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PubMed1998

Adolescent mothers four years later: narratives of the self and visions of the future.

This study examined patterns, variations, and existential turning points in young mothers' narratives of self and their visions of the future as part of a larger hermeneutic, longitudinal study. The study was philosophically based in the phenomenology of everyday practices as inherently meaningful, situated, and historically derived and drew on dialogical views of the self. The sample consisted of 13 (of the original 16) young mothers and family members who had been interviewed 4 years earlier. For the present study, data consisted of life history accounts of the intervening 4 years, stories of caregiving routines, and recent coping episodes of parenting elicited through in-depth interviews. Findings offer a situated understanding of young mothering and highlight meaningful distinctions in the ways young mothers experience the self and project themselves into the future. The discovery of patterns and variations in the young mother's sense of self and future have implications for guiding clinical practice and are preliminary to designing programs and interventions that are tailored to the practical understanding and situated possibilities of young mothers.

Adolescent↗
PubMedDate not supplied

Teen mothers and their teenaged children: the reciprocity of developmental trajectories.

This article reports on the fifth wave of a multigenerational study of teen mothering. Two paradigm cases reveal how teen mothers' agency and development are linked with their teenaged children's development in a world shaped by poverty and limited resources. Teens with attenuated relationships and without anchors of hope and behavioral expectations for the future face an existential void that sets them adrift. Teens with well-developed parental relationships, family routines, and behavioral expectations have a stake in the future. This emic view shows how teens respond to the challenges of adolescence shaped by mothers' agency, family practices, class, and culture.

Adolescent↗
PubMed2005

Communication in palliative care: a review of recent literature.

PURPOSE OF REVIEW: The quality of communication with patients, family, and team members is an extremely important element in palliative cancer care. The current paper reviews the literature on these topics as published in 2004. RECENT FINDINGS: Trust was found to be a major factor for relationship building. Information gathered by patient self-report is the method of choice, given improved insight in symptom prevalence, duration, frequency, and interference. Cultural factors in information giving, the optimal process and content, and the difficulty of conveying hope were addressed. Decision making in palliative care requires a complex integration of conceptual knowledge, ethical and legal implications, and communication skills. Aspects of manageability are explored. Although health care providers must communicate about emotions, the existential distress of cancer patients and carers often goes overlooked in the last phases of life. SUMMARY: Themes included the education of health care providers, the need to care for carers, and interdisciplinary communication. Little attention was given to the growing population of elderly patients. Observer-based studies are unfortunately scarce, making the practice of palliative communication unseen. Finally, few studies report the cost-effectiveness of palliative care interventions though such studies may enhance palliative care and convince policy makers of the need to support such care. More empirical work is needed to improve the level of quality needed to ensure a good remaining lifetime for cancer patients whose disease cannot be cured.

Communication↗
PubMed2004

Trauma, change in strength of religious faith, and mental health service use among veterans treated for PTSD.

One of the most pervasive effects of traumatic exposure is the challenge that people experience to their existential beliefs concerning the meaning and purpose of life. Particularly at risk is the strength of their religious faith and the comfort that they derive from it. The purpose of this study is to examine a model of the interrelationships among veterans' traumatic exposure, posttraumatic stress disorder (PTSD), guilt, social functioning, change in religious faith, and continued use of mental health services. Data are drawn from studies of outpatient (N = 554) and inpatient (N = 831) specialized treatment of PTSD in Department of Veterans Affairs programs. Structural equation modeling is used to estimate the parameters of the model and evaluate its goodness of fit to the data. The model achieved acceptable goodness of fit and suggested that veterans' experiences of killing others and failing to prevent death weakened their religious faith, both directly and as mediated by feelings of guilt. Weakened religious faith and guilt each contributed independently to more extensive use of VA mental health services. Severity of PTSD symptoms and social functioning played no significant role in the continued use of mental health services. We conclude that veterans' pursuit of mental health services appears to be driven more by their guilt and the weakening of their religious faith than by the severity of their PTSD symptoms or their deficits in social functioning. The specificity of these effects on service use suggests that a primary motivation of veterans' continuing pursuit of treatment may be their search for a meaning and purpose to their traumatic experiences. This possibility raises the broader issue of whether spirituality should be more central to the treatment of PTSD, either in the form of a greater role for pastoral counseling or of a wider inclusion of spiritual issues in traditional psychotherapy for PTSD.

Ambulatory Care↗
PubMed2004

Religion, spirituality, and medicine: research findings and implications for clinical practice.

A growing body of scientific research suggests connections between religion, spirituality, and both mental and physical health. The findings are particularly strong in patients with severe or chronic illnesses who are having stressful psychologic and social changes, as well as existential struggles related to meaning and purpose. Recent studies indicate that religious beliefs influence medical decisions, such as the use of chemotherapy and other life-saving treatments, and at times may conflict with medical care. This article addresses the ways physicians can use such information. Spirituality is an area that makes many physicians uncomfortable, since training in medical schools and continuing medical education programs are limited. Not only do most physicians lack the necessary training, they worry about spending additional time with patients and overstepping ethical boundaries. While these concerns are valid, each can be addressed in a sensible way. Taking a spiritual history, supporting the patient's beliefs, and orchestrating the fulfillment of spiritual needs are among the topics this article will address. The goal is to help physicians provide medical care that is sensitive to the way many patients understand and cope with medical illness.

Attitude of Health Personnel↗
PubMed2003

Measurement of quality of life III. From the IQOL theory to the global, generic SEQOL questionnaire.

The Danish Quality of Life Survey is based on the philosophy of life known as the integrative quality-of-life (IQOL) theory. It consists of eight different quality-of-life concepts, ranging from the superficially subjective via the deeply existential to the superficially objective (well being, satisfaction with life, happiness, meaning in life, biological order, realizing life potential, fulfillment of needs, and objective factors [ability of functioning and fulfilling societal norms]). This paper presents the work underlying the formulation of the theories of a good life and how these theories came to be expressed in a comprehensive, multidimensional, generic questionnaire for the evaluation of the global quality of life--SEQOL (self-evaluation of quality of life)--presented in full length in this paper. The instruments and theories on which the Quality of Life Survey was based are constantly being updated. It is an on-going process due to aspects such as human development, language, and culture. We arrived at eight rating scales for the quality of life that, guided by the IQOL theory, were combined into a global and generic quality-of-life rating scale. This was simplified to the validated QOL5 with only five questions, made for use in clinical databases. Unfortunately, the depth of human existence is to some extent lost in QOL5. We continue to aim towards greater simplicity, precision, and depth in the questions in order to explore the depths of human existence. We have not yet found a final form that enables us to fully rate the quality of life in practice. We hope that the several hundred questions we found necessary to adequately implement the theories of the Quality of Life Survey can be replaced by far fewer; ideally, only eight questions representing the eight component theories. These eight ideal questions have not yet been evaluated, and therefore they should not form the basis of a survey. However, the perspective is clear. If eight simple questions can accurately rate the quality of life as well as its depth, we have found an instrument of immense practical scope.

Health Status↗
PubMed2004

Clinical holistic medicine: treatment of physical health problems without a known cause, exemplified by hypertension and tinnitus.

In the medical clinic, we often face health problems that have no known cause, even after a thorough examination. Biomedicine is often unable to find a cure in these situations, leaving the problem unsolved or leaving the patient on a palliative pharmaceutical cure, which is often for a lifetime. In this case, consciousness-based, holistic medicine could be an alternative. Using the theories and tools of holistic medicine wisely, the physician can often provide treatment for the patient. The toolbox of holistic medicine makes it possible to work on everybody because there is always something related to the patients quality of life that can be improved: his love, his purpose of life, and the way he uses his talents, his mind, his feelings, his body, and his sexuality. For treatment in holistic medicine, it really does not matter as much that you cannot give the patient a precise medical diagnosis, because you can always work on the patient with the intention of healing his or her whole life and existence. It is quite a paradox that many of these diseases can be understood on the level of the individual patient at the same moment that the patient is cured; many of these diseases seem to be clearly related to the repression of the individual character, as stressed already by Hippocrates. So if you simply start working with the patient to help him confront old existential pain and coach him in his personal development of his life by intensifying its meaning and purpose, the symptoms very often simply disappear. The toolbox of holistic medicine also seems relevant to even difficult, neurotic, psychosomatic, and hypochondriac patients. Believing in the treatment and not giving up on your patient, and moving forward in the treatment with the patient himself is the ultimate goal, even when you yourself do not understand the mechanism fully. This will force you to develop your own competence and is, in essence, what makes an outstanding holistic physician.

Adult↗
PubMed2004

A combination of gestalt therapy, Rosen Body Work, and Cranio Sacral therapy did not help in chronic whiplash-associated disorders (WAD)--results of a randomized clinical trial.

The chronic state of whiplash-associated disorder (WAD) might be understood as a somatization of existential pain. Intervention aimed to improve quality of life (QOL) seemed to be a solution for such situations. The basic idea behind the intervention was holistic, restoring quality of life and relationship with self, in order to diminish tension in the locomotion system, especially the neck. A psychosomatic theory for WAD is proposed. Our treatment was a short 2-day course with teachings in philosophy of life, followed by 6-10 individual sessions in gestalt psychotherapy and body therapy (Rosen therapy and Cranio Sacral therapy), followed by a 1-day course approximately 2 months later, closing the intervention. Two independent institutions did the intervention and the assessments. In a randomized, clinically controlled setting, 87 chronic WAD patients were included with a median duration of 37 months from their whiplash accidents. One patient never started. Forty-three had the above intervention (female/male = 36/7, ages 22-49, median 37 years) and another 43 were assigned to a nontreated control group (female/male = 35/8, ages 18-48, median 38). Six had disability pension and 27 had pending medicolegal issues in each group. Effect variables were pain in neck, arm, and/or head; measures of quality of life and daily activities; as well as general physical or mental health. Wilcoxon test for between-groups comparisons with intention-to-treat analyses was conducted; the square curve paradigm testing for immediate improvements of health and quality of life was also used. The groups were comparable at baseline. From the intervention group, 11 dropped out during the intervention (4 of those later joined the follow-up investigation), 22 of the remaining 32 graduated the course, and 35 of the 43 controls did as well. Approximately 3 months later, we found no clinically relevant or significant increase in any effect measure. The above version of a quality of life intervention based on alternative therapy had no effect on patients with chronic WAD.

Adolescent↗
PubMed2004

The life mission theory VI. A theory for the human character: healing with holistic medicine through recovery of character and purpose of life.

The human character can be understood as an extension of the life mission or purpose of life, and explained as the primary tool of a person to impact others and express the purpose of life. Repression of the human character makes it impossible for a person to realize his personal mission in life and, therefore, is one of the primary causes of self-repression resulting in poor quality of life, health, and ability. From Hippocrates to Hahnemann, repression of physical, mental, and spiritual character can be seen as the prime cause of disease, while recovery of character has been the primary intention of the treatment. In this paper, human character is explained as an intersubjective aspect of consciousness with the ability to influence the consciousness of another person directly. To understand consciousness, we reintroduce the seven-ray theory of consciousness explaining consciousness in accordance with a fractal ontology with a bifurcation number of seven (the numbers four to ten work almost as well). A case report on a female, aged 35 years, with severe hormonal disturbances, diagnosed with extremely early menopause, is presented and treated according to the theory of holistic existential healing (the holistic process theory of healing). After recovery of her character and purpose of life, her quality of life dramatically improved and hormonal status normalized. We believe that the recovery of human character and purpose of life was the central intention of Hippocrates and thus the original essence of western medicine. Interestingly, there are strong parallels to the peyote medicine of the Native Americans, the African Sangomas, the Australian Aboriginal healers, and the old Nordic medicine. The recovery of human character was also the intention of Hahnemann''s homeopathy. We believe that we are at the core of consciousness-based medicine, as recovery of purpose of life and human character has been practiced as medicine in most human cultures throughout time. We believe that such recovery can help some (motivated) patients to survive, even with severe disease.

Adult↗
PubMed2004

Clinical holistic medicine: developing from asthma, allergy, and eczema.

This paper shows how consciousness-based holistic medicine can be used in the case of asthma, allergy, and eczema. We have many fine drugs to relieve patients from the worst of these symptoms, where many children and adults suffer health problems related to hyper-reactivity of the immune system. Many symptoms remain throughout life because the drugs do not cure the allergy and allergy today is the sixth leading cause of chronic illness. The etiology of the immune disturbances is mostly unknown from a biomedical perspective. Consciousness-based holistic medicine could therefore be used to treat these diseases if the patient is willing to confront hidden existential pain, is motivated to work hard, and is dedicated to improve quality of life, quality of working life, and personal relationships. Improving quality of life is not always an easy job for the patient, but it can be done with coaching from the physician. An increased physical health is often observed after only a few sessions with a physician skilled in using holistic medical tools and able to coach the patient successfully through a few weeks of dedicated homework. Children with allergy and asthma can also be helped if their parents are able to do work on personal development, to improve the general quality of life in the family and their relationship with the child.

Adult↗
PubMed2004

Clinical holistic medicine: the "new medicine", the multiparadigmatic physician, and the medical record.

The modern physician is often multiparadigmatic as he serves many different types of people in many different existential circumstances. The physician basically often has three, very different sets of technologies or "toolboxes" at his disposal, derived from three different medical paradigms: classical, manual medicine; biomedicine; and holistic or consciousness-oriented medicine. For lack of a better term, we have called the extended medical science--integrating these three different paradigms and their three strands of tools and methods--the "new medicine". The excellent physician, mastering the "new medicine", uses the most efficient way to help every patient, giving him or her exactly what is needed under the circumstances. The excellent physician will choose the right paradigm(s) for the person, the illness, or the situation, and will use the case record to keep track of all the subjective and objective factors and events involved in the process of healing through time. The case or medical record has the following purposes: A. REFLECTION: To keep track of facts, to provide an overview, to encourage causal analysis, to support research and learning, and to reveal mistakes easily. B. COMMUNICATION: To communicate with the patient with a printout of the case record to create trust and help the patient to remember all assignments and exercises. C. EVIDENCE AND SAFETY: To provide evidence and safety for the patient or to be used in case of legal questions. D. SELF-DISCIPLINE: To encourage discipline, as a good case record is basically honest, sober, brief, and sticks to the point. It forces the physician to make an effort to be more diligent and careful than a busy day usually allows. The intention of the case or medical record is ethical: to be sure that you, as a physician, give the best possible treatment to your patient. It helps you to reflect deeply, communicate efficiently, provide evidence and safety, and back your self-discipline, never to be carried away by the high speed of modern-day clinical work to give less than the optimal treatment. The patient"s life, now and in the future, is in the palm of your hand, and to assume this huge responsibility, the physician must be anxious and careful about the quality of the medical record. Much too often, the essence of the session is nowhere to be found in the case record, so most of the generated value is lost between consultations.

Holistic Health↗
PubMed2005

Clinical holistic medicine: chronic pain in internal organs.

Holistic medicine seems to be efficient in the treatment of chronic pain in internal organs, especially when the pain has no known cause. It is quite surprising that while chronic pain can be one of the toughest challenges in the biomedical clinic, it is often one of the simplest things to alleviate in the holistic clinic. These pains are regarded as being caused by repressed emotions and are explained as psychosomatic reactions. Using holistic medicine, the patients can often be cured of their suffering when they assume responsibility for the repressed feelings. The holistic process theory of healing states that the return to the natural (pain free) state of being is possible whenever the person obtains the resources needed for existential healing. This shift is explained by the related quality of life and life mission theories. The resources needed are "holding" or genuine care in the dimensions of awareness, respect, care, acknowledgment, and acceptance with support and processing in the dimensions of feeling, understanding, and letting go of negative attitudes and beliefs. The preconditions for the holistic healing to take place are "love" and trust. Obtaining the full trust of the patient, therefore, seems to be the biggest challenge of holistic medicine, especially when dealing with a patient in pain.

Abdominal Pain↗
PubMed2005

Clinical holistic medicine: holistic treatment of rape and incest trauma.

Studies indicate that at least 15% of the female population in western countries has experienced sexual abuse and severe sexual traumas. This paper explains how even serious sexual abuse and trauma can be healed when care and resources encourage the patient to return to the painful life events. When the physician cares and receives the trust of the patient, emotional holding and processing will follow quite naturally. Spontaneous regression seems to be an almost pain-free way of integrating the severe traumas from earlier experiences of rape and incest. This technique is a recommended alternative to classical timeline therapy using therapeutic commands. When traumatized patients distance themselves from their soul (feelings, sexuality, and existential depth), they often lose their energy and enjoyment of life. However, this does not mean that they are lost to life. Although it may seem paradoxical, a severe trauma may be a unique opportunity to regain enjoyment of life. The patient will often be richly rewarded for the extensive work of clearing and sorting out in order to experience a new depth in his or her existence and emotional life, with a new ability to understand life in general and other people in particular. So what may look like a tragedy can be transformed into a unique gift; if the patient gets sufficient support, there is the possibility of healing and learning. Consciousness-based medicine seems to provide severely traumatized patients with the quality of support and care needed for their soul to heal.

Adolescent↗
PubMed2005

Suicide from a holistic point of view.

Suicide has been honoured and respected in the eastern culture, especially in Japan with the famous tradition of Hara-kiri or seppuku, while in most western societies suicide has been seen negatively and many contemporary physicians tend to consider suicide the most self-destructive and evil thing a human being can do and something that should be avoided at all cost. Religions also have different viewpoints on suicide, but from a philosophical point of view we believe that considering the choice of life and dead to be extremely relevant for a good living. The choice of life and dead is real, since responsibility for life is necessary in order to live life and even the best physician cannot keep a patient alive, who deep inside wants to die. In this chapter we present parts of a story of a young girl who had experienced child sexual abuse. In holistic existential therapy it is our experience, when the patient is well supported in the confrontation of the fundamental questions related to assuming responsibility for the coherence, that this confrontation will almost always lead to a big YES to life. Without confronting the fundamental question of "to be or not to be", life can never be chosen 100% and thus never be lived fully.

Adult↗
PubMed2006

Human development III: bridging brain-mind and body-mind. introduction to "deep" (fractal, poly-ray) cosmology.

Reality can be interpreted in many ways, but two distinctly different ways are the mental and the emotional interpretation. The traditional way of thinking in science today is the first: an often simple and mechanical interpretation of reality that empowers us to handle the outer physical world with great, often brutal efficiency. The development of a mind that enables us to handle the outer physical world and survive makes a lot of sense from an evolutionary perspective; the problem is that the mental reason and linear logic reduces all phenomena to well-defined interacting objects, which might not exist from a deeper perspective of reality. A more intuitive way to interpret the world makes much more sense, when it comes to our human relations. So to function as a human being, we need both these two ways of seeing the world, and two different modi operandi. In many patients, we find an internalized conflict between logical and mental reasoning on one hand, and emotional and sexual approach to reality and human needs on the other. We speculate that this conflict causes the deep emotional problems that really are the basis of most human diseases. Only by merging brain-mind and body-mind will we be whole and free and truly ourselves. We need to develop our mental understanding, deepen our cosmology, and develop our sexuality and body-mind in order to make them meet and merge. To facilitate this existential healing, we propose a third integrative way of looking at our human nature, which we call "the energetic-informational interpretation of reality". What it does is allows us to look at both brain-mind and body-mind as a highly structured field of "energy and information". Energy and information are actually the same from a scientific point of view; when the world is seen through the body-mind, it looks more like energy; when seen though the brain-mind, it looks more like information.

Brain↗
PubMed2000

Spirituality: description, measurement, and relation to the five factor model of personality.

The present article focused on the development and measurement of a factor model of the expressions of spirituality. Study 1 (N = 534) involved the use of factor analysis to examine the latent factor structure in a sample of 11 measures of spiritual constructs. Study 2 (N = 938) focused on the replication of Study 1 results and on the construction and initial validation of an instrument to operationalize the factor model of spirituality. Results indicate that at least 5 robust dimensions of spirituality underlie the spirituality test domain. These dimensions were labeled Cognitive Orientation Towards Spirituality (COS), Experiential/Phenomenological Dimension (EPD), Existential Well-Being (EW-B), Paranormal Beliefs (PAR), and Religiousness (REL). The measure developed, named the Expressions of Spirituality Inventory (ESI), takes the form of a 98-item instrument that generated scores demonstrating satisfactory reliability and adequate initial validity. Examination of the relation of spirituality to the Five Factor Model (FFM) as measured by the NEO Personality Inventory-Revised revealed that the dimensions of the FFM appear to differentially relate to the major elements of spirituality but are nevertheless conceptually unique, pointing to the possible existence of major aspects of personality not represented in the FFM.

Adolescent↗
PubMed2004

Content and processes of postpartum counseling after a distressing birth experience: a review.

BACKGROUND: A distressing birth experience can produce debilitating symptoms of psychological trauma; however, little is known about the content and processes of counseling interventions to relieve trauma symptoms. This review identifies and examines common content and processes of postpartum counseling interventions to address trauma symptoms following childbirth. METHOD: A search of major databases (Cinahl 1982-2003; Cochrane 2003; Embase; Proquest; Psychlit; Pubmed/Medline 1966-2003; Sociofile) was conducted, using combinations of the key words of "childbirth,""postpartum,""posttraumatic stress disorder,""anxiety,""trauma,""stress,""debriefing," and "counselling" or "counseling." Identified content and processes were clustered through a thematic analysis. RESULTS: Nineteen publications were retrieved. Counseling strategies provided women with opportunities to talk about their birth experience, express feelings about what happened, have questions answered, address gaps in knowledge or understanding of events, connect the event with emotions and behavior, talk about future pregnancies, and explore existential issues. CONCLUSIONS: Descriptions of postpartum counseling and debriefing are generalized and nonspecific; they provide minimal direction for postpartum counseling models, lack necessary detail for replication, may require psychotherapeutic training and therefore be unsuitable for use by caregivers, and are often based on opinion with little empirical evaluation. Few studies have tested specific counseling interventions on a range of maternal outcomes. Further research is needed to develop counseling models for use by health professionals with women who report a distressing birth experience.

Counseling↗
PubMed2005

Patients with haematological malignancies show a restricted body image focusing on function and emotion.

The diagnosis of cancer threatens the psychological and bodily integrity. Based on this assumption, we aimed to explore how newly diagnosed patients cope with special regard to the body image (BI). In total, 40 patients (32 haematological malignancies) were assessed by questionnaires on mood, complaints, self-regulation and quality of life (QOL). The BI was assessed by the 'Body Grid' which reveals the constructs patients choose to characterize the body. The constructs were categorized using a model of six predefined categories comprising: emotion, control, activity, strength, function and appearance. Tinnitus sufferers and medical students served as comparison groups. Cancer patients showed significantly more anxious depression and a significantly lower QOL than controls. Their BI was restricted, focusing the functional status of body organs (e.g. opposing healthy vs. ill organs) as well as emotional aspects (e.g. trust vs. fear). The data convey fundamental psychological distress in newly diagnosed cancer patients. Restriction of BI and use of functional constructs may help to buffer the threat to body integrity. The emotional constructs reflect the existential impact. The data give a clear indication for the need for early psychosocial support which should aim at stabilizing the psychological and bodily integrity of the patient.

Adaptation, Psychological↗