The existential dimension in psychiatry: an enactive framework

ABSTRACT

In his paper Psychiatry and religion: Consensus reached!, Verhagen advocates the relevance of spirituality and religion for the “origins, understanding, and treatment of psychiatric disorders”. In this comment, I argue for the broader claim that the existential dimension is important for understanding psychiatric disorders – of which religion can, but must not necessarily be, part. The existential dimension refers to our ability to relate to ourselves, our experiences, and our situation. This evaluative relation can play an important role in psychiatry: it can co-constitute the disorder, be affected by the disorder, and/or modulate the course of the disorder. Given this importance, it makes sense to explicitly recognize the existential dimension in our explanatory model of psychiatric disorders. The biopsychosocial model goes a long way in providing an integrative model, but there is room for improvement, especially when it comes to integration of its aspects, and acknowledging the existential aspect. I briefly introduce the research paradigm of enactivism, and suggest that an enactive framework is well-suited to incorporate this existential dimension – along with the traditional dimensions of the biopsychosocial model.     

Understanding and working with existential information in a Norwegian adolescent psychiatry context: a need and a challenge

This is one of several studies on existential information in psychotherapy in Southern Norway. The aim of this study was to explore how therapists' backgrounds and existential information influence their therapeutic practice and philosophy of care, and the use of existential information in psychotherapy. The method used was qualitative, semi-structured interviews. Through emerging themes from the interviews and clinical case illustrations, information relating to therapists' backgrounds and existential orientations strongly influenced: therapeutic practice, philosophy of care, and if as well as how existential information was used in therapy. Professional and continued education/training in this area were insufficient. However, the area itself was considered essential for understanding clients' psychosocial and sociocultural needs in multicultural Norway. Therapists expressed the importance of communication about existential information. Clinical examples were given that focused on this information's usefulness for identifying strategies addressing both salutogenic and pathogenic aspects of adolescent psychosocial functioning. Clinical educational and training insufficiencies related to working with existential information were noted. Although strategic thinking and organisational framework in the working context permitted existential information to be raised in therapy, many expressed the lacking of methodological confidence and training in this area. Education and training were, therefore, priorities. Accessing this type of information with all clients, whatever their existential information, was emphasised for strengthening the therapeutic alliance.     

The existential assumptions of traditional logic

There have been and continue to be disagreements about how to consider the traditional square of opposition and the traditional inferences of obversion, conversion, contraposition and inversion from the perspective of contemporary quantificational logic. Philosophers have made many different attempts to save traditional inferences that are invalid when they involve empty classes. I survey some of these attempts and argue that the only satisfactory way of saving all the traditional inferences is to make the existential assumption that both the subject and predicate classes and their complement classes are non-empty for all the propositions we admit. I briefly indicate the room for continued controversy over how properly to interpret Aristotle’s statements regarding these inferences, but find some plausibility in the views of Manley Thompson and A.N.Prior that Aristotle had in mind a particular arrangement of existential import unfamiliar to most contemporary logicians     

The case for existential therapy in HIV-related psychotherapy

Few topics currently evoke such debate and dynamics as HIV and AIDS. It is a phenomenon that affects people at all levels of their existence, including in their psychotherapy experience. There is an ever growing field of HIV related psychotherapy. Currently this field contains work from a cognitive behavioural focus, a systemic one, work from a psychodynamic focus and from the Group Analytic approach. In this paper the case for existential psychotherapy will be made as an important approach with a great deal to offer the field of HIV-related psychotherapy.     

The triumph of American psychiatry: How it created the modern therapeutic state

Over the past 170 years, American psychiatry has progressively asserted its authority over a larger segment of the American population. From the mid-1800s to the end of World War II, psychiatry had authority over the asylum population, which markedly increased in the first half of the twentieth century due to the influence of eugenics, an ideology that argued the ‘mentally ill’ had to be segregated from society. After the war, American psychiatry adopted Freudian conceptions of mental disorders, which enabled it to begin treating people in the community who were ‘neurotic’ in some way, which dramatically expanded its influence in society. Then, in the 1970s, when many in American society were questioning psychiatry’s legitimacy as a branch of medicine, the American Psychiatric Association (APA) responded by adopting a disease model for diagnosing mental disorders, which it set forth in the third edition of its Diagnostic and Statistical Manual. There were no scientific discoveries that led to this new model, but soon the APA was informing the American public that mental disorders were diseases of the brain, and that psychiatric drugs helped fix those diseases, ‘like insulin for diabetes.’ The APA, in concert with pharmaceutical companies, has successfully exported this belief system to much of the developed world. In order to break free of this ‘therapeutic state,’ the public needs to understand the history of how it came to be, and see the social injury it has caused.     

The WPA position paper on spirituality and religion in psychiatry: a North American perspective

ABSTRACT

The WPA position statement is a clear challenge for psychiatrists to recognize how religion/spirituality (R/S) is relevant to their work. North American psychiatry has shown progress related to each principle articulated in the statement, especially in the areas of research and scholarship. However, most advances are yet to be widely implemented or coordinated, so that the statement offers valuable encouragement and direction in moving forward.     

Divergences in American psychiatry during the Depression: somatic psychiatry, community mental hygiene, and social reconstruction

The differences between somatic psychiatrists and mental hygienists, already apparent earlier, became much more pronounced during the Depression years, partly as a consequence of their different perspectives on this social crisis. Somatic psychiatrists, emboldened by the apparent success of new medical treatment methods, reasserted the central position of the mental hospital within psychiatry, attempted to improve the discipline's position within medicine, and promoted basic research. Mental hygienists, following the ideal of prevention, proposed far-reaching programs of community mental hygiene to alleviate widespread mental distress. A small group of mental hygienists embraced socialism and advocated measures of radical social reconstruction.     

Semantics for existential graphs

This paper examines Charles Peirce's graphical notation for first-order logic with identity. The notation forms a part of his system of existential graphs, which Peirce considered to be his best work in logic. In this paper a Tarskian semantics is provided for the graphical system.