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The initial encounter: what to do first?

The first interview presents dilemmas to the psychiatric practitioner. Is he or she to concentrate in objective-descriptive fashion, observing symptoms and signs, seeking the likely syndrome or disease concept? Is he or she to work associatively, toward unconscious themes as developed by the psychoanalytic schools? Would an existential approach be best, an attempt to understand the patient's life purposes and difficulties empathically? Alternatively, should the therapist grasp the patient's situation in interpersonal terms? The authors suggest that these decisions are less central than the need to establish a working relationship in order to continue the investigation or treatment and to uncover as much as possible of the relevant data, and that the newer schools of existential and interpersonal psychiatry offer the critical keys to achieving this.

Adult↗

Beyond eclecticism.

Biopsychosocial eclecticism is incomplete because it does not address the important issues of differential causation and treatment staging. Psychiatric serialism goes beyond eclecticism to consider biological, psychosocial, and existential-moral parameters as equipotential and hierarchical. What this means in practice is that, after forming a treatment alliance, the therapist must always assess the evidence for a biological substrate of disorder and, where feasible, administer the appropriate biological treatments. On a stable biological platform, psychosocial interventions can then be utilized to promote the goals of lieben and arbeiten, and an existential therapy relationship can be forged to promote personal integrity.

Existentialism↗

Relationships of age and gender to hope and spiritual well-being among adolescents with cancer.

The purpose of this study was to examine hope and spiritual well-being, with its 2 dimensions of religious well-being and existential well-being, as they relate to age and gender among adolescents with cancer. A cross-sectional design was guided by the conceptual framework, Adolescent Psychosocial Adaptation to the Cancer Experience. A total of 78 adolescents with a diagnosis of cancer were enrolled from 2 pediatric oncology clinics. Middle adolescents (15-17 years of age) reported higher religious well-being than late adolescents (18-20 years of age). Middle-adolescent boys were more hopeful than were early adolescent boys (13- 14 years of age). Also, girls were more hopeful and reported higher spiritual well-being than age the boys. Developmental phase and/or gender may influence adolescents' levels of hope, spiritual well-being, religious well-being, and existential well-being as they cope during the cancer experience. The nurse should consider developmental phase and gender when planning interventions to foster hope and spiritual well-being in adolescents' adaptations to the cancer experience.

Adaptation, Psychological↗

Uncertainty, spiritual well-being, and psychosocial adjustment to chronic illness.

This research was undertaken to assess spiritual well-being as an internal coping resource to buffer the effects of uncertainty on psychosocial adjustment among 94 persons with diabetes mellitus. Five instruments were used to collect data; descriptive, correlational, multivariate, and content analysis procedures were used for data analysis. A predicted negative relationship between uncertainty and spiritual well-being was supported, with a stronger relationship between the existential well-being component of spiritual well-being and uncertainty than the religious well-being component. Uncertainty explained 43% of the variance in psychosocial well-being; existential well-being added an additional 10%, suggesting that it serves as a buffer between uncertainty and psychosocial well-being. The findings suggest that spiritual well-being may be an important internal resource for persons forced to adjust to uncertainty related to long-term health problems such as diabetes mellitus.

Adaptation, Psychological↗

Reactions to 9/11 as a function of terror management and perspective taking.

The authors used terror management theory to investigate people's reactions to the terrorist attacks of 09/11/01. According to the theory, people have a primary need to eliminate or reduce existential terror in response to such horrific events as 9/11. The authors obtained people's reactions to 9/11, an event in which the threat to one's existence was more authentic than those of previous events that were imagined. The authors of the present study collected data two weeks after 9/11 from young adults on a large university campus in the U.S. Midwest. The authors asked participants about their proximal and distal reactions to 9/11 and their reasons or motives for those reactions. The results indicated that the vast majority of participants' proximal reactions to 9/11 were shock and/or disbelief, whereas their distal reactions included performing altruistic or prosocial behavior, searching for meaning or value in life, seeking or sharing information, spending time in talking to others, and making bigoted remarks about Arab Muslims. The main finding was that interpersonal communication is an important means of eliminating or reducing existential terror.

Adaptation, Psychological↗

Silence is not golden: conversations with the dying.

Conversations about dying involve interaction on multiple intellectual and emotional levels. The paradigm of clinicians as existential messengers is characterized by process and content and validated by the clinicians' ongoing presence. The necessary attributes that allow clinicians to function as existential messengers and communicate effectively with the dying include recognition of and confidence in one's own strengths, limits, and capabilities; clarity in one's personal understanding of living and dying; the ability to listen carefully and learn from the experience; the willingness to remain present in the face of profound anguish; and a strong belief in the worth of the work. In the process, personal biographies are amended permanently and clinicians are wiser for the experience.

Aged↗

[Body and existence].

The intention of this article is to introduce a complement to the natural science paradigm by giving medicine, especially general practice, a dimension of understanding inspired by existential philosophy. The presuppositions of natural science regarding human nature dividing body and soul, subject and object, are discussed and found insufficient for an understanding of what it means to be human. Case studies illustrate that for the patient, the meaning of symptom in existential terms has vast practical consequences for deciding treatment.

Body Image↗

The Demoralization Scale: a report of its development and preliminary validation.

The development and elaboration of a conceptualization of existential distress in patients with advanced disease is crucial in order to optimize our clinical response within palliative medicine. Demoralization is one expression of existential distress. Its empirical study will be greatly enhanced by a self-report measure that captures its dimensions and intensity. We report here on the development and testing of the Demoralization Scale in 100 patients with cancer. Factor analysis identified five relatively distinct dimensions: loss of meaning, dysphoria, disheartenment, helplessness, and sense of failure. These factors show high internal reliability, and convergent validity with the McGill Quality of Life Scale, Patient Health Questionnaire, Beck Depression Inventory, Beck Hopelessness Scale, Hunter Opinions and Personal Expectations Scale, and the Schedule of Attitudes toward Hastened Death. Its divergent validity is demonstrated through the differentiation of a subgroup of patients with high demoralization who do not meet DSM-IV categorization for a diagnosis of major depression. Confirmatory validation is needed for the scale to be used as a measure of change in interventions designed to treat demoralization.

Anger↗

[The will to meaning in dreams--the dream as the will to meaning].

As the literature on logo-therapy and existential analysis has not up to this day developed a dream theory and dream interpretation method of its own, this paper tries to suggest, on the basis of Frankl's books, some procedures for a dream interpretation method in existential analysis. The will to meaning and the meaning in dreams are, according to this view, but the two sides of the same coin.

Dreams↗

[Method of existence analytic psychotherapy].

Introducing questions of individual purpose and meaning into psychotherapy was an important contribution of Viktor Frankl and a necessary supplement to traditional psychotherapy. V. Frankls "Logotherapy" (logos = meaning) however has found its main application in counselling (especially bereavement and grief processes) and prophylactic endeavours (e.g. pedagogics). Suffering from meaninglessness, on the other hand, showed up to be a respectively rare indication for psychotherapeutic interventions in its proper sense. Thus the question was arising how to apply Frankl's valuable meaning-centered concept of man (which he called "Existential Analysis") in a genuine way to other neurosis and to personality disorders, so far "unspecific indications" to Logotherapy. This paper gives an outline and methodological foundation of "Existential Analysis Psychotherapy". A case study finally is illustrating its phenomenological proceeding.

Adult↗

Suicide in the literary work of Cesare Pavese.

On the basis of an existential analysis (Daseinanalyse), the authors consider the suicide, at age 42, of Cesare Pavese, one of the most important Italian poets and writers of the post-World War II period. It is found that in his poems, his novels, and particularly his letters and diary the idea of suicide was present in his consciousness since adolescence; year by year it is possible to follow the development of his ideas and fantasies about suicide. Incapable of establishing authentic communication with others, Pavese narrowed his existential horizon to the point of being less and less capable of living in the world and projecting himself into the future. From these considerations it is concluded that Pavese's acute feeling of incapacity caused him to have lasting experiences of failure that brought him to view suicide as the only way to free himself from his own torment.

Adjustment Disorders↗

[Reflections and perspectives on institutional therapy in neurotic depressions].

We have found that an institutional psychothérapy for neurosis could benefit by using elements of the work of Winnicott as well as of the bioenergetic and existential movements. This corresponds to a more and more explicit request from depressed patients who are expecting more from their stay in the hospital than simply to recharge their energy. We thought that our department, because of its size, type of patients, staff and its own orientation would be well adapted to an experience of this kind. In our hospital we try to facilitate in the patient: --regressive experiences; --the perception of "being"; --the symbolic and emotional feeling of the reality of time and place and particularity of the body; --the capacity to repair himself; --playing in the sense of Winnicott: playing with the in and the out (of onesself), the positions of the body, verbal play, play of alternation. --Centering on desire on the interior space, with the capacity to be "alone in the presence on another"; --the discovery of "responsability" and "compassion", also in the sense of Winnicott. We must take into consideration that in order to benefit from this type of therapy, there must be a good enough integration and a pain that is authentically experienced, that is, not acted out, not sutured, and without too many defenses. The results can be appreciated only very subjectively, since improvement is of a qualitative order, in the area of development of being serious existentially. We can perhaps envisage another future for the depressed patient than the interminable repetition of relapses or of beign treated indefinitely. This consists of discovering another way of being, more global, more serious, more authentic (real-self), considering the difficulties involved in the engagement of the realself in an already structured existence.

Adjustment Disorders↗

Tanner's story: a phenomenologic stance towards newborn death.

A phenomenologic stance is explored as a perspective from which to develop personal knowledge for nursing with families experiencing perinatal loss. The author's experience of newborn death is analyzed using van Manen's existential themes. An essential theme--validating motherhood--emerges from an analysis based on van Manen's lifeworld existential themes. Phenomenologic reflection is presented as a path to self-understanding and reflection, which may inform personal knowledge for nursing practice and the relationships nurses nurture with families.

Adaptation, Psychological↗

The application of a model of psychotherapy to world problems.

This editorial uses a model of psychotherapy to respond to the question of why conservative attitudes seem to be gaining ground in our world. We assume that a patient who desires change also has a great need to resist it because he or she cannot tolerate uncertainty. The rapid changes in the world provide all of us with an increasing number of choices and consequently with existential anxiety. The return to yesterday's certainty, however, has significant dangers for the survival of the individual as well as mankind. Survival is a viable question when we consider that we play our war-games still by the rules of yesterday and thereby deny the fact that we are given the realistic choice of self-destruction. Such attitudes are very reminiscent of suicidal patients, who typically show a great deficit in information-gathering in the vulnerable areas of their lives. Resistance to change is at least one base to the understanding of a fundamentalist philosophy. Resistance can be defined as a wish to stay with the problems one knows rather than the ones dictated by existential demands: A reluctance to accept uncertainty. While the traditional values may in fact be "better" than new ones, the need on the part of either patient or society to act as though the traditional values were still intact denies reality. (The parent who does not want to see his offspring sexually active before marriage has to deal with the fact that presently available technology enhances sexual stimulation, lack of supervision, and privacy and opportunity).(ABSTRACT TRUNCATED AT 250 WORDS)

Communication↗

Self-concept and questions of life: identity development during late adolescence

The purpose of the present study was to explore identity development in late adolescent (18-20) years. Three areas were examined: (a) self-concept, (b) existential questions; content and communication patterns, and (c), connections between (a) and (b). The population consisted of 44 Swedish college students. Three methods were used: a questionnaire, the writing of a short essay and a self-evaluation test, Structural Analysis of Social Behavior (SASB). The results demonstrated a positive and stable self-concept for the majority of the group, and that questions of life mainly concerned questions of future. The quality of the self-concept (positive vs. negative) was significantly related to how subjects experienced adults' interest in their existential questions. Several issues are discussed: the importance of the social environment for identity development not only during early childhood but also during adolescence, the use of the SASB method in this age group and the need for placing processes of integration into focus in research concerning late adolescence.

Journal Article↗

Coping with the physical and psychosocial sequelae of bone marrow transplantation among long-term survivors.

We used a situation-specific approach to investigate common problems and associated coping processes among long-term survivors of bone marrow transplantation (BMT). Surveys were returned by 156 of the 191 (82%) eligible BMT survivors. Work and finance problems were endorsed relatively infrequently by respondents; physical problems and existential concerns were much more common. Problem occurrence was significantly related to demographic and treatment variables. The choice of coping mechanisms was related to the type of problem being faced: Significant effects were observed for four coping mechanisms from the COPE Inventory-active coping, suppression of competing activities, restraint, and acceptance. The differences were between one type of problem, infertility concern, and one or more of three other categories of problems (other physical problems, existential concerns, and work/finance problems) nominated by survivors. Some methodological considerations and directions for future research are outlined.

Adaptation, Psychological↗

[Peritoneal dialysis indication--importance of psychosocial aspects of the indications of the situation].

Peritoneal dialysis treatment is as efficient as hemodialysis if properly administered; therefore, psychological aspects of peritoneal dialysis must be taken into account if this is to be the best treatment for patients suffering from terminal renal disease. This paper presents these aspects from the view of logotherapy and existential analysis. The description of the change in viewing patients from a medical aspect is followed by an outline of basic logotherapy and existential analysis. The consequences to patients and their current problems are described, together with theoretical basics and practical guidelines for communication with patients.

Adaptation, Psychological↗

Is there a correlation between spirituality and anxiety and depression in patients with advanced cancer?

AIMS AND OBJECTIVES: To establish whether there is a correlation between spirituality and anxiety and depression in patients with advanced cancer. PATIENTS AND METHODS: Patients with a diagnosis of cancer at St. Peter's day hospice in Bristol were asked to complete three questionnaires to assess anxiety, depression and spirituality. Informed consent was obtained. Anxiety and depression are indicated by the Hospital Anxiety and Depression Scale score, and spirituality is indicated by scores on the Spiritual Well-Being Scale (SWBS) and the Royal Free Interview for Spiritual and Religious Beliefs. As will be explained, religion and spirituality are generally recognised as having different meanings--religion entailing a relationship with a higher being, while spirituality can be thought of in terms of meaning and purpose in life. RESULTS: Eighty-five complete data sets were obtained. A significant negative correlation was found between both anxiety and depression scores and overall spiritual well-being scores (p < 0.0001). When the SWBS subscale scores were analysed individually, a significant negative correlation was found between the existential well-being scores and the anxiety and depression scores (p < 0.001). However, no correlation was found between the religious well-being scores and anxiety or depression. CONCLUSIONS: This study found a significant negative correlation between spirituality (in particular, the existential aspect) and anxiety and depression in patients with advanced cancer. Religious well-being and strength of belief had no impact on psychological well-being in this study.

Adult↗