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PubMed2003

[Relationship between spiritual well-being and minor psychiatric disorders: a cross-sectional study].

OBJECTIVE: To assess the influence of spiritual well-being in mental health of college students. METHODS: It was interviewed 464 medical and law students of Pelotas, Brazil. Data collection was carried out in groups in the school classroom, 43 absent students were not interviewed and represented a loss of 9.3% of the sample. It was used a self-reported questionnaire with three instruments: 1) Spiritual Well-Being Scale (SWBS), 2) SRQ-20, and 3) a precoded questionnaire with questions on sociodemographic data, religious/spiritual practices, and stressful life events. Statistical analysis was performed using Chi-square test and logistic regression. RESULTS: Most of the students (80%) declared that they had a spiritual belief and/or religious denomination. The mean score of spiritual well-being was 90.4 with scores 45.6 and 45.1 in the existential and religious subscales, respectively. SWBS showed an association with religious practices, but it was not influenced by sociodemographic and cultural variables. Subjects presenting low and moderate spiritual well-being showed a doubled risk of presenting minor psychiatric disorders (MPD) (OR=0.42; 95%CI: 0.22-0.85). Subjects presenting low or moderate existential well-being showed almost five times more MPD (OR=0.19; 95%CI: 0.08-0.45). CONCLUSIONS: The study reveals spiritual well-being as a protection factor for minor psychiatric disorders, and that the results were mostly due to the Existential Well-Being subscale.

Adult↗
PubMed2005

[Hospital sepsis and pre-existing disease].

AIM: By retrospective study in a fifteen period from 1990 to 2004 to research if a pre-existential disease influences the appearance of gram-positive and gram-negative clear determinated hospital sepsis among 200 septic patients, selected by a random method and with clinic-laboratory signs of sepsis and monomicrobial blood culture. METHODOLOGY: Specimen of septic patients analysed in relation to the patient condition and statistically processed using chi2 test and contigential coefficient C. RESULTS: We received statistically significant results when we have correlated gram-negative hospital sepsis and pre-existential disease, until this significancy was absent in gram-positive hospital sepsis. CONCLUSION: Pre-existential disease can indicate sepsis, the place of acquisition and etiology.

Comorbidity↗
PubMed2000

Anagogy of autonomy.

The philosophical and ethical concept of autonomy is herein examined, ex post facto, using an existential lens to examine the process of a personal friend's dying. Anagogy, defined as interpretation of a word, passage, or text that finds beyond the literal, allegorical, and moral senses a fourth and ultimate spiritual or mystical sense, is intended to enlarge the understanding of the use of autonomy in this case. The idea of personhood linked inextricably to reason is, therefore, understood as empowering an individual to choose among various actions, to define and redefine life goals, and to give priority to selected values and moral tenants, which reveal a moral hermeneutic. Conditions and circumstances, existentially exposed, limit choice in unexpected ways, such that the predicted value of autonomy is vulnerable to misuse or misunderstanding. The intent to respect the dignity of every person is central to the philosophy of Respect for Persons ethics, and assumes that autonomy, as freedom of the moral agent, is a moral duty. Implicit reality of freedom is, in a practical sense, essential to being rational agents who can thereby exercise informed choice. The moral law, law of freedom, involves the autonomy of the will and an ultimate end to which all action is directed. Defined as the highest good, morality unites virtue and happiness by ascribing the ultimate end sought as God. The freedom to use rational will finds principles within its own rational nature. The ability to create maxims is autonomy of the will, which equates with the dignity of persons. My recent experience as a companion to a personal friend with a terminal illness inspired me to re-evaluate the concept of autonomy as it is too often interpreted in modern ethical discourse as a individualistic right of choice as opposed to the hermeneutic of dignity of person. This paper describes a shift of position in understanding the paradox of autonomy in this existential context.

Advance Directives↗
PubMed1991

Areas of concern and sources of advice for Israeli adolescents.

This study explored the concerns of Israeli adolescents, who grow up in a socially, politically, and economically highly stressed environment. Ninth- and eleventh-grade students (N = 1,645) completed a questionnaire in which they indicated three important problems they had recently experienced. Content analysis identified six major categories of concerns (listed in descending order of occurrence): studies and career, social "I," personal "I," existential issues, army or national service, and health and drugs. Younger adolescents were found to be more concerned with problems involving studies and career and with issues pertaining to the social "I"; older adolescents were more concerned with existential issues and army or national service. Boys were more concerned with existential issues, army or national service, studies and career, and the social "I." Girls were more concerned with issues pertaining to the personal "I." Three major sources of advice were identified: friends, parents, and brothers/sisters.

Achievement↗
PubMed1989

Defending and coping in psychically disturbed adolescents. I. Theory, results of factor analysis.

More recent contributions of a sociologically, development-psychologically or also characterologically orientated psychoanalysis stress the significance of defence and coping mechanisms for psychopathology in childhood and adolescence. Cognitive development psychology and interactional psychopathology point in a similar direction. An empirical analysis of 1008 child and adolescent psychiatric patients went into the question of the relative importance of these dimensions of defence and coping for the diagnosis of these patients. Alongside behaviour disorders and psychopathological symptoms also formal personality attributes, existential themes and existential techniques were recorded. The data was factor analytically reduced. Particularly informative in the existential techniques was a comparison between a factor of coping and several defence factors. The factor analysis of second order confirmed the expectation, according to which a close association of coping and expansion/restriction as a dimension of life world resulted on the one hand and a connection between psychopathology and defence dimensions on the other hand. As a total result, a confirmation of the significance of dimensions of defence and coping for a psychopathology in childhood and adolescence can be recognized. Self strength, lacking impulse control, evasive fear resistance, physical symptoms and signs, narcissistic resistance, fear of achievement, foregoing and misled autonomy present, on a factoral level, a crossing of psychopathology and dimensions of defence and coping and thus an enrichment of psychopathological diagnosis in childhood and adolescence.

Adaptation, Psychological↗
PubMed1987

[Affective ambivalence of the psychosomatic patient].

Ambivalence is conceived as a condition of an internal contradiction between an emotional verification of self-feeling, and the imaginative action-ability in respect to an existential life performance, if by the a priori of temporality no adequate actionability in terms of imaginations, and no adequate assertion of an unreflected self-feeling as an emotional quality of self-awareness is simultaneously available. Four cases will illustrate that in psychosomatic patients a as if actionability, e.g. as a mere over-adaptation following life-events of significant others, is predominantly given replacing a self-conform action-ability, and that the assertion of self-feeling is preponderantly fixed to the somatic phenomena. Thus the historical life-performance remains arrested by the predominance of unachieved affective moments in the condition of an affective ambivalence, though psychosomatic patients are well aware enough of the existential necessity to arrange temporality as an existential quality of the futural aspects of their life-performance.

Adaptation, Psychological↗
PubMed1983

A re-conceptualization of Erikson's identity stage.

This brief theoretical paper argues that Erikson's concept of identity was originally proposed as something constructed to a significant degree by the individual, i.e., an Instrumental Identity. With the decline in instrumentality in a consumer/service-oriented society, Erikson's original concept fits less well. A new conceptualization of identity, that of Existential Identity, is proposed. Thus, the earlier issue of success versus failure at achieving an Instrumental Identity has begun to give way to a new dimension--of being either a victim or a beneficiary in seeking an Existential Identity. Alternatively, the stage of "adolescence" can be viewed as a stage of seeking Instrumental Identity, and Keniston's new stage of "youth" as the locus of the new Existential Identity.

Achievement↗
PubMed1998

[The human language of medicine. Physical expression of empathy added to diagnosis promotes understanding].

The article consists in a review of the clinical encounter in terms of existential anatomy and bodily empathy. Making a diagnosis and understanding the patient are not seen as discrete, mutually exclusive endeavours. In addition to relying on their biomedical expertise, doctors need to be attuned to their patients' symptom presentations as living, experiential expressions of the body, existential anatomy. By 'sharing' his patients' basic bodily conditions, the doctor accumulates abundant knowledge throughout his professional life. Diagnosis is preceded, and its accuracy enhanced, by grasping the experiential essence of the patient's symptomatology. The doctor's ability to communicate with the patient within the realm of existential anatomy is what is referred to as bodily empathy. It is proposed that satisfactory management is dependent on interplay between diagnostic expertise and bodily empathy.

Communication↗
PubMed1979

Communication and abnormal behaviour.

In this paper the similarities between normal and abnormal behaviour are emphasized and selected aspects of communication, normal and aberrant, between persons are explored. Communication in a social system may be verbal or non-verbal: one person's actions cause a response in another person. This response may be cognitive, behavioural or physiological. Communication may be approached through the individual, the social situation or social interaction. Psychoanalysis approaches the individual in terms of the coded communications of psychoneurotic symptoms or psychotic behaviour; the humanist-existential approach is concerned more with emotional expression. Both approaches emphasize the development of individual identity. The interaction between persons and their social background is stressed. Relevant are sociological concepts such as illness behaviour, stigma, labelling, institutionalization and compliance. Two approaches to social interactions are considered: the gamesplaying metaphor, e.g. back pain as a psychosocial manipulation--the 'pain game'; and the 'spiral of reciprocal perspectives' which emphasizes the interactional complexities of social perceptions. Communicatory aspects of psychological treatments are noted: learning a particular metaphor such as 'resolution' of the problem (psychotherapy), learning more 'rewarding' behaviour (learning theory) or learning authenticity or self-actualization (humanist-existential).

Communication↗
PubMed1987

Psychological and spiritual well-being in college students.

Two separate correlational studies were conducted to investigate the relationship between spirituality and psychological mood states in response to life change. In the first study a spiritual well-being index, a spiritual-maturity scale, a life-change index, and a depression scale were administered to 95 freshman nursing students. The spiritual well-being index was composed of two sub-scales; a religious well-being and an existential well-being scale. In the second study a spiritual-outlook scale and the Profile of Mood State index was added to the above tests and administered to 75 randomly selected college students. The results demonstrated a weak positive relationship between life change and depression. unlike a previous study, spiritual well-being, existential well-being, and spiritual outlook showed strong inverse relationships with negative moods suggesting that spiritual variables may influence psychological well-being.

Adolescent↗
PubMed1997

Shattered assumptions: time and the experience of long-term HIV positivity.

This paper elucidates one of the main existential problems faced by people living with an HIV positive diagnosis-the disruption in their routine orientation towards time and the way in which this has the capacity to affect their lives more generally. Drawing upon research with people who have been living with an HIV positive diagnosis for at least five years, the paper aims to illuminate the "provisional existence" imposed upon the individual by the diagnosis and suggests that this ambiguous position underpins the many psychological and social problems confronted by them. In addition, however, the paper argues that in order for the individual to adjust effectively to living with an HIV positive diagnosis, it is necessary for him/her to develop alternative ways of conceiving and living within time, which "compensates" for the loss of the temporal assumptions that existed prior to diagnosis. The various ways in which individuals manage to do this are documented in this paper, as is the failure to do so and the psychosocial consequences ensuing from this. It is further argued that the ability to achieve compensatory temporal understanding is related to the individual's more general "existential orientational framework", of which temporal perspective is a constituent component. Finally, the implications of such findings are discussed for the targeting of appropriate intervention strategies.

Adult↗
PubMed2006

The folk psychology of souls.

The present article examines how people's belief in an afterlife, as well as closely related supernatural beliefs, may open an empirical backdoor to our understanding of the evolution of human social cognition. Recent findings and logic from the cognitive sciences contribute to a novel theory of existential psychology, one that is grounded in the tenets of Darwinian natural selection. Many of the predominant questions of existential psychology strike at the heart of cognitive science. They involve: causal attribution (why is mortal behavior represented as being causally related to one's afterlife? how are dead agents envisaged as communicating messages to the living?), moral judgment (why are certain social behaviors, i.e., transgressions, believed to have ultimate repercussions after death or to reap the punishment of disgruntled ancestors?), theory of mind (how can we know what it is "like" to be dead? what social-cognitive strategies do people use to reason about the minds of the dead?), concept acquisition (how does a common-sense dualism interact with a formalized socio-religious indoctrination in childhood? how are supernatural properties of the dead conceptualized by young minds?), and teleological reasoning (why do people so often see their lives as being designed for a purpose that must be accomplished before they perish? how do various life events affect people's interpretation of this purpose?), among others. The central thesis of the present article is that an organized cognitive "system" dedicated to forming illusory representations of (1) psychological immortality, (2) the intelligent design of the self, and (3) the symbolic meaning of natural events evolved in response to the unique selective pressures of the human social environment.

Attitude to Death↗
PubMed2006

Seeing I to I: a pathway to interpersonal connectedness.

The authors introduce the construct of I-sharing--the belief that one shares an identical subjective experience with another person--and the role it plays in liking. In Studies 1-3, participants indicated their liking for an objectively similar and an objectively dissimilar person, one of whom I-shared with them and the other of whom did not. Participants preferred the objectively similar person but only when that person I-shared with them. Studies 4 and 5 highlight the role that feelings of existential isolation and the need for closeness play in people's attraction to I-sharers. In Study 4, people with high needs for interpersonal closeness responded to I-sharers and non-I-sharers with great intensity. In Study 5, priming participants with feelings of existential isolation increased their liking for I-sharers over objectively similar others. The results highlight the importance of shared subjective experience and have implications for interpersonal and intergroup processes.

Adolescent↗
PubMed2003

Meaning out of chaos: a way to understand chronic pain.

Pain is a multidimensional phenomenon lying at the intersection between biology and culture. The modern understanding of pain takes into account emotional, psychological, socio-political and existential aspects of pain as well as physiological, anatomical factors. Our aim in this study was to deepen the understanding of psychosocial, existential aspects of pain and to discuss how clinicians can better understand and treat patients with chronic pain. A focus group was formed consisting of a researcher and a group of clinicians (n = 3) with various backgrounds working at a specialized pain clinic. The group met once a month during a 6-month period. Questions concerning the life-world of the pain patient as well as inquiries into the conditions for 'the good clinical encounter' were investigated. The results of this study consist of a systematization of the data (focus group meetings) collected and analysed in a collaborative effort between the researcher and group participants. The findings are presented in terms of themes. The main metaphor used to describe the path from the seeking of medical help to successful rehabilitation was order out of chaos. Ordering chaos was a process moving from diagnosis through a phase of heightened self-awareness towards responsibility-taking on the part of the patient. Related themes presented, illustrated and discussed in the paper concern problems of linkage, the role of flexibility and creativity in the healing process and the kind of clinical encounter conducive for the journey from chaos to the creation of new meaning.

Activities of Daily Living↗
PubMed2002

Reflections on the humanities in medical education.

BACKGROUND: In recognition of the views advanced by the philosopher Maurice Merleau-Ponty, this paper considers some of the implications for medical practice and, hence, medical education, of recognizing the human body as an 'intertwining' of the natural (or physical) and the existential (or experiential) - something which is taken for granted in ordinary experience, but which becomes the medium through which disease can manifest itself in illness and disability. Our condition is the condition of creatures of frail flesh. Perhaps because this 'intertwining' is taken for granted, we tend to overlook the extent to which it is metaphysically astounding, even though it constitutes the daily arena and phenomena of clinical medicine. Clinical medicine is, among other things, the routine intervention in this intertwining. This fact is largely discounted by biomedical science, which concentrates on 'the natural' at the expense of neglecting 'the existential'. Such neglect arguably underlies the perceived deficiencies in medical education that the GMC sought to redress in its landmark document Tomorrow's Doctors. PROPOSAL: If the humanities disciplines concern themselves with recording and interpreting human experiences, the 'medical humanities' do so for the human experiences of illness, disability and medical intervention. This paper argues for an integrated conception of the medical humanities, and for their incorporation into the core medical curriculum. The paper concludes by outlining a proposed core module in medical humanities, based around a syllabus divided not into the characteristic enquiries of constituent disciplines, but rather into groups of topics relating to key philosophical questions prompted by the 'intertwining' in embodied human nature.

Clinical Competence↗
PubMed2002

Questions posed to hospital chaplains by palliative care patients.

CONTEXT: Questions of vital importance are actualized when facing one's own death. Studies on patient need for a hospital chaplaincy as an integral part of hospital care are lacking. OBJECTIVE: To categorize the three most important questions patients pose to hospital chaplains at the end of life and to assess the degree to which hospital staff should be able to handle them. DESIGN AND SETTING: A Swedish national survey using an open-ended questionnaire and content analysis. PARTICIPANTS: One hundred seventy-two Swedish hospital chaplains (national coverage, 74% response rate). Categories developed from open-ended questions. Categories of questions posed to hospital chaplains. RESULTS: Five main categories were identified: meaning (34%); death and dying (21%); pain and illness (13%); relationships (15%); and religious issues (8%). Questions of a general existential nature concerned with meaning-related issues and with death and dying were frequently the primary issue. Many questions dealt with pain, fear of suffocation, and illness in general (i.e., questions that the palliative team should be able to handle). Only 8% of the issues were explicitly religious and these were often third-hand choices. CONCLUSION: The role of the hospital chaplaincy has changed. Today it entails specialized competence and is needed in existential discussions with different patients in crisis, regardless of their personal faith or lack of faith. Nonetheless, physicians and other staff members should be able to handle many of the questions that are of a more general/medical character.

Adaptation, Psychological↗
PubMed2006

Humanistic principles in relation to psychiatric nurse education: a review of the literature.

This paper addresses the topic of humanistic educative principles and examines it in the context of Irish psychiatric nurse education. Humanistic or existential philosophy influences the nursing curriculum profoundly, and yet a dichotomy continues to exist in relation to the epistemological basis informing nurse education. The dichotomy is manifested broadly in relation to the notion of individual choice and statutory responsibility as regulated professional governing bodies. Humanism is based on the notion that people are born 'blank slates' only to become who they are later. McKenna would describe the humanistic theory of learning as emphasizing feelings and experiences, leading to self-awareness, personal growth and individual optimization. A review of the literature indicates there are very few empirical studies relating to the area of the humanistic principles as applied to psychiatric nurse education. Most of the literature that was initially located referred to humanistic existentialism in the field of psychology, which although provided interesting reading and relevant, to a point, did not apply specifically to psychiatric nursing education. The emphasis of this paper is psychiatric nursing education and these studies do not apply to the area under investigation.

Attitude of Health Personnel↗
PubMed1995

The inner ache: an experiential perspective on loneliness.

This paper examines the various theoretical approaches that have informed both the conceptualizations and the research approaches to investigations of loneliness. A focus on phenomenological and existential perspectives of loneliness can assist in an understanding of what is essentially a subjective distressing experience. The elderly, particularly those residing in nursing homes, are vulnerable to feelings of existential loneliness because following busy lives, often they are left without meaningful roles. Concomitant to this sense of loss of meaning is an alteration in the perception of lived time. It is the purpose of this paper to stimulate research into what is a common but profoundly distressing experience.

Aged↗