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PubMed1998

Sartre's Freud and the future of Sartrean psychoanalysis.

I describe Sartre's analysis of Freud as an exemplary case study in existential psychoanalysis, a kind of anti-psychiatric analysis; in addition Sartre's analysis of Freud is a practical critique of the latter's theory. Sartre's overall aim is revolutionary, not primarily concerned with healing people; his method transcends the traditional aims of psychoanalysis and psychotherapy. The paper is divided into four sections: 1) Sartrean Existential Psychoanalysis: An explanation of the basic understandings of Sartre's Existentialism and Psychoanalysis. 2) Sartre and Anti-psychiatry: An analysis of the relation and influence of Sartre's philosophy on R.D. Laing's anti-psychiatry, and a review of the contemporary anti-psychiatric practice of the Philadelphia Association. 3) Sartre's Case-study of Freud: An exemplary application of Sartrean psychoanalysis and a critique of traditional psychoanalysis. 4) Transcending the Boundaries of Therapy: A proposal for a radical application of Sartre's philosophy that extends beyond the aims of clinical approaches.

Existentialism↗
PubMed1998

[Cool, clever, established--variations on anxiety defenses in today's society].

Anxiety is a psycho-biological phenomenon, psychologically manifested in feelings of constrainment, threat, and vulnerability; and physically in evidence of increased sympathetic tone. Three phenomenologically different forms of anxiety can be distinguished (real anxiety, existential anxiety, neurotic anxiety). Existential anxiety is based on four themes: self-development, self-submission, change and finality. Anxiety and anxiety defences are a part of human existence. Every culture develops its own rituals for defending against anxiety. Three variations of anxiety defence are described which typically appear in affluent societies: coolness, cleverness and happiness. These strategies are, depending on the situation, sensible and advantageous in dealing with, perceiving, overcoming and defending against existential anxieties.

Adaptation, Psychological↗
PubMed2001

Physicians' responses to patients' requests for physician-assisted suicide.

BACKGROUND: Studies show that patient requests for physician-assisted suicide (PAS) are a relatively common clinical occurrence. The purpose of this study was to describe how experienced physicians assess and respond to requests for assisted suicide. METHODS: Focused ethnography in the offices of 11 acquired immunodeficiency syndrome physicians, 8 oncologists, and 1 hospice physician who had received requests for assisted suicide in their practice. Ten had facilitated PAS. RESULTS: Informants had a similar approach to evaluating patients who requested assisted suicide, often asking, "Why do you want to die now?" Reasons for requests fell into 3 broad categories: physical symptoms, psychological issues, and existential suffering. Physicians thought they competently addressed patients' physical symptoms, and this obviated most requests. They treated depression empirically and believed they did not assist depressed patients with assisted suicide. Physicians had difficulty addressing patients' existential suffering, which led to most facilitated requests. Informants rarely talked to colleagues about requests for assisted suicide, suggesting a "professional code of silence." CONCLUSIONS: Regardless of divergent attitudes about PAS, physicians respond similarly to requests for assisted suicide from their patients, creating a common ground for professional dialogue. Our sample addressed physical suffering aggressively, treated depression empirically, but struggled with requests arising from existential suffering. A professional code of silence regarding PAS creates professional isolation. Clinicians do not share knowledge or receive social support from peers about their decisions regarding assisted suicide. Educational strategies drawing on approaches used by experienced clinicians may create an atmosphere that enables physicians with divergent beliefs to discuss this difficult subject.

Adult↗
PubMedDate not supplied

Re-creating your life: a spiritual/psychotherapeutic intervention for people diagnosed with cancer.

This paper describes a pilot psychotherapy program for people who have experienced cancer that integrates spiritual issues and resources. The name of the program is: Re-Creating Your Life: During and After Cancer. The literature suggests that people experiencing cancer wrestle with existential concerns related to control, identity, relationships, and meaning. For spiritually oriented people, religious and spiritual issues are likely to be embedded in these existential concerns. Moreover, spiritual resources are likely to play a role in resolving these issues. This seems even more likely given the body of research suggesting that spirituality and religion play a helpful role when people face a traumatic life event. The few studies that have examined the importance of religious variables for people experiencing cancer have found that this is also true for this population. Thus, a psychotherapeutic program for persons diagnosed with cancer might be more efficacious if it integrated spiritual issues and resources. This paper describes a treatment program oriented towards this goal and presents rationales for the interventions that are included in the therapy process. The program addresses the four existential concerns listed above, in ways that integrate spiritual issues and assist participants in drawing on spiritual resources. An outcome study is currently underway to evaluate the effectiveness of this intervention. Ten participants have participated, results are promising, and will be published when data collection is completed.

Adult↗
PubMed2006

Effects of spiritual mantram repetition on HIV outcomes: a randomized controlled trial.

We examined the efficacy of a psycho-spiritual intervention of mantram repetition--a word or phrase with spiritual associations repeated silently throughout the day--on psychological distress (intrusive thoughts, stress, anxiety, anger, depression), quality of life enjoyment and satisfaction, and existential spiritual well-being in HIV-infected adults. Using a 2-group by 4-time repeated measures design, 93 participants were randomly assigned to mantram (n = 46) or attention control group (n = 47). Over time, the mantram group improved significantly more than the control group in reducing trait-anger and increasing spiritual faith and spiritual connectedness. Actual mantram practice measured by wrist counters was inversely associated with non-HIV related intrusive thoughts and positively associated with quality of life, total existential spiritual well-being, meaning/peace, and spiritual faith. Intent-to-treat findings suggest that a mantram group intervention and actual mantram practice each make unique contributions for managing psychological distress and enhancing existential spiritual well-being in adults living with HIV/AIDS.

Adaptation, Psychological↗
PubMed2005

Interface problems: structural constraints on interpretation?

Five experiments investigated the interpretation of quantified noun phrases in relation to discourse structure. They demonstrated, using questionnaire and on-line reading techniques, that readers in English prefer to give a quantified noun phrase in (VP-external) subject position a presuppositional interpretation, in which the noun phrase limits or restricts the interpretation of an already available set, rather than giving it a nonpresuppositional or existential interpretation, in which it introduces completely new entities into the discourse. Experiment 1 showed that readers prefer a presuppositional interpretation of three ships over the existential interpretation in Five ships appeared on the horizon. Three ships sank. Experiment 2 showed longer reading times in sentences that are disambiguated toward the existential interpretation than in sentences that permit the presuppositional interpretation. Experiment 3 suggested that the presuppositional preference is greater when the phrase three ships occurs outside the verb phrase than when it occurs inside the verb phrase. Experiment 4 showed that Korean subjects marked with a topic marker received more presuppositional interpretations than subjects marked with a nominative marker. Experiment 5 showed that German subjects in VP-external (but nontopic) position received more presuppositional interpretations than VP-internal subjects. The results suggest the syntactic position of a phrase is one determinant of its interpretation, as expected according to the mapping hypothesis of Diesing (1992).

Eye Movements↗
PubMed1994

Elderly patients' experiences of pain and distress in intensive care: a grounded theory study.

The aim of the present study was to develop a theoretical understanding of elderly patients' experiences of pain and distress in intensive care, using a grounded theory approach. 18 patients, 7 women and 11 men, were interviewed and observed in an intensive care unit (ICU). Their average age was 76.5, varying from 70-85. A model was generated from data, according to which elderly patients' experiences of pain and distress in intensive care can be described as four interrelated aspects: a sensory, an intellectual, an emotional, and an existential dimension. 16 categories form the four dimensions. The categories, in turn, are grounded in a number of interview and observational data. The sensory dimension is formed by the categories physical pain, physical discomfort, fatigue, and breathing problems, and the intellectual dimension by the categories not knowing, difficulty in expressing oneself/not being understood and confused perception of reality. The categories in the emotional dimension are worry, fear, resignation, bitterness, anger/irritation and dependency. Finally, the existential dimension is formed by the categories despair, threat to life and death acceptance. The categories within the four dimensions may be separate, but often they interact and influence each other in various ways. The model is discussed in relation to existing models and definitions of pain, where the intellectual and existential dimensions in particular have not been emphasized in a similar way.

Aged↗
PubMed2005

Changes in medical and nursing care in cancer patients transferred from a palliative care team to a palliative care unit.

The primary aim of this study was to explore the changes in medical/nursing care in patients who transferred from a palliative care team (PCT) to a palliative care unit (PCU) in the same hospital, and to explore the reasons why new or modified interventions were required. This was a retrospective study of 50 consecutive patients who were transferred from PCT to PCU in a 750-bed general hospital. A trained nurse performed a chart review and recorded the changes in 1) medical/nursing care, 2) help with decision-making within 48 hours after PCU admission, and 3) documentation of family and psycho-existential care. Group discussions among PCT and PCU staff members explored the potential reasons for the changes. Five patients were excluded due to admission periods of shorter than 48 hours. The number of new/modified medical and nursing care interventions after PCU admission averaged 1.9 +/- 1.5 and 1.5 +/- 1.3 per patient, respectively. The most common medical treatments were: reduction in hydration volume, dose titration of opioids, change in opioid administration device, opioid rotation, and addition of NSAIDs and steroids. The most common nursing interventions were: allowing patient to take a bath, changing mattress, use of massage, and discontinuation of bronchial suctioning. In addition, PCU staff newly coordinated opportunities to discuss preferred end-of-life care with primary caregivers in 38% of the cases, family members other than primary caregivers in 16%, and patients in 6.7%. The chart documentation of family care and psycho-existential care increased considerably after PCU admission. The chief reasons for these changes were: under-recognition of the problems and unavailability of treatments (pharmacological treatments), no intention to intervene and recommendations not followed by primary physicians (rehydration therapy), no intention to intervene (nursing care), and no intention to intervene and under-recognition of the problems (help with decision-making). These data demonstrate that many patients under PCT consultation receive new or modified interventions after PCU admission. Potentially useful strategies to strengthen the PCT interventions are: modification of intervention structure to minimize under-recognition of symptoms and decision making problems (e.g., use of standardized assessment tools, regular conferences), changes in the health care system to allow unlicensed drugs, clinical studies to clarify the benefits of artificial hydration therapy, and greater efforts to intervene in the areas of nursing care, help with decision making, family care, and psycho-existential care.

Aged↗
PubMed2003

Actualizing Gadow's moral framework for nursing through research.

The purpose of this paper is to describe how Sally Gadow's perspectives on existential advocacy as the moral framework for the nurse-patient relationship were synthesized with a general theory of motivation, self-determination theory (SDT), to inform the design of a study in which the influence of interpersonal care on the process of tobacco dependence treatment was explored. Consistent with the tenets of existential advocacy, participants who perceived their care providers as interpersonally sensitive and bringing more of their whole selves to the care encounter reported more autonomous motivation and felt competence for stopping smoking. The integration of existential advocacy with SDT, which led to the empirical work in which Gadow's ideas were actualized and her model supported, is described. Study findings are discussed in light of Gadow's philosophical views, and implications for nursing highlighted.

Humans↗
PubMed2004

Major stressors facing patients with amyotrophic lateral sclerosis (ALS): a survey to identify their concerns and to compare with those of their caregivers.

OBJECTIVE: To identify and compare the primary existential, physical, and psychosocial stressors affecting patients with ALS and their caregivers. Health care providers, together with patients and their caregivers, are challenged to identify both physical and psychosocial concerns that have the greatest impact on quality of life over the course of a serious illness. It is also helpful to understand the priorities of these concerns from the patients' and caregivers' perspectives so that we can render optimal care and help patients and their families with the myriad problems that accompany a progressive and fatal disease. METHODS: We analyzed responses from the first 66 patients with ALS and 61 ALS caregivers who attended the Baylor College of Medicine, Department of Neurology, Vicki Appel MDA ALS Clinic and who completed our internally generated 19-item survey. Subjects were asked to choose their three most important concerns. For analysis purposes we categorized the data into three domains: existential, physical, and psychosocial. Demographic data were collected. The Appel ALS Rating Scale (AALS) was used to measure disease symptom severity. RESULTS: Sixty-six patients (45 men, 21 women) with a mean age of 57.9 (range 30-82) years and 61 caregivers completed the checklist. At the time the patients completed the survey, their mean AALS total score was 77.0 (range 34-132), indicating mild to moderate disability. The most important stressors identified by patients and caregivers were existential concerns (86.4% of patients and 79.7% of caregivers) and physical stressors (80.3% of patients and 76.3% of caregivers). Less than 50% of both groups endorsed psychosocial stressors (38%). However, when we analyzed the domain specific items, there was a significant difference between patients and caregivers on worries about the patient's dependency (37.9% of patients and 6.8% of caregivers). DISCUSSION: Health care professionals should apply a holistic approach to treatment and care of patients with ALS. Families should be included in the process, and it should not be assumed that patients and caregivers will agree on all issues. Future research should focus on therapeutic interventions to help ALS patients and their families cope with the multiple stressors accompanying a catastrophic illness.

Adaptation, Psychological↗
PubMed2006

Religious coping is associated with the quality of life of patients with advanced cancer.

BACKGROUND: For patients confronting a life-threatening illness such as advanced cancer, religious coping can be an important factor influencing their quality of life (QOL). OBJECTIVE: The study's main purpose was to examine the association between religious coping and QOL among 170 patients with advanced cancer. Both positive religious coping (e.g., benevolent religious appraisals) and negative religious coping (e.g., anger at God) and multiple dimensions of QOL (physical, physical symptom, psychological, existential, and support) were studied. DESIGN: Structured interviews were conducted with 170 patients recruited as part of an ongoing multi-institutional longitudinal evaluation of the prevalence of mental illness and patterns of mental health service utilization in advanced cancer patients and their primary informal caregivers. MEASUREMENTS: Patients completed measures of QOL (McGill QOL questionnaire), religious coping (Brief Measure of Religious Coping [RCOPE] and Multidimensional Measure of Religion/ Spirituality), self-efficacy (General Self-Efficacy Scale), and sociodemographic variables. RESULTS: Linear regression analyses revealed that after controlling for sociodemographic variables, lifetime history of depression and self-efficacy, greater use of positive religious coping was associated with better overall QOL as well as higher scores on the existential and support QOL dimensions. Greater use of positive religious coping was also related to more physical symptoms. In contrast, greater use of negative religious coping was related to poorer overall QOL and lower scores on the existential and psychological QOL dimensions. CONCLUSIONS: Findings show that religious coping plays an important role for the QOL of patients and the types of religious coping strategies used are related to better or poorer QOL.

Adaptation, Psychological↗
PubMed1996

Quality of life in HIV disease as measured by the McGill quality of life questionnaire.

OBJECTIVE: To test the acceptability, validity, and internal consistency reliability of the McGill quality of life questionnaire (MQOL) for persons living with HIV/AIDS. DESIGN: The validity of MQOL was tested by having HIV-seropositive outpatients complete the 16-item MQOL, a single-item scale (SIS) measuring overall quality of life (QOL), and a physical symptom questionnaire. METHODS: Factor analysis was used as a guide for construction of MQOL subscales. Validity was studied by determining the correlation between MQOL and SIS, and between MQOL physical measures, CD4 counts and the physical symptoms questionnaire. Multiple regression was employed to determine how best to combine MQOL subscales to predict SIS. RESULTS: MQOL was acceptable to this patient population. Factor analysis suggests that MQOL can be represented by live measures: a single item measuring physical well-being and four subscales representing physical symptoms, psychological symptoms, existential well-being, and support. Multiple regression analyses suggest that the existential domain contributes greatly to QOL for people with advanced HIV disease (CD4 counts < 100 x 10(6)/l). CONCLUSION: MQOL is an acceptable and valid measure of QOL for people living with HIV/AIDS, with meaningful and reliable subscales as well as a summary score. The inclusion of a measure of existential well-being in MQOL may make it a more valid measure of QOL, especially for people with advanced disease, than QOL instruments which do not include this domain.

Adult↗
PubMed2005

Inverse correlations between symptom scores and spiritual well-being among African American patients with first-episode schizophrenia spectrum disorders.

Spirituality, religiosity, and spiritual/religious well-being are relatively understudied in the context of severe mental illnesses. Nonetheless, individuals dealing with such disorders, including schizophrenia, often make use of spirituality and religious affiliation as coping resources. In this preliminary study, we examined correlations between psychopathology severity and spiritual well-being among first-episode schizophrenia-spectrum disorder patients. The sample consisted of 18 African American patients hospitalized on an inpatient psychiatric unit in a large, urban, public hospital. After confirmation of diagnosis with the Structured Clinical Interview for DSM-IV Axis I Disorders, symptom severity was rated with the Positive and Negative Syndrome Scale, and self-reported spiritual well-being was evaluated with the Spiritual Well-Being Scale. Spearman correlations revealed that negative symptom scores were inversely correlated with religious well-being scores (rho = -.614; p = 0.007), and that general psychopathology symptom scores were inversely correlated with existential well-being scores (rho = -.539; p = 0.021). These preliminary findings indicate that negative symptoms and general psychopathology symptoms may have a detrimental effect on religious and existential well-being in patients with a first episode of a schizophrenia-spectrum disorder, or that religious and existential well-being may have an effect on symptomatology.

Adolescent↗
PubMed2004

Clinical holistic medicine: a psychological theory of dependency to improve quality of life.

In this paper, we suggest a psychological theory of dependency as an escape from feeling existential suffering and a poor quality of life. The ways in which human beings escape hidden existential pains are multiple. The wide range of dependency states seems to be the most common escape strategy used. If the patient can be guided into the hidden existential pain to feel, understand, and integrate it, we believe that dependency can be cured. The problem is that the patient must be highly motivated, sufficiently resourceful, and supported to want such a treatment that is inherently painful. Often, the family and surrounding world is suffering more than the dependent person himself, because the pattern of behavior the patient is dependent on makes him or her rather insensitive and unable to feel. If the patient is motivated, resourceful, and trusts his physician, recovery from even a severe state of dependency is not out of reach, if the holistic medical tools are applied wisely. The patient must find hidden resources to take action, then in therapy confront and feel old emotional pain, understand the source and inner logic of it, and finally learn to let go of negative attitudes and beliefs. In this way, the person can be healed and released of the emotional suffering and no longer be a slave to the dependency pattern.

Adult↗
PubMed2005

Clinical holistic medicine: holistic rehabilitation.

Quality of life, health, and ability are often lost at the same time and most often in one decaying existential movement over 5 or 10 years. This "loss of life" is mostly too slow to be felt as life threatening, but once awakened to reality, it provokes the deepest of fears in patients: the fear of death itself and destruction of our mere existence. The horrible experience of having "lost life", often without even noticing how it happened, can be turned into a strong motivation for improvement. Personal development is about finding the life deeply hidden within in order to induce revitalization and rehabilitation. Rehabilitation is about philosophy of life with the integration of the repressed painful feelings and emotions from the past and the letting go of the associated negative beliefs and decisions. The holistic medical toolbox builds on existential theories (the quality of life theories, the life mission theory, the theory of character, the theory of talent, and the holistic process theory) and seems to have the power to rehabilitate the purpose of life, the character of the person, and fundamental existential dimensions of man: (1) love; (2) strength of mind, feelings, and body; and 3) joy, gender, and sexuality; allowing the person once again to express and realize his talents and full potential. The principles of rehabilitation are not very different from other healing, but the task is often more demanding for the holistic physician as the motivation and resources often are very low and the treatment can take many years.

Adult↗
PubMedDate not supplied

Understanding the will to live in patients nearing death.

This study examined concurrent influences on the will to live in 189 patients with end-stage cancer The authors found significant correlations between the will to live and existential, psychological, social, and, to a lesser degree, physical sources of distress. Existential variables proved to have the most influence, with hopelessness, burden to others, and dignity entering into the final model. Health care providers must learn to appreciate the importance of existential issues and their ability to influence the will to live among patients nearing death.

Activities of Daily Living↗
PubMedDate not supplied

Brief psychotherapy at the bedside: countering demoralization from medical illness.

Bedside psychotherapy with medically ill patients can help counter their demoralization, which is the despair, helplessness, and sense of isolation that many patients experience when affected by illness and its treatments. Demoralization can be usefully regarded as the compilation of different existential postures that position a patient to withdraw from the challenges of illness. A fruitful interviewing strategy is to discern which existential themes are of most concern, then to tailor questions and interventions to address those specific themes. Illustrative cases show how such focused interviewing can help patients cope assertively by mobilizing existential postures of resilience, such as hope, agency, and communion with others.

Chronic Disease↗
PubMed2004

An integrated approach to the formulation and psychotherapy of medically unexplained symptoms: meaning- and attachment-based intervention.

Persistent medically unexplained symptoms (MUS) are a serious problem because they are common, difficult to treat effectively, and have a significant impact on both functional outcomes and health-care utilization costs. An attachment-existential formulation of psychological factors that are associated with persistent MUS is presented, based on the interaction of death anxiety and preoccupied (anxious) attachment. Psychotherapeutic treatment recommendations that follow from this formulation are described in the form of a brief psychotherapy, involving semi-structured weekly sessions and narrative-writing homework that explores attachment and existential themes. This is the first description of a brief psychotherapy that integrates attachment theory and existential psychology.

Delivery of Health Care, Integrated↗