The Expression of the Psychosomatic Body from a Phenomenological Perspective, Dordrecht: Springer
Abstract
The patient who presents somatic symptoms with no clearly discernible lesion or dysfunction presents a problem to the traditional health care system. These symptoms are medically unexplainable and, as such, constitute an anomaly for the materialistic understanding of health problems that underlies the practice of modern medicine. Although the advances made by medicine have made possible the cure and prevention of many diseases and are very useful for treating those conditions that can be properly understood in material terms, the traditional biomedical model is not appropriate for understanding a variety of health issues that we call “psychosomatic”. For this reason, biomedical theory and practice must be complemented by another theoretical understanding in order to adequately grasp the psychosomatic problematic. This book establishes a complementary understanding of psychosomatic ill health in terms of a non-reductionistic theory allowing for the (psychosomatic) expression of the lived body. In order to understand psychosomatics, we must reframe our conceptualization of mind and material, meaning and the body. The philosophy of Merleau-Ponty provides such a reformulation. Inspired by the work of the French phenomenologist Maurice Merleau-Ponty, a phenomenological theory of psychosomatics is worked out as an alternative to traditional, biomedical thinking. The book contains not only a philosophical grounding of a truly “holistic” approach to health care, but also provides case examples, treatment guidelines and practical strategies for working with patients with psychosomatic health problems.
Chapters (7)
The first part of this chapter introduces the problem of medically unexplained symptoms (MUS) and explains why we need an alternative theoretical understanding of psychosomatics in order to grasp the idea of a “speaking body.” The theoretical and clinical problems connecting to psychosomatic pathology are presented. The failure of traditional psychosomatic theories (psychodynamic, psychosomatic medicine and stress theory) to make psychosomatics comprehensible is demonstrated through text analyses, philosophical argumentation and exemplification from the literature. The final part of this chapter presents empirical evidence that psychosomatic symptoms in adults and children/young adults are common causes for seeking health care today. Four clinical challenges connected to the treatment of these patients is presented and discussed at the end of this first introductory chapter.
This chapter focuses on the early writings of Maurice Merleau-Ponty (The Structure of Behavior and Phenomenology of Perception). Firstly, an introduction to the science of phenomenology places the reader within the correct philosophical framework in order to understand the aim of Merleau-Ponty’s work on the body. Concepts from these two early works, such as “the lived body”, “the intentional arc”, “motor intentionality”, “structure” and “structure transformation” are presented. These concepts will be used in Chap. 5 as a new way to understand the “mystery” of psychosomatic pathology. Merleau-Ponty’s explication of the meaning-constitution of the (lived) body solves many of the mind–body problems associated with psychosomatics. In this chapter (and Chaps. 3 and 4), the philosophical groundwork for a phenomenological theory of psychosomatics (Chap. 5) is laid out.
Now that we have established that the body is involved in a rudimentary meaning-constitution, the question becomes, what is “meaning”? The chapter begins with a brief look at the traditional view of meaning, moving quickly into the texts of Merleau-Ponty that have to do with language and expression (Signs, Prose of the World, Consciousness and the Acquisition of Language) in order to explicate an entirely new way of understanding “meaning”, not simply as a way of designating thoughts and things, but rather, as the very bringing of thoughts and things into presence. The relationship between perception and language and the origin of meaning is in focus in these texts. Finally, the notion of “expression” finds its ultimate form in the ontology of the late Merleau-Ponty in his description of the meeting between man and world as “flesh” which will be the subject matter of the following chapter (4).
This chapter takes the reader into the late Merleau-Ponty (The Visible and the Invisible) where a visionary description of the relations between man and world is put forth in terms of “the flesh.” The goal of his last work was to bring the insights from his earlier (phenomenological) work to an ontological level. For example, what does it really mean to see? I find myself “with” the thing at the end of my gaze, but it is somehow also “in” me. The mysterious way we “have” the world is described in this last work a unitary movement where man and the world become together in one event. In order to understand this, the concepts of “chiasm”, “reversibility”, “écart/dehiscence”, “the visible” and “the invisible” are presented. All the chapters on Merleau-Ponty’s philosophy (Chaps. 2, 3 and this chapter) contain extensive quotes from his texts and explanatory footnotes.
In this chapter, the phenomenological theory of psychosomatics is presented. The solution to the mind–body problematic is shown to be found in the concept of the lived body and the relationship between body—world as flesh. The psychosomatic condition is understood as a disarticulation of self and world, which is the result of a collapsed meaning-constitution at the higher (psychosocial) levels. The body takes over the task of expression (meaning-constitution at the level of the body), attempting to manage a life situation by using bodily structures which are not adapted to this level of meaning. Merleau-Pontian concepts are used in order to understand psychosomatics as a specific way of being-in-the-world. The consequences of this understanding of psychosomatics for the clinical encounter are drawn out. Teaching psychosomatics and supervision of psychosomatic case work is also discussed from this perspective. The theory is illustrated with patient examples.
This chapter examines the notion of “holistic” health. The literature today is full of references to “holistic care” and “holistic medicine” but one rarely sees any content to this term, except for some general phrases about man being a biological, psychological and social being. The chapter begins with an overview of different conceptions of health and illness throughout history, demonstrating that the notion of health has deep-rooted cultural associations to ideas about balance and harmony, virtue and morality, societal norms and behaviors. A brief presentation of modern theories of health follows. Afterwards, an analysis of scientific literature shows how the term “holistic” is in need of a philosophical grounding in order to make any genuine contributions to health care. Finally, a sound holistic view of health is extrapolated from the theory of psychosomatics presented in Chap. 5, which should be an appreciated contribution to the literature on health.
The last chapter contains a summing up of the theoretical contribution of the book, followed by drawing out some implications about what this point of view means for the organization of health care and the education and training of health care professionals. Some work-place strategies for treating persons with the “psychosomatic solution” are presented in order to help both students and professionals properly prepare these patients for a psychosomatic form of treatment.
... In that way, body awareness transcends the physical body. Husserl distinguished the physical body (Körper) with object-like characteristics from what is called the lived body (Leib), which is intentional and more subject-like (Bullington, 2013). This lived body, defined as our bodily anchoring in the world, refers to the meaningful experience of living in the world through the body (Stanghellini, 2013). ...
... Chronic suffering or illness is thought to impact the obvious and harmonious experience of having and being a body. The obviousness of being bodily aware tends to disappear and tuning into the body often becomes a problem in chronic illness (Bullington, 2013). Grytten et al., (2005) describes the mechanism of creating a protective capsule around the self as a result of no longer meeting socially acceptable standards and feeling useless. ...
... Besides its effects on body awareness, chronic illness seems to heavily impact how people experience their identity. Loss of identity and feelings of being alienated and detached from what once gave meaning to their lives are common in chronically ill people (Bullington, 2013). In phenomenology, this is easily understood because an individual is conceived as the perspectival origin of his experiences, behavior and thoughts and considered to be the center of self-awareness, object-experience and meaning bestowing (Stanghellini, 2013). ...
People with multiple sclerosis benefit from exercise, however, they commonly lead a more sedentary lifestyle. Therefore, they may lack the positive effects of activity on body awareness and selfidentity. This study explores changes in body awareness and identity in people with multiple sclerosis after a unique hiking expedition through the Jordan desert in the spring of 2014. A qualitative study design was applied, the interpretative phenomenological analysis method was used in a focus group with all nine participants of the expedition. Three main themes and six subthemes were identified to explore this study on a thematic basis. The first main theme ‘Peers and society’ focused on group dynamics and social stigma. The second theme, the ‘Lived body’ discussed bodily experiences and selfidentity. In the third theme, ‘Therapeutic effects’ of the journey and their implementation into daily life were explored. The findings suggest that participating in this unique hiking project had a powerful effect on the lived body experience of the participants. Experiencing outdoor life brought them back to basics, changed their bodily attunement and empowered their self-belief and social resilience. Several participants described this experience as an awakening in dealing with multiple sclerosis.
... In order to capture the complex meanings women attribute to their experience, we adopted a phenomenological approach drawing on Merleau-Ponty's body theory. A key concept in this work is that of "embodied identity", whereby the body is recognized as an integral part of one's self, through which indivi duals perceive and understand their self and connect to the world (Bullington, 2013). Merleau -Ponty (1945, as cited in Bullington, 2013 distinguishes the "subjective" body, which is perceived pre-reflectively, from the "objective" body, which is observed by others or can be investigated through science. ...
... Given that gender is a central element of embodied identity, we would argue that women's experience of altered femininity is associated with a broader sense of ambiguity of existence (Piot-Ziegler, 2010). From a phenomenological perspective, this experience highlights the crucial role of the body in the perception of women's self (Bullington, 2013). Moreover, the important role of the body in one's sense of gender identity is illustrated in the examples that follow: Vicky, 37 years: "look, I think, you lose the core elements of femininity: hair, breast, eyelashes, gaze, things that are basic to a woman's femininity, we want long eyelashes, long hair, don't we? ...
In addition to a potentially life-threatening illness, women with breast cancer also face several challenges related to the effects of medical treatment on their bodies and their embodied identity. Mastectomy, as a highly invasive treatment, has significant impact on women's lives. This study aims to investigate the experience of mastectomy and the subjective meanings that it holds for women, in relation to their identity and relationships. The research questions were explored through a phenomenological approach in order to better understand the role of the body in this experience, and a gender perspective was adopted in order to critically examine the socio-cultural background that shapes women’s experience. Seventeen women, aged between 26-57, who had undergone mastectomy following a breast cancer diagnosis, participated in the study. The research material was collected through semi-structured interviews and analyzed using phenomenological analysis. The analysis also drew upon a gender perspective, given a focus of the study on the gendered dimension of embodied identity. Findings indicate that a core element of the experience of mastectomy concerns the alteration of embodied identity and a sense of liminality, an unresolved state of being in between the previous normal life and life post-diagnosis. The analysis highlighted the need to expand the concept of liminality in psycho-oncology, to include the ambiguity associated with women’s self-identification as ‘normal women’, in relation to embodied experience and the socio-cultural constructions of the female breast. Interestingly, liminality in relation to gender identity characterizes many women’s experience, despite the use of silicone pads and/or plastic reconstructive surgery to manage the altered body. The findings enrich our theoretical understanding of the experience of mastectomy, broaden the concept of liminality, highlight the gendered dimensions of identity and the role of the socio-cultural context in shaping the experience of mastectomy. Moreover, they point to useful directions for the design and delivery of individualized support to women who have undergone mastectomy.
... This means that healthcare professionals need to approach a young woman as a whole, not divided into parts such as the physical and the mental. Bullington (2013), inspired by Merleau-Ponty's philosophy, explains this as an integrated whole, a lived body in which there are no dividing lines between body, mind, and world. The young women in the present study describe how the body is experienced as unpredictable and limits everyday life and the opportunity to fully live their lives, perhaps based on fear and a feeling that new situations that are daunting, as she faces new and unknown changes. ...
... The goal of caring is health, which can be described in terms of well-being and the quality of being able to live out one's life as desired and to manage one's life projects. Bullington (2013) posits that care needs to bring out the experience and the story that lies behind the bodily expressions to fully understand the lived situation. This is also in line with Dahlberg's (2019) assertion that there is a need to make room for both objective and subjective perspectives on the body, and the movement between them. ...
Purpose: The aim of this study is to describe young women’s (16–25 years old) experiences of living with existential concerns for which they have sought support from healthcare professionals, teachers, family, or friends, among others.
Methods: This phenomenological study is based on a reflective lifeworld research (RLR) approach. Nine young women were interviewed about their experience of living with existential concerns.
Results: The results show the essential meaning of the phenomenon of “existential concerns” that can be described as living a life that is marked in a profound way by a feeling of being lost in an unknown terrain. To further understand the essential meaning, four constituents are described: the unpredictable body, longing for comprehension, playing a game, and longing to share one’s vulnerability.
Conclusions: Young women with existential concerns are vulnerable, as they are profoundly influenced by these concerns. They have to navigate through daily life while trying to fit in and to make their situation comprehensible. These young women have a longing to share their existential concerns with a trustworthy person, while at the same time they fear revealing their existential concerns and risking being rejected by others. A lifeworld-led, caring science approach, intertwined with the results of the present study, has the potential to direct caring practice.
... The clinical dilemma surrounding psychosomatic ill health concerns finding a way to help both patients and professionals understand how the patient has, for various reasons, designated the place of his/her suffering in the body. The theoretical point of departure for this supervision intervention study is a phenomenological theory of psychosomatics which understands the body symptom as rudimentary meaning constitution (25)(26)(27). The somatic signalling of the body becomes the focus of clinical interest as a 'speaking body'. ...
... From a phenomenological perspective on psychosomatics (27), the clinical focus shifts from repairing the objective 'body machine' to understanding the expressive speaking body (the lived body). Based on this, a variety of treatment strategies emerge, which ultimately aim to transform body meaning (the symptom) to meaning constitution on a psychosocial level. ...
Background:
In primary health care, efficacious treatment strategies are lacking for these patients, although the most prominent symptoms accounting for consultation in primary care often cannot be related to any biological causes.
Aim:
The aim was to explore whether group supervision from a specific phenomenological theory of psychosomatics could provide healthcare professionals treating patients with psychosomatic health issues within primary care a deeper understanding of these conditions and stimulate profession-specific treatment strategies. Our research questions were as follows: (i) What is the healthcare professionals' understanding of psychosomatics before and after the intervention? (ii) What are the treatment strategies for this group of patients before and after the intervention?
Methods:
The study was an explorative qualitative intervention pilot study. The six participants from a primary healthcare setting in a medium-sized city in Sweden participated in the study. A supervision group was formed, based on a mix of professions, age, gender and years of clinical experience. Supervision consisted of one 75-minutes meeting every month during the course of 6 months. Participants were interviewed before and after the supervision intervention.
Findings:
The study showed two distinct categories emerged from the data. One category of healthcare professionals espoused a psycho-educative approach, while the other lacked a cohesive approach. The supervision improved the second category of healthcare professionals' understanding of psychosomatics. The psycho-educative group did not change their understanding of psychosomatics, although they felt strengthened in their approach by the supervision. Profession-specific strategies were not developed.
Implications:
This pilot study indicates that a relatively short supervision intervention can aid clinicians in their clinical encounters with these patients; however, further research is necessary to ascertain the value of the specific phenomenologically based supervision intervention.
... Leib) paskaidro un ļauj vienā teorijā apvienot gan izpratni par ķermeni kā ārēji novērojamu lietu citu lietu vidū (trešās personas perspektīva), gan arī izprat ni par miesu kā sub jektīvi pieredzēto ķermeni (pirmās personas perspektīva). 1 Ķermenis, pēc feno menologu domām, vienmēr jau paredz teorētisku uzslā ņoju mu jeb priekš status par tā dabu (vai tie būtu balstīti uz dabaszinātņu idejām, socioloģiju vai noteiktiem filo so fijas virzieniem), savukārt miesa izsaka teorē tisko uzslā ņojumu nepastarpinātu, tiešu sajūtu pieredzi. Tiesa, lai arī feno menoloģija sniedz gan ķermeņa, gan arī miesas izpratni, tā dod priekšroku miesas pieredzei. ...
The collection of papers “Philosophical Anthropology II” is the second volume of papers in philosophical anthropology that contains papers written by members of the Department of Humanities at Rīga Stradiņš University. The collection consists of a foreword and ten chapters. Each chapter addresses its individual topic. The collection is oriented to general reader and does not presume background knowledge of philosophy or philosophical anthropology. / Krājumā “Filosofiskā antropoloģija II” tiek turpināts pirmajā krājumā iesāktais konceptuālais virziens, saskaņā ar kuru filosofiskā antropoloģija “ieņem vidutāja lomu starp dabaszinātnēm un humanitārajām zinātnēm, cenšoties apkopot dažādu zinātņu nozaru atklājumus par cilvēku” (Sīlis, 2015, 14). Tā ir multidisciplināra pieeja, kas izmanto filosofijas metodes, lai interpretētu empīriskus datus (procesus, stāvokļus) un izdarītu vispārinājumus par konkrētiem ar cilvēka eksistenci saistītiem jautājumiem. Tāpat kā iepriekšējā krājumā, arī šī krājuma rakstu struktūra ir saistīta ar nepieciešamību aplūkot pagātnes domātāju veikumu, lai noskaidrotu, cik tas ir aktuāls mūsdienās. Vienlaikus krājuma autori cenšas iekļaut arī mūslaiku problēmas, kas parādās viņu izvēlētās tēmas kontekstā. Atbilstīgi katras tēmas specifikai tiek izskatītas vairākas teorētiskās nostādnes, kritiski analizēti to trūkumi un priekšrocības. Krājums sastāv no desmit rakstiem. 6.3. Filozofija, reliģija, ētika. Filozofiskās antropoloģijas apakšnozare.
... Patients' responses to their symptoms are based on the meaning that the patients attribute to them (Bullington, 2013;Salkovskis et al., 2016). The correction of dysfunctional beliefs about symptoms has been shown to be a mediator of change (Chow et al., 2018;Harvey et al., 2017). ...
Understanding psychological mechanisms of change is essential to advance treatments for patients suffering from medically unexplained physical symptoms (MUPS). This study aimed to test the role of selected change mechanisms (incl. interoceptive awareness, emotional regulation skills, symptom acceptance, relational needs satisfaction, clarification of meaning, working alliance, and group cohesion) in the modification of patients' somatic symptom intensity and well-being.
N = 290 patients suffering from MUPS participated in a multi-component group-based treatment at seven clinical sites. Data were collected weekly. Multi-level modeling was used to test cross-lagged relationships between the hypothesized mechanisms and outcomes in terms of Granger causality (with lags of 1, 2, and 3 weeks).
None of the mechanisms predicted a time-lagged change in outcomes in the expected direction. In fact, there was a consistent pattern of negative time-lagged relationships (i.e., an increase in a mechanism predicted worsening of the outcome). Findings consistent with the hypothesized role of the mechanisms were found only in concurrent relationships between mechanisms and outcomes.
This study did not support time-lagged relationships under the condition of weekly measurement and many methodological factors remain to be considered (e.g., a finer time resolution).
... Yet this premise on which Rilkean memories are based also continues the line of philosophical inquiry into consciousness as a corporeal, embodied phenomenon defined by its limitations (Madison, 1981). Likewise, Rilkean memories as embodied sedimentations of episodic memories, and as bodily dispositions, correspond conceptually to both the phenomenological project of Merleau-Ponty (2011) and its more recent elaborations that concentrate on the sedimentation of experiences in bodily and behavioural structures (Bullington, 2013). ...
In two recent papers, I introduced the idea of embodied Rilkean movement knowledge and perception into the current philosophical debate on sports knowledge. In this paper, I offer a new analysis of how embodied movement knowledge and perception help us to identify and define movement consciousness. I develop a phenomenological account of embodied movement consciousness and show how it is closely linked to self-consciousness by generating anticipations and affordances that implicate pre-reflective self-awareness. I also expand Rowlands’ Rilkean memory notion to include affective phenomenological properties that rely on the constitutive fault-lines between bodily material sensations and the ingrained recollections they are based on. From this perspective, embodied movement consciousness comprises empirical sensations that phenomenologically unfold as physical acts grounded in materiality.
... This is because this illness, which Merleau-Ponty describes as "the reduction" of the world to frozen experiences and "the suspension" of expressive values, becomes "a general possibility of human existence when the illness confronts consistently one of its paradoxes-the phenomenon of expression". 14 The reduction and suspension, this epochē that Cézanne suffers in his illness stops being an absurd fact and destiny when it engenders expression 12 There are a number of recent studies on Merleau-Ponty's notion of expression, among them the arelady mentioned Fóti (2013), but also Landes (2013a), Bullington (2013). 13 Merleau-Ponty (2007b: 69). ...
Phenomenology’s return to lived experience and “to the things themselves” is often contrasted with the synthesized perspective of science and its “view from nowhere.” The extensive use of neuropsychological case reports in Merleau-Ponty’s Phenomenology of Perception, however, suggests that the relationship between phenomenology and science is more complex than a sheer opposition, and a fruitful one for the praxis of medicine. Here, I propose a new reading of how Merleau-Ponty justifies his use of Adhémar Gelb and Kurt Goldstein’s reports on Johann Schneider for his phenomenology of embodied perception. I argue that for Merleau-Ponty these neuropsychological case reports represent a coherent deformation of the intercorporeally expressed existence of Schneider that through speech fall again onto the common ground of perception, thereby allowing Merleau-Ponty to understand, in the equivalent sense delivered by language, Schneider’s total being and fundamental illness. I then discuss what Merleau-Ponty’s method implies for a phenomenological praxis of medicine, and for the role of science in this praxis.
... Diese subjektiven Erfahrungen basieren auf der bereits erwähnten Körperlichkeit des Individuums, welche die Basis für das Erleben von Raum ist und als Schnittstelle zwischen Welt und Einzelperson fungiert. Der gelebte Körper ‚lived Body' ist somit Instrument der Rezeption als auch Vehikel für individuelle Mobilität und selbstbestimmtes Handeln (Bullington 2013). Im Zusammenspiel dienen gelebter Raum, gelebte Erfahrung und gelebter Körper in der Phänomenologie der Beschreibung der Art und Weise, wie sich die Welt dem Individuum zeigt und erfahren werden kann. ...
Die vorliegende Arbeit befasst sich mit der Fragestellung „Wie lässt sich landschaftsbezogenes Wohlbefinden in der räumlichen Planung greifbar machen?“. In den Vorüberlegungen werden Grundlagen des Wahrnehmens und Erlebens von Landschaft, sowie der Landschaftstheorie zusammengestellt und systematisch aufbereitet. Weiterhin werden die Begriffe Landschaft, Gesundheit, Wohlbefinden und Erholung inhaltlich gefasst und theoretische Wechselbezüge dargestellt. Anschließend werden unterschiedliche Möglichkeiten zur Ermittlung von menschlichen Emotionen im Raum vorgestellt. Dabei handelt es sich um innovative Formate der Raumforschung, wie spaziergangs- oder fotografiebasierte Forschungsmethoden und etablierte Instrumente der Psychologie, wie Emotionsfragebögen. Diese werden systematisch aufbereitet, um Vorteile bzw. Herausforderungen aufzuzeigen. Danach wird ein Forschungsdesign entwickelt und in konkreten Untersuchungsgebieten zur Anwendung gebracht. Es entstehen empirische Daten zu menschlichem Wohlbefinden in diversen Erholungsgebieten, welche systematisch ausgewertet und zusammengeführt werden. Zugehörige Ergebnisse werden auf kreativem Wege visualisiert und in Form von Diagrammen, Fotos sowie Karten präsentiert. Das Buch richtet sich sowohl an Wissenschaftler*innen und Planer*innen als auch an naturbegeisterte Personen und Menschen, welche Landschaft zu Erholungszwecken aufsuchen.
Der Autor
Dr.-Ing. Daniel Münderlein ist wissenschaftlicher Mitarbeiter am Institut für Landschaftsarchitektur der RWTH Aachen.
... Motor intentionality is directed towards otherness at the body level and is meaningful, whereby meaning is still not articulated at the order of reflective thoughts: it entails a notion of perception in which the world is taken up in an active moment of meaning constitution (Merleau-Ponty, 1962;Bullington, 2013). This "body meaning" provides us with habitual functioning that establishes appropriate relations with the world without needing any prior reasoning, as a form of pre-reflexive understanding (Gallagher & Zahavi, 2008). ...
Wearable technologies are increasing both in number and variety enabling new ways for collecting personal data, as well as novel interaction modalities. Even though the Human-Computer Interaction (HCI) community has widely explored the potential applications of wearables, its theoretical contribution on this research field has been far from impressive. Most scholars and designers seem to rely on a series of dominant assumptions that look at wearables “from the outside” by focusing on their “external properties.” When these assumptions are fully embraced at design-time, however, they may cloud opportunities for designing for the “internal aspects” of our everyday experience. In this article, I propose a theory that looks at wearables “from the inside,”giving a theoretical backdrop to all those wearable designs that pay attention to the internal aspects of interaction. By adopting a postphenomenological approach, I conceptualize wearable devices as “extensions” of our intentionality and introduce the “extension relation” to explain how wearables may alter how we relate to the world. In doing so, I propose a series of design considerations that aim to trace future research lines for all those wearables that are currently designed from an “externalistic” perspective.
... Benson rightly argued that highlighting the cultural mechanisms behind migration is one of the important contributions of lifestyle migration to the wider field of migration studies (2011); but following Halfacree, we could also extend this contribution, going beyond (not around) cultural mechanisms and also embracing the chaotic tangibility. Here Halfacree comes close to the phenomenological tradition and Merleau-Ponty's thoughts on the inseparability of inside and outside and his understanding of the lived unity of the mind-body-world system as "the lived body" (Bullington 2013 (1945( /1962( : 16-17 in Bullington 2013. It is from this perspective that the post-and pre-migration phases crumbled, resulting in unpredictable endings, and that the scientific categories and representations and cultural narratives of places became soaked with the sea and ruffled by the wind. ...
... Accordingly, earlier bodily experiences progressively ensure the building of a stable and cohesive self-representation, intended as the introjection of a good object that can serve as the basis for all mental processes from childhood to adult life [12]. However, when the individual experiences some threats to physical integrity, the increasing awareness of the loss of bodily intactness may cause a body-psyche disruption [16][17][18]. Indeed, in chronic somatic diseases, illness often represents a sort of personified enemy (personification) that becomes the protagonist in the narrative when making sense of one's condition (protagonization) [19,20], replacing the taken-for-granted mood of a lived body with the disturbing unfamiliarity of a broken body [21]. ...
Objectives The current research study aims at investigating the illness experience of people affected by Pulmonary Hypertension (PH), as a particularly challenging rare disease that is paradigmatic for the understanding of regulatory processes. Methods The study used Giorgi’s method to analyze the illness narratives of 11 adult Italian women affected by PH according to a qualitative phenomenological approach. An object relations perspective looking at chronic illness as an internal object was adopted for result interpretation. Results Four general themes were identified that characterize illness narratives of people with PH and illustrate the progressive stages of the disease. They respectively deal with the body/mind disruption at symptom onset, the protagonization of illness in the search for a diagnosis, the complicated grief at the time of diagnosis, and the anaclitic strategies to face the future. Conclusion Findings make a significant contribution to the exploration of the subjective experience of people with PH in managing illness-related challenges from symptom onset to after diagnosis.
... As humans, we exist in an intersubjective manner, immersed with those meanings that life is full of.; Bullington (2013) takes this philosophical idea further in developing the meaning of the lived body for holistic care. She describes the importance of adopting a phenomenological (lifeworld-led) perspective, reflecting on the lived body and the natural attitude (the taken-for-granted) to create the possibility of holistic dialogue with a patient-one that takes into account their unique way of being older as both experiential and biological, subjective and objective. ...
Purpose: This study aimed to explain and understand the existential meaning of the finality of life from the perspective of healthy older adults.
Method: Participants were recruited from a major project on older adults’ life situations. They were interviewed about their thoughts on the end of life, and their responses were interpreted using a lifeworld hermeneutic approach.
Results: The findings showed that thinking about the inevitable finality of life involves feelings of liberation, frightening thoughts, a comforting promise of something beyond death, acceptance of the concept of death as a companion in life and a desire to live. Philosopher Simone de Beauvoir’s existential ideas about ageing and death were then used to further explain and understand the meaning of the finality of life and to support a comprehensive understanding. de Beauvoir suggests that when the temporal horizon of existence shrinks, one lives closer to the finality of life. For a comprehensive understanding, attributing meaning to the finality of life required the intertwining of reconciliation and displacement. The interpretations were further discussed using ideas from the fields of existential philosophy and caring science in order to develop a basis for caring practice.
Conclusions: The conclusions suggested that professional health care for older adults would benefit from a lifeworld-led caring science approach that includes readiness for a caring dialogue that focuses on existential issues.
... In the same vein as Fitspiration, there has been an influx of media promoting a more "holistic" approach to achieving ideals of health and wellness. A central tenet of the holistic health paradigm is a focus on all aspects of the human experience in health, including physical, emotional, social, psychological, and spiritual components (Bullington 2013). This "holistic way of seeing things" includes making connections between health and other aspects of one's life and drawing on experiential knowledge to illuminate the "wider picture" of health (Nissen 2015 p. 167). ...
In modern Western society, women commonly encounter media that conflates appearance and health. However, this phenomenon is seldom explored qualitatively from the perspective of the women who encounter and internalize these messages. The present study describes how a group of women perceive appearance, health, and wellness ideals promoted through media and social media as well as how they attempted to challenge and negotiate these. Qualitative data were collected from in-depth semi-structured interviews with 25 women (aged 22–72 years) who embraced a holistic health perspective in Perth, Western Australia. Thematic analysis of the data revealed multiple overarching themes, including the women’s recognition of unrealistic ideals in the media, the potential for harmful social comparisons, their desire to achieve the appearance of health and wellness, and the use of various strategies to modify their exposure to such media and uphold a positive body image. Some participants were challenged by media claiming a more “holistic” orientation in which ideals of appearance, health, and wellness are closely intertwined. The findings from our research provide timely guidance on mechanisms to promote positive body image amidst a rapidly changing media landscape, including the use of critical media literacy and social media literacy interventions. Such interventions should encourage critical appraisal of appearance ideals that are promoted under the guise of health and wellness.
... As humans, we exist in an intersubjective manner, immersed with those meanings that life is full of.; Bullington (2013) takes this philosophical idea further in developing the meaning of the lived body for holistic care. She describes the importance of adopting a phenomenological (lifeworld-led) perspective, reflecting on the lived body and the natural attitude (the taken-for-granted) to create the possibility of holistic dialogue with a patient-one that takes into account their unique way of being older as both experiential and biological, subjective and objective. ...
The aim of this study is to understand how healthy, older adults in Sweden perceive their life situation after retirement. The study is based on a lifeworld approach, and a phenomenographic method was used. Eighteen participants were interviewed,
and data were analysed according to the phenomenographic principle of qualitatively different categories. Two categories were developed. The first category, “perceptions that draw attention inward, towards one’s self”, was further described in three subcategories: Sense of decreased status in society, the desire to keep aging at a distance, and contemplation of one’s own existence. The second category, “perceptions that draw attention outward, away from one’s self” was further described in the following four subcategories: caretaking of family members, involvement in social relationships, finding of deep meaning in animals and nature and engagement with society. In the discussion, the findings are further illuminated through comparisons with concepts such as maturity, wisdom and gerotranscendence, and reflections on the findings’ relevance to a caring context follow. The conclusion suggests this study can provide knowledge that will allow healthcare providers to bridge the gap between generations in order to provide high-quality care. However, for a more profound caring dialogue, for example, about the end of life, a deeper analysis is required.
... This is not a theoretical but a practical knowledge (Umbelino 2015). It is not only the mind-body dichotomy that is questioned by Merleau-Ponty, but also the subject-object dichotomy: between both opposing sites there is a middle ground where experience and meaning happen (Bullington 2013), and where both the subject and the world are constituted as a corporeal event. ...
The aim of this study is to understand how a shared creative process of construction of virtual corporeality in collaborative virtual environments becomes an aesthetic experience. The research is divided into two main but correlated themes: virtual corporeality and shared creativity. It is my purpose to find the relationship between the constitution of a virtual corporeality and the new processes of creative sharing and creation in collaborative virtual environments. I also aim to relate these two aspects to the new forms of aesthetic experience emerging from these virtual contexts.
Meta_Body is the main practical artwork that sustains this investigation, an ongoing project since 2011. This is a participatory art project. Initiated in Second Life and in a tangible art exhibition (All My Independent Women 6th edition, at Vienna), it now continues in the collaborative virtual environment’s creative flux. Meta_Body focuses on two aspects: first, the avatar as expressive body, open to experimentation and potency; second, avatar building as a shared creative process and as aesthetical experience. Through the practice of avatar creation, distribution, embodiment and transformation, I aim to understand the processes of virtual corporeality constitution. I interrogate the role of the body in the virtual environment, its importance in engaging with the world and in self-expression, exploring its metaphorical aspects. The method used to implement this project is a shared creative process, in which multiple subjects come to be authors along different phases of the project. Through the embodiment and transformation of avatars, the artwork’s aesthetical experience becomes itself a creative process. This research is therefore grounded on an art-based and project-based methodology, whose results can be seen not only in this written thesis, but also in the artworks themselves, and their derivatives.
I accomplished my intended goals and came to a new understanding of virtual corporeality and its connection to shared creativity and aesthetical experience. I believe this work to be an important starting point for new investigations that will arise with the new turn to virtual reality.
... Phenomenological accounts of cognition have found support in two specific accounts of AE called, respec-31 Merleau-Ponty, M. (1945). 32 Bullington (2013). tively, embodied cognition and environmental cognition. ...
This paper will present an argument in support of the Extended Mind Hypothesis (EMH). The argument consists of two sub-arguments, an evolutionary and a systematic one. The evolutionary sub-argument advances that there is good empirical and analytic reason to suppose that the mind is designed by natural selection to extend. The systematic states that EMH is more consistent with the current system of science and scientific taxonomy. In force of the connection between these sub-arguments, I will conclude that EMH is epistemically advantageous compared to purely internalist accounts of cognition. Furthermore, this essay situates EMH in a broader landscape of philosophical and scientific ideas and theories about the mind.
... It tells this story through a sensitive, non-judgemental, and informal manner. Our Fiction Probe was designed to: 1. De-alienate healthcare and health conditions 2. Provide insights into patients' experiences of the healthcare system and create meaningful representations of a patient's experience of their condition 3. Be a method for recording and archiving patient's stories 4. Be a playful interactive probe kit ...
Understanding patient needs is an important factor in the design of healthcare services, however ethnographic research methods can be intrusive in sensitive care settings and create privacy concerns such as when researching Type 2 diabetes. We offer the Fiction Probe as a contribution in the form of a field study tool that uses storytelling to allow patients to tell their story from their perspective. We used speculative design and the multi-choice narrative, represented as a pick-a-path storybook, to re-imagine the form and content of field study research tools. With our work, we hope to expand the range of methods used to understand patients in healthcare settings and to also inspire new ways of thinking about field study research tools in sensitive care settings, and more broadly, in ambiguous design contexts.
... Intentionality is, according to Bullington, the central structure of an experience. It characterises the way in which consciousness always points towards or "intends" the world-as-meant (Bullington 2013). Svenaes argues that the cultural and personal background of a user serves as a frame of reference and provides a context for every phenomenon and situation encountered by that person (Svanaes 2013). ...
This article discusses “Exposing the Invisible: A Brain-driven Audiovisual Walk”, an audiovisual installation that was part of the Digital Media Studio Project entitled Invisible Cities. Commencing with an analysis of the research, and experimental and compositional strategies we devised for the installation, we will explore the possibilities afforded from the creative combination of sounds, visuals, emotions and places, in relation to more general aesthetic considerations relevant to data sonification and visualisation. Our approach understands visualisation as a bridge interlinking the emotions with various types of visual elements and sonification as a translation of the inaudible into the sphere of the audible; most importantly, the combination of both as an instrument for comprehending the human-city bond via the embodied sensory experience of place. Our practice, inspired from the interaction between the lived body and the (urban) environment, uses the EEG data with an artistic approach in order to reflect upon and re-interpret this bond.
... Among the many features of these phenomenological investigations was a return to the rich particularity of place through the experience of the 'lived body' (as distinct from the 'body-asobject'). In different ways, phenomenologists showed how place could not be without the body, and likewise the body without place (Bullington 2013;Casey 1998;Seamon 2000). In effect, the distinction between the human body and the places it inhabits became less definitive, more enmeshed. ...
Where do tendencies to exclude, discriminate, and dominate originate from? Why for many do harmful traits like these appear so characteristic of modern life? How might we move beyond this predicament to foster more sustainable and enriching relationships with one another and with Nature? In this paper, I explore the classic geographic concepts of space, place, and scale and apply them to a consideration of the body and of selfhood. In doing so, I trace out two markedly different ‘geographies of the self’. The first ‘self’ emerges from the basic tenet that space and matter are mutually exclusive, a premise that underpins the dominant episteme of objective rationality. This is the self as selfish, insular, and oppositional. The second ‘self’ emerges from the basic tenet that matter dynamically includes and is included in space, giving rise to the philosophy of ‘natural inclusionality’. The natural inclusional self is hence dynamically distinct but not definitively discrete, a vital inclusion of its natural neighbourhood. I consider some of the implications of these two versions of the self for society, contending that the first promotes a culture of exclusion and the second a culture of belonging. In finishing, I consider questions of method and praxis as they relate to the project of evolving inclusional selves.
... In recent years, physiotherapists have increasingly turned their attention towards embodied approaches to practice, although its impact in the profession is distinctly limited in comparison with the volumes of research undertaken which promotes only a biomedical perspective (Bullington, 2009(Bullington, ,2013Øien, Råheim, Iversen and Steihaug, 2009;Shaw and Connelly, 2012;Sivertsen and Normann, 2014;Sviland, Martinsen and 8 Råheim, 2014). Embodiment is only now emerging as an approach that can bring together disparate fields: rehabilitation and recovery; medicine and surgery; acute and chronic; and primary, secondary and tertiary care (Williams, 1996;Armstrong, 2006;Doyle and Roen, 2008;Papadimitriou, 2008;Nettleton, 2008;Tarr and Thomas, 2011;Newman and Carpenter, 2014). ...
In recent decades, physiotherapists have become concerned with cultural, economic, philosophical, political, and social questions and have been exploring more flexible ways of speaking about and practicing physiotherapy. While recognizing the need to embrace a broader range of perspectives, physiotherapy educators and other medical educators have been at a loss as to how to best achieve this. Drawing on two examples from South Africa and New Zealand, we seek to illustrate possibilities and barriers to teaching social sciences to physiotherapy students, specifically theories of embodiment as an alternative to the biopsychosocial model. We review each educator’s choice of embodiment theory in curriculum design and the role of the educator’s disciplinary background on teaching, learning, and assessing that learning. Against this background, we explore physiotherapy students’ experiences with theories of embodiment and possible transformative implications for their self-worth and/or professional practices. We suggest that students were able to explore physiotherapy’s relation to the body and the profession’s historical inattention toward the body as a philosophical/theoretical construct. From the lessons learned, some can perhaps be usefully passed onto others thinking of introducing a more diverse and inclusive approach of the body; one that we argue will be needed in the future.
... We also examine whether and how discourses of ageism and ableism may contribute to repressive and productive tendencies of four technologies above. Next, we explore the body-as-experience, which according to phenomenologist Merleau-Ponty, is a body that is lived, experienced and in constant dialogue with the world ( Bullington, 2013). Examples of studies are provided to emphasize the experiential and communicative capacity of the body as a means of maintaining or deconstructing personhood, and how nurses and health care staff can use the bodyas-experience to decode and recode embodied cues to detect and meet the frail older person's needs. ...
In this article, we sought reconciliation between the “body-as-representation” and the “body-as-experience,” that is, how the body is represented in discourse and how the body of older people with cognitive impairment is experienced. We identified four contemporary “technologies” and gave examples of these to show how they influence how older people with cognitive impairment are often represented in acute care settings. We argued that these technologies may be mediated further by discourses of ageism and ableism which can potentiate either the repressive or productive tendencies of these technologies resulting in either positive or negative care experiences for the older person and/or their carer, including nurses. We then provided examples from research of embodied experiences of older people with dementia and of how nurses and other professionals utilized their inter-bodily experiences to inform acts of caring. The specificity and individuality of these experiences were more conducive to positive care experiences. We conclude the article by proposing that the act of caring is one way nurses seek to reconcile the “body-as-representation” with the “body-as-experience” to mitigate the repressive effects of negative ageism and ableism. The act of caring, we argue, is the essence of caring enacted through the provision of person-centred care which evokes nurses to respond appropriately to the older person's “otherness,” their “variation of being” while enabling them to enact a continuation of themselves and their own version of normality.
... Husserl differentiated the physical body (Körper), which has object-like characteristics and the "lived body" (Leib), which is intentional and more subject-like. 8 The lived body is defined as an intelligent body, it is what makes interaction with others and the world possible. By definition, the lived body is central to the experience of the self, the world and others. ...
Background: Although people with MS benefit from exercise, a more sedentary life seems common among this population. Exercise positively influences body awareness (BA), while chronic illness seems to have an adverse effect. Objectives: This study explores changes in BA and identity ' the so called 'lived body'- in people with MS after a unique hiking expedition through the Jordan desert in the spring of 2014. Methods and design: A focus group was organized afterwards with all nine participants. The Interpretative Phenomenological Analysis was used to analyze the data. Results: Three main themes and six subthemes could be identified. The first main theme 'Peers and society' focuses on group dynamics and social stigma. The second theme 'the lived body' discusses bodily experiences and self-identity. In the third and last theme, therapeutic effects of the journey and their translation into daily life are explored. Conclusion: Participating in this unique hiking project had a powerful effect on body awareness and the lived body of the participants with MS. Experiencing life outdoors brought them back to basics, changed their bodily attunement and empowered them in self-belief and social resilience. It was described as an awakening in dealing with MS.
الأهداف: تهدف الدراسة إلى فحص تأثير صور الوعي بالجسد الأنثوي في المجتمع على تجارب النساء، مع التركيز على إنتاج تمثيلات للقوة والمقاومة في علاقات المرأة مع المجتمع وذاتها. وتتناول التحليل أحد نماذج الخطاب الروائي النسائي المصري المعاصر، من خلال أعمال الكاتبة "ميرال الطحاوي"، باعتبارها مصدرًا غير تقليدي للفكر السياسي، ونظرًا لأهمية الكاتبة كممثلة لجيل التسعينيات في القرن العشرين واستمرارها في إنتاج خطاب أدبي. المنهجية: اعتمدت الدراسة على الفلسفة الفينومينولوجية لـ "موريس ميرلو بونتي" كإطار عام للتحليل، واستفادت من مدخل الصور المجازية كأداة منهجية لاستكشاف صور الوعي بالجسد الأنثوي وتحليل تمثيلات القوة والمقاومة في الروايات الثلاث: "الخباء" و"الباذنجانة الزرقاء" و"بروكلين هايتس". النتائج: أظهرت نتائج الدراسة أن تأثير التعامل مع جسد المرأة كموضوع للإدراك يبدأ منذ طفولتها في مجتمعات الروايات الثلاث: "الخباء" و"الباذنجانة الزرقاء" و"بروكلين هايتس". يسلط الضوء على الدور البارز للجسد في تشكيل مسار حياتها وعلاقاتها، وتُبرز صورة الجسد الأنثوي أهمية كبيرة في وعيها وتجربتها المعيشة. تحدد المجتمع معايير لقيمتها ترتبط بدورها في الإنجاب وإرضاء الرجل، وتظهر تحليلات النصوص تنوعًا في تجاربها المعيشة. يكشف البحث عن إنتاج متنوع لممارسات السيطرة والقوة على مستويات مختلفة من علاقات المرأة، تتجاوز العلاقة التقليدية مع الرجل، وتشمل علاقتها بنفسها وبالنساء الأخريات والمجتمع بأكمله. وتظهر محاولات متنوعة للمقاومة، التي قد تكون إيجابية في بعض الحالات، ولكن في بعض الأحيان قد تسهم في إعادة إنتاج مظاهر القهر والخضوع. الخلاصة: توضح الدراسة البعد السياسي للتفاعلات الإنسانية بالتجربة المعيشة للمرأة، من خلال صور الوعي بجسدها الأنثوي في المجتمع ومدى حضوره، عبر مستويات العلاقات المختلفة وبما يتجاوز العلاقة المباشرة بين الرجل والمرأة، التي ينتج عنها العديد من تمثيلات القوة والمقاومة.
This qualitative study examines the characteristics exhibited by Chinese patients with somatization symptoms during their treatment process, focusing on changes in illness interpretation and language use. A semi-structured in-depth interview was conducted with 10 patients receiving treatment in a clinical psychology department of a general hospital who reported somatic symptoms as their main complaint. The interview data were recorded and transcribed, and analyzed using interpretive phenomenological analysis. Two core themes emerged from the analysis: avoidance at the utterance level; and at the semantic level, power and contestation. Patients with somatization symptoms exhibit avoidance behaviors, and their experience of illness and the therapeutic process impact their discourse. Professionals should pay attention to patients’ own interpretations, cultural background and acceptance of the illness.
In diesem Open-Access-Buch wird Marc Richirs Projekt einer Neugründung der Phänomenologie untersucht, das unter dem Leitfaden der Spannung des konkreten Leibes und der subjektiven Leiblichkeit als Weltbezüglichkeit das Phänomen als Phänomen in den Blick zu bekommen versucht. Das Selbst fällt für Richir weder mit dem Leib (dem Phänomenologischen) noch mit dem Körper (dem Symbolischen) zusammen. Zwischen beiden Registern besteht ein unvermeidlicher Abstand, der auf den Überschuss der Erfahrung, das Abenteuer der Sinnbildung in ihrer unendlichen Mannigfaltigkeit hindeutet.
Die These der Studie ist, dass der Überschuss des Leibes und der Leiblichkeit im Überschuss des Sprachphänomens bezeugt ist und dass die Spannung zwischen der phänomenologischen Darstellung des Leibes bzw. der Leiblichkeit und ihrer symbolischen Bestimmung im Sprachlichen aufgezeigt werden kann. Zudem wird die interdisziplinäre Anschlussfähigkeit des Ansatzes Richirs profiliert.
Zusammenfassung
In diesem Kapitel behandeln wir Richirs Phänomenologie des Selbst, die auf zwei Stufen aufbaut. Im ersten Schritt wendet sich Richir gegen all diejenigen Theorien des Selbst, die als „ leiblose “ Ideale zusammengefasst werden können und die durch das Prisma einer metaphysischen Hyperbel (Heidegger, Levinas, Binswanger) denkbar sind. Im zweiten Schritt folgt Richir Husserl, um die transzendentale Geschichte des Selbst zu verteidigen. Hier wird das Konzept des Leibes unvermeidlich, wenn man alle Schwierigkeiten, Ambiguitäten und Rätsel der ersten Stufe, also des leiblosen Selbst , abbauen muss. Im Rahmen dieses zweiten Schrittes, in dem das Register des primordialen Leibes als Basis der Erfahrung und der Orientierung im Raum durch die Einfühlung (die Introjektion der transzendentalen Intersubjektivität) aktiviert wird, vertrete ich als erste These, dass das Selbst als Leib-Körper eine unmögliche Möglichkeit ist. Mit dieser Bezeichnung, die für ein Zeichen des Überschusses in der Erfahrung steht, argumentiere ich im Anschluss an Husserls physisch-psychische Einheit des Menschen, dass das Selbst aus der lückenhaften Einheit zwischen einem Nichtdarstellbaren und einem Darstellbaren, einer Unmöglichkeit und einer Möglichkeit besteht. Ich argumentiere, dass der Phantasieleib im Abstand zwischen der Unmöglichkeit und der Möglichkeit ein „Nichtgegebenes“ empfindet und so ein kommunikatives Verhältnis zwischen den Leibern ermöglicht. Weiter vertrete ich die zweite These, dass die oben genannte Unmöglichkeit im Hinblick auf das leibliche Selbst und die Möglichkeit im Hinblick auf das Körperding verstanden werden kann. Das leibliche Selbst bleibt für uns unmöglich, insofern es ein Träger des Sinns ist; jedoch ist es als Körperding erst innerhalb der Bedeutung (in einem Sprachsystem) möglich. Mit dem Begriff des Phantomleibs werden eine mögliche Täuschung des Selbst und eine Sinnlosigkeit behandelt. Nur so können alle von Richir erhobenen Vorwürfe von Richir gegen ein „ideales Selbst“ konsistent aufgehoben werden.
In this chapter, we briefly review how emotions at work have been treated in the research literature. We also describe the power of emotions and address the importance of emotions when making reasoned and wise decisions. We emphasize that managers can improve their understanding and handling of emotions in the workplace.
In phenomenology, Leiblichkeit articulates the idea of subjectivity and the relationship to the world; Leib attests the phenomenological experience of subjects otherwise captured by the term Leiber. Husserl and Merleau-Ponty have sought to understand this relationship to the world and to characterize this phenomenological experience. Thus, they thematized a form of relationship to the world which is not only intentional but also, and each in his own way, passive and based on image (bildlich). On his part, Marc Richir sought to overcome this idea by bringing an "active, non-specular mimesis from within" into play. Proposing an examination of these approaches, I defend the idea that in order to be able to think of the openness to the world-which is made possible by corporeality-it is of great necessity here to articulate the dimension of sense.
Ship of Theseus (Gandhi, 2013) an experimental film, presents an intriguing narrative of human and technology relations involving three characters namely Aaliya, who is a visually differently abled woman photographer, Maitreya, a monk diagnosed with liver cirrhosis and fighting against testing animals for drug validation, and that of Navin, a stockbroker, who after receiving kidney transplantation set out to help a poor man to get back his stolen kidney. This study examines the human-technology relations between Aaliya and her passion for photography that she took up after she lost the cornea in both her eyes. The film narrates the post-abnormal phase in her life and how she engages with the world without eyesight. However, regaining her eyesight following cornea transplantation, affords a different experience engaging with photography wherein she realizes that visuality squashes her ingenuity. The ocular-centric visual regime surrounding photography disables her from clicking pictures. Her feeling and sensing the world through technology is dictated by seeing unlike her embodied relations she experienced before her surgery. Analysed through the theoretical frameworks of phenomenology and post-phenomenology, this paper found out that, prior to 2 regaining eyesight, Aaliya embodied camera and concomitant technologies to make sense of the world. Her embodiment of photo editing software, video chat with her mother online and other technological material objects anchored her sense of being. While Aaliya is caught in a tension between her embodied relations with technologies during the moments when she was visually differently abled and later when she regains eyesight, she comes across as a post-human establishing an intercorporeal relationship between Aaliya and technologies she uses in the film. Besides, her differently abled body represents a cyborgian body challenging the corporeal fetishism humanistic approaches advance.
Ship of Theseus (Gandhi, 2013) an experimental film, presents an intriguing narrative of human and technology relations involving three characters namely Aaliya, who is a visually differently abled woman photographer, Maitreya, a monk diagnosed with liver cirrhosis and fighting against testing animals for drug validation, and that of Navin, a stockbroker, who after receiving kidney transplantation set out to help a poor man to get back his stolen kidney. This study examines the human-technology relations between Aaliya and her passion for photography that she took up after she lost the cornea in both her eyes. The film narrates the post-abnormal phase in her life and how she engages with the world without eyesight. However, regaining her eyesight following cornea transplantation, affords a different experience engaging with photography wherein she realizes that visuality squashes her ingenuity. The ocular-centric visual regime surrounding photography disables her from clicking pictures. Her feeling and sensing the world through technology is dictated by seeing unlike her embodied relations she experienced before her surgery. Analysed through the theoretical frameworks of phenomenology and post-phenomenology, this paper found out that, prior to 2 regaining eyesight, Aaliya embodied camera and concomitant technologies to make sense of the world. Her embodiment of photo editing software, video chat with her mother online and other technological material objects anchored her sense of being. While Aaliya is caught in a tension between her embodied relations with technologies during the moments when she was visually differently abled and later when she regains eyesight, she comes across as a post-human establishing an intercorporeal relationship between Aaliya and technologies she uses in the film. Besides, her differently abled body represents a cyborgian body challenging the corporeal fetishism humanistic approaches advance.
Introducción: La bioética pensada desde el enfoque principialista, ha predominado en la toma de decisiones guiada por principios, contexto médico-paciente. Sin embargo, la bioética podría pensarse desde enfoques que metodológicamente reconozcan las características fenomenológicas/existenciales del ser humano. Se pretende establecer una metodología que vincule Narrativa, Cuerpo Vivido y Bioética, en la comprensión de experiencias vividas situadas en el acoso escolar. Metodología: Se proponen dos diseños de investigación: la investigación documental y la investigación biográfico narrativa. En la investigación documental, narrativa y cuerpo vivido, desde la fenomenología, proveen conceptos que permitirían identificar los tres momentos/etapas que debe contar el desarrollo metodológico para estructurar los procesos deliberativos en bioética como procesos de intervención (comprensión) y de formación. Por otro lado, la investigación biográfico narrativa, desde la narrativa, provee tanto instrumento de recabación de información, como esquematismo para el análisis narrativo. La muestra se toma a conveniencia: cinco médicos graduados, laborando y con experiencias vividas como espectadores del acoso escolar. Resultados: El resultado de implementar la metodología, son cuatro narrativas por cada médico (agente narrativo). El análisis narrativo revela, como cada narrativa expone una comprensión de lo vivido, y a la vez, cada narrativa al avanzar hacia la otra (N1, N2, N3 y N4), revela el proceso de formación del agente narrativo. Discusión: La narrativa del cuerpo vivido, estructura los procesos deliberativos en bioética, como procesos de comprensión-formación de los médicos situados como espectadores del acoso escolar. Conclusión: La narrativa del cuerpo vivido aporta a la bioética una forma de pensar el lugar de residencia del hombre, como forma de habitar con otro en el mundo de la vida. Emerge la bioética como constitutiva del ser en el mundo.
This thesis, in the field of music composition and performance practice, presents the results of a practice-research project into performance validity and notational reliability in vigilant musical practice.
From my initial inquiry into what constitutes a valid performance, three ground principles were observed: non-normative cognitive states (how the performer thinks); embodied multimodal imagery across a full effort scale (the images a performer draws with their presence); and inter-personal communication (the performer’s readiness to react to the audience’s presence) and the performance environment. These three interconnected skills form what I come to call vigilant performance practice. This thesis aims to define a conceptual framework for vigilant music practice, at the stages of composition, of rehearsal, and of performance.
In support of vigilant practice, a set of developmental tools and activities were constructed that promote each of the three vigilance skills. These tools and activities are developed in practice in a sequence of sixty-four scores entitled Games for Musicians and Non-Musicians. This workbook promotes the development of vigilance skills in the context of improvised music performance in groups. Games for Musicians and Non-Musicians was rehearsed and performed publicly on several occasions. Reports of those events are presented here.
Vigilant performance practice has the potential to be of use in music education and professional training, with different age groups (including children), as well as in other types of performance practice. It may be of use outside the performance environment altogether, in personal or community development.
The present qualitative study aimed to explore how the attitudes, experiences, and feelings of Autonomous Sensory Meridian Response (ASMR) videos could be used to enhance psychosocial wellbeing similar to mindfulness-based treatment programs. ASMR is an atypical and multisensory phenomenon in which a tingling sensation is often elicited following specific audio-visual stimulations. Although ASMR experiences have been announced to enhance wellbeing and phenomenologically superimposed with mindfulness, there is a lack of research exploring how ASMR experiences relate to wellbeing. In this study, the theoretical underpinnings of the Differential Susceptibility to Media Effects Model (DSMM) by Patti M. Valkenburg and Jochen Peter (2013) are merged with Positive psychology's wellbeing theory (PERMA) by Seligman (2011) for the first time with the objective to explore and link the distinguishing characteristics of ASMR video with wellbeing outcomes.The study entailed two in-depth semi-structured interviews, which were conducted with three university students (one female and two males) in Finland. Interpretative phenomenological analysis with coding schemes was employed and guided by DSMM and Seligman's five domains of well-being. Three main themes and fourteen subthemes emerged from the analyses of the interview transcripts corresponding to the research question. The main themes include ASMR intentional use, ASMR media contents, and ASMR multisensory integration. The subthemes encompass prior ASMR-like experiences, social pressure from family members and curiosity, different types of sound, voices, and movement; nostalgic thoughts, pro-change bias, and positive responses. Exploration of interviewees' narratives further brought to light issues concerning ASMR's emotional effects on wellbeing. Analyses reveal different subthemes clustered into five main themes: Positive Emotion, Engagement, Relationships (Connectedness), Meaning and Making a Connection, and Accomplishment.The findings showed how ASMR videos enhance wellbeing through mindfulness-like experiences. These research findings are significant due to the ASMR videos' potential to increase wellbeing and happiness. Furthermore, their influence can extend to elevating the ability to concentrate on tasks at hand, improving the quality of sleep by stopping rumination, increasing self-confidence, and motivating altruistic behavior. The beneficial potential of ASMR videos to promote psychosocial wellbeing is remarkable
Ecological Psychology and Enactivism both challenge representationist cognitive science, but the two approaches have only begun to engage in dialogue. Further conceptual clarification is required in which differences are as important as common ground. This paper enters the dialogue by focusing on important differences. After a brief account of the parallel histories of Ecological Psychology and Enactivism, we cover incompatibility between them regarding their theories of sensation and perception. First, we show how and why in ecological theory perception is, crutially, not based on sensation. We elucidate this idea by examining the biological roots of work in the two fields, concentrating on Gibson and Varela and Maturana. We expound an ecological critique of any sensation based approach to perception by detailing two topics: classic retinal image theories and perception in single-celled organisms. The second main point emphasizes the importance of the idea of organism-environment mutuality and its difference from structural coupling of sensations and motor behavior. We point out how ecological—phenomenological methods of inquiry grow out of mutualism and compare Gibson's idea of visual kinesthesis to Merleau-Ponty's idea of the lived body. Third, we conclude that Ecological Psychology and varieties of Enactivism are laying down different paths to pursue related goals. Thus, convergence of Ecological Psychology and Enactivism is not possible given their conflicting assumptions, but cross-fertilization is possible and desirable.
This study, which analyzes the meaning and experience of womanhood in Igbo land, reveals a power inequality, captured by the depiction of women as the property of men. Though most of the intuitions found in post-structuralism might be confirmed in our analysis (e.g., that discourse produces the subjects and that language operates alongside power and social control), my greatest motivation in this essay is different: it proposes that power inequality as evident in the depictions of women and their oppressive subordinating consequences therein are not consciously intended by all classes of agents while acting in accordance with normal rules and accepted practice; an aspect that is usually lacking in other accounts of the institutionalization of social realities where dominant discourse, collective intentionality etc., are usually emphasized. Whence the questions: What is then the origin of unequal power distribution among the sexes? And what is the origin of unintended but oppressive images and subordinating depictions of women as the property and unequal of men? Inspired by Jean-Paul Sartre, I make an elaborate use of passive synthesis as developed by Husserl's analysis of perceptual objects and phenomenological perception of time consciousness, and as found in Merleau- Ponty's habituation to respond to these questions.
In this study, we investigated how women struggling with long-term pelvic girdle pain after giving birth experienced and coped in their daily life. We conducted individual interviews with 9 women with pain between 3 and 26 years after giving birth. We found that pelvic girdle pain results in significant challenges, influencing women’s relationships with their children, partners and wider network. The pain demands careful planning and time for rest, influences women’s ability to work, and creates feelings of isolation and shame. The informants connect the lack of formal diagnostic criteria for the condition to the low level of societal recognition.
This chapter examines the implications of the use of neuroprosthetics such as artificial hippocampi or neurostimulation techniques for the understanding of personal identity in patients with Alzheimer’s disease (AD): first, regarding a conceptualization of personal identity based on psychological continuity (memory), and second, according to a conceptualization of personal identity based on psychological continuity (memory) and embodiment. This chapter provides an overview of the various stages of AD, including how the disorder impacts people’s memory capabilities and personality and generates behavioral changes. It focuses on neuroprosthetics as a technique to help patients in the early stages of AD to compensate for lost neural functionality and cognitive abilities. It also critically examines the concept of personal identity through the work of John Locke and Derek Parfit and provide an alternative account called bio-psycho-somatic unity. Finally, the chapter offers an ethical framework for the care of patients with AD who experience identity loss that includes the preservation or restoration of psychological continuity, the acknowledgment of an embodied identity, and the necessity of a relational narrative.
The body is an important starting point concept throughout deconstruction, reconstruction and recontextualization of the body’s concept. This change of focus in research that stems from the results to the process of contextualization means that the researcher should engage with texts or images, as they are reflected in the process of cultural development and exchange, through which decontextualization is exhibited. This article deals with the concept of new materialism and endeavors to explain, how discourses come to matter. It examines the issue of how new materialism tackles visual art in innovative ways – through the intersections of artistic practice, art-as-research, and philosophical analysis. Such definitions as Maurice Merleau-Ponty’s “a bodily being”, Julia Kristeva’s “the abjection of the self”, Arjun Appadurai’s “the aesthetics of decontextualization” and “singularized object”, Igor Kopytoff’s “the cultural biography of things”, and Nicholas Thomas’ “entangled objects”, constitute the methodological frameworks of our research. We will analyze such approaches as Hans Belting’s concept of body as a “living medium”, Giorgio Agamben’s view on body as an object of commodification and Jacques Derrida’s “trust in painting”. An attempt to understand body reconceptualization and deconstruction through the categories of new materialism is the most important aim of this article. Karen Barad’s concept of intra-action (that implies a clear-cut subject-object distinction) is crucial to our research, which underlines that bodies have no inherent boundaries and properties and that the analyzed representations are “material-discursive phenomena”. The artworks under consideration will be confronted with a diagnosis that, according to Barad, all bodies come to matter thanks the intra-activity and its performativity. The case studies of Svajonė Stanikienė and Paulius Stanikas, Evaldas Jansas and Eglė Rakauskaitė works show how the image of the body is developed through the processes of their deconstruction and decontextualization.
Santrauka
Kūnas, kūniškumo koncepcija dažnai yra atskaitos taškas naujojo materializmo filosofinėms kryptims, ieškančioms naujų kūno ir kūniškumo apibrėžčių, taip pat pasitelkiančioms ir naujas kūrybiškumo koncepcijas. Tai reiškia, kad tyrėjas turi naujai pažvelgti ne tik į pačią kūno sampratą, tačiau ir permąstyti kūniškumą apibrėžiančius tekstus bei vaizdus (taip pat vaizdinius, įvaizdžius) neperžengiant kultūrinės interakcijos ribų. Perkurti kūniškumą kartu reiškia perkurti kultūrinius tekstus ir tekstūras apskritai.Straipsnyje daugiausia remiamasi naujojo materializmo koncepcijomis, kurių visuma formuoja kūniškumo sampratą. Tekste susitelkiama į tas naujojo materializmo koncepcijas, kuriomis bandoma naujai pažvelgti į vizualiuosius menus, pasitelkiant ir derinant įvairias jų praktikas, meninius tyrimus, taip pat filosofinę analizę.Straipsnio metodologines gaires galima apibrėžti Maurice’o Merleau-Ponty „kūniškos būties“, Julios Kristevos „svetimumo savastyje“ arba „savasties atmetimo“, Arjuno Appadurai „dekontekstualizavimo estetikos“ ir „unikalaus objekto“, Igorio Kopytoffo „daiktų kultūrinės biografijos“, Nicholaso Thomaso „susaistančių objektų“ daikto, kūno ir kūniškumo koncepcijomis. Straipsnyje iš dalies aptariamos ir Hanso Beltingo kūno kaip „gyvos medijos“, Giorgio Agambeno kūno kaip objekto idėjos, taip pat glaustai aptariama Jacques’o Derrida „tiesos tapyboje“ koncepcija.Galiausiai naujai kūniškumo sampratai svarbi ir Karen Barad suformuluota intra-akcijos (ne tiek objektų, kūnų, kiek bendros energijos sąveikos) samprata, kurią filosofė pasiūlė vietoj interakcijos sąvokos. Pasak filosofės, kūnai nėra statiški, užbaigti objektai su savo ribomis. Kūnas aktualizuojasi per pasaulio kartotines in-tra-akcijas ‒ dėl savojo performatyvumo. Remiantis menininkų Svajonės Stanikienės ir Pauliaus Staniko, Evaldo Janso ir Eglės Rakauskaitės kūrybos pavyzdžiais, bandoma parodyti, kaip kuriamos naujos kūniškumo apibrėžtys, įvaizdžiai, įvairiais būdais išardant ir perkuriant kūno sampratą.
Reikšminiai žodžiai: atmetimas, kūno perkūrimas, prekės, kūrybiškumas, emocinis teroras, materija, naujasis materializmas, posthumanizmas, seksualumas, smurtas.
Gangguan psikofisiologis merupakan gangguan fisik yang disebabkan oleh faktor-faktor psikologis terutama stres. Gangguan psikofisiologis memfokuskan perhatian pada hubungan kausal satu arah pada interaksi antara psike dan soma, atau dampak dari faktor psikologis secara negatif terhadap kondisi medis secara umum. Bagi sebagian individu, pendidikan kedokteran dipersepsikan sebagai keadaan yang penuh dengan stres. Adanya stres akademik pada mahasiswa kedokteran, khususnya mahasiswa kedokteran tahun pertama memiliki konsekuensi yang merugikan terhadap kondisi kesehatan, seperti kecenderungan gangguan psikofisiologis. Hardiness merupakan sekumpulan trait dari karakteristik kepribadian yang menjadi sumber perlawanan ketika individu berhadapan dengan peristiwa yang penuh dengan stres. Adanya hardiness pada mahasiswa kedokteran tahun pertama akan membantu untuk mengatasi stres akademik secara efektif sehingga tidak mengarah pada kecenderungan gangguan psikofisiologis. Penelitian ini merupakan penelitian kuantitatif untuk mengetahui peran stres akademik dan hardiness terhadap kecenderungan gangguan psikofisiologis pada mahasiswa kedokteran tahun pertama. Pengambilan sampel dilakukan dengan teknik simple random sampling. Sebanyak 158 mahasiswa dari Program Studi Pendidikan Dokter Fakultas Kedokteran (FK) Universitas Udayana dan Fakultas Kedokteran dan Ilmu Kesehatan (FKIK) Universitas Warmadewa digunakan sebagai subjek dalam penelitian ini. Alat ukur yang digunakan adalah Skala Somatic Symptom Scale–8, Skala Gangguan Psikofisiologis, Skala Stres Akademik, dan Skala Hardiness. Hasil uji Moderated Regression Analysis (MRA) menunjukkan nilai koefisien parameter individual stres akademik sebesar 0,727 dengan signifikansi 0,028 (p<0,05), yang berarti stres akademik berperan seacara signifikan terhadap kecenderungan gangguan psikofisiologis, selanjutnya nilai koefisien parameter individual moderasi Hardiness sebesar -0,003 dengan signifikansi 0,348 (p>0,05), yang berarti Hardiness tidak berperan secara signifikan dalam memperkuat ataupun memperlemah hubungan antara stres akademik terhadap kecenderungan gangguan psikofisiologis. Kata Kunci: Stres Akademik, Hardiness, Kecenderungan Gangguan Psikofisiologis Mahasiswa Kedokteran Tahun Pertama
The phenomenal body is an intriguing concept, and Merleau-Ponty’s notion of habit, coupled with motor intentionality, provides a novel perspective on its inner workings. I contend that his portrayal of habit tacitly bears two faces – motoric habit and instrumental habit respectively. The former is an attunement to some bodily possibilities that are already at our disposal while the latter is an explicit relation to external objects and a process of incorporating those objects into our own bodies. These two notions play into each other, creating a mechanism that offers an intuitive illustration and simple productive definition for a dynamic picture of bodyhood. Furthermore, it carries an internal delimitation that marks the boundaries of its application. The result is a view that provides something new to current interpretations of Merleau-Ponty, as well as potential applications in areas that derived from his appeals to motor intentionality.
This paper uses the relational space paradigm to bridge some gaps between the field of aesthetics and the field of urban studies. By introducing the concept of aesthetic space, I analyze a particular sort of direct lived experience through which memories of the past, latent reality and the actualized perceived present are conjured together, informing one another. Studying the aesthetic space can help urban researchers better understand how the world becomes internalized or externalized by inhabitants, how they develop a stronger concern for justice, or how novelty is borne from a constant dialogue between the ethical and the aesthetic. Like many other social phenomena, aesthetic categories are emergent, meaning that categories with different qualities appear at each different scale. In this sense, aesthetic appreciation of the city as a whole cannot be solely understood as the sum of the aesthetic appreciations of its separate parts. The production of a scale as a societal problem is analyzed through the concept of style. A few examples are examined.
This paper contributes to an understanding of existential authenticity and existential anxiety in tourism studies through an investigation of tourists’ perceptions of death, the Self, and ‘others’ at the Hindu cremation grounds in Varanasi, India. Encounters with death at dark tourism sites serve as reminders of one’s own mortality affecting one’s attitude towards death, perception of self, and even challenging one’s personal values. Existentialists assert that anxiety is a condition of existential authenticity, and therefore moments of the existentially authentic experience are not always pleasurable. This paper argues that confrontation with death, as exemplified by the Aghori rituals and the cremation grounds in Varanasi, offers tourists an opportunity to examine the inevitability that life will end and to engage with this existential predicament and anxiety in an embodied sense, thereby pushing some of them towards life changes in the pursuit of existential authenticity.
A disordered body image is retained as a hallmark feature of all major eating disorders (ED). However, its role in psychopathology and classification of these complex mental illnesses has varied throughout the centuries. Indeed, while in the first descriptions of anorexia nervosa, body image disturbances were not included into its psychopathological core, the early European transcendental phenomenological tradition has attributed a central importance to disturbances of the “embodiment” processes for ED psychopathology. Since the second half of twentieth century ED have been intimately linked to perceptual and conceptual body image disorders and current nosological criteria for major ED retain those aspects of body distortion and denial of thinness as key diagnostic features. However, several issues concerning the inclusion and meaning of such diagnostic criteria for other mental disorders within the “eating-feeding” spectrum have been raised along the past decades and are reviewed here, also in the light of recent socio-cultural and neurobiological empirical evidence. Finally, issues concerning the boundaries with other mental illnesses in which a disordered body image is typically present are also critically considered. In conclusion, the role and relevance of body image disturbances in the diagnosis and classification of ED still remain to be fully clarified, although they might be of great relevance for designing more tailored psychological interventions for ED.
This article leads a phenomenological reading towards the dramaturgy of Samuel Beckett and more specifically his Endgame with recourse to the doctrine of Merleau-Ponty. By mapping out a drama that decentralizes subject-ivity, Beckett‟s Endgame textualizes the subversion of the constancy of identity (“être-pour-soi”) of the modern man who holds a dichotomous look on subject and object in his dominating view on the world. From this perspective, Endgame exudes an atmosphere of existential Angst which peaks in a potential way of being that prevails in the hope for an authentic life but yet at the same time falls in a cosmic exile that emanates from man‟s failure in his dominance over the world. Here, the examples of the Hegelian master-bondage concept and experimental psychology are felicitous reflections of this tragic relegation of man. Accordingly, registering the Pontian phenomenology of disembodiment delineates the characters of the Endgame as (in)human beings lost in a meaningless space that abandons all attempts to influence the
progress of the mechanistic material world they live in. Nevertheless, this case study traces the humanistic resonance of man to bestow new methods of exploring Beckett‟s „art of failure‟ as a relevant aesthetic reaction of the destabilized man in the modern world.
Step-counting turns walking into a health intervention. In the era of the Fitbit, physical activity tracking is commonplace, and a growing body of literature investigates the implications of digitally mediated human movement. This paper grows out of concern with the proliferation of tracking technologies; however, the focus here is not on the technology itself, but on the activity of step-counting that the technology has popularized. I look at step-counting to think about the ramifications of the promotion of physical activity in what Ilona Kickbusch (J Epidemiol Community Health 60(7):561, 2006) has called “the health society”. As a theoretical reflection, the paper contributes to discussions about the reach of health promotion discourses into daily life. Drawing on Foucauldian analyses of neoliberal approaches to health, I argue that the instrumental understandings of physical activity that surface in health promotion efforts around walking constrain meanings people can make of their bodies. I extend Foucauldian critique with materialist perspectives from the phenomenology of Maurice Merleau-Ponty and Drew Leder. Adopting Leder’s notion of the “absent body”, I argue that in the health society, strategies like step-counting make life smaller and narrow our ability to imagine life differently, with all the political consequences that might entail.
Recent turns in social sciences, namely the visual, qualitative, actorial or spatial turns, all indicate a rising interest in individuals. Since the aesthetic dimension always nourishes and informs individuals' spatialities and their decision-making processes, my research explores how the subjective realm of the aesthetic has proved itself able to generate conditions that lead to action, and consequently influence other dimensions of society, especially in the ethical, political or legal realms.
My systemic approach is grounded in the relational theory of space, the phenomenological study of the imagination, and the theory of urbanity. Hence, I investigated both urbanity and beauty as some of the most intriguing and interesting emergent (and not resultant!) phenomena of the urban system; where urbanity belongs to its objective realm and beauty to its subjective realm. It is essential to recognize that humans, unlike the components that create the natural systems, are capable of a particular sort of action due to their imaginative capacities that allow them to overpass the actual perceived world. The aesthetic dimension directly involves the human imaginative consciousness, which in turn activates the realm of the virtual, i.e., the realm that which exists only in a latent state, and does not appear visibly (fr. ce qui n'est qu'en puissance). While engaged in aesthetic experience, humans exhibit a particular sort of intentionality through which they bring to mind what is not visible through what is present and perceived. By making use of their lived body, individuals are capable to engage in a particular sort of imaginative play through which memories of the past, anticipations of the future and the actualized perceived present are conjured together, informing one another. Since every human intentional experience is spatialized, I investigated a particular spatial structure through which aesthetic experience occurs as such. I called this structure aesthetic space.
In the last chapter, I investigate more precisely the influence of the urban environment on the way in which individuals' aesthetic judgments evolve and mature. By considering the experience of modernity and the city as pivotal in the construction of individuals' aesthetic sensitivities, I explore the spatial component of aesthetic judgments on some particular cases. I also focus on the importance of the urban public space, the lifestyle change, as well as on the period of childhood, which appear to be critical to the (aesthetic) development of individuals.
In today’s health care, participation is acknowledged as important. However, there is limited research on how relatives of patients at risk of suicide experience their opportunities to participate in care during periods when their close ones are subject to inpatient care. The aim of this study was to describe the phenomenon of participation, as experienced by relatives of persons who are subject to inpatient psychiatric care due to a risk of suicide. The study was conducted through a reflective lifeworld research (RLR) approach, based on phenomenological philosophy. Eight relatives of patients receiving care from professionals in a psychiatric specialist health care context in Sweden participated in phenomenon-oriented interviews. Data were analysed to elucidate a meaning structure of the phenomenon. The findings show that the phenomenon of participation was more associated with patients’ recovery processes than with the caring process, and means “being actively involved in a process in which the person regains the desire to live”. The meaning of participation is further described by its meaning constituents: struggling for being able to be present for the person at risk of suicide, being able to share everyday life, and nurturing sources for vitality. These insights into the meaning of participation highlight the importance of allowing supportive relatives to be a part of the patient’s life, while the person is cared for in an inpatient hospital setting. Thus, participation enables relatives to be acknowledged as resourceful human beings in the patient’s recovery process, and thereby facilitates a sense of being able to manage and share life itself together with the person. This means that mental health nurses need to recognize individual variations of relatives’ participation processes, and take on the responsibility of acknowledging relatives’ lifeworlds.
Reflective Lifeworld Research is a suitable title for a text that argues for, and gives convincing philosophical credence to, a qualitative sensibility in the human sciences. The key concept is 'reflective'. This is a rightful scientific attitude, the implications of which become the main theme of an academic publication that finally articulates messages that have been superficially addressed in newer texts in qualitative research. In other introductory human science research texts (such as Murray, 2004; Terre Blanche, Durrheim, & Painter, 2006; Willig, 2008), adopting a reflective attitude or its more political variation, reflexivity, is recommended. However, other introductory texts appear to avoid a philosophically rigorous grappling with the reflective and/or reflexive attitude in research. Reflective Lifeworld Research takes on this challenge and succeeds in a manner that avoids activist or apologetic discourses, instead adhering to an empirical discourse. This becomes the main strength of Reflective Lifeworld Research, a well-grounded and sensible contribution to methodology in the human sciences. Whereas other texts on research method encourage reflexivity and the reflective attitude in a more cursory manner, this text traces the epistemological roots of this attitude. It therefore offers a much needed philosophical justification for the scientific value of a reflective approach. It goes even further by integrating this particular attitude with the data-gathering and data analysis processes of research. The first chapter accurately documents the philosophy that shapes the reflective lifeworld approach; chapter 2 introduces the secondary theme, 'openness'; chapter 3 links this paradigm of openness in research to the practice of 'bridling'; chapters 4 and 5 apply the epistemological tenets to data gathering and data analysis respectively; and chapter 6, within the enterprise of science, reconciles the reflective lifeworld philosophy with the canonical requirements of objectivity, validity and generalization. This achievement is not minor, since the writers draw the reader seemingly effortlessly into their paradigm of science (although neophytes to qualitative research, particularly undergraduate psychology students, could deem the crucial chapter 1 to be too philosophical or abstract).
■ How did phenomenology inspire anthropology to re-evaluate its principal method: participant observation? This question is answered by exploring how phenomenology has contributed to the anthropological study of religion. The focus in this field is not only on the way people perceive but also how they experience the world. This allows for a view that does not treat experience of the world separately from cognition of the world. Religion can thus be studied as it is lived and acted in concrete situations. By seeing the scholar as part of the life-world of the people in whose lives she participates, phenomenology in anthropology goes against the tendency to privilege `scientific' knowledge over other kinds of knowledge. This has some important theoretical ramifications, most notably the refusal to transcend lived experience through theory. This discussion will be illustrated from authors' fieldwork. The influence of phenomenology in anthropology also raises some important doubts. At the end of this article, these doubts will be addressed.
This book contributes to the idea that to have an understanding of the mind, consciousness, or cognition, a detailed scientific and phenomenological understanding of the body is essential. There is still a need to develop a common vocabulary that is capable of integrating discussions of brain mechanisms in neuroscience, behavioral expressions in psychology, design concerns in artificial intelligence and robotics, and debates about embodied experience in the phenomenology and philosophy of mind. This book helps to formulate this common vocabulary by developing a conceptual framework that avoids both the overly reductionistic approaches that explain everything in terms of bottom-up neuronal mechanisms, and the inflationistic approaches that explain everything in terms of Cartesian, top-down cognitive states. Through discussions of neonate imitation, the Molyneux problem, gesture, self-awareness, free will, social cognition and intersubjectivity, as well as pathologies such as deafferentation, unilateral neglect, phantom limb, autism and schizophrenia, the book proposes to remap the conceptual landscape by revitalizing the concepts of body image and body schema, proprioception, ecological experience, intermodal perception, and enactive concepts of ownership and agency for action. Informed by both philosophical theory and scientific evidence, it addresses two basic sets of questions that concern the structure of embodied experience. First, questions about the phenomenal aspects of that structure, specifically the relatively regular and constant phenomenal features found in the content of experience. Second, questions about aspects of the structure of consciousness that are more hidden, those that may be more difficult to get at because they happen before one knows it, and do not normally enter into the phenomenal content of experience in an explicit way.
The distressed personality (Type D) is an emerging risk factor in cardiovascular disease (CVD) that incurs a risk on par with left ventricular dysfunction in patients with ischemic heart disease. Type D is defined as the co-occurring tendencies to experience increased negative emotions and to inhibit self-expression in social interactions. Evidence is accumulating that Type D may also be a risk factor for adverse outcome across CVD patient groups, including patients undergoing revascularization with drug-eluting stent implantation or bypass surgery, patients with heart failure, peripheral arterial disease, and arrhythmia. In these patient groups, Type D personality has been associated with a 2-5 fold increased risk of adverse prognosis, impaired quality of life and symptoms of anxiety and depression independent of traditional biomedical risk factors, including disease severity. Although little is known about the pathways responsible for the detrimental effects of Type D on clinical outcome, the immune system and health-related behaviors, such as smoking and noncompliance, are likely candidates. Further research is warranted to investigate whether Type D personality is here to stay as a risk factor for CVD, but weighing current evidence on Type D against a set of external criteria shows that Type D personality fulfills the majority of these criteria. Importantly, Type D can easily be assessed in clinical research and practice with the standardized and validated DS14.
Forty patients (aged 29–57 yrs) with pain disorders participated in a controlled study. Half of the patients were treated with psychodynamic body therapy (PBT) for 33 sessions, and the other half received treatment as usual or no treatment. All patients were evaluated before therapy (T1), at the end of therapy (T2), and at 1-year follow-up (T3) with a visual-analogue-pain scale (subjective experience of pain), symptom checklist, inventory of interpersonal problems, Minnesota Multiphasic Personality Inventory, and the affect-consciousness interview. The study demonstrated that at T2 the pain was significantly reduced in the PBT group compared to the controls, and 50% of the PBT patients reported no pain. The findings further showed a significant and substantial change on level of somatization, depression, anxiety, denial, assertiveness, and social withdrawal, and increased affect consciousness. The results remained stable at T3, and the PBT patients even continued their improvement on some scales during follow-up. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Agoraphobia is commonly considered to be a fear of outside, open, or crowded spaces, and is treated with therapies that work
on acclimating the agoraphobic to external places she would otherwise avoid. I argue, however, that existential phenomenology
provides the resources for an alternative interpretation and treatment of agoraphobia that locates the problem of the disorder
not in something lying beyond home, but rather in a flawed relationship with home itself. More specifically, I demonstrate
that agoraphobia is the lived body expression of a person who has developed an inward-turning tendency with respect to being-at-home,
and who finds herself, as a result, vulnerable and even incapacitated when attempting to emerge into the public arena as a
fully participatory agent. I consider this thesis in light of the fact that since World War I agoraphobia has been diagnosed
significantly more in women than in men; indeed, one study found women to be 89% more likely than men to suffer from agoraphobia.
I conclude that agoraphobia is a disorder that stands as an emblematic expression of the ongoing pathology of being a woman
in contemporary society–a disorder that reflects that even today women belong to a political world in which they are not able
to feel properly at-home.
KeywordsAgoraphobia–Existential phenomenology–Existential health–Lived body–Gender–Agency–Being-at-home
Background:
The aim of the study was to investigate changes in psychosomatic complaints (PSC) and long-term illness (LTI) and the association between parents' socioeconomic conditions and children's complaints in the five Nordic countries (Denmark, Finland, Iceland, Norway and Sweden).
Methods:
The cross-sectional study covered a representative sample of children, aged 2-17 years in each country, altogether 10,219 in 1984 and 10,317 in 1996. The data were collected by mailed questionnaires. The relationship between LTI, PSC and parents' education, income, satisfaction with economy and family situation was analysed using descriptive statistics and logistics regression.
Results:
LTI and PSC in children have increased in all age groups between 1984 and 1996. The prevalence of LTI was higher among boys than girls, whereas the prevalence of PSC was higher among girls. In both years, the prevalence was higher in low-income, low-educated, one-parent families. The general tendency is the same in all countries, although there are some minor differences. The differences in 1984 remained unchanged in 1996 except for LTI that increased in low-educated families for Nordic children as a whole.
Conclusion:
Socially and economically vulnerable families seem to run the greatest risk of having children with LTI and PSC, although the data do not permit a strict causal relationship to be drawn. Also, families with high formal education, solid economy and general satisfaction with their situation seem to be able to offer their children sheltered and stimulating conditions for growth and development, even in times of economic recession.
The successful introduction of new methods for managing medically unexplained symptoms in primary care is dependent to a large degree on the attitudes, experiences and expectations of practitioners. As part of an exploratory randomised controlled trial of reattribution training, we sought the views of participating practitioners on patients with medically unexplained symptoms, and on the value of and barriers to the implementation of reattribution in practice.
A nested attitudinal survey and qualitative study in sixteen primary care teams in north-west England. All practitioners participating in the trial (n = 74) were invited to complete a structured survey. Semi-structured interviews were undertaken with a purposive sub-sample of survey respondents, using a structured topic guide. Interview transcripts were used to identify key issues, concepts and themes, which were grouped to construct a conceptual framework: this framework was applied systematically to the data.
Seventy (95%) of study participants responded to the survey. Survey respondents often found it stressful to work with patients with medically unexplained symptoms, though those who had received reattribution training were more optimistic about their ability to help them. Interview participants trained in reattribution (n = 12) reported that reattribution increased their confidence to practice in a difficult area, with heightened awareness, altered perceptions of these patients, improved opportunities for team-building and transferable skills. However general practitioners also reported potential barriers to the implementation of reattribution in routine clinical practice, at the level of the patient, the doctor, the consultation, diagnosis and the healthcare context.
Reattribution training increases practitioners' sense of competence in managing patients with medically unexplained symptoms. However, barriers to its implementation are considerable, and frequently lie outside the control of a group of practitioners generally sympathetic to patients with medically unexplained symptoms and the purpose of reattribution. These findings add further to the evidence of the difficulty of implementing reattribution in routine general practice.
This study aimed to estimate the prevalence and risk factors for medically unexplained symptoms across a variety of specialities.
A cross-sectional survey was conducted at two general hospitals in southeast London between 1995 and 1997. Eight hundred and ninety consecutive new patients from seven outpatient clinics were included. Demographic and clinical characteristic variables were assessed.
Five hundred eighty-two (65%) of the subjects surveyed returned completed questionnaires. A final diagnosis was available in 550 (62%). Two hundred twenty-eight (52%) fulfilled criteria for medically unexplained symptoms. The highest prevalence was in the gynecology clinic (66%). After adjustment for confounders, medically unexplained symptoms were associated with being female, younger, and currently employed. Psychiatric morbidity per se was not associated with the presence of medically unexplained symptoms, but was more likely in those complaining of multiple symptoms. Those with medically unexplained symptoms were less disabled, but more likely to use alternative treatment in comparison with those whose symptoms were medically explained. Patients with medically unexplained symptoms were more likely to attribute their illness to physical causes as opposed to lifestyle factors.
Medically unexplained symptoms are common across general/internal medicine and represent the most common diagnosis in some specialities. Medical behavior, training, and management need to take this into account.
Merleau-Ponty: Key Concepts introduces the reader to the fundamental ideas that have emerged from these intertwinings, outlined in Chapter 1, of Merleau-Ponty's philosophical heritage, cross-disciplinary interests, and his personal and political life. His own reflections on the philosophical enterprise indicate how he may have understood the relationship between “life” and “work”, and they also provide the best guide to how we might approach his philosophy, as well as to how to approach the essays in this book. In the Preface to Phenomenology of Perception, Merleau-Ponty concludes his rendition of phenomenology and existentialism with the suggestion that philosophy “is not the reflection of a pre-existing truth, but, like art, the act of bringing truth into being” and “[t]rue philosophy consists in relearning to look at the world” (PP: xx). He later made a similar point in his inaugural lecture at the Collège de France in 1952 (published as In Praise of Philosophy in 1953): “the philosopher, in order to experience more fully the ties of truth which bind him to the world and history, finds neither the depth of himself nor absolute knowledge, but a renewed image of the world and of himself placed within it among others” (EP: 63). These definitions of philosophy in part reflect Merleau-Ponty's ontological commitments, in particular the idea that the self and world are inextricably entwined: to express oneself is to express a world that is already both a historical and natural event of meaning, but is no less real for that; and expression, whether philosophical, historical or scientific, is fundamentally creative. © Editorial matter and selection, 2008 Rosalyn Diprose and Jack Reynolds.
This paper argues that the medical conception of health as absence of disease is a value-free theoretical notion. Its main elements are biological function and statistical normality, in contrast to various other ideas prominent in the literature on health. Apart from universal environmental injuries, diseases are internal states that depress a functional ability below species-typical levels. Health as freedom from disease is then statistical normality of function, i.e., the ability to perform all typical physiological functions with at least typical efficiency. This conception of health is as value-free as statements of biological function. The view that health is essentially value-laden, held by most writers on the topic, seems to have one of two sources: an assumption that health judgments must be practical judgments about the treatment of patients, or a commitment to “positive” health beyond the absence of disease. I suggest that the assumption is mistaken, the commitment possibly misdescribed.
Sexuality and sexual health discussion often remain taboo within nursing practice, despite being recognized as an integral part of the ′whole person′. Kathryn Odey outlines some of the possible reasons why health professionals find it so difficult to address this topic. The importance of introducing sexuality to legitimize it as a normal aspect of holistic health care will be discussed. Nurses should be aware of the impact of their own beliefs and attitudes on the way they approach matters of sexuality and sexual health, particularly as patients expect health professionals to identify and initiate such discussions.
Objective.
—To examine the impact of common mental illness on functional disability and the cross-cultural consistency of this relationship while controlling for physical illness. A secondary objective was to determine the level of disability associated with specific psychiatric disorders.Design.
—A cross-sectional sample selected by two-stage sampling.Setting.
—Primary health care facilities in 14 countries covering most major cultures and languages.Patients.
—A total of 25916 consecutive attenders of these facilities were screened for psychopathology using the General Health Questionnaire (96% response). Screened patients were sampled from the General Health Questionnaire score strata for the second-stage Composite International Diagnostic Interview administered to 5447 patients (62% response).Main Outcome Measures.
—Patient-reported physical disability, number of disability days, and interviewer-rated occupational role functioning.Results.
—After controlling for physical disease severity, psychopathology was consistently associated with increased disability. Physical disease severity was an independent, although weaker, contributor to disability. A dose-response relationship was found between severity of mental illness and disability. Disability was most prominent among patients with major depression, panic disorder, generalized anxiety, and neurasthenia; disorder-specific differences were modest after controlling for psychiatric comorbidity. Results were consistent across disability measures and across centers.Conclusions.
—The consistent relationship of psychopathology and disability indicates the compelling personal and socioeconomic impact of common mental illnesses across cultures. This suggests the importance of impairments of higher-order human capacities (eg, emotion, motivation, and cognition) as determinants of functional disability.(JAMA. 1994;272:1741-1748)
[Claire Poppe - STS 901 - Fall 2006]
Fleck focuses on the cognitive and social structures idea and fact development and acceptance.
- All ideas stem from "proto-ideas" - hazy, unspecific, unscientific concepts accepted as truth in their time period and existing in a socio-cognitive system.
- The social structure involved in cognition is conceived as the relationship between:
1) the knowing subject (individual)
2) the object to be known (objective reality)
3) the existing fund of knowledge (provided by the thought collective).
- The thought collective is a community of persons mutually exchanging ideas; it is the bearer of collective knowledge and the historical developer of knowledge. The individual's role is to decide whether results fit within the conditions specified by the collective. In this, he/she is influenced by the "thought style," an ambiguous cloud which directs perception and limits the options for interpretation without the perceiver being aware that they are being influenced.
- A scientific fact is a signal of resistance opposing free, arbitrary thinking. Facts are 1) in line with the interests of the collective, 2) accepted by the general membership of the collective, and 3) expressed in the style of the collective.
- Truth is only true within a single collective. It changes as collectives gradually change with the incorporation/adaptation or rejection of challenges to the thought style.
- Within a thought collective, there is a hierarchy consisting of two different groups:
a) Esoteric: a small group of experts with specialized knowledge who develop exoteric, popular knowledge
b) Exoteric: a larger, more "popular" group that creates public opinion, though not the entire public
- Categories of science from more exoteric to esoteric, more concrete to more flexible:
a) Popular science: attractive, lively, readable, artificially simplified science in which facts are reality and truth is objective
b) Vademecum science: a closed, organized system of the "commonly held" view of science where facts become fixed
c) Journal science: a personal, cautious and modest system open to contradictions and explorations
The everyday experience of someone, or something, getting in one’s face reveals a depth that is the difference between a world
that is intrusive and a world that is respectful. This depth, I argue, should be conceived, not in feet and inches, but in
terms of violation and honor. I explore three factors that contribute to this depth’s emergence. First, I examine our body’s
capacity, at the level of sense experience, for giving the world a figure/ground structure; this structure insures that most
of the world we are in constant contact with, nonetheless, keeps its distance as background. I demonstrate the importance
of this figure/ground structure to the depth of our world by considering the experience of people with autism; for those with
autism, this structure seems to be, if not entirely missing, at least substantially less robust than our own. Next, I examine
our body’s ability, at the level of more personal experience, to handle the world; our handling of the world, which rests
on the acquisition of specific skills, transforms things that could easily assault us into the usually motionless objects
we tend to take for granted. I demonstrate the importance of these skills to the depth of our world by considering the experience
of Gregg Mozgalla; until recently, Mozgalla, who has cerebral palsy, could only “lurch,” rather than walk, through the world.
Finally, I draw on the work of the artist Mierle Ukeles to examine the maintenance work that other people, at a broader social
level, perform; other’s maintenance work keeps in good condition a world that, by falling into bad condition, could easily
intrude on us.
There is increasing interest in the concepts through which lay people identify states of health - in their cultural origins and in their connection with preventive or remedial behaviour. A study of the concepts used by elderly Aberdonians is reported, exploiting two data sources: an intensive study of two social networks, and a random sample survey.
Concepts of health as the relative absence of disease are distinguished from health as a dimension of strength, weakness and exhaustion, and from health as functional fitness. In this Scottish material, functional fitness is dependent on freedom from disabling disease and not on strength, but strength is an important concept logically distinct from both disease and functional fitness. The `strength' dimension is poorly represented in scientific research on health indicators; but on the other hand lay concepts tend not to acknowledge pain as a dimension in itself.
A comparison with a similar French study suggests that while these three lay dimensions of health are present in both cultures, in France functional fitness is dependent on strength as well as on freedom from disabling disease, and this difference seems to be related to the practice of medical consultation.
Merleau-Ponty's reference to "a past which has never been present" at the end of "Le sentir" challenges the typical framework of the Phenomenology of Perception, with its primacy of perception and bodily field of presence. In light of this "original past," I propose a re-reading of the prepersonal as ground of perception that precedes the dichotomies of subject-object and activity-passivity. Merleau-Ponty searches in the Phenomenology for language to describe this ground, borrowing from multiple registers (notably Bergson, but also Husserl). This "sensory life" is a coexistence of sensing and sensible—bodily and worldly—rhythms. Perception is, then, not a natural given, but a temporal process of synchronization between rhythms. By drawing on Bergson, this can be described as a process in which virtual life is actualized into perceiving subject and object perceived. Significantly, this process involves non-coincidence or delay whereby sensory life is always already past for perception.
Chronic pain is a disruptive experience with far-reaching consequences in the somatic, psychological, social, and existential realms. The authors have previously (2003) introduced an approach to understanding chronic pain as a state of chaos where the individual lacks meaning-bearing structures and concepts needed to make his or her life understandable. In this article the authors investigated whether the theoretical construct "meaning out of chaos," used previously to describe the successful rehabilitation of patients with chronic pain could be helpful in understanding the rehabilitation process of 2 long term pain patients at a specialized pain clinics. The two cases were analysed in terms of meaning evolution from body meaning to symbolic content in order to generate further knowledge about the psychosocial, existential aspects of the pain-rehabilitation process and to further develop the theoretical construct "meaning out of chaos." Case 1 was a 30-yr-old woman with severe pain symptoms in her back; she was eventually diagnosed with fibromyalgia Case 2 was a woman in her late 20s who was also eventually diagnosed with fibromyalgia. The therapy work in the two case studies shows a journey from chaos to meaning. The meaning achieved had to do with re-appropriating a sense of self and finding a new platform from which the patients were able to get on with their lives. Pain became reduced to the margins of the experiential field, while problematic areas of their lives were brought into focus and worked through. The process from chaos to order takes time and involves all aspects of the patients' life situation, involving courage, dignity, and responsibility. Both patients discovered that they could make decisions with a sense of resoluteness they had not felt before. They had given up the "victim position" where things were done to them (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Here she [the author] focuses her attention on psychosomatic disorders and alexithymia (apparent lack of affect) as they make their appearance on the psychoanalytic stage. Persons accustomed to "speaking through their bodies" present enormous challenges to both physicians and psychoanalysts. Their physical distress is disconnected from its emotional component; they have no words to reconnect the two, even in the context of talking therapy.
With this formulation in mind, Dr. McDougall shares with her readers unforgettable stories of patients: mothers and grown children who seem trapped in a preverbal merger with one another, which she calls "one body for two"; Tim, whose grief is buried so deeply that he is "heartless"—until he suffers a heart attack; Georgette, whose alarming psychosomatic maladies seem to confirm her very existence; Jack Horner, who disparages the analyst at every turn and yet complains, "I don't know how to live," and many more. With the therapist's insightful and gentle guidance, words are given to the body's messages and the preverbal trauma is addressed.
In addressing the needs of psychosomatic patients, often thought to be ill-suited to psychoanalysis, Dr. McDougall not only offers rich theoretical formulations but also expands the realm of the psychoanalytic endeavor. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This review explores the most significant dimensions and findings of phenomenological approaches in anthropology. We spell out the motives and implications inherent in such approaches, chronicle their historical dimensions and precursors, and address the ways in which they have contributed to analytic perspectives employed in anthropology. This article canvasses phenomenologically oriented research in anthropology on a number of topics, including political relations and violence; language and discourse; neurophenomenology; emotion; embodiment and bodiliness; illness and healing; pain and suffering; aging, dying, and death; sensory perception and experience; subjectivity; intersubjectivity and sociality; empathy; morality; religious experience; art, aesthetics, and creativity; narrative and storytelling; time and temporality; and senses of place. We examine, and propose salient responses to, the main critiques of phenomenological approaches in anthropology, and we also take note of some of the most pressing and generative avenues of research and thought in phenomenologically oriented anthropology.
Brown J, Wimpenny P. International Journal of Nursing Practice 2011; 17: 9–18
Developing a holistic approach to obesity management
The aim of this paper is to discuss the theoretical background and relevance of a holistic approach to obesity management by nurses. There is a global rise in the number of people with obesity, such that it now represents one of the major health challenges. However, nurses are often influenced by physical and dietetic focused approaches and could fail to acknowledge a range of other factors that can impact on weight management. As part of the development of a holistic approach to obesity a literature search was undertaken to establish relevant theoretical perspectives that underpin practice in physical, psychological and social aspects of care (focused on the period 1995–2005). In addition, experiences of working in a secondary care weight management clinic were also drawn upon. Psychobiological, attribution and social support theories were identified that could contribute to a better understanding of obesity. If these theoretical perspectives and supporting evidence can be integrated in a holistic approach to care and management it might be possible to promote better health and well-being in those with obesity. Creating a greater understanding of the range of theoretical perspectives and supporting evidence related to obesity could, it is argued, provide enhanced care and management.
The sick-man may be said to have disappeared from medical cosmology in two related senses during the period 1770–1870. Firstly,
as control over the means of production of medical knowledge shifted away from the sick towards medical investigators the
universe of discourse of medical theory changed from that of an integrated conception of the whole person to that of a network
of bonds between microscopical particles. Secondly, as control over the occupational group of medical investigators was centralized
in the hands of its senior members the plethora of theories and therapies, which had previously afforded the sick-man the
opportunity to negotiate his own treatment, were replaced by a monolithic consensus of opinion imposed from within the community
of medical investigators.
This article reports on a phenomenological study undertaken to explore the meaning of spiritual care as described by a group of palliative care professionals. The research process was informed by van Manen's (1990) hermeneutic phenomenological approach. Eight palliative care professionals (nurses, complementary therapists and pastoral carers) were recruited from a community palliative care agency in Melbourne, Victoria, which provided home-based palliative care. All participants were female and came from diverse ethnic backgrounds. Data were collected by in-depth conversational interviews and were analyzed thematically. Two themes emerged: 'a living nexus between spiritual care, spirituality and holism' and 'a world of relationships'. The findings of the study point to the need for healthcare professionals to incorporate spiritual care guidelines into practice in order for palliative care to be truly representative of holistic health care.
Since nurse education moved to universities, a reoccurring concern of health consumers, health administrators, and some practising nurses is that nurses are not able to transfer the theoretical knowledge of holistic care into practice. Much has been written about this concern usually under the heading of the theory-practice gap. A common reason that has been highlighted as the cause of this gap is that the theoretical knowledge that nurses learn in academia is predicated on concepts such as humanism and holistic caring. In contrast, the bureaucratic organisation where nurses provide care tends to be based on management concepts where cost containment and outcome measures are more acceptable. Hence nurses' learned values of holistic caring are pitted against the reality of the practice setting. So what is this practice reality? This paper attempts to provide an insider view of why the theoretical knowledge of holistic care may be difficult to enact in the clinical setting. In-depth taped interviews with nurses and participant observation were conducted in acute care hospitals in Western Australia. The interviews were transcribed verbatim and analysed using the constant comparative method. The findings indicated that utilitarian nursing and role models had impacted on the transference of theoretical knowledge of holistic care into practice. The paper outlines some measures that nurses themselves can undertake to ensure the narrowing of the theory-practice gap in this area.
The author discusses the theoretical, investigative, clinical, and teaching aspects of psychosomatic medicine in the seventies. Major research and clinical developments are discussed in relation to key theoretical postulates and concepts. The rapidly expanding field of psychosomatic medicine is far more divant than ever before. Its hallmarks include a multifactorial approach to the study of health and disease, formulation of testable hypotheses and their careful validation, concern with the clinical applicability of research, and development of integrative theories. Current advances in the field have far-reaching inplications for medicine, psychiatry, and the behavioral sciences.
Somatic symptoms are one of the leading reasons for medical outpatient clinic visits, with the most common symptoms having a prevalence of 10% or more. However, the usual diagnostic workups are often unproductive, with less than 1 in 5 symptoms having an organic explanation after the initial physical examination and laboratory testing. Therapy appears more effective for some symptoms than for others. Of patients with unspecified pain or gastrointestinal complaints, greater than 70% state that some type of treatment has been helpful, whereas less than 50% of individuals with fatigue, dizziness, numbness, insomnia, sexual dysfunction, anxiety, or depression report any relief. Future educational efforts and research need to focus on that majority of symptoms that are either psychiatric or unexplained, in order to improve our current evaluation and management strategies.
Semantics and history of psychosomatic medicine are not popular topics nowadays, if they ever were; yet both of them constitute indispensable facets of any discipline that lays claim to a separate identity, as psychosomatics does. The latter, being an inchoate and inherently complex field of study, is especially in need of repeated efforts to clarify the meaning of its key terms, to delineate its scope, and to chart its development over time. Such efforts should pay off in improved teaching of this subject and in more effective communication with workers in other disciplines and with the general public. I have tried in this paper to sketch the historic development of psychosomatic conceptions and address some relevant semantic issues. It appears that early in this century, the convergence of two ancient conceptions, the holistic and the psychogenic, prepared the ground for the emergence in the 1930s of psychosomatic medicine as an organized scientific discipline and a counterreformation against the mechanistic view of man and medicine. Those two conceptions came to be subsumed by the word "psychosomatic" and thus contributed its two distinct connotations. The latter have not usually been clearly distinguished; hence, the ambiguity of the term. I have argued that only the holistic connotation should be retained, as it properly conveys the contemporary viewpoint. It is unfortunate that the word "holistic" has been appropriated recently by an anti-scientific and antiintellectual so-called "holistic health movement" (67), with resulting increment in semantic confusion and, in the eyes of many, loss of credibility for the misappropriated term. However, to retain it has merit as it is short, simple, and derived from the Greek - as were the very conceptions it has come to connote. Moreover, "holistic" has been part of the basic vocabulary of psychosomatic medicine from the beginning and conveys its core premises and purpose faithfully. As a historian aptly put it, the historic function of the psychosomatic movement has been to "vitalize the whole of medicine, psychiatry no less . . . with the holistic and ecologic viewpoint" (59, p. 9).(ABSTRACT TRUNCATED AT 400 WORDS)
The purpose of this paper is to give an explication of the concept of health which does not rely on the concept of disease. The explication is informed by a view of the human individual as an acting subject and it therefore places the abilities of agents in the centre. Abilities may be qualified in different ways. The qualification essential for understanding the dimension of health and illness relates abilities to environmental circumstances and high-ranking projects in the life plan. For this purpose generalized adaptedness is introduced as the overarching construction. The dimension of health and illness is characterized in terms of the adequacy of the repertoire for generalized adaptedness. Some immediate consequences concerning the notion of care are noted.
In this essay in honor of Donald Oken, I emphasize coping as a key concept for theory and research on adaptation and health. My focus will be the contrasts between two approaches to coping, one that empha- sizes style—that is, it treats coping as a personality characteristic—and another that emphasizes proc- ess—that is, efforts to manage stress that change over time and are shaped by the adaptational con- text out of which it is generated. I begin with an account of the style and process approaches, discuss their history briefly, set forth the principles of a process approach, describe my own efforts at measurement, and define coping and its functions from a process standpoint. This is fol- lowed by a digest of major generalizations that re- sulted from coping process research. The essay con- cludes with a discussion of special issues of coping measurement, in particular, the limitations of both coping style and process approaches and how these limitations might be dealt with. There has been a prodigious volume of coping research in the last decade or two, which I can only touch on very selectively. In this essay, I also ignore a host of important developmental issues that have to do with the emergence of coping and its cognitive and motivational bases in infants, as well as a grow- ing literature on whether, how, and why the coping process changes with aging.
In the past few years scientists and scholars in a variety of disciplines have been making concerted efforts to answer an ancient question, namely, How exactly do the physical processes in the brain cause consciousness? What is distinctive about the way in which modern scientists and scholars are approaching this question is that they are treating it as a scientific problem rather than a metaphysical one. This transition reflects the air of expectation in contemporary cognitive science to the effect that an empirical solution is imminent to a philosophical problem that previously was considered insoluble. Nevertheless, a recent authoritative review of the publications of such leading contemporary workers in the field as Francis Crick, Daniel Dennett, Gerald Edelman, Roger Penrose, and Israel Rosenfield has concluded that they have all failed to provide a satisfactory answer to the question (Searle 1995a). The present paper makes a psychoanalytic contribution to this interdisciplinary effort and provides an alternative answer to the question, based on Freud's conceptualization of the problem of consciousness. The paper takes a concrete example from Searle's review, reanalyses it within Freud's metapsychological frame of reference, and shows how this frame provides a radical solution to the problem. This implication of Freud's work has not hitherto been recognized and so has not received the attention it deserves.
Developments have occurred in all aspects of psychosomatic medicine. Among factors affecting individual vulnerability to all types of disease, the following have been highlighted by recent research: recent and early life events, chronic stress and allostatic load, personality, psychological well-being, health attitudes and behavior. As to the interaction between psychological and biological factors in the course and outcome of disease, the presence of psychiatric (DSM-IV) as well as subclinical (Diagnostic Criteria for Psychosomatic Research) symptoms, illness behavior and the impact on quality of life all need to be assessed. The prevention, treatment and rehabilitation of physical illness include the consideration for psychosomatic prevention, the treatment of psychiatric morbidity and abnormal illness behavior and the use of psychotropic drugs in the medically ill. In the past 60 years, psychosomatic medicine has addressed some fundamental questions, contributing to the growth of other related disciplines, such as psychoneuroendocrinology, psychoimmunology, consultation-liaison psychiatry, behavioral medicine, health psychology and quality of life research. Psychosomatic medicine may also provide a comprehensive frame of reference for several current issues of clinical medicine (the phenomenon of somatization, the increasing occurrence of mysterious symptoms, the demand for well-being and quality of life), including its new dialogue with mind-body and alternative medicine.
In a previous study we reported the prevalence of psychosomatic symptoms in 1619 Osaka elementary schoolchildren using our original general health questionnaire assessed by their parents. We found that psychosomatic symptoms were increasing with age. This study was designed to investigate psychosocial factors responsible for increasing psychosomatic symptoms with age.
We calculated a correlation coefficient between the physical complaints score (PCS) and these psychosocial variables using quantitation I of multiple regression analysis separately in the older (10-12 years, n = 860) and the younger age group (7-9 years, n = 759).
A stronger relationship between PCS and psychosocial problems was found in the older (r = 0.719, P < 0.0001) than in the younger age group (r = 0.570, P < 0.0001). Further analysis demonstrated that difficulties in school performance and increasing psychological conflicts with human relationships were major causes of somatic complaints in the older age group. In the younger age group, however, immaturity of social skills seems to be a primary problem. In addition, poor parental interaction and the playing of computer games were found to increase somatic complaints in children.
Children in the older age reflect the closer bio-psycho-socio interaction compared with their younger counterparts. This may give rise to a high incidence of psychosomatic disorders and school refusal in Japanese children. We emphasize that psychological support by parents in daily life is necessary to reduce psychosomatic symptoms in children.