order in society by the force of law. Being in charge of such a great responsibility, with a sense of duty to his people, Creon declared that by law all Thebans are equal under the law. Thus, the city’s enemies must be killed and not be honored by their families.

        Antigone consciously transgressed the law of Thebes by promoting a proper funeral for her brother Polynices who was trying, by arms, to recover his turn as king of Thebes, since her other brother Eteocles had broken the contract of rotation of power. Even considering she had been advised by Creon himself, she consciously deposited in his hand her fate: death. One could say that Antigone challenged Creon's authority (the authority of the State). Despite her being his niece, he could not tolerate someone, anyone, breaking the law. Would one blame Creon for not being tolerant? Was Creon unable to have sympathy (not empathy) for Antigone’s actions, in the sense that he should know the importance of a funeral for a defeated hero? But Creon, who did not read the Iliad and did not know about Achilles’ last-minute revolution and the empathy he showed towards Priam - he was born before the dammed war -  ignored the warnings sent by Zeus.  What we could say is - as the philosophers of the Sophocles’ time used to say - that one important element in life is to have a sense of measurement or common sense, and that at that moment Creon may have had sympathy, but he lacked common sense.

        I understand that Antigone committed suicide, as Hector Warnes says, by hanging herself with her veil to escape from a long terrible period of agony of being completely isolated in a dark, walled-in cave. In the tragedy, she only killed herself after being condemned by Creon because she had rebelled by trying to honor her defeated brother, as well as her having been loyal to her father (condemned by the gods to a miserable life for wanting to know too much). For Creon to maintain his authority, Antigone had to be destroyed.  For Antigone to maintain her dignity and loyalty to her brother, she had to confront Creon, representative of the authority of the State, and allow herself to be condemned to death by the blind State, not by her hand. Antigone could have declared: by honor (moral) I am right; by the rigidity of law, the State is wrong. (By the way, the name Antigone contains the prefix “anti,” against.)

        At the end of Antigone, Zeus punishes Creon for being responsible for the suicide of Creon’s son, Haemon, who was in love with and planned to marry Antigone. But it was not just that loss that Creon suffered; his wife, Eurydice, upon learning of her son’s death, also killed herself.

        I think psychiatrists may apprehend from the Greek mythology and tragedies the multi-face of human feelings and their expressions, how they inflict pain and joy, and by derivative action or inaction, lead their existence.

        Saying something about the question posed by Warnes, “is there any difference between Einfühlung and Empathy?" I can only repeat what I have learned, that empathy (an English word) came to light at the beginning of the last century as a translation of Einfühlung. Since the German language is much richer than English, possibly a German psychiatrist or even a philosopher could better answer him. However, considering Camille’s paper, she refers to Edith Stein’s 1989 Zum Problem der Einfühlung where Einfühlung means empathy; the same empathy she relates to the writing of Edmond Husserl (1989) and Max Scheler (2017). In my studies about phenomenology and psychopathology, I could not find any significant difference.

        Karl Jaspers (1963) developed the concept of understanding and non-understanding based on the writings of Wilhelm Dilthey (1951, 1978), and the “understanding" may imply sympathy and empathy. It follows that understanding is essential to medical practice.  I know that decades after Eugen Bleuler, in 1941 Henricus Cornelius Rümke  (1952) wrote about a “praecox feeling” when facing a schizophrenic: “it was like hitting a glass wall around the schizophrenic,” impossible for the observer to develop sympathy and empathy (which a psychiatrist should not progress to) towards the patient. This kind of psychological shock, became an alert, a sign to identify a schizophrenic. A psychiatrist should sympathize but never empathize. While empathizing, the psychiatrist would have the patient’s feelings, as though living the patient’s situation and having the same reaction;  this way, he would fade and/or distort his analysis and judgment that should remain impartial.

        Of course, from the other side (the psychiatrists’ side), the “praecox feeling” depends on the doctors’ level of sensibility and means in a constitutional pre-condition and a disposition (attitude) to phenomenologically reach the intimacy of the patient. I say the process of understanding suffers a significant trauma and practically disappears in the schizophrenic; many schizophrenic acts make explicit what before was just a praecox feeling (an intuitive, subjective tool). In Three Forms of Frustrated Existence, Ludwig Binswanger (1972) gives a paradigmatic example: a father has a daughter suffering from cancer; before the death arrives, comes her birthday; the father decides to give her a present; the present is a coffin.

        Initially, I (as a psychiatrist) am shocked; I cannot sympathize; I cannot understand (be in the father’s place). However, if I move my phenomenological analysis, I realize that the “understanding process” is failing in the father; he is unable to have the transposition movement and place himself in the daughter's situation. What does happen? I rationally explain that the father is not moved anymore by common sense (compassion, empathy, respect for the other’s situation); a linear law, a causality law moves him: what someone in agony needs is a coffin; a dying daughter needs a coffin.

        One of my schizophrenic patients, a woman lawyer (still active at that time), lived in a small city; her house was in the middle of many others; she used to study piano and was told that silence was necessary to practice well; so, to the despair of many neighbors, she played at 2:00 a.m.; she would become infuriated with the “pointless” frequent complaints. Once more, logic prevailed against sympathy. Both examples well characterize the autistic (extravagant) schizophrenic mode of existence: a human being breakdown, when the sense of the self splits and human interaction also splits, and existence is conducted by the rigidity of logic, not common sense, resulting in a disturbed common life.

        Reviewing Eugen Bleuler’s (1960) masterpiece, Dementia Praecox, the group of schizophrenias, I could not find a clear reference to empathy, despite the extensive and precious description of numerous schizophrenic experiences. Bleuler’s book doesn’t specifically lead to a method to diagnose schizophrenia. In French 19th century style, his book’s important value relies on the schizophrenic descriptions and elaboration of a theory for the disease.

        However, in Bleuler’s dense textbook of psychiatry, a revision of which was made by Manfred Bleuler and published in Spanish in 1967, a chapter (8 pages) is dedicated to diagnosis and differential diagnosis. Maybe referring to himself, the chapter’s first sentence by  Eugen Bleuler is: “In most of the chronic cases, and partially in acute cases, the diagnosis for an experienced clinician is easy.” Although empathy is not explicitly mentioned, Bleuler describes schizophrenia as making the patient an impenetrable person, rare. Bleuler does not go further. The chapter is mainly dedicated to differential diagnosis.

 

References:

Binswanger L. Tres Formas de la Existence Frustrada. Amorrotu, Buenos Aires; 1972.

Bleuler E. Dementia Precoz, El Grupo de las Esquizofrenias. Paidós, Buenos Aires; 1960.

Bleuler M. Tratado de psiquiatría [por] Eugen Bleuler, con la colaboración de Rudolf Hess [et al.] Rev. por Manfred Bleuler. Madrid, Espasa-Calpe; 1967.

Dilthey W. Psicologia y Teoria Del Conocimiento. Fondo de Culture Economics, Mexico; 1951.

Dilthey W. El Mundo Historico. Fondo de Culture Economics, Mexico; 1978.

Husserl E. Ideas Pertaining to a Pure Phenomenology and to a Phenomenological Philosophy, Second Book: Studies in the Phenomenology of Constitution. Translated by Rojcewicz R, Schuwer A. Dordrecht: Kluwer; 1989.

Jaspers K: Psicopatologia General. Editorial Beta, Buenos Aires; 1963.

Rümke HC. Signification de la Phénomenologie was L’études Cliniques des Delirantes. In: Premier  Congrés Mondial de Psychiatry, 1. Hermann, Paris; 1952.

Scheler M. The Nature of Sympathy. Translated by Peter Heath. New York: Routledge; 2017.

Sophocles. In: Greek theater. Complete Tragedies. Volume I. Esquilus, Sophocles, Euripides. Tragedias Completas. Aguilar S.A. de Ediciones. Madrid; 1978.

Stein E. Zum Problem der Einfühlung (On the Problem of Empathy). Translated by Stein W. Washington: ICS Publications, 1989.

 

July 8, 2021