In this lecture I will argue from the
point of view of the Berlin school of Gestalt theory, developed by WERTHEIMER,
KÖHLER, KOFFKA and LEWIN, and its application in educational sciences and
psychotherapy by METZGER and WALTER.
In my view it is not possible to talk about diagnosis without explicitly or
- as it happens by far more often - implicitly referring to a theory of personality
and to a theory of the person - be it an elobarated theory or a more or less
vague idea. The authors of the taxonomies of psychic diseases (disorders) of
ICD or DSM believe to be a-theoretical, but in fact they refer to a defect focussed
model of the person. Disorder is defined by a summing of symptoms of the person.
That seems to fit a piecemeal and static theory of the person.
The Gestalt theoretical point of view is a holistic and dynamic one. It was
Kurt LEWIN who developed a dynamic theory of personality, which can be applicable
to the problem of diagnosis.
LEWINs main idea is that you cannot isolate a person from its environment. Therefore
every experience and behavior is a function of the (psychological) person and
the (psychological) situation. Psychological person and psychological situation
are both interrelated parts of the 'life space' or psychological field (have
a look at the graphical representation).
The organization of the life space follows the principle or law towards a 'Good
Gestalt' as a general tendency of the self-organization in the psychological
field. The combination of the forces in the psychological field establishes
a dynamic balance.
In this sense both psychic order as well as psychic disorder of a person can
be understood as a adaptive and self-organized process of the psychological
field including person and environment.
Important differentiations of the psychological field are time perspective
and the levels of reality and unreality. LEWIN describes several dimensions
of description of the psychological field which are relevant for experience
and behavior:
- Narrowness or width of the psychological
field (e. g. time perspective, levels of reality and unreality)
- Disorder or order and the kind of organization of the regions of life
space
- Fluency or rigidity of the borders of the regions
- Undifferentiation or differentiation of the life space
Applying this theory of personality, diagnosis in a Gestalt theoretical sense
means the description of the dynamic facts and dimensions of the given life
space (=psychological field). The description of the life space is not only
an explanation of what happens, but also a guide what can happen and what can
be done. In this way diagnosis is connected with the causes of behavior and
experience and it is connected with the therapeutic process.
'Pathological symptoms' are one (but not the only) dynamic and interdependent
fact in life space.
To put it in a nutshell: Gestalt theoretical diagnosis in psychotherapy has
to be 'field diagnosis'.
The diagnostic way then is nearly the same as the way in psychotherapy, it is
the way of phenomenological analysis of facts and forces in the psychological
field. From this analysis one can draw conclusions to the dimensions of the
life space. With this kind of diagnosis we have a holistic and dynamic view
of the personality.
Practical application:
At the psychiatric hospital of Haina in Germany we work with long time hospitalised
persons (with the psychopathological diagnosis: chronic schizophrenia or similar)
in a multi-professional team. 'Field diagnosis' is an essential part of the
therapeutic work with the patients as an adaptive process. It takes place in
team discussions and includes the experience of the team members in therapeutic
contacts with the patients. 'Field diagnosis' consists of the regions of the
person (abilities, needs, emotions, contact and relation and so on), their differentiation
and organization in a developmental process of the person. It also can be applied
to the group of patients as a self-organized whole.
Even though the psychiatric diagnosis of
the individual does not change (in the classical psychiatric view), by field
diagnosis we can detect changes and development of the person and the group
in the process of therapy. On the other side the 'field diagnosis' is a powerful
mean to find out the right therapeutic strategy and interventions for the individual
patient as well as for the group of patients.
Published in: Studies in Gestalt Therapy, No. 8, 1999, 292-293.
Contact the author: Dipl.Psych.
Michael Ruh
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