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PubMed2003

Knowing hatred.

Hatred is known to be a common phenomenon and a lot has been written about this affect. However, the author believes that the more we read and write about hate the further away we find ourselves from a real sense of understanding of this so familiar and yet so elusive experience. She feels that using a single concept to describe 'hatred' seems to be a simplification of the matter, since it consists of a chain of affects that does not lend itself to easy theoretical or experiential distinction. In this paper the author aims at 'knowing' the experience of hatred as the individual's reaction to an unbearable existential excess, that is, as the psychic attempt to handle an emotional profusion in the context of human relation and in relation to it. The emotional abundance that the psyche cannot contain and process by itself is dealt with by the defensive use of simplification, detachment and distancing. An attempt is made to understand the relation between psychic existing and hatred, between craving, desiring and hate, between passionate aliveness--or a passion to live--and the difficulty in containing the excessive dimension of it. The author illustrates her thesis through a reading of Tolstoy's 'Kreutzer sonata' as a monologue of hatred.

Affect↗
PubMed2004

Another language, another place: to hide or be found?

The author examines some specific features of the analytic encounter when both patient and analyst are émigrés from the same cultural and linguistic background. This can result in splitting processes that operate silently and are difficult to reach, but can also provide rich material, as they offer the couple the opportunity to work through the pain and the guilt over what is lost--ultimately the lost mother--murdered and betrayed. Working through the split faces the analyst with important technical considerations, bearing in mind that the shared cultural identity can conceal itself in the more undifferentiated features of the couple's psyche and be projected on to the setting. As such, it needs to be put to analytic scrutiny if the treatment is to avoid a stalemate. These are specific cultural defences deployed in the problematic existential encounter with the foreigner/other within oneself. Using clinical material from two cases, the author shows how the couple's access to a dual linguistic signifying system can enrich the analytic dialogue, but can also result in enactment. Careful monitoring of the transference-countertransference relationship is essential to the progress of the analytic work.

Adult↗
PubMed1993

What constitutes our understanding of a patient?

A number of approaches to the search for methodology in the human sciences are reviewed. Heidegger's use of Husserl's phenomenology led to his exploration of the background practices on which he believed all our understanding is based. This use of phenomenology was adopted by Sartre and R. D. Laing, and existential psychiatrists and psychoanalysts in their emphasis on the here-and-now encounter between the patient and the therapist, along with various embellishments and emendations on Heidegger's notion of what it meant to live authentically or inauthentically. Foucault maintained that there is a politics embedded in all the human sciences such as psychiatry and psychoanalysis, and this politics revolves around the use of power and its operations, including the actual use of the human sciences in the culture and what the different theories imply in the way of an ideology. Lacan emphasized this when he challenged the prevailing ideology of United States psychoanalysis, in which adaptation was seen as the crucial task of the ego. The existence of background practices and outer horizons required for any understanding in the human sciences leads to a situation that questions the use of empirical methods to establish what is accepted as "truth" in the human sciences. A predominant alternative, that of hermeneutics, has gained acceptance by eminent analysts such as Gill and certain interpersonal theorists. But the term hermeneutics is used in many ways by many authors and runs the danger of a relativism and a nihilism. This leads to a discussion of the value of various philosophical positions in throwing light on our search for a methodology in the human sciences. A review of arguments invoking the "end of philosophy" such as those of Rorty reveals that they are paradoxical and based on premises which in turn represent a philosophy. This debate remains unresolved. In general the postmodern view sees "truth" as more relative and emphasizes the role of social and cultural aspects of prevailing ideologies in constituting and determining what we call truth and understanding, including the "understanding" of a patient in psychotherapy. An example of the postmodern blend of philosophy and psychoanalysis is presented by Arlow's emphasis on unconscious fantasies and his insightful comments on how these unconscious fantasies organize and determine what we experience from the very beginning of life. This I believe is most consistent with Rescher's philosophical notion of "conceptual idealism," also briefly reviewed in this paper.(ABSTRACT TRUNCATED AT 400 WORDS)

Empathy↗
PubMed1998

Divine space: contemplating the object behind a religious patient's spatial metaphor.

If we accept that psychic space is fundamentally all about "having somewhere to put what we find" (Winnicott, 1967, p. 99), then the patient's becoming aware of and pointing out the metaphor--and her ability to utilize it--indicates that such "place" is well on the way of having been experienced as available for creative psychic use. In the course of this exposition, I also think we've managed to confirm Charles Taylor's contention that "the self only exists in a space of moral questions, that moral topography is not an external addition, an optional extra, but that the question of being or failing to be a self could not arise outside of this space" (1988, p. 317, emphasis mine). In Bollas's terms (1992, p. 31), makom may be identified as "the place of the complex self." No longer played upon according to the whim of external objects, nor even lost--albeit creatively--in the world of transitional illusoriness, the complex self has attained a modicum of detachment from which high point it questions, challenges, and redefines its relationship to objects. Moses and my patient, each in their own ways, sought out this place in the presence of what they identified as Other. Each individual found a medium for carving out a better sense of internal dimensionality, even though this achievement required relinquishing the concrete comforts of the ever-present object and welcoming a certain degree of existential loneliness. In some sense, the Other's reciprocal sense of loneliness and alterity also has been discerned and must be internalized as well, adding that characteristically bittersweet element increasingly recognized as proper to the domain of the unknown within the very limnal categories of internal space. Ultimately, the makom of utmost psychological relevance to humankind is that place made sacred by internalization. And "there, in the solitary space, we repeatedly contact that essential aloneness that launches our idiom into its ephemeral being" (Bollas, 1989, p. 22).

Adult↗
PubMed2002

The Mortal Stage of late life.

A Mortal Stage of later life may be considered as a subdivision of Erik Erikson's eighth stage of life which he called Mature Age, characterized by issues of integrity versus disgust, despair. Mortality poses the optimal task of Realization (in many positive coping and existential senses) versus Denial (or other non-recognition or emotional paralysis) or Fear (or apprehension or even terror). Premorbid awareness of illness may contribute to or challenge Realization. Literary examples also suggest a reviewing of one's life and works, possible regressions from genitality to anal preoccupations, little social withdrawal, and a compassionate interest in the next generation. In dying the self is not given up, but rather the alternate universe of further interpersonal relations had one lived on.

Aged↗
PubMed2002

Lesbian, gay, and bisexual suicidal behavior: testing a constructivist model.

The present investigation surveyed 162 self-identified lesbian, gay, and bisexual individuals recruited from LGB-related social organizations or contacted through networking procedures with regard to suicidal behaviors, suicide risk factors, and reasons for living. Approximately 41% of the respondents indicated a serious consideration of suicide including the identification of a specific suicide plan (23%) or a past suicide attempt (36%) with significant intent to die (13%). Forty-six percent of the sample indicated at least some degree of chance of attempting suicide in the future. Grounded in the existential-constructivist theory of suicide (Rogers, 2001), empirically and theoretically identified suicide risk factors were found as a group to predict suicidal ideation (R2 = .16) and attempts (R2 = .17), with abuse-related items independently predicting both suicidal ideation (R2 = .03) and attempts (R2 = .08). Items related to self-identity issues and social acceptance were predictive of suicidal ideation (R2 = .04), while substance abuse was predictive of suicidal ideation (R2 = .05) and attempts (R2 = .13) for males only. The established factor structure of the Reasons for Living Inventory (Linehan et al., 1983) was not supported in the current data, suggesting that it may not be an appropriate measure of reasons for living with LGB individuals.

Adult↗
PubMed2000

Depressive illness and Navajo healing.

What is the experience of Navajo patients in Navajo religious healing who, by the criteria and in the vernacular of contemporary psychiatry, would be diagnosed with the disorder called depression? We ask this question in the context of a double dialogue between psychiatry and anthropology and between these disciplines' academic constructs of illness and those of contemporary Navajos. The dialogue is conducted in the arena of patient narratives, providing a means for observing and explicating processes of therapeutic change in individuals, for illustrating variations in forms of Navajo religious healing sought out by patients demonstrating similar symptoms of distress, and for considering the heuristic utility of psychiatric diagnoses and nomenclature in the conceptualization of illness, recovery, and religious healing. From among the 37 percent of patients participating in the Navajo Healing Project who had a lifetime history of a major depressive illness, three are discussed herein, their selection based on two criteria: (1) all met formal psychiatric diagnostic criteria for a major depressive episode at the time of their healing ceremonies, and (2) together, their experiences illustrate the range of contemporary Navajo religious healing, including Traditional, Native American Church (NAC), and Christian forms. We suggest that, despite the explicit role of the sacred in religious healing interventions available to Navajo patients, differences between biomedical and religious healing systems may be of less significance than their shared existential engagement of problems such as those glossed as depression.

Anecdotes as Topic↗
PubMed2004

Finding meaning in first episode psychosis: experience, agency, and the cultural repertoire.

The article examines individuals' attempts to generate meaning following their experiences with psychosis. The inquiry is based on a person-centered ethnographic study of a Danish mental health community program for early intervention in schizophrenia and involves longitudinal interviews with 15 of its participants. The article takes an existential anthropological perspective emphasizing agency and cultural phenomenology to investigate how individuals draw on resources from the cultural repertoire to make sense of personally disturbing experiences during their psychosis. It is suggested that the concept of "system of explanation" has advantages over, for example, "illness narrative" and "explanatory model" when demonstrating how some individuals engage in the creative analytic and theory-building work of bricolage, selecting, adding, and combining various systems of explanation. Delusions are equally derived from the cultural repertoire but are constructed as dogmatic explanations that are idiosyncratic to the individual who holds them.

Culture↗
PubMedDate not supplied

[Preoperative orientation: comprehensive analysis of the patient's point of view].

In this study we approach the issue preoperatory orientation which we understand to be a vital practice in the field of Nursing also allowing the identification of same features at clients perception regarding the information achieved before operation. It is also suitable to recognize the failure of this procedure in the daily work at surgical units which upsets us with the absence of a guideline for preparing patients to surgical acts. Facing this need, we have decided to deeply investigate this issue to achieve the dimension, the description and analyzing the trajectory follow-up started in the first contact with the phenomenological approach. Thus, we make use of our patient operatory phase through his talk according to MARTINS & BICUDO's reference. So, this research aims at presenting the knowledge feature achieved through patients talk, its meaning and repercussion onto the individual plane as well as identifying what should alone improve it. That is the way phenomenological method questions the need of a preoperatory orientation which links us to theme dimension. In our experience of guiding patients to cope with their surgical intervention, we open a space that allows us to intervene under the perspective of conducting patients to recognize their existential dimension of experiencing an operation.

Attitude to Health↗
PubMedDate not supplied

[Risk factors for the spine: nursing assessment and care].

The present work aimed at studying risk factor that affect people with back pain, identifying them and implementing an intervention proposal of a health education program based on self-care teaching, existential humanist philosophical projects and stress equalization approach line, skeletal-muscle reintegration activities, basic techniques on stress equalization and massage. It has been developed for a population of 42 (forty-two) clients. Two instruments which integrate nursing consultation protocol have been used in data collection. The results showed the existence of associated risk factors which are changeable according to health education programs. The assessment process has contributed for therapeutic measures focus, using non-conventional care methods for this approach providing an improvement to these clients life quality.

Adult↗
PubMedDate not supplied

[Living with coronary disease: between authentic living and living with daily ties].

Phenomenological study, which purpose is the meaning that the persons suffering from coronary diseases ascribe to the experiences undergone. From the interviews, significances were obtained: fear of death and of the return of the acute symptoms; perceiving the social, professional and sexual life transformations; feeling watched; resigning oneself to the new conditions; and feel sadness and no resignation. These significances permitted the comprehensive analyses, that was supported by Martin Heidegger in his book Being and time. The person suffering from coronary diseases showed themselves as inauthentic existences when fearing "something", by becoming tied to chatter and to the satisfaction they once had. Moreover, they transcend to the authentic living when they feel anguished, assuming coronary illness as a possibility of existence, although they fail and become tied to daily life traps. The study reflects about the need to privilege the existential dimension in health assistance and in the training of professionals, getting ahead the idea of the other as a guidance to be followed.

Activities of Daily Living↗
PubMedDate not supplied

[Significance of sex education in the parents-adolescents relationship].

This study had as reference the phenomenological sociology of Alfred Schütz. This author had as purpose understanding parents and adolescents' behavior towards sexual education. The phenomenological interview, used to gather data from parents and youngsters, allowed the understanding of the types: "parents who educate adolescents for sexual life" and "adolescents who are educated for sexual life". The comparative analyses of these two types showed the need of implementing a dialog about sexual life among parents and teenagers enabling the youngster to have a satisfying and safe sexual initiation. The comprehensive social action theory by Schütz was presented, in this study, as an educational health strategy. According to the author, there is a need of considering the person's inner existential preoccupations in order to understand his/her social behavior towards sexual matters.

Adolescent↗
PubMedDate not supplied

[Use of discarded material in the therapeutic relationship].

This is a descriptive exploratory study with a qualitative perspective accomplished in 1996. Its objective is to demonstrate how discarded material can be used as an alternative and cooperative resource in the therapeutic communication process. Based on a theoretical reference that favors the dialogistical posture of the professional, this research approaches matters inherent to the process of communication. It also considers discarded material a mean to facilitate the expression of latent feelings which are difficult to express orally. The study presents the material used and discusses its applications from a phenomenological existential point of view. As a result of the study, it was concluded that discarded material can be a valuable resource to be used in the therapeutic relationship.

Communication↗
PubMedDate not supplied

[Maternal experiences at the intensive care unit: a phenomenological experience].

This is a phenomenological research in Martin Heidegger's perspective with eight mothers staying with their babies in the hospital, with the aim of understanding their maternal feelings at the ICU of the Albert Sabin Infant Hospital in Fortaleza-CE. The information was obtained by means of phenomenological interviews with the following probing question, "What is it like for you as a mother to be in an ICU and at the same time follow all that goes on in the hospital unit?" and submitted to the analysis of the phenomena sited as proposed by Martins and Bicudo. The experiences of the mothers revealed safety and feer, hope and anguish, potentialities and impotence, existential concerns and expectations of a human being in the world. Beyond these aspects, the mothers showed themselves to be authentic people that got free of the occupation and deal with the pre-occupation.

Humans↗
PubMedDate not supplied

[Unveiling the daily experience of the hospitalized adolescent].

My experience in the adolescence was marked by the hospitalization process. Currently, as a nursing professional that take care of hospitalized young, there arose inquietudes that originated this study. The investigation object was the significance of the hospitalization in the adolescence, having as objective to understand this significance for the hospitalized adolescent. It was used the qualitative approach in the light of the Martin Heidegger's existential phenomenology. The setting was a specific internment unit for adolescents and the deponents were hospitalized young. This study made possible to understand that the adolescent unveiled himself as a being-with and understand of himself as a being--in the--world thrown to the death. The research pointed to the need of a real implementation of the public policies addressed to the hospitalized adolescent.

Adolescent↗
PubMedDate not supplied

[Climacteric: the corporeity as cradle of life experience].

Qualitative study of phenomenological approach, accomplished from women's testimony aged between 58 and 55, who had presented spontaneous menopause over the last 12 months or more. The results evidenced five thematic categories that were analyzed and interpreted under the light of Maurice Merleau-Ponty's philosophical theoretical referral. Among the categories that have emerged from the testimonies, the unveiled theme "Make yourself aware of the world through your body in space and time" will be presented with the objective of stimulating the reflection on existential aspects of experiencing this reproductive cycle phase and make considerations on the climacteric woman health care.

Female↗
PubMedDate not supplied

[Mothers' conceptions about their premature children in ICU].

In this study, our purpose was to direct ourselves to the mothers who had babies that were born prematurely and needed to be assisted in a Neonatal Intensive Care Unit, searching for the comprehension of the feelings provoked in these mothers due to such situation and, thus, project new possibilities of caring aimed at these beings. For that, we opted for a qualitative-descriptive study, based on the principles of the existential phenomenology. From the analysis, four categories emerged; the pain to see her child be born prematurely and then be taken away from her arms; undergoing the possibility of losing a part of hers; revival of feelings from the understanding of the situation of the child and; the importance of the hospital's staff during the process of her child's recovering. We inferred that listening and paying attention are vital instruments to aid the mother and her child in their singularities.

Emotions↗
PubMed2005

Factorial validity of the Maslach Burnout Inventory (MBI-HSS) among Spanish professionals.

OBJECTIVE: To assess the factorial validity and internal consistency of the Maslach Burnout Inventory (MBI-HSS). METHODS: In a sample consisting of 705 Spanish professionals from diverse occupational sectors (health, education, police and so one), seven plausible factorial models hypothesized were compared using LISREL 8. RESULTS: The four-factor oblique solution and the three-factor oblique solution showed the best and similar fit. Deletion of Item 12 and Item 16, taking into consideration the suggestions in the manual, improved the goodness of fit for both models. The four-factor oblique model suggests that, in addition to Emotional Exhaustion (EE) and Depersonalization (DP), Personal Accomplishment (PA) consists of two components labeled here Self-Competence (Items 4, 7, 17, and 21) and the Existential Component (Items 9, 12, 18, and 19). However, the alpha coefficient was relatively low for the Self-Competence component, suggesting that it is more suitable to estimate the syndrome as a three-dimensional construct. The Cronbach's alpha was satisfactory for PA (alpha =.71) and EE (alpha =.85), and moderate for DP (alpha =.58). CONCLUSIONS: The results show that the MBI-HSS offers factorial validity and its scales present internal consistency to evaluate the quality of working life for Spanish professionals.

Burnout, Professional↗