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.     

Sanctuary and presence: An existential view of the therapist's contribution

Abstract

This inquiry endeavors to form an understanding of the summons to caring. The effort will expand upon the work of Milton Mayeroff and Martin Heidegger by way of incorporating an existential interpretation of the Buddhist concept of suffering.     

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.     

A note on existential import

It is shown that a linguistically well-motivated semantical analysis of certain extensions of categorical sentences is compatible with a semantics that fulfils the so-called existential import condition, but is not compatible with a semantics that does not fulfil this condition.This work was written during a stay at the Institute for Mathematical Studies in the Social Sciences at Stanford University and funded by grant No. Bo 778 of the Deutsche Forschungsgemeinschaft.I wish to thank Patrick Suppes for critical remarks and to gratefully acknowledge the use of the facilities of the Institute of Mathematical Studies in the Social Sciences and the Center for the Study of Language and Information.     

Subject-predicate calculus free from existential import

Two subject-predicate calculi with equality,SP ₌ and its extensionUSP ₌, are presented as systems of natural deduction. Both the calculi are systems of free logic. Their presentation is preceded by an intuitive motivation.It is shown that Aristotle's syllogistics without the laws of identitySaP andSiP is definable withinSP ₌, and that the first-order predicate logic is definable withinUSP ₌.     

A critical examination of existential feeling

Matthew Ratcliffe (2008, 2015) has argued that existential feelings form a distinct class of bodily and non-conceptual feelings that pre-intentionally structure our intentional experience of others, the world, and ourselves. In this article, I will identify and discuss three interrelated areas of concern for Ratcliffe’s theory of existential feelings. First, the distinct senses in which existential feelings are felt as background bodily feelings and as spaces of possibility calls for further clarification. Second, the nature of the suggested bi-directional relationship between existential feelings and intentional experience remains ambiguous. Third, viewed in light of existential guilt, the categorically non-conceptual nature of existential feelings may not be as definite as presumed. The aim of the article is to draw critical attention to aspects of the theory that would benefit from further development, and therefore, to advance the ongoing discussion about existential feelings.     

Schizophrenia: A Neurodevelopmental Perspective

Diverse lines of research suggest that schizophrenia is a genetically influenced neurodevelopmental disorder. Family, twin, and adoption studies suggest that most cases of schizophrenia involve a genetic diathesis that is necessary but not sufficient for development of the disorder. Histological, neuroimaging, and neuropsychological findings converge in providing evidence for medial-temporal and frontal lobe dysfunction that likely predates the onset of psychosis. Behavioral phenomenology and neurobiology suggest that dopamine plays a crucial moderating role between these structural abnormalities and functional impairment. Recently, investigators have used animal models and clinical syndromes to integrate these findings into neurodevelopmental models of schizophrenia that hold great potential for yielding etiological insight.     

Recovery from Schizophrenia: An Autoethnography

Medication- and symptom-free recovery has been the author’s experience since March 2006. Details of 127 potentially therapeutic lifestyle activities were explored using a structured reflective analysis. These activities were divided into twelve communities: family, arts, romance, etc. Perceived therapeutic effects are noted. Also included is the author’s method for weaning from psychiatric medication very slowly, plus personal details of success.     

Our existential dilemma:Bor orBe'er

An evaluation is made of the choices available to individuals in dealing with their essential alone-ness, the existential dilemma; and a parallel is drawn between these choices and flowing and stagnant waters, as interpreted by traditional sources.