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PubMedDate not supplied

Living in it, living with it, and moving on: dimensions of meaning during chemotherapy.

PURPOSE/OBJECTIVE: To explore the meanings assigned to the experience of receiving chemotherapy. DESIGN: Descriptive exploratory. SETTING: An oncology outpatient clinic in a university hospital in Montreal, Quebec, Canada. SAMPLE: Ten women with breast cancer who experienced chemotherapy for the first time. METHODS: Semistructured interview using a grounded theory approach. FINDINGS: Women described three dimensions of their experience with breast cancer and chemotherapy: "living in it," "living with it," and "moving on." Existential and situational meanings were an integral part of their experience. The existential meaning seemed to be present in varying degrees of intensity throughout the treatment, whereas the situational meanings were predominant at the beginning of the treatment phase and became less important as the treatment progressed. CONCLUSIONS: The intrapersonal and interpersonal dimensions of the chemotherapy experience as well as the capacity to move on evolve within a context of both situational and existential meanings. IMPLICATIONS FOR NURSING PRACTICE: The study results suggest the potential value of exploring each woman's inner world of meanings in relation to her sense of self, relationships with others, resources, and coping strategies during treatment for breast cancer. Because existential and situational meanings are an integral part of women's experience, the nurse's role is to create an environment that permits and facilitates dialogue about these dimensions of meaning.

Activities of Daily Living↗

PubMed2005

The importance of spirituality among gay and lesbian individuals.

Religion is a conduit for expressing spirituality. Since most mainstream religions condemn any form of homosexuality one would expect that gay men and lesbians would have little to do with spirituality. Experts, however, believe that gay and lesbian individuals would especially benefit from spiritual nourishment because of the oppression they face. Using an instrument that measures spiritual well-being, this study investigated the spirituality of 93 gay and lesbian individuals. The findings revealed that respondents espoused high levels of spiritual well-being: how one relates to God (religious well-being) and how one feels about life (existential well-being). Those who identified with a formal religion and who attended religious services frequently espoused higher religious well-being. Respondents with a diagnosis of depression, on the other hand, espoused lower existential well-being. Multiple regression analyses revealed that existential well-being was a significant predictor of adjustment: having high self-esteem, accepting one's homosexual orientation, and feeling less alienated. In contrast, religious well-being was not a significant predictor of any measure of adjustment. These findings point to the importance of the existential aspect of spirituality among gay and lesbian individuals in determining adjustment. They also suggest that being well-adjusted does not entail being reconciled with a traditional religion or with a theistic belief.

Adolescent↗

PubMed1975

Religion and reality: the three doubts of Hillel.

The authors present an existential approach to the understanding of reality through an analysis of doubt. Doubt is understood as a healthy questioning of what others take for real, a search for that which will stand up to all criticism. Doubt begins in childhood, when one questions the authenticity of his parent's relationship to him. This doubt evokes anger, which normally leads to rebellion against or identification with the parents. Neither choice leads to personal authenticity or reality. Only the discovery of the true Self can heal this pain. There is a third choice possible, however, which takes account of another aspect of doubt, the one who doubts. When I doubt, I know that I don't know. Doubt then leads to the existential question, Who am I? This doubt is really faith, leading to Self-discovery. On the basis of this analysis, we re-open the old question of religion and reality. In predominantly religious cultures, the existential question, Who am I? has given rise to practical philosophies such as Yoga and Zen, together with their Western counterparts, the mysticisms associated with Judaism, Christianity and Islam. The same analysis of existential doubt as a path to the Self is to be found in Hillel's three questions.

Child Development↗

PubMed2005

The impact of adolescent spirituality on depressive symptoms and health risk behaviors.

PURPOSE: The purpose of this study was to examine spirituality as a meaningful construct in adolescents' lives, and to examine the contribution of spirituality above and beyond that of religiosity to depressive symptoms and health-risk behaviors. METHOD: A total of 134 adolescents from a suburban high school completed a questionnaire assessing spirituality, religiosity, depressive symptoms, and health-risk behaviors. Spirituality was measured with 2 subscales: (1) religious well-being ("I believe that God loves/cares about me") and (2) existential well-being ("Life doesn't have much meaning"). Religiosity was assessed via belief in God/Higher Power and importance of religion. The Children's Depression Inventory-Short Form and the Youth Risk Behavior Survey (YRBS) were used to assess depressive symptoms and health-risk behaviors. RESULTS: The majority of the sample was Caucasian, with a mean age of 16.2 years. Eighty-nine percent reported a belief in God/Higher Power and 77% stated that religion was important in their lives. After controlling for demographics and religiosity, existential well-being and religious well-being accounted for an additional 29% of the variability in depressive symptoms and 17% of the variability in risk behaviors. Existential well-being was the only predictor significant in both final models (p < .01). CONCLUSIONS: Most of these adolescents reported some connection with religious and spiritual concepts, and those with higher levels of spiritual well-being, in particular, existential well-being, had fewer depressive symptoms and fewer risk-taking behaviors. This supports the inclusion of these concepts in our efforts to help promote resilience and healthy adolescent development, and in expanding our investigations beyond religious identification or attendance at religious services to broader concepts of spirituality.

Adolescent↗

PubMed2005

Clinical holistic medicine: mental disorders in a holistic perspective.

From a holistic perspective, psychiatric diseases are caused by the patient's unwillingness to assume responsibility for his life, existence, and personal relations. The loss of responsibility arises from the repression of the fundamental existential dimensions of the patients. Repression of love and purpose causes depersonalization (i.e., a lack of responsibility for being yourself and for the contact with others, loss of direction and purpose in life). Repression of strength in mind and emotions leads to derealization (the breakdown of the reality testing, often with mental delusions and hallucinations). The repression of joy and gender leads to devitalization (emotional emptiness, loss of joy, personal energy, sexuality, and pleasure in life). The losses of existential dimensions are invariably connected to traumas with life-denying decisions. Healing the wounds of the soul by holding and processing will lead to the recovery of the person's character, purpose of life, and existential responsibility. It can be very difficult to help a psychotic patient. The physician must first love his patient unconditionally and then fully understand the patient in order to meet and support the patient to initiate the holistic process of healing. It takes motivation and willingness to suffer on behalf of the patients in order to heal, as the existential and emotional pain of the traumas resulting in insanity is often overwhelming. We believe that most psychiatric diseases can be alleviated or cured by the loving and caring physician who masters the holistic toolbox. Further research is needed to document the effect of holistic medicine in psychiatry.

Adult↗

PubMed1999

The applicability of quality-of-life assessment in palliative care: comparing two quality-of-life measures.

Two self-administered quality-of-life measures, the McGill Quality of Life Questionnaire (MQOL) and the Patient Evaluated Problem Scores (PEPS) were compared in patients receiving palliative care. The MQOL is a multidimensional questionnaire consisting of 16 items in five quality-of-life (QOL) domains: physical symptoms, physical well-being, psychological, existential and support domains. The PEPS is an individualized questionnaire asking patients to identify and rate major problems affecting their QOL. Both questionnaires were completed by 36 patients during outpatient clinic visits in three palliative care settings in Wales. Of those patients who stated their questionnaire preference 60% favoured MQOL due to its comprehensiveness, while others (28%) preferred PEPS due to its simplicity. The MQOL showed excellent internal consistency (alpha = 0.90). The intrapatient analysis of answers from both questionnaires showed that MQOL was better than PEPS in reporting physical symptoms and support domain, while PEPS detected more psychosocial issues. The MQOL overall QOL score correlated highly with its existential domain (rs = 0.57, P < 0.0005) and the PEPS overall quality of life (rs = 0.77, P < 0.0005). Similarly, the PEPS overall QOL correlated well with MQOL total score (rs = 0.76, P < 0.0005) and existential domain of the MQOL (rs = 0.63, P < 0.0005). The findings support the importance of an existential domain in assessing the QOL of this population. Both MQOL and PEPS were found to be relevant and acceptable in advanced cancer patients receiving palliative care. However, with its favourable psychometric properties MQOL may be more suitable for QOL assessment in this population.

Adolescent↗

PubMed1982

[When night infringes on the day.].

In this article I describe the theoretical bases and the elements of my professional experience which led me to develop an approach which aims at helping the terminally-ill to attain their ultimate development. My central hypothesis is that patients experience, during the terminal phase, the repercussions of the existential drama which become visible while beforehand they had been concealed behind the character armour. This drama consists in the acceptance or the refusal of the fact of having and of being a decomposable mortal body. In the first section, I refer to the work of Gesell in which I derived a conception of human development based on the observation of children. I focus particularly on the pre-puberty period (from 7 to 9 years), a period in which the existential drama surfaces and in which the bulwarks against anxiety are constructed. I also show how parents can, through contact with their children, re-live through them, certain periods of their own development. In the second part, I employ certain notions developed in the theoretical framework by applying them to the situation of the terminally-ill. The latter re-live, mostly in the form of nightmares, the existential drama of the pre-puberty period. The rode of helping agents is to have them share theses nightmares with others, ans thus to prevent terror from becoming omnipresent and to help them to realize their ultimate development. However, just as parents with their children, the helping agents terminally-ill, and in particular their own mourning. They ought then to understand well their own existential predicament.

English Abstract↗

PubMed1998

Trauma and meaning.

The central point in the recovery process after traumatization is the integration of the traumatic experience into a meaningful context in the person's psyche. However, there is no consensus on the best method to achieve this goal, as well as on the healing factors in post-traumatic therapy. On this background, we present the personal existential analysis as a method for the treatment of traumatized people. In our experience with war victims, traumatic experiences could spontaneously shed an additional light on the existential elements of life including its meaning. When the traumatized victim failed to elaborate the existential content of his/her traumatic experience, the symptoms became the most important way through which he/she communicated. Through the method of "protective questioning", personal existential analysis helped the individuals in integrating their traumatic experience into a meaningful attitude towards the trauma and life. The work on biographical elements supported the process of integration. In our experience, authenticity in the therapeutic relationship is the most important healing element.

Adaptation, Psychological↗

PubMed2003

Gadow's contribution to our philosophical interpretation of nursing.

Sally Gadow influenced our work when we first began exploring the meaning of nursing philosophically. In this article, we discuss two major themes of Gadow's work that have influenced us: existential advocacy and treating the body objectively without reducing the patient to the moral status of an object. Our treatment of these issues is appreciative but not uncritical. We argue that existential advocacy makes an important contribution to the meaning of nursing but that it cannot be its essential meaning. We contend that Gadow, by making self-direction the essence of care, tends to diminish the intersubjective nature of care. Then we show how Gadow recovers the intersubjective nature of care by disclosing how nurses and patients both become subjects in personal relationships, even when tending to the body objectively. We show how hermeneutic phenomenology, which we favour, can contribute to Gadow's existential phenomenology by using examples from nursing practice to disclose the meaning of nursing. Gadow's major contribution to our work has been in the ways her work has evoked creative thought from us concerning the meaning of nursing.

Adult↗

PubMed1998

The magic of hypnosis: is it child's play?

Hypnosis is often disregarded and undervalued because it cannot be currently explained by natural science or scientific method. An alternative existential psychology paradigm, specifically an existential-phenomenological model, is offered here to close the gap between the theoretical and the actual clinical practice of hypnosis. This existential-phenomenological model emphasizes the individual's experience over any preconceived notions or diagnoses. In this context, the author introduces and discusses the idea that perception prefigures embodiment, creating the power of suggestion. And children's greater overall hypnotic susceptibility is explained as a result of natural unbiased observations of the world, free of the mind-body split that adults apply to perception.

Adult↗

PubMed1986

Sartre and psychoanalysis.

Why read Sartre? Such is the question which is addressed in this article. In a series of publications, principally his monumental Being and Nothingness (1943), the French philosopher of existentialism challenged traditional psychoanalysis with his "existential psychoanalysis." It has remained a matter of debate whether Sartre's alternative approach to the analysis of human motivation and behavior has any value for the psychoanalytic therapist or theorist. In recent publications two clinicians, Charles Hanly (1979) and Richard Chessick (1984), who have read Sartre extensively, respond negatively, arguing that there is nothing productive in Sartre's challenge to Freudian psychoanalysis. In this article I would like to take issue with that point of view and argue that there is indeed much to be gained from reading Sartre, that the challenge which he poses to traditional psychoanalytic thinking with his "existential psychoanalysis" is in fact a productive one for the contemporary clinician and theorist.

Austria↗

PubMed2003

The life mission theory V. Theory of the anti-self (the shadow) or the evil side of man.

According to the life mission theory, the essence of man is his purpose of life, which comes into existence at conception. This first purpose is always positive and in support of life. This is not in accordance with the everyday experience that man also engages in evil enterprises born out of destructive intentions. This paper presents a theory about the evil side of man, called the "anti-self" (the shadow), because it mirrors the self and its purpose of life. The core of the anti-self is an evil and destructive intention opposite to the intention behind the life mission. The evil side of man arises when, as the life mission theory proclaims, man is denying his good, basic intention to avoid existential pain. The present theory of the anti-self claims that all the negative decisions accumulated throughout the personal history, sum up to a negative or dark anti-self, as complex, multifaceted, and complete as the self. All the negative decisions taken through personal history build this solid, negative, existential structure. The anti-self, or shadow as Carl Gustav Jung used to call it, is a precise reflection of man's basically good and constructive nature. When mapped, it seems that for most or even for all the many fine talents of man, there is a corresponding evil intention and talent in the person's anti-self. As man is as evil as he is good, he can only realize his good nature and constructive talents by making ethical choices. Ethics therefore seem to be of major importance to every patient or person engaged in the noble project of personal growth. Understanding the nature and structure of the evil side of man seems mandatory to every physician or therapist offering existential therapy to his patient. The theory of anti-self makes it possible to treat patients with destructive behavioral patterns, who want to be good deep in their heart, by helping them let go of their evil intentions. The anti-self also seems to explain the enigma of why human beings often commit suicide. Integrating the shadow often leads to dramatic, subjective experiences of ubiquitous light in an "unpersonal" form, of enlightenment, or of meeting light and consciousness in a personal, universal form, known as G-d.

Ego↗

PubMed2004

Suffering related to health care: a study of breast cancer patients' experiences.

A previous study indicated that patient narratives include experiences of suffering caused or increased by health-care encounters. The aim of this study was to interpret and understand the meaning of patients' experiences of suffering related to health care from an ethical, existential and ontological standpoint. Sixteen women with breast cancer in Sweden and Finland took part in qualitative interviews analysed with a hermeneutic, interpretive approach. The outcome showed that suffering related to health care is a complex phenomenon and constitutes an ethical challenge to health-care personnel. The women's experiences of suffering related to health care tended to be of similar seriousness as their experiences of suffering in relation to having cancer. In an ethical, existential and ontological sense, suffering related to health care is basically a matter of neglect and uncaring where the patient's existential suffering is not seen and she is not viewed as a whole human being.

Adult↗

PubMed2004

The progression of suffering implies alleviated suffering.

There is a lack of research focusing directly on both patients' suffering and alleviated suffering in relation to care. The aim of this paper was to investigate the progression of suffering in relation to the encounter between the suffering person and the caregiver from the perspective of an understanding of life. The progression of suffering is assumed to be an existential 'sign' of the development of understanding of life as an ontological or spiritual entity, which demands a meaning-creating encounter between the patient and caregiver. The concept 'existential caring encounter' was used to describe how the encounter between patient and caregiver can create meaning in communion and thereby alleviate suffering by making it bearable. The study was carried out using an interpretive, hermeneutic approach. The study as a whole comprises three parts, and these include letter-writing and interviews. The findings are described by the following main theses: (a) a darkness in life understanding is existentially experienced as unbearable suffering and requires an encounter involving attentive care and confrontation; (b) the turning point means that the struggle of suffering begins; and (c) the encounter involves being meaning-creating in a communion in the struggle of suffering. An understanding of the patterns of unbearable and bearable suffering can be of help to the caregiver in caring for the patient by serving as a basis for meaning-creation in communion. This may thereby be a way of alleviating the patient's suffering by making it bearable during the progression of suffering.

Adaptation, Psychological↗

PubMed1986

'To be or not to be'--anxiety following bereavement.

This paper is concerned with existential anxiety, as elaborated by Paul Tillich. It is related to and distinguished from neurotic anxiety. The paper is in four sections: a brief historical background of the development of existentialism with particular reference to Heidegger; a discussion of Tillich's thought regarding three basic forms of anxiety associated with death, meaninglessness and condemnation; a description and discussion of the experiences of a young woman with extreme anxiety; (4) a consideration of the case in the light of Tillich's propositions suggests that, although more familiar psychodynamic theories go some way towards understanding her symptoms, fundamental to her distress and important in therapy were basic, existential anxieties.

Adult↗

PubMed2000

[Suicide -- an essay trying to reveal the theme].

This essay proposes to reveal facets of the suicide through the discourse of different authors treating this theme as well as through contacts that I was able to have in my nursing training, through my academic trajectory. This trajectory includes an incursion by phenomenological ideas, mainly by the ideas of Heidegger and his existential analysis of the man as being-there. In this way, the understanding of a person who decides to finalize his/her existence, can be, by the existential analysis perspective, a way to reconstruct and redimension his/her existential perspectives.

Existentialism↗

PubMedDate not supplied

Dying, dignity, and new horizons in palliative end-of-life care.

Palliative care practitioners are now better able than ever before to ameliorate end-of-life symptom distress. What remains less developed, however, is the knowledge base and skill set necessary to recognize, assess, and compassionately address the psychosocial, existential, and spiritual aspects of the patient's dying experience. This review provides an overview of these areas, focusing primarily on empirical data that has examined these issues. A brief overview of psychiatric challenges in end-of-life care is complemented with a list of resources for readers wishing to explore this area more extensively. The experience of spiritual or existential suffering toward the end of life is explored, with an examination of the conceptual correlates of suffering. These correlates include: hopelessness, burden to others, loss of sense of dignity, and desire for death or loss of will to live. An empirically-derived model of dignity is described in some detail, with practical examples of diagnostic questions and therapeutic interventions to preserve dignity. Other interventions to reduce existential or spiritual suffering are described and evidence of their efficacy is presented. The author concludes that palliative care must continue to develop compassionate, individually tailored, and effective responses to the mounting vulnerability and increasingly difficult physical, psychosocial, and spiritual challenges facing persons nearing the end of life.

Attitude to Death↗

PubMed2005

Physicians' and pharmacists' attitudes toward the use of sedation at the end of life: influence of prognosis and type of suffering.

End-of-life sedation remains a controversial and ill-defined clinical practice; its applications vary considerably. With this in mind, a study was conducted using a 2 x 2 experimental design. The variables experimented with were prognosis (short- or long-term) and type of suffering (physical or existential). The goal was to study the influence of the two independent variables on attitude toward sedation. Four clinical vignettes were completed by 124 clinicians, doctors, and pharmacists working in different palliative care environments in the Province of Quebec. The results indicate that the type of suffering influences a subject's attitude to end-of-life sedation. Thus, when a patient was suffering physically, the respondents were significantly in favour of sedation, whereas they were not in favour of this practice if the suffering was existential. Lastly, it is clear that health professionals are uncomfortable when confronted with their patients' existential suffering. This is an issue worth exploring in future studies.

Attitude of Health Personnel↗