Phenomenological and Psychodynamic understanding of Multiple Sclerosis
By: Dr. Estella Sneider, PhD

Multiple Sclerosis (MS) is a disease of the central nervous system (CNS)involving damage to the myelin sheath that covers the CNS structures.

Multiple Sclerosisis also a disease, which can radically alter one’s body and consequently one’s perceptions, emotions, and even world view. The phenomenological and psychoanalytic perspectives add insights into the dynamics of these
alterations.

There are
biographical accounts of the MS experience related by people with MS; these
accounts do capture a number of features of the experiences: the reaction to
diagnosis, coping with the multitude of symptoms, psychological adjustment to
the new reality ushered in with the disease ( see, for example, Ottenberg, 1978
and Matthews, 1985).

These
biographical accounts indicate that people with MS do encounter the existential
struggle to create a meaningful life after real or threatened loss of bodily
functions associated with MS. The person, often at great emotional cost, is
confronted with the task of recognizing the new situations created by the
limitations of body function.

Individuals go
through a number of phases of coping with the new reality.

There is at first a denial that one has the disease.  Ottenberg specifies other
phases, which she and others encountered en route to accepting the disease.
There is withdrawal from others and an attempt to escape; there is an effusion
of emotion—sadness, depression and anger—as the full implications of having the
disease are realized; the person then makes some alterations in lifestyle, but
not without resentment or anger (why do I have MS?); in time, if prudent
adjustments are made to accommodate the condition, there comes a stage in
which, as Ottemberg states, “ the pretense is over.”

Emotions,
Ottenberg observes, “play an extremely important part in the whole illness”
(p.127). Facing MS she adds, is a grieving process, a way of coping with the
loss of body function. Even after the individual has made a mature adjustment
to the reality of having the illness, stress can aggravate the symptoms of the
disease.

Ginther (1978)
corroborates much of what Ottenberg has to say about the emotional adjustment
to the disease. But his case demonstrates that caution must be exercised so
that the wide variety of experiences of thse with MS are not too neatly
categorized. Ginther had the disease for a number of years before his wife and
doctor told him that he had MS. The remission of symptoms common to MS as ell
as the various forms or types of MS, one more serious than the other, make it
difficult to treat the MS experience with too broad a brush.

One biographical account of MS, that of Talshir (1977) echoes some observations made by Merleau-Ponty. Talshir was 25 when MS stuck; she was recently divorced and
cared for her child, three years of age. Within a few years she was confined to
a wheelchair with a severe case of MS. She writes:

“Our bodies are so delicate. It amazes me, sometimes, that they ever work at all.
Extraordinary machines. So why is it that most people never give their bodies a
second thought? Why is it that to them a body is just there?

Unless, of course, something goes wrong with it. Then it isn’t all just there anymore>

I was used to dressing a body almost 6 feet tall that worked. And that looked good.

Now I clothe a shorter body that sits. But it will look good too…with a little planning and a lot of trial and error.

My body is new to me again (p.71). “

Talshir is confronted with redefining her situation in life’s many contexts and planning
new strategies that will sustain a meaningful life.

In both the phenomenological and psychodynamic viewpoints
there is great appreciation of the intimate relationship between the
mind and the body. For Merleau –Ponty (1962) , for example the body is a way of
perceiving and apprehending the world; the body plays an indispensable role in
defining situations and the possibilities of interacting with objects. We find
this same sense of the importance of the body in Tustin’s analysis of the
relation of the infant’s body and its relation to sensation-objects (defining
the elementary sense of self). The autistic child is beset with the dilemma of
separating body and object and defining situation and reality.

In both the phenomenological and psychodynamic perspectives we find insight into the
process of mourning and loss. Klein and Freud speak of mourning as a time of
testing reality , responding to a felt loss. The phenomenologists likewise note
that it is most difficult at first for a person who has suffered a loss to
redefine the world and situations to accommodate that loss. Sartre speaks, for
example, of emotion as a way of perceiving the world and of sadness as an
emotion which enables the person to deny at least for the moment that reality
and one’s situation in any way changed.

In both perspectives  there is a recognition the  “world” is a construction in which the
individual plays a creative role, investing in it through perception, emotion
and bodily motility. It is this willingness to consider the bond between the mind and world which enables both perspectives to clarify the experience of loss and the relationship between mind and loss. Finally, both perspectives seriously entertain the relationship between loss and the threat of annihilation and nothingness and thus
communicate something of the terror which can be associated with the travails
in life., including the loss of bodily integrity.

References:

Ginther, J. and
Farkas, E.  (1961).  But you look so well: A personal account
of one’s man’s confrontation with MS. Chicago: Nelson Hall

Merleau-Ponty, M.
(1962). The primacy of perception.

Evaston: Northwestern
University Press

Ottenberg, M.  (1978). The pursuit of hope.   New York: Rawson, Wade Publishing.

Talshir, D. (1984). My
body is new to me again. In A.J. Brigham, (Ed.) Ordinary moments: The
disabled experience, Baltimore: University Park Press, pp. 154-156

Tustin, F  (1981). Autistic states in children.
London: Routledge and Kegan Paul.