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PubMed1989

Samson's complex: the compulsion to re-enact betrayal and rage.

A comparison of the life story of a psychotherapy patient to that of biblical Samson reveals that both men suffer from a behavioural disturbance, manifested in the compulsion to re-enact the experience of betrayal by women, followed by destructive attacks of rage against others, and ultimately against their own tormented selves. The author tracks the origin of repetition compulsion to its proposed psychobiological foundations of attachment-formation and its development. Samson's complex is viewed as a deep-seated, characterological defect, stemming from faulty object relations and leading to existential despair and suicidal longing. The existence of a detailed psychopathological phenomenology embedded in timeless biblical lore denotes once more the alliance between myth and psychology.

Anger↗
PubMed1995

Power, boundaries, intersubjectivity.

The first part of this paper is a brief overview of the keynote speech given by Jeffrey Masson at the Sixth Conference of the Society for Existential Analysis, London, entitled Issues of power in the psychotherapeutic relationship, in which Masson raised various questions about the assumptions of what constitutes the alleged inappropriate behaviour of therapists, and the boundaries of the professional role that must not be overstepped. These criticisms are begun to be addressed in this paper. The overall aim of this paper is to promote a sceptical and critical discussion of the psychotherapeutic relationship and a few of its founding assumptions.

Awareness↗
PubMedDate not supplied

Freedom, responsibility, and health.

Freedom and responsibility, how much of each and how they are balanced, have profound implications for our personal lives and for our work. The health of a population and its achievement in the workplace are enhanced when individuals have some freedom and some responsibility, but not too much of either, and when civil associations of individuals rather than individuals acting alone are the essential social units. The consistent association of social contacts with health and productivity provides strong support for the premise that intimate relationships are the focus around which people's lives revolve. Membership of a "social network" may be merely conforming to a reigning social norm, and this could mean having to pay an important price in the loss of creativity associated with individualism. But social conformity should not prevent individuals from going their own way, and it should be possible to combine the luxury of individuality with an active life in civic affairs. Less than complete freedom may fall short of existential utopia, but it may be best for our health and wellbeing.

Freedom↗
PubMed2002

'He found me very well; for me, I was still feeling sick': the strange worlds of physicians and patients in the 18th and 21st centuries.

It is commonplace today to deplore the dissatisfaction of patients with the physician-patient relationship. Furthermore, historical investigation shows that this problem is not really new. We investigated an important source of patients' views in the 18th century, namely the letters of patients received by the famous Swiss physician, Samuel Tissot, and noted remarkably similar feelings of frustration. Yet the medical paradigms of today and of Tissot's times are considerably different. We propose that the persisting problems in the physician-patient relationship are due to a basic dissonance between the patient's ordinary modes of perception and the systematic way of perceiving reality characteristic of the physician. In addition, they reflect the unavoidable chasm between the ultimately private and singular nature of the illness experience, and the general and anonymous stance of medical theory. This chasm is therefore a permanent feature of the patient-physician relationship, predating the advent of scientific medicine, even if the latter reinforced it. In line with the current medical humanities movement, we believe that the engagement of physicians and medical students with literature and the arts helps them explore, and to some extent overcome, the existential divide between the patient's experiential self knowledge and the systematic, impersonal knowledge that plays a central role in medicine. We suggest a few examples of contemporary fiction that may be relevant and useful in this respect.

Communication↗
PubMed2004

A functional view of consciousness and its relations in brain.

Consciousness is seen as evolving jointly with plasticity, self-direction, and autonomy. Its main function is interpreted as the partially autonomous direction of behavioral living in accordance with a vast system of plastic patterns of inner construction, and the development of these--all in the service of a central concern with widely-perceived global well-being. Its central constituents are: conscious awareness itself; sensations and images of sensory bombardment; active development and utilization of inner constructions; and active direction of attention, actions, and behavior. Consciousness operates by the partially autonomous feedback redirection of activation-energization in response to a global distribution of neurobiological flags and states. Central qualities of conscious experience are addressed from this view. Consciousness may act towards an overall principle of minimization. Contrasting its existentially observable manifestations and its neurobiological correspondences provides foundations for five basic views of the fundamental nature of consciousness and its relation to brain.

Animals↗
PubMed2006

[The last phase in the progressive neoplasic disease: care at the end-of-life, refractory symptoms and sedation].

End-of-life is one of the most stressful phases during course of a neoplasic disease. Frequently, death of patients with cancer comes after a continuous and progressive physical impairment. As death approaches, the medical team might redefine outcomes and treat as priority symptoms and relief suffering. That care encompasses the physical, psychological, social, spiritual, and existential needs of patients and their families. However, symptoms are frequently observed that are intolerable for the patient and which do not respond to usual palliative measures. The intolerable nature and being refractory to treatment indicates to the health-care team, on many occasions, the need for sedation of the patient. The medical team can take comfort in the knowledge that they did their best to provide safe passage to all their patients and that, although they did not always cure them, the patients often were healed.

Analgesics↗
PubMedDate not supplied

Psychological disorders in survivors of torture: exhaustion, impairment and depression.

Post-traumatic stress disorder (PTSD) has been described as the characteristic sequel to extreme events in life such as war and especially torture. This limitation to a single approach in regard to diagnosis and treatment has been criticised as being a too narrow concept to describe the effects following extreme events in life, especially as most studies so far were limited to PTSD and a small range of symptoms or disorders. The study presents data on psychiatric disorders in a group of exiled survivors of torture presenting to an out-patient department for psychiatry. A DSM-III-R-based psychiatric interview, including the general assessment of functioning scale (GAF), an open list of symptoms and the Vienna diagnostic criteria in regard to depression were used to evaluate a broader range of possible sequels. The most frequent present diagnosis in 44 patients seen over a period of 3 years was PTSD (n = 40), but criteria for a present diagnosis of other disorders were fulfilled in 34 patients, even years after torture, mainly major depression or dysthymia (n = 26). Criteria for functional psychosis were fulfilled in 4 patients. Many patients reported symptoms not assessed by DSM-III-R criteria, including feelings of shame and guilt, and ruminations on existential fears. The impairment as indicated by the GAF (mean 59.1) correlated best with the presence of the endogenomorphic-depressive axial syndrome, but not with duration of imprisonment, age or other factors. Research on sequels to extreme trauma should not be restricted to a simple diagnosis of PTSD, but should continue to look for a broader conceptualisation, including neglected categories like the axial syndrome, as PTSD is common, but might not be the only factor of importance for research and treatment. ICD-10 might offer a more adequate interpretation of sequels.

Adult↗
PubMedDate not supplied

An exploratory study into the effect of group psychotherapy on cardiovascular and immunoreactivity to acute stress in breast cancer patients.

BACKGROUND: : Previous studies of cancer patients investigated the effect of psychological treatment on basal endocrine and immune values. Using a randomized experiment, we explored the effect of a 13-week experiential-existential group psychotherapy (EEGP) program on the reactivity to a speech task in breast cancer patients. We explored whether changes in cardiovascular and immune reactivity to a speech task over the 3-month period correlated with changes in psychological distress and emotional expression. METHODS: Patients who had been treated for early-stage breast cancer and who were diagnosed as having either positive axillary lymph nodes or distant metastases were randomly assigned to either EEGP or a waiting list control (WLC) condition. We continuously recorded heart rate (HR), diastolic (DBP) and systolic blood pressure (SBP) in response to the speech task before and after treatment. We also measured lymphocyte proliferation to pokeweed (PWM) and phytohemagglutinin (PHA), and natural killer cell activity (NKCA) as well as peripheral blood lymphocyte distributions in blood samples that were drawn before, during and after the speech task. RESULTS: Patients in EEGP had smaller increases in natural killer (NK) cells induced by the speech task after treatment versus task-induced values observed at study entry and greater than pre-/posttreatment changes seen in patients randomized to the WLC. A similar pattern emerged with respect to NKCA over the intervention period, which was independent of the changes in NK cells. There were no differences between patients assigned to EEGP and WLC in HR, DBP and SBP responses as well as in changes in PWM- and PHA-induced lymphocyte proliferation in response to the speech task measured before and after the 3-month intervention period. Individual differences in pre-/posttreatment increases in emotional expression but not in psychological distress were significantly associated with smaller changes in the number and function of NK cells over the 3-month period. CONCLUSIONS: These findings may indicate that emotional expression during EEGP may render breast cancer patients more comfortable expressing their emotional responses to the speech challenge, which, in turn, results in smaller stress-induced changes in NK cells and function.

Aged↗
PubMed1994

[Laryngeal contact granuloma--a psychosomatic disorder?].

In a multidimensional design using the hypothesis of a psychosomatic genesis, 28 patients (1 female, 27 male) showed, in their personality profile, increased scores in 'impulsiveness', 'emotionality (neuroticism)', 'strain' and 'inhibition'. In addition to the voice disorders other somatic symptoms were observed, especially general symptoms as dysthymia, depression and excessive vegetative stimulation. Their social competence was reduced by the fear of making contacts and the inability 'to say no'. Also psychosocial stress factors were registered due to loss of a loved one with feelings of an existential danger. Thus, contact granuloma can be considered as a secondary reaction to a specific combination of personal disposition and social life situation. Lastly a causal model is presented, which can be used as a diagnostic criterion.

Adult↗
PubMed1989

Delusional theme, sex and age.

In a retrospective study of 865 delusional syndromes, connections were investigated between delusional themes and the sex of patients, and the ages in which these themes extensively occurred. According to previous reports, the results of this investigation indicated that differences exist between the ages of manifestation regarding the themes of hypochondria, persecution, love and jealously. Furthermore, differences could be observed between males and females in relation to the frequency of choice of particular themes, as well as the age of occurrence. Based on psychological studies concerned with the content's dependence on motives we conclude that the age distribution of delusional themes corresponds to the main existential concerns in different life periods.

Adolescent↗
PubMed1976

Diazepam in the treatment of tardive dyskinesia. Preliminary observations.

Three patients, aged 23-33 years, with the diagnosis of schizophrenia, developed symptoms of tardive dyskinesia while receiving neuroleptic treatment, mostly with haloperidol. Existential problems and emotional upset seemed contributory. Diazepam was found effective in controlling dyskinesia. Its therapeutic effect seemed not to be related to sedation. Some implications of the reported observations are mentioned.

Adult↗
PubMed1979

Philosophical foundations of French and U.S. nosology.

The author examines the philosophical foundations of French and American nosology with a view toward understanding the relatively minor influence of French psychiatry in America. Despite the excellence of its descriptive psychiatry, much of French nosological writing is based on philosophical viewpoints that are antithetical to the empirical and pragmatic traditions of American psychiatry. French nosology, which is closely involved with the metaphysical issues of existentialism, phenomenalism, and structuralism, reveals these interests in language and concepts that do not easily permit its hypotheses to be scientifically tested, a prerequisite for any American classification.

France↗
PubMed2002

Pilot study of spirituality and mental health in twins.

OBJECTIVE: The goal of this study was to investigate associations between empirically defined dimensions of spirituality, personality variables, and psychiatric disorders in Vietnam era veterans. METHOD: One hundred pairs of male twins from the Vietnam Era Twin Registry were administered the self-report Spiritual Well-Being Scale and a pilot Index of Spiritual Involvement. Correlation analyses were supplemented with regression analyses that examined the relative influence of genetic and environmental factors on aspects of spirituality. RESULTS: Existential well-being was significantly associated with seven of 11 dimensions of personality and was significantly negatively associated with alcohol abuse or dependence and with two of three clusters of personality disorder symptoms. Associations between mental health variables and religious well-being or spiritual involvement were much more limited. CONCLUSIONS: Useful distinctions can be made between major dimensions of spirituality in studies of spirituality, religious coping, and mental health.

Adult↗
PubMedDate not supplied

Spirituality, religion, and depression in the terminally ill.

OBJECTIVE: This study examined the impact of spirituality and religiosity on depressive symptom severity in a sample of terminally ill patients with cancer and AIDS. METHODS: One hundred sixty-two patients were recruited from palliative-care facilities (hospitals and specialized nursing facilities), all of whom had a life expectancy <6 months. The primary variables used in this study were the FACIT Spiritual Well-Being Scale, a religiosity index similar to those used in previous research, the Hamilton Depression Rating Scale (HDRS), the Karnofsky Performance Rating Scale, the Memorial Symptom Assessment Scale, and the Duke-UNC Functional Social Support Questionnaire. RESULTS: A strong negative association was observed between the FACIT Spiritual Well-Being scale and the HDRS, but no such relationship was found for religiosity, because more religious individuals had somewhat higher scores on the HDRS. Similar patterns were observed for the FACIT subscales, finding a strong negative association between the meaning and peace subscale (which corresponds to the more existential aspects of spirituality) and HDRS scores, whereas a positive, albeit nonsignificant, association was observed for the faith subscale (which corresponds more closely to religiosity). CONCLUSIONS: These results suggest that the beneficial aspects of religion may be primarily those that relate to spiritual well-being rather than to religious practices per se. Implications for clinical interventions and palliative-care practice are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1976

The collapsing perimeter. A commentary on life, death, and death-in-life.

The individual is encased in an existential, phenomenological space that has the capacity to contract or expand, to isolate itself, or to join with others. An analysis is provided of how this individual space capsule functions under varying circumstances, such as depression, schizophrenia, sociopathy, divorce, child-battery, aging, death, overpopulation, cultural disruption, and execution.

Aging↗
PubMed1984

Current therapies and the ancient East.

Current therapies, their theories and techniques ebb and flow in popularity, but there is a residue of basic principles and practices which remain. Much of this useful residue has been present in ancient Eastern religions and philosophies. This article compares the content of several current theories of individual, group, and family therapies to seed ideas in ancient Taoist, Zen, Confucian, yoga, and Buddhist source materials. Gestalt, existential, psychoanalytic, transactional analysis, cognitive-behavioral and family therapy concepts are traced to these ancient precursors. Illustrative examples are presented such as satori (flash of insight), koans (insight riddles), parables, yanas (exercises), rituals, and written teachings. The article concludes with the Four Noble Truths and the 8-fold path of Buddhism, given 2500 years ago but very timely to contemporary problems of life adjustment and a useful guide to counseling and therapy.

Buddhism↗
PubMed1995

Narrative and psychotherapy--the phenomenology of healing.

In part I, I presented some results of empirical research on mind/body relationship: writing about traumatic experiences brings about improved psychological and physiological health. One important factor of healing in psychotherapy is thereby isolated empirically. In part II, it was shown that the cognitive science explanation of these findings, however, is based on categories deriving from common sense and is insufficient. Phenomenological method can serve as a form of criticism of the assumptions shared by most contemporary approaches to the human mind and brain in psychology, psychiatry, and medicine (e. g. cognitive, psychodynamic, behavioral, and biological). In part III, I presented research and concepts developed in the phenomenological tradition that have bearing on the problem of the healing factor in narrative acts (in writing and speech), including the "talking cure" of psychoanalysis and psychotherapy. I described the problem of the unconscious in narrative acts from the phenomenological point of view and provide an alternative explanation for their healing effects. In short, the way we overcome painful and traumatic experiences is not seen in terms of the cognitive theory in which a painful feeling is "translated" into a cognitive or linguistic representation that organizes it. Such a theory objectifies the human subject. Healing through narration and "opening up," involves an existential act of self-transcendence of an embodied person who organizes his/her experience in time.

Defense Mechanisms↗
PubMed1999

"Generative caring" psychotherapy for patients who are reluctant to talk.

Patients seek psychotherapy for relief of symptoms and resolution of problems in living. Yet, they sometimes balk at the prospect of having to choose a topic without being prompted by therapist questions. This paper suggests that this apparently self-sabotaging behavior represents an acting out of a fundamental existential dilemma for many individuals, i.e., to be or not to be an adult. Adulthood comes with the heavy burden of responsibility for making life choices, and the possibility of making the wrong choices. The psychotherapeutic situation, with its demand that the patient choose a topic, is a microcosm of the adult-adult relationship. The author proposes that the proper treatment for these patients is Generative Caring Psychotherapy, which promotes emotional growth and facilitates patients' transition from childhood dependence to adult responsibility.

Adult↗