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PubMed2001

Existential loneliness: a review of the concept, its psychosocial precipitants and psychotherapeutic implications for HIV-infected women.

While many of the most urgent psychological issues that women with HIV infection are forced to deal with are existential in nature, and therefore shared by humankind, the assault on their physical and psychological being may trigger these issues in large amounts and may overwhelm their defensive structure. Existential loneliness may be an important existential issue that arises for these women and needs to be given equal consideration alongside other forms of loneliness. In this paper, we review the concept of existential loneliness, discuss methods to measure the concept, delineate some central psychosocial precipitants of existential loneliness among HIV-infected women, and discuss psychotherapeutic implications. We conclude that incorporating an existential philosophical perspective into one's particular therapeutic stance may be especially appropriate with this population.

Existentialism↗

PubMed2003

Existential concerns of terminally ill cancer patients receiving specialized palliative care in Japan.

BACKGROUND: Although alleviation of existential distress is important for terminally ill cancer patients, the concept of existential distress has not been fully understood. The aim of this study was to categorize existential concerns of Japanese terminally ill cancer patients and explore care strategies based on the categorizations. METHODS: A multicenter cross-sectional study in 88 terminally ill cancer patients receiving specialized inpatient palliative care was performed. The nurses explored patient existential concerns by asking several key questions, and recorded the answers that they considered typically described the patients' concerns. All statements recorded by the nurses were analyzed using content analysis methods. RESULTS: A total of 89 statements were subjected to analysis. The categories and their prevalence were: relationship-related concerns (22%; isolation, concerns about family preparation, conflicts in relationship), loss of control (16%; physical control, cognitive control, control over future), burden on others (4.5%), loss of continuity (10%; loss of role, loss of enjoyable activity, loss of being oneself), uncompleted life task (6.8%), hope/hopelessness (17%), and acceptance/preparation (25%). CONCLUSIONS: Existential concerns of Japanese terminally ill cancer patients were categorized as relationship-related concerns, loss of control, burden on others, loss of continuity, uncompleted life task, hope/hopelessness, and acceptance/preparation. These themes seemed to encompass universal human suffering beyond cultural differences, and this conceptualization may contribute to the development of effective therapeutic interventions to alleviate existential distress.

Adult↗

PubMed2004

Palliative sedation to relieve psycho-existential suffering of terminally ill cancer patients.

To clarify the prevalence and the characteristics of patients who received palliative sedation therapy for psycho-existential suffering, a questionnaire was sent to 105 responsible physicians at all certified palliative care units in Japan. The participants were requested to report the number of patients who received continuous deep sedation for refractory psycho-existential suffering during the past year, and to provide details of the 2 most recent patients. A total of 81 physicians returned questionnaires (response rate, 80%). Twenty-nine physicians (36%) reported clinical experience in continuous deep sedation for psycho-existential suffering. The overall prevalence of continuous deep sedation was calculated as 1.0% (90 cases/8,661 total patient deaths), and a total of 46 patient histories were collected. Performance status just before sedation was 3 or 4 in 96%, and predicted survival was 3 weeks or less in 94%. The suffering requiring sedation was feeling of meaninglessness/worthlessness (61%), burden on others/dependency/inability to take care of oneself (48%), death anxiety/fear/panic (33%), wish to control the time of death by oneself (24%), and isolation/lack of social support (22%). Before sedation, intermittent sedation and specialized psychiatric, psychological, and/or religious care had been performed in 94% and 59%, respectively; 89% of 26 depressed patients had received antidepressant medications. All competent patients (n=37) expressed explicit requests for sedation, and family consent was obtained in all cases where family members were available (n=45). Palliative sedation for psycho-existential suffering was performed in exceptional cases in specialized palliative care units in Japan. The patient condition was generally very poor, and the suffering was refractory to intermittent sedation and specialized psychiatric, psychological, and/or religious care. Sedation was performed on the basis of patient and family consent. These findings suggest that palliative sedation for psycho-existential suffering could be ethically permissible in exceptional cases if the proportionality and autonomy principle is applied. More discussion about the role of palliative sedation therapy for refractory psycho-existential suffering in end-of-life care is urgently necessary.

Aged↗

PubMed2003

Existential concerns of families of late-stage dementia patients: questions of freedom, choices, isolation, death, and meaning.

UNLABELLED: Several studies focus on palliative aspects of the caregiver burden of dementia families. However, only few studies have addressed the existential perspective in this situation. The aim of this study was, therefore, to focus on issues of freedom/responsibility, existential isolation, death, and issues of meaning/meaninglessness. METHOD: Qualitative tape-recorded in-depth interviews with 20 family members were conducted. The transcripts were analyzed with a hermeneutic approach. RESULTS: To take responsibility (faithfulness; paying back) was generally perceived as rewarding, but in some cases it was more a matter of duty with elements of guilt and obligation. Existential isolation dealt with the hampered or ended communication with a spouse or parent who was no longer able to communicate; the situation of having no other relatives left in life or, the role-reversal (i.e., to parent your own parent). Thoughts about the impending death were affected by previous experiences, not only by the actual situation. Anticipatory grief was commonplace. Some informants described an increased awareness of the shortness of life, which made them live more intensely in the present. The illness itself was discussed in terms of meaninglessness. Still, many respondents were able to identify meaning in the past (memories), present (daily routines, positive aspects of responsibility) and future (to pass on the patient's lifework). DISCUSSION: The study underlines the importance of not only seeing the physical and psychosocial caregiver aspects, but also the existential ones that emerge when confronting impending death. Staff need to be more aware of existential issues in order to support families also in existential crisis.

Adult↗

PubMed2002

The Existential Loneliness Questionnaire: background, development, and preliminary findings.

We described the background and the development of a new measure of existential loneliness, the Existential Loneliness Questionnaire (ELQ). Specifically, we analyzed the items of the preliminary version of the ELQ (ELQ-P) using methods based on item response theory (the Rasch model) and examined the convergent and discriminative validity of the ELQ in a sample of 47 HIV-infected women. Item analysis produced an ELQ version consisting of 22 items that were internally consistent and performed well in measuring an underlying construct conceptualized as existential loneliness. In addition, the ELQ discriminated well between symptomatic and asymptomatic HIV-infected women. The ELQ correlated strongly with measures of depression, loneliness not identified as existential and purpose-in-life and moderately strongly with a measure of hopelessness. Holding constant depression scores, the correlation between the ELQ and loneliness not identified as existential was significantly attenuated. Limitations of the study include the small sample size, which precluded an analysis of the dimensional structure of the ELQ.

Adult↗

PubMed2005

Life, illness and death--existential reflections of a Swedish sample of patients who have undergone curative treatment for breast or prostatic cancer.

The aim of this study is to describe cancer patients' existential reflections and how these reflections were met by the nursing staff. A qualitative method of data collection was used. Ten patients with breast- or prostate cancer who had completed curative treatment were interviewed. The results showed that the cancer diagnosis resulted in existential reflections in some of the patients. These reflections concerned the meaning of life, God/a higher power, health, work, relations and sexuality. Reflections on the cancer consisted in beliefs about the causes of cancer, treatment and cancer and sexuality. It could also be seen that loss of important life values, such as health and sexuality could lead to loss of meaning of life. Explicit reflections on sexuality were only made by two of the men in the study. The patients reported a need of existential support as well as obstacles for giving such support. Obstacles could be lack of time and lack of continuity, as well as lack of knowledge resulting in an inability to identify existential issues. Some of the patients had wanted existential support from nurses, while others received the support they needed from family and friends.

Adaptation, Psychological↗

PubMed2006

Conceptualization of psycho-existential suffering by the Japanese Task Force: the first step of a nationwide project.

BACKGROUND AND PURPOSE: Although the relief of psycho-existential or spiritual suffering is one of the most important roles of palliative care clinicians, lack of an accepted conceptual framework leads to considerable confusion in research in this field. The primary aim of this article is to illustrate the process of developing a conceptual framework by the Japanese Task Force as the initial step of a nationwide project. METHODS: We used consensus-building methods with 26 panel members and 100 multidisciplinary peer reviewers. The panel consisted of six palliative care physicians, six psychiatrists, five nursing experts, four social workers or psychologists, two philosophers, a pastoral care worker, a sociologist, and an occupational therapist. Through 2 days of face-to-face discussion and follow-up discussion by e-mail, we reached a consensus. RESULTS: The group agreed to adopt a conceptual framework as the starting point of this study, by combining the empirical model from multicenter observations, a theoretical hypothesis, and good death studies in Japan. We defined "psycho-existential suffering" as "pain caused by extinction of the being and the meaning of the self". We assumed that psycho-existential suffering is caused by the loss of essential components that compose the being and the meaning of human beings: loss of relationships (with others), loss of autonomy (independence, control over future, continuity of self), and loss of temporality (the future). Sense of meaning and peace of mind can be interpreted as an outcome of the psycho-existential state and thus the general end points of our interventions. This model extracted seven categories to be intensively studied in the future: relationship, control, continuity of self, burden to others, generativity, death anxiety, and hope. CONCLUSIONS: A Japanese nationwide multidisciplinary group agreed on a conceptual framework to facilitate research in psycho-existential suffering in terminally ill cancer patients. This model will be revised according to continuing qualitative studies, surveys, and intervention trials.

Adult↗

PubMed2005

The life mission theory VII. Theory of existential (Antonovsky) coherence: a theory of quality of life, health, and ability for use in holistic medicine.

A theoretical framework of existential coherence is presented, explaining how health, quality of life (QOL), and the ability to function were originally created and developed to rehabilitate human life from an existential perspective. The theory is inspired by the work of Aaron Antonovsky and explains our surprising recent empirical findings -- that QOL, health, and ability primarily are determined by our consciousness. The theory is a matrix of nine key elements in five layers: (1) coherence; (2) purpose and talent; (3) consciousness, love, and physicality/sexuality; (4) light and joy; and (5) QOL/meaning of life. The layer above causes the layer below, with the layer of QOL again feeding the fundamental layer of coherence. The model holds the person responsible for his or her own degree of reality, happiness, and being present. The model implies that when a person takes responsibility in all nine "dimensions" of life, he or she can improve and develop health, the ability to function, all aspects of QOL, and the meaning of life. The theory of existential coherence integrates a wide range of QOL theories from Jung and Maslow to Frankl and Wilber. It is a nine-ray theory in accordance with Gurjieff's enneagram and the old Indian chakra system. It can be used in the holistic medical clinic and in existential coaching. Love is in the center of the model and rehabilitation of love in its broadest sense is, accordingly, the essence of holistic medicine. To know yourself, your purpose of life (life mission) and talents, and taking these into full use and becoming coherent with life inside and reality outside is what human life is essentially about. The new model has been developed to integrate the existing knowledge in the complex field of holistic medicine. Its strength is that it empowers the holistic physician to treat the patient with even severe diseases and can also be used for existential rehabilitation, holistic psychiatry, and sexology. Its major weakness is that it turns holistic medicine more into an art than into a science because the physician must master intent, which is a poorly understood dimension of existence.

Consciousness↗

PubMed2005

An existential view of adolescent development.

In clinical work with adolescents there is a stark similarity between what they experience and the concepts of existentialism. However, surprisingly very little has been written in terms of how the concepts of existentialism can or should be applied to this age group. Rather, existentialism seems to be a concept reserved for its application to the adult population. In fact, a search of the literature included in PsychINFO under "existentialism" and "adolescent development" results in only 5 hits. Perhaps by avoiding the use of these ideas as they might apply to adolescents, for various reasons a disservice is being done. Drawing on ideas posited in existential literature will not only benefit adolescents, it will assist caring adults in their work with them and encourage professionals to expand on existing ideas when conducting research and developing theories that apply to this age group.

Adolescent↗

PubMed2005

Clinical holistic medicine: the existential crisis--life crisis, stress, and burnout.

The triple and parallel loss of quality of life, health, and ability without an organic reason is what we normally recognize as a life crisis, stress, or a burnout. Not being in control is often a terrible and unexpected experience. Failure on the large existential scale is not a part of our expectations, but most people will experience it. The key to getting well again is to get resources and help, which most people experience with shame and guilt. Stress and burnout might seem to be temporary problems that are easily handled, but often the problems stay. It is very important for the physician to identify this pattern and help the patient to realize the difficulties and seriousness of the situation, thus helping the patient to assume responsibility and prevent existential disaster, suicide, or severe depression. As soon as the patient is an ally in fighting the dark side of life and works with him/herself, the first step has been reached. Existential pain is really a message to us indicating that we are about to grow and heal. In our view, existential problems are gifts that are painful to receive, but wise to accept. Existential problems require skill on the part of the holistic physician or therapist in order to help people return to life--to their self-esteem, self-confidence, and trust in others. In this paper, we describe how we have met the patients soul to soul and guided them through the old pains and losses in order to get back on the track to life.

Adult↗

PubMed2006

Patients' existential situation prior to colorectal surgery.

AIM: The aim of this paper is to present a hermeneutic phenomenological study illuminating patients' existential situation prior to colorectal surgery. The intention was also to explore the value of the encounter between patient and nurse. BACKGROUND: Patients waiting for major surgery experience multifarious reactions. Emotions of anxiety, fears of the unknown, anaesthesia, cancer diagnosis and death can arise. Several earlier studies have reported the importance of information, coping strategies and the need to reduce anxiety and stress in relation to surgery. However, there is a lack of studies focusing on patients' existential situation in the preoperative phase. METHODS: Conversational interviews were conducted with 28 patients 1 week before their surgery during autumn 2002. Analysis of the data was influenced by van Manen's existential themes: lived space/spatiality, lived body/corporeality, lived time/temporality and lived relation/relationality. FINDINGS: Participants expressed either hope of increased spatiality or fear of restricted spatiality, according to whether they had a benign or malign diagnosis. Statements about lived time were also related to the diagnosis. Patients waiting for surgery for a benign diagnosis could use the time to relax and gather energy, while malignancy gave them high levels of anxiety and stress. Lived body experiences showed the ambivalence felt in entrusting one's body to professionals. Statements about lived relations drew attention to the need for considerate caregivers to enhance feelings of security and continuity. CONCLUSION: The existential situation of patients in a preoperative context was shown to be a state of uncertainty with regard to lived space, body, time and relation. The significance of meeting and talking to the nurse did not appear in the statements. The nurse was invisible. If nurses were to employ the existential themes proposed by van Manen in preoperative encounter with patients, their need for care might be more clearly identified and affirmed.

Adult↗

PubMed1996

Existential well-being is an important determinant of quality of life. Evidence from the McGill Quality of Life Questionnaire.

BACKGROUND: The McGill Quality of Life Questionnaire (MQOL) is being developed to correct what we perceive to be a flaw in existing quality of life instruments: neglect of the existential domain. METHODS: This study reports the first use of MQOL for people with cancer at all phases of the disease, including those with no evidence of disease after therapy. RESULTS: The data suggest that MQOL is comprised of an item measuring physical well-being and four subscales: physical symptoms, psychological symptoms, existential well-being, and support. MQOL is acceptable to oncology outpatients. Correlation of the MQOL total and subscale scores with a single item scale measuring overall quality of life and with the Spitzer Quality of Life Index suggests that MQOL has construct and concurrent validity. CONCLUSIONS: The hypothesis that the existential domain is important, especially to those patients with a life-threatening illness, is supported because multiple regression showed that the existential subscale is at least as important as any other subscale in predicting a single item scale measuring the overall quality of life and plays a greater role in determining the quality of life of patients with local or metastatic disease than in patients with no evidence of disease.

Adult↗

PubMed1998

Some reflections on clinical supervision: an existential-phenomenological paradigm.

This paper reviews psychotherapy, counselling, and nursing literature related to ideas of clinical supervision and attempts to illuminate areas important to effective health related practice and specifically palliative care. Included are explorations of existentialism, phenomenology, existential phenomenology and psychoanalytical concepts. The phenomenological idea of lived experience is outlined and the Heideggerian notion of authenticity is explored in context. The paper also examines dynamic forces such as hope, trust and personal values that might influence clinical supervision design and so inform a framework for practice. An existential-phenomenological method of supervision is offered as one basis for professional practice. The central recommendation of this paper is, however, to identify relevant value and belief systems to direct clinical supervision. Nursing models might appropriately instruct approaches to supervision. The writer considers the phenomenological idea of the lived experiences as a means by which to at once capture the essence of palliative care nursing and guide the supervision towards the existential idea of authenticity.

Clinical Competence↗

PubMed2001

Absurdity and being-in-itself. The third phase of phenomenology: Jean-Paul Sartre and existential psychoanalysis.

Existentialism and phenomenology are closely linked philosophies. Existentialism preceded phenomenology and is not considered a single philosophy but several schools of thought, both theist and atheist in thinking, which grew out of a reaction to traditional philosophy. The development of phenomenology is divided into three separate phases ultimately merging with existentialism. Following Second World War, the phenomenological movement gained momentum in France and encompassed many of the ideas of Edmund Husserl and Martin Heidegger. Gabriel Marcel, Maurice Merlieu-Ponty and, notably, Jean-Paul Sartre established a 'third phase' of phenomenology. This paper explores some of Sartre's ideas related to being and later applications through Medard Boss and R.D. Laing, and offers a short illustrative case vignette that shows the concepts as they might apply to nursing practice. Consideration is finally given to existential psychoanalysis as an applied research methodology

Existentialism↗

PubMed2005

[Schizophrenia -- an existential disease].

This paper deals with familiar findings in the field of schizophrenic psychosis re-interpreted from a medical anthropological (V. Weizsäcker) as well as theoretical pathological (W. Dörr) view-point. Schizophrenic psychosis is thus discussed as an existential illness of the person as well as an aesthetic challenge for a certain cultural framework. This paper therefore investigates phenomenologically three main points that are not new but ought to be continuously re-considered: 1. The cultural-scientific thesis of a uniform onto- and pathogeny: Schizophrenic psychosis serves as topical example for the genetic and ontogenetic uniformity of so-called organic and psychic illnesses. 2. The anthropological thesis of the existential "Spiegelfunktion" of schizophrenic psychosis: From the phenomenological point of view, schizophrenic psychosis is defined as an existential illness hitting and reflecting the primary nature of human beings in a shocking way. 3. The therapeutic thesis of the effect and scientific basis of the paradoxical intervention: This thesis aims at describing the impossibility of understanding schizophrenic psychosis as a pathological but rather an anthropological phenomenon and problem of life, the acknowledgment of which shows therapeutic effect. The article's main concern is to discuss schizophrenic psychosis as phenomenon of existence and suffering, however not understandable, yet reflective of the existential predicament of humanity. This cultural-scientific concern is considered a permanent aim of subject-oriented medical analysis.

Anthropology↗

PubMed2002

An existential approach to risk perception.

Existential, or existential-phenomenological philosophical approaches to the social psychology of risk perception provide a novel framework for understanding issues that are common to all humanity, such as fear of death, freedom and responsibility, isolation and meaninglessness, as these anxieties are a function of existing, or being-in-the-world. These fundamental anxieties can be related theoretically to the ways people perceive risks within social and cultural milieus, and can also be used practically within case studies, as demonstrated in the three examples presented, which examine perceptions of climate change, food-related risks, and environmental awareness via a mixture of quantitative and qualitative techniques. The discussion focuses on the possible insights that can be gained from taking an existential perspective on risk perception, and relates notions of contemporary technologically-oriented societies to the existential challenges faced by individuals and societies in the contemporary world.

Anxiety↗

PubMed2003

Nurses and the virtues of dealing with existential questions in terminal palliative care.

We have conducted a small qualitative empirical study into the problems that nurses encounter in delivering existential support in their care of dying patients. We found that nurses are confronted with four types of problem: determining whether the patient actually has put a genuine question for existential support on the agenda; assessing what the import of such a question is; devising an adequate procedure for offering existential support; and organizing adequate support for themselves. Our analysis shows that it takes a 'fine-tuned antenna' from nurses to determine these existential questions, which are often put indirectly and in a variety of forms. We have attempted to show that the subtleties of the communicative dimension of palliative terminal care require an intricate set of virtues on the part of the nurse. We have analysed these virtues in a bottom-up approach, inferring them directly from the material obtained from interviews. The framework utilized is the Aristotelian one of striking the right balance between the poles of a morally relevant dimension.

Adaptation, Psychological↗

PubMed2002

Existential issues in group psychotherapy.

Existential issues in group psychotherapy derive from existential thought both as a philosophy and as a value system. Its origins derive from the weakening of traditional values and the growing alienation of man from himself. The unique features of existentialism can be applied to all forms of therapy. These features are universal to humankind. They are finiteness, aloneness, guilt, responsibility, and freedom. In including existential concerns as part of group psychotherapy, therapist and patients move more closely to bilateral relationships and subjective interactions.

Existentialism↗