The dialogues of the body
Adriana Schnake, a Chilean psychiatrist, uses Gestalt therapy to propose a truly holistic approach to the sick person, in which the therapist-patient relationship finds its roots in Buber's I-Thou relationship.Adriana states: “Our mission is, first and foremost, to help those who ask for help to be aware of the fact that what is happening to them has to do with themselves, and that however serious and complicated it may seem, what is happening to them is informing them of something definitively important for their life.”
During her clinical experience, the author made her first discovery: people talk about their illness as if it were not their own. The sick person is no longer even in control of their own body; what speaks for them is their clinical picture. The more serious their illness, the more patients prefer to know in medical terms what ails them.
The patient is an informant, whom doctors carefully scrutinize to assess their credibility. However, the credibility of someone battling a part of themselves, with symptoms that oppress them and from which they want to free themselves, is greatly reduced.
This doesn't mean the informant is lying; it's just that they don't know, nor believe, that what's hurting them or manifesting itself in such an unacceptable way is part of themselves, but rather believe that what's hurting them is simply an illness. As feelings of helplessness and abandonment increase, patients' ability to perceive that what's hurting or disturbing is part of them is diminished; this makes them poor informants and simultaneously distances them from themselves.
L’autrice pone l’attenzione sulla relazione tra corpo e malattia in funzione della propria visione del mondo, della propria credenza e della propria fede. L’unica credenza di tutto il testo, frutto dell’esperienza del lavoro con gli organi della Schnake, è che così come in qualsiasi cellula c’è la struttura genetica totale dell’individuo, in ogni organo c’è un’informazione totale della persona.
“How can we not allow those organs to speak?”
Thus, the author began to include, in her therapeutic project, work with the symptoms or illnesses afflicting the people participating in the groups. All participants started from a common idea: the person's conflicts had something to do with the illness.
The individual cannot be separated into mind and body and assumes a central place in the therapeutic relationship. Generally, even after being diagnosed with a serious illness, the person doesn't believe it's possible to find out for themselves what's happening to them: the doctor is the only one who knows.
Despite this, the most basic and ancient principle of medicine teaches us that symptoms are alarm bells; but the individual is incapable of hearing, much less understanding, this warning. A key aspect of the author's thinking is the overcoming of Cartesian dualism: there is only one therapy, and psychotherapy should not exist separately from organotherapy.
No action on a human being can separate what cannot be divided or separated. Words are part of the cure, and by giving voice to the diseased organ, it is possible to understand a part of ourselves and open a dialogue to understand what to do with what has happened.
The author proposes a method of listening to and acknowledging the body that seeks to alleviate suffering by facilitating people's connection with the profound messages emanating from their diseased organs. The resulting clinical approach has a reach that goes beyond simple therapeutic efficacy.
For the patient, it offers the opportunity to encounter the part of themselves that has been ignored and relegated to the background; that part that, for a variety of reasons, the individual has placed in the ailing organ, overestimating, or conversely, underestimating, its natural functions. Sometimes, simply becoming aware of certain problematic situations allows us to correct a vicious cycle that fuels a "pathological gestalt."
This occurs in a very simple way, when one personifies one's own organs, using the empty chair technique with the diseased organ. By engaging in dialogue with one's own organs or alienated parts, the person becomes reconciled with themselves, regains the organismic balance altered by their personal beliefs or inventions, experiences unity, and re-savors organismic wisdom.
The author devotes an entire chapter to an excursus on the possible meaning of the most well-known diseases afflicting humans, from tuberculosis to AIDS. Among the diseases considered, the comparison between cancer and depression is interesting: "When we describe depression in analogical terms, it appears significantly similar to cancer in one respect: the failure to recognize limits.
From the perspective of the depressed person, everything appears meaningless, shapeless, and devoid of value; this invasion of despondency, which spares nothing, is like a veritable invasion of cancer cells, not localized in any one organ but encompassing the entire person. This is why I call them diseases of omnipotence.
In the inability of cancer cells to accept the limits imposed by normal growth, just as in the difficulty of depressed people to accept limitations, separations, and losses, we find a culture that increasingly favors the denial of limits, exalting the self-sufficient, omnipotent, magnificent being in its singularity and exceptionality, with no tolerance for failure or loss.” According to the author, there is no doubt that illness makes us sincere, if we listen.
Perls, the father of Gestalt therapy, was the first person to address the alienation of the body. He denounced the practice of speaking in the third person about the body or its parts (the stomach) instead of using the possessive pronoun, such as "my stomach."
Starting with language, he forced us to reclaim ourselves, to stop placing ourselves in the hands of another like a package whose contents we don't know. People need to be truly taken into consideration for who they are, and this isn't achieved by adding further data to the information a person is providing about their clinical condition or symptoms.
What we need is for the person to move from being a mere informant to the primary actor. It is the patient, the one experiencing the symptoms, who must be at the center of the therapeutic relationship, with the aim of seeking the meaning of their illness, at that precise moment, and in that specific organ.
It's not easy to learn to listen to the body's messages and begin to escape this pointillist trap that comes from the medical gaze and reaches those who love us most, every time we complain about something.
The world around us has become increasingly filled with noises designed to deafen us to our own messages, and our bodies have lost the ability to perceive even the most basic things. It's difficult and tiring to get in touch with the true demands and needs of our bodies, threatened by those terrible monsters—diseases—that lurk behind every weakness, ready to attack us.
Here's where the drama begins: if illnesses are our enemies, we'll never know if they have a positive message for us. Therapeutic duty is to provide positive tools, to help the person develop effective self-help skills, so as not to further increase their alienation.
Experiencing and understanding one's body differently can help change the meaning of illness, and also reduce the high frequency of disabling and crippling diseases, as well as the frightening incidence of suicide in the age of major crises, where self-talk can connect the person with messages that are not reflected in the surrounding world.
At the Gestalt Institute of Córdoba (Argentina), they have developed a teaching model of "experiential anatomy and physiology" as an integral part of the Gestalt Psychotherapy specialization courses.
The goal is to encourage therapists to act as an auxiliary ego in the Gestalt dialogues of patients presenting with so-called organic disorders. This approach seeks to help individuals take responsibility for their own illness and understand the message it carries, working with the entire characterological structure of the person seeking a consultation.
Sometimes, what the person discovers can halt the process, if it isn't yet irreversible. It is the patient who holds the ultimate key to their illness; and this key is hidden both from them and from those who seek to cure them. The patient doesn't know that it is precisely there that the true message lies, which they are not listening to.
Since humans generally get angry with the part of their body that limits or disturbs them in some way, they don't talk to it, much less listen to it. The diseased organ or part speaks in many ways, and until the individual understands the message, it is their enemy. The person, at war with the disease, doesn't facilitate its treatment: they simply seek to rid themselves of a part of themselves they've never fully understood or accepted.
If with the proposed approach symptoms, signs, or illnesses that disturb a person disappear, it is because the message of that illness has been understood, and a change has been possible in that person.
The author presents numerous clinical cases treated with the Gestalt method.
As an example, I will give you my work with a patient, Samuel, who had lung cancer.
Samuel consulted us after undergoing lung cancer surgery. After an initial meeting in Santiago, he decided to join a therapy group in Chiloé.
I explain to him our perspective on the disease. I say: we can't consider the disease an enemy. We can't argue with it without knowing what it's here to do. It's settled in a part of us. Listen to that lung where a group of cells have declared themselves in rebellion.
The secret is the message they wanted to give us and we didn't listen to; it's an absolutely and utterly unique secret, like fingerprints. That organ, born with us, knows something about us that it isn't willing to let us forget. In this way, we can explain to the person how important it is to connect experientially with the diseased organ, to describe ourselves and speak for it.
The figure highlights the need to reclaim one's own organ and put oneself in its shoes, through Gestalt therapy techniques (dramatization, empty chair), in order to begin a dialogue with it, in order to find meaning to one's illness.
To accomplish this, the author has developed a true Gestalt method, creating operational charts for the organs. This work involves describing the personal characteristics that an individual resembling our organs should possess; characteristics deduced from the function, shape, and consistency of each organ.
One side of the cards describes the anatomical and physiological characteristics of the organ, while the other lists the characteristics the organ would have if it were a person, according to its function and constitution. It is from these cards that the "body dialogues" begin.
I find this working method fascinating and believe it has significant therapeutic efficacy for the sick person, as it offers the possibility of restoring meaning to one's existence and, therefore, to one's illness, starting from the basic existentialist idea that "it doesn't matter what happens, but what we do with it."
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