As a population, humans have created various systems of classification by way of organizing that which is not easily understood into smaller, more digestible parts. According to Tanya Luhrmann, by naming “something mysterious and out of control, ” placing identities on people and things, and categorizing by those identities, humans have harnessed the ability to “gain mastery ” over something.
While certain categorizations have evolved to be effective in organizing characteristics of people, the constructs created are not the most helpful in understanding the limitless ways of being. Maurice Leenhardt and Antonio Damasio have presented two different constructs for understanding, or classifying, a person. These constructs present defined boundaries that make it possible to understand the philosophical person as its own entity separate from other beings.
Leenhardt’sÂ Do KamoÂ expresses the Melanesian understanding that there are two elements comprising a person. First, the formation of a body exists as a portal or mechanism that allows the personage to exist in reality. Without the body, the psychological self would have no fixed space to reside in and no means of expression (165). Second, the formation of the personality must be maintained through social interaction and relationship development. Thus, the second element of a person establishes that an individual must understand him/herself as in relation to other individuals and beings.
Damasio, on the other hand, discussed a biological approach that there are certain physiological representations of body states that manifest in behavior. For example, hormonal regulation varies between people and influences a person’s state of being. Additionally, emotions and feelings are stated as “powerful manifestation[s] of drives and instincts ” that contribute to the understanding of the self (115).
The defining criteria for a human, as understood by Damasio, resides in a single element that underlies all of human action — so, thus, we all possess it — but exists differently within each person. This element, termed ‘background feelings,’ described inÂ Descartes’ Error: Emotion, Reason, and the Human Brain, “represent not a specific part of anything in the body but rather an overall state of most everything in it ” (152).
Background feelings are neither emotions nor moods, but are the presence of one’s overall state of being that exists subtly within the landscape of the individual’s personhood. The defining characteristics of a person exist within these background feelings. While they are internal and reside purely within a person, background feelings influence a person’s ability to exist socially and contribute to how the world understands this person as an interacting unit within the broader social reality.
While Leenhardt was referring to the Melanesian understanding of a person and Damasio was recounting something biological, so thus it pertains to all humans, both of their constructs are significant as precursors to the idea that there is a way to define and organize personhood. Despite discrepancies regarding the two ideas of understanding what makes a person, both Leenhardt and Damasio establish the necessity for social interaction.Â The ability to interact as part of a group comprised of other socially aware beings contributes to an individual’s perception of him/herself and others and is necessary in a world in which social interaction establishes the nature of one’s identity.
Liked and respected by most everyone before his accident, Gage transitioned from a being of social aptitude to one of extreme maladaptive behaviors. Although he recovered physically, Gage’s personality and state of being suffered immeasurably from the accident involving an iron rod penetrating his prefrontal lobe. While social behavior is complex and involves a myriad of biological and environmental systems, the damage done to Gage’s prefrontal lobe and the following actively maladaptive behavior implies the existence of a center within the prefrontal lobe that is “concerned specifically with unique human properties ” (10).
Gage’s situation is unique however: maladaptive social behavior arises more commonly in those with “no overt neurological disease ” and those who have not suffered from brain trauma (19). Phineas Gage is an important case to remember because his transition from socially advantageous to socially maladaptive behaviors supports the notion that “what is wrong with a patient is that his interactions with other people…have gone awry, ” according to Luhrmann (83).
While there are various ways to understand a person as both Leenhardt and Damasio pointed out, it is clear that someone is a person until “he loses the ability to behave like a person among people ” (271). To account from this deviation of normal social functioning, psychiatry and psychoanalysis have evolved as two methods of categorization that attempt to organize those patients with abnormalities in behavior.
Both psychiatry and psychoanalysis are effective in organizing people into the categories presented in the DSM, but assuming these illnesses onto a person diminishes his/her personhood.
Although psychiatry and psychoanalysis are effective in targeting mental illness using different approaches, the current methodology is one that does not consider abnormalities to be various ways of being, but instead understands abnormalities as a dysfunction of the person. Tanya Luhrmann, inÂ Of Two Minds, discusses the two different approaches, such that psychiatric science is understood to be a rejection of the psychodynamic approach to mental illness. The psychiatric approach labels disorders from a checklist of criteria and symptomatic behavior using the Diagnostic Statistical Manual (DSM) as a framework for illness.
In psychiatry, the emphasis placed on understanding mental illness from a physiological approach accounts for abnormalities in brain functioning that contribute to maladaptive social behavior. Differences in neurotransmitters that affect behavior are shown through magnetic resonance imaging (MRI) and positron-emission tomography (PET), which act as evidence that mental illness has a neurobiological basis (166).
Medications are prescribed to counteract the neurological and hormonal impairments in hopes that it would fix the behavior. Medications are not always reliable, however, and do not necessarily create the desired effect, contributing to the understanding of the complexity of what it means to be a person. Even still, the psychiatric approach seems to have found an “explanatory foundation of mental illness ” that the psychoanalysis technique simply cannot be compared to (181).
Due to the emphasis of neurobiological malfunctions and the psychiatric perspective’s reliance on medications, there is the assumption that patients are rational beings with malfunctioning brain chemistry. This model of interpreting mental illness alienates the patient from the illness, and treats the illness as something existing independently of the person and his/her experiences. Matters involving the patient’s family, spouses and “the way they lived their lives ” were not considered as contributing factors to the psychological illness (131).
Thus, the psychiatric perspective presents severe limitations in its ability to consider the whole person, as an interacting unit in society, with difficult to understand exogenous influences. In sum, the advances that have been made to establish neurological malfunctions as a scientific framework for illness do not take in to account the complexity of a psychological illness and its multiple forms of expression and manifestation.
A mental illness’s ability to “distort the defining features of personhood, ” reminds us of the limitations of the definition of personhood.Luhrmann (270)
The contradiction of the psychiatric perspective pertains to the idea that psychological illnesses manifest independently of the person, and yet they determine the psyche of the individual. Thus, there is no definitive line between psychological illness and personhood; the interaction between the two implies a complicated conscious beyond the constructs that the DSM assumes.
This model suggests that a person’s thoughts, goals, and desires are not owned by the person but by the illness (270). While this model has helped to separate illness from the person and instead see it as something that can be fixed at a neurobiological level, the idea of mental illness residing within a person at all limits the understanding of personhood to two dimensions. A person is only as healthy as the mental illness defines him/her as.
On the other hand, psychoanalysts pursue a more therapeutic approach and understand that “a patient is ill because he has learned to interpret and respond to other people in maladaptive ways ” (142). Through interaction, a patient undergoing psychoanalytic therapy is expected to learn how to be responsible for his/her own feelings and their impact on others (149).
The psychoanalyst is expected to keep him/herself private from the patient and is forbidden to divulge any personal information. Unlike other forms of therapy, the goal is less for social and emotional connection of both participants, and more focused on establishing a nurturing environment for the socially disadvantageous patient.
While it may seem counterproductive to have such an asymmetrical relationship with the psychoanalyst remaining distant from the emotionally vulnerable patient, this dichotomy is necessary to exemplify the emotional response of the patient. This emotionality of the patient is the necessary component of psychoanalysis, as it provides the psychoanalyst a way to organize and structure the patient’s being (190).
The psychoanalytic approach attacks unconscious motivations in the patient’s life as mechanisms that perpetuate the maladaptive behavior. While effective in classifying a patient based on emotional response, there exist significant limitations in person-to-person interactions that contribute to questions of humans’ ability to assess personhood.
The notion that people are “limited by their own unconscious [such that] no one person can be an authority on what is going on with any other ” is crucial in understanding the effectiveness of psychoanalysis (142). When psychoanalyzing a patient, the psychoanalyst can never be sure that he/she effectively understands the patient and is not simply superimposing his/her own personality on the patient. To some extent, the relationship two people create together does not accurately define the individual personalities of the two people.
Social interaction is perpetuated by the individual psychological self of each participant (such as Damasio’s ‘background feelings’) as expressed in a socially accepted fashion. The participants create the relationship together such that it is “a story about who they are to each other ” (66).
People are defined by the peculiar social banter that is created from each participant’s individual psychological self. The ability to “use oneself to understand another self…is part of a human intuition that some people have naturally ” however, but there is no guarantee, or empirically derived, mathematically correct answer (82). The limitations humans possess in understanding personhood are reflected in the constructs imposed by psychiatry and psychoanalysis. The limitations of each individual person suggest that the construct created by people to understand people is also limited.
Within the DSM, there are various categories to determine where exactly a person’s illness lies and what behavior has gone awry. Lists with time parameters and scales of severity lump numerous different kinds of people under one category. There are only a limited number of symptoms that account for the wide selection of psychiatric illnesses and “even these symptoms are not straightforward ” (48). Thus, very different people can carry around the same label based on symptoms that are not easily definable.
Furthermore, the label given to a person does not account for the whole person, the whole being, and yet, the rest of society treats that labeled person by the personality they assume accompanies the label. The DSM clumps together certain maladaptive behaviors and assumes an illness from the accumulation of the symptoms, despite the fact that the presence of certain symptoms does not necessarily signify an illness. The mental illness labels that the DSM and the broader psychological world have insisted are “organic disease[s], a ‘thing’ underlying and generating the symptoms ” only exist due to the assumption that human sociality composes the defining element of personhood.
As psychological issues are difficult to diagnose due to individual limitations, the nature of variations in brain chemistry and the complexity of biological rhythms implies various ways of being that cannot be defined by one labeled category. Although humans have established effective ways to delineate between people by way of the symptoms of illness, these symptoms are more indicative of the complexities of the social world and the limitless ways the psyche can react than of a neurobiological issue. Medications treat the symptoms, not the disease or the label (48).
While the symptoms can be real and exist within people, the accumulation of a number of these symptoms does not inherently imply a disorder that can be altered or fixed. Psychiatrists have been taught to believe that these illnesses are real and are naturally occurring diseases; a more realistic understanding is such that the symptoms persist but not within the existing categories.
Perhaps the self is not either diseased or healthy, but exists as multiple parts that should be understood on a continuum of behavior with multiple selves functioning together. What is labeled as disease now could perhaps be just another name for another part of the self existing in tandem with the rest of one’s being. The need to define and to understand each other, however, has overtaken humanity and our moral obligation to consider the ambiguity of personhood.
While it seems innately human to have created systems meant to define and organize every aspect of life — including each other — the systems that have been created falsely simplify personhood into categories and labels that do not fit the categorized or the labeled. Creating boundaries for what constitutes a person is both unhelpful and limiting when assessing the full possibilities of personhood, but it is also uniquely human. Defining constructs, as Leenhardt, Damasio, and the DSM have done exemplifies the human need to organize things into understandable categories and thus, the need to gain control.Â
According to Damasio, Phineas Gage and neurobiological research have demonstrated that there are centers in the brain that contribute to the human ability to plan and organize the future, while taking into account the complex social environment that humans plan around (10). Thus, organization of our surroundings and habitat is critically innate to understanding. If the environment surrounding the human is organized, one can better know one’s place. Furthermore, by categorizing others, one is essentially categorizing oneself; if it is known what someone is, it is known what one is not.
This categorization is limiting in our understanding of personhood, however, because by defining what makes a person, humans have helped facilitate systems of thought of depersonalization. If abnormalities exist within a person that limits his/her sociality, the defining labels of personhood, as established by the DSM, label illnesses in place of what could be different ways of being.
Luhrmann describes how, for the purposes of diagnosing a person, a patient who meets criteria for a particular mental illness is the illness itself (276). The person is no longer seen, only the illness is seen, superimposed over them, as if the illness itself was a naturally occurring, physiologically recognized virus that disrupts a person’s personhood and disqualifies them from the possibility of having a normal existence. Despite humanity’s limitations in understanding mental illness, there are three responses to the social stigma of not following the previously defined boundaries of personhood.
For those individuals who either do not have the resources to cope or who respond to life in angry, externalizing, and harmful behavior, incarceration acts as a holding facility to keep those who desire aid from getting it. While this generalization may not accurately describe those labeled as mentally ill, a psychiatric clichÃ© claims “that disturbed men tend to act out their aggression…and end up in jail, whereas disturbed women…end up hospitalized ” (144).
Regardless, imprisonment exists as an institution for those which society has deemed socially worthless. Due to our perceived construct for personhood existing in socially adaptive behaviors, the existence of those who behave in destructive ways are seen as threatening to society and not worth helping. Certain acts, especially by the incarcerated, are viewed as immoral by society as a whole which limits our understanding of personhood.
If our energy was instead focused on realizing the various possibilities of personhood, without assuming the actions of an individual to be the result of an illness that does not take in to account the whole being, we could determine more effective ways to help those who would otherwise end up as an empty body behind bars.
For the individuals with a sense of hope for social functionality in accordance with the rest of society, they seek out two options as a means of coping with the ‘illnesses’ they have been labeled with: (1) scientific understanding or (2) spiritual enlightenment.
Scientific understanding rooted in the psychiatric, biological perspective accompanies the acceptance that the answer to one’s mental illness lies in medication and neurological misfiring. While medications have been proven to be effective, there is still discrepancy involving how and why a particular drug works the way it does.
While medication and scientific reasoning can only do so much, religion and spiritual enlightenment are sought after to heal wounds that cannot be healed. The impossible difficulty of “the way we struggle in the world, being the specific people we are, of a certain character, in this specific place and time ” can only be addressed through soul-searching means (272). And as humans with various levels of social functioning and ways of being, our role lies not in assuming disorders from symptoms, but in learning to empathize with others and in being comfortable with the ambiguous nature of personhood.