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Below are contributions from Dr. Ledermann, a practising art therapist and one of Dr. Ledermann's patients.

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Surfacing of sub-terranean love

Mrs AB. Aged 63
Daughter Aged 35

Whole Person Medicine stresses the uniqueness of every person and the importance of a spiritual wholeness.

I recently have had something that happened in my life which made me reflect on this wholeness. My daguhter 935) is a very successful married doctor with two little girls. For several months she has been hostile, remote and indifferent to me. I began to feel that she no longer loved me. I stopped ringing her because I felt I was an irritation for her. I tried to understand why she seemed to hate me. My relationship with her had been affected by my divorce many years ago from her father. I felt that she was blaming me for her unhappy childhood. I blamed myself for not being a better and warmer mother. I felt guilty for having been too preoccupied with my own emotional life.

However, after some days she rang me up and told me that she loved me. She came to see me and kissed me. I felt that this was re-surfacing of sub-terranean love and I had become a whole person again.

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Abortion and the Ethic of Conscience

In my account of Medical Humanities I arrived at a definition of psychotherapy based on the acknowledgement of Ethical Freedom which is manifest in a person's conscience. This freedom answers the question, “what is my duty in a particular vital situation”? This duty affects myself and others.

I should like to examine how such ethic operates in either deciding to have or not to have an abortion. The therapist's duty consists in helping the patient to make this decision.

In the section "A Guide to Holistic Medicine" the reader will find termination of pregnancy discussed in my book, Faithlessness: A Therapist's Concern; An Ethical, Social and Cultural Investigation. There is an account of the spiritual conflict of a Roman Catholic patient whose pregnancy was terminated on medical grounds. There is also the case of an abortion, the result of a husband's refusal to accept a baby, causing a pregnant woman's agony.

Obviously different women have different types of conscience, of values which guide them in their decisions. Abortion is a very complex subject and I shall offer four situations in which women have or lack the freedom to be guided by their true selves. I believe they represent types among the thousands who seek abortions.

1) A girl asks the therapist to arrange an abortion for her. He induces her to talk about the matter, invite her to consider all the possibilities which would allow her to keep the baby.
They talk about her mother's attitude and possible help with the baby. They consider her father's attitude and any financial consequences of having a baby which requires an enormous amount of devotion over the years, especially the first few years.

At the end of several discussions, this girl arrives at the conclusion that she no longer wants an abortion. She has decided that she wants the baby and is prepared to accept all the difficulties including those of her professional career. The wish of the boy friend is not crucial. If he refuses to support her, she knows that she can use legal power to try to obtain money from him, but this does not weigh heavily on her decision. She is prepared to loose him.

She has gained enlargement of true selfhood as a mother.

2) Another pregnant girl has also been given a chance to understand all the consequences of her pregnancy. She arrives at the conviction that her true self requires a termination of her pregnancy. Although she finds the decision very painful, her conscience tells her that she owes to herself a life without the baby.

One could argue that she would be able to have such life if she carried the pregnancy to term and have the baby adopted. She feels she cannot carry out such a plan, as she thinks she might feel unable to part with the baby after it is born. However, she is still convinced that she ought not to be a mother at this stage in her life.

She has struggled, considering all the implications of a pregnancy and has reached the conclusion. We must assume that this struggle has a deep effect on her self. She is prepared to bear the guilt of her abortion as a necessary price. Her self has gained in depth.

3) This girl considers the relation with her boy friend to be most important factor in her life. He flatly refuses to accept the role of a father. She now has the choice to lose him or to have the baby. She rejects the possibility of bringing up the child without him. She would miss the boy friend too much. Hence she decides to have an abortion.

The dependency on her boy friend deprives her of the freedom to make a decision of true selfhood.

The relationship lacks mutuality. Later in life she may break the connection. Her therapist does not think that at the present time she would be able to discontinue the relationship.

4) A married couple have already three children. They love them and care for them. They had been planned as had all the other important matters in their lives. They do not exclude the possibility of having a fourth child later on. But at this time a pregnancy would be too inconvenient. Thus they decide to have an abortion.

Although this woman clearly loves her children and is a true self with them, with her husband and many other people, in the matter of her present pregnancy she is dominated by the ethic of pragmatism which overshadows the ethic of conscience. As a result she suffered no doubts or guilt.

I wish to interpret these cases in the light of the following definitions of conscience which were given in my book Mental Health and Human Conscience, the True and the False Self.

"Conscience is the force that causes man to make the effort of improving his selfhood, his awareness of his present state and his vision of a better, more acceptable state. It is the essential element that enables him to liberate himself."

I hold that this definition of conscience can be applied to the first two patients, if we allow acceptance or rejection of motherhood to constitute a form of liberation from a state of indecision in a vital matter. The last two patients would not achieve such "liberation".

In the same work I quote Martin Buber's definition of conscience which I have accepted: "Conscience means to us the capacity and tendency of man radically to distinguish between those of his past and future actions which should be approved and those which should be disapproved. Conscience can, naturally, distinguish and if necessary condemn in such manner not merely deeds but also omissions, not merely decisions but also failures to decide, indeed even images and wishes that have just arisen or are remembered."

As Buber allows for conscience to act in relation to past and future situation, it remains possible that all the women, discussed by me, may later modify their moral judgement or they may confirm that it was correct. The third patient may have arrived at a more mature selfhood, having broken off the relationship with her boy friend which would have given her the chance of keeping the baby, directed by her conscience. The fourth patient may find that her pragmatic ethic has given way to the ethic of conscience.

I have dealt with personal conscience and not with some impersonal conscience which may be religious or non-religious. I admit that I have not been able to make an allowance for the innumerable variations of people's selves.

It is certainly not the therapist's conscience that decides the issue, although patients may be influenced by what they perceive to be the therapist's ethic.

Art Therapy and Whole Person Medicine

The need to express oneself through the making of images (painting and drawing) is as old as the first recorded cave paintings. Carl Jung used image-making with clients, as have many practitioners over the years. However, the subtle adaptation of image-making within a psychotherapy frame, to a focussed therapeutic approach with it’s own unique qualities, has been developed over the last 80 years. Thus contemporary art therapy claims it’s own influences, disciplines, literature and practice which has evolved and developed enormously.

Art therapy is distinct from psychotherapy in that the healing potential depends on the psychological processes that are activated through creative work. Art therapy uses creativity as the primary tool for growth. The creative work can be identified as a self-expression made tangible. In art therapy one can express non-verbally what may be difficult to express verbally, and the art therapist provides the therapeutic environment to grow from that expression. The making of art, by it’s very nature, is healing; personal problems to personal potential can be explored through the structure of art therapy.

In verbal psychotherapy the relationship between therapist and client is a dyad (between 2 people). In art therapy, the relationship is between the client, the image and the therapist. It is a triad. The art therapist works through the image1. For example, a client can spend 20 years ‘on the psychoanalytic couch’ and will competently articulate everything s/he understands about his/her family. However, as in theme-directed art therapy, if you suggest to the client to paint a symbolic family portrait, and then ask the client to talk about what they see in the image, as opposed to what they know and understand about their family, the client will see new things. If you encourage the client to make observations about what they see - looking at the style, the composition, the scale, the colours, and the order in which they portrayed various family members etc. etc., there will be discoveries. For example, a client might reflect "it’s interesting that I painted myself last....." or " it’s funny…my Dad’s feet don’t really seem to touch the ground....."or " I used the same colour for my mother and me." etcetera.

The art therapist needs to address the client’s emotional responses to this reflection, and specifically help the client understand, accept and integrate the experience. The art therapist might also gently explore the inner conversation that the client had with his/her painting while doing the painting.

Many people can devise interesting ‘opening-up’ experiences using the medium of art - sometimes art therapy is like a superhighway to the unconscious - where deep material can surface very quickly. However the skill of any therapist is in helping the client to integrate the experience and to facilitate the healing process.

Reich wrote about how our bodies remember our feelings. When difficult feelings are not expressed, they are retained in the physical body, where they can be somatised - leading to dis-ease. When the feeling is released onto the paper, it is no longer held in the body to the same extent as previously. The permission to release onto paper, to draw out the pain, contributes to the healing process.

A 6 year old girl referred to me for emotional behavioural problems (as a result of her parents’ difficult and acrimonious divorce) needed to be very angry in the art therapy sessions. In her second session, she needed to enact a messy destruction, rather than create “a fine piece of work”. She wanted to play “splishy-sploshy” with water and very diluted paint. I allowed an enormous mess to unfold, which I felt was a symbolic defecation. In the middle of the session the girl asked to go to the toilet, I accompanied her and she then returned to her “splishy-sploshy.” The following week her mother told me that she had been much calmer and amazingly, she had been to the toilet that week. Until that moment I had not known that the girl also suffered from chronic constipation which had been ameliorated by the art therapy intervention.

Not all images can provide literal information, or diagnostic criteria. One of the guiding principles in art therapy is to be able to stay with the unknown. The art therapist, Liesl Silverstone wrote “an image can sometimes know in advance. Images, dreams, intuition, don’t operate chronologically; trust them. They know........ Paradoxically, the more you can say of an image: I don’t know what it means to me - the more likely it contains potentially valuable information for you. When you are ready to know, you will know.”

This is, perhaps, why the profession has a humility, and in that art therapists reflect a genuine Whole Person Medicine approach.

Hephzibah Kaplan
B.Ed (Hons), Dip. ATh. SRAsT(A)


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