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This paper explores the essential features of recovery and the need for an existential approach in psychiatry. The biopsychosocial model often fails to sufficiently validate the existential suffering of patients. We review the major principles of recovery and the philosophical and psychiatric principles of existentialism. The ontological or intrinsic existential issues of death, isolation, freedom and meaninglessness are described and their manifestations are explored in clinical syndromes. When ultimate existential concerns are recognised, patients have an opportunity to understand their life on a deeper level that is not defined as a medical disorder but as a part of human existence. Understanding that existential concerns underlie a great deal of human behaviour helps to free patients from the stigma of psychiatric labels. An existential approach is a humanistic way toward recovery.
Psychiatria Danubina, 2009; Vol. 21, No. 4, pp 453–462 View point article
© Medicinska naklada - Zagreb, Croatia
Laurie Jo Moore & Mila Goldner-Vukov
University of Auckland Faculty of Medical and Health Sciences, Auckland District Health Board
Manaaki House Community Mental Health Centre, 15 Pleasant View Rd, Panmure, Auckland, New Zealand
This paper explores the essential features of recovery and the need for an
existential approach in psychiatry. The biopsychosocial model often fails to
sufficiently validate the existential suffering of patients. We review the major
principles of recovery and the philosophical and psychiatric principles of
existentialism. The ontological or intrinsic existential issues of death, isolation,
freedom and meaninglessness are described and their manifestations are explored in
clinical syndromes. When ultimate existential concerns are recognised, patients
have an opportunity to understand their life on a deeper level that is not defined as a
medical disorder but as a part of human existence. Understanding that existential
concerns underlie a great deal of human behaviour helps to free patients from the
stigma of psychiatric labels. An existential approach is a humanistic way toward
Key words: existentialism – death – isolation – freedom – meaninglessness -
* * * * *
“The soul in its essence will say to herself: no one can build the bridge on
which you in particular will have to cross the river of life-no one but
yourself. Of course there are countless paths and bridges and demigods
ready to carry you over the river, but only at the price of your own self. In
all the world, there is one specific way that no one but you can take…”
(Nietzsche from May, 1983)
Existentialism is important in recovery
because of the strong emphasis it places on the
individual. In psychiatry clinicians should pay
more attention to each individual’s unique
existential experiences. We found in our
experience with existential group therapy, that
existential principles resonate with the recovery
model and help clinicians and patients/consumers
transcend what they experience as the confining
aspects of the medical model. (Goldner-Vukov et
al. 2007)
The recovery model was adopted as a guiding
principle in mental health in the United States in
the 1980’s. New Zealand (MHC 2001) and
Australia followed and in 1998 New Zealand
implemented the recovery model as a national
standard of care (MHC 2001). The recovery model
has similar origins to the 12 Step Recovery Model
for Alcoholics Anonymous. Recovering alcoholics
found that traditional mental health approaches
failed to meet their needs and lacked a basic
understanding of what they were experiencing. The
recovery movement expresses the desire of those
receiving care to take ownership of their own path
toward recovery. This parallels the philosophical
and psychological ideas of existentialism. There
are ongoing debates about the principles, terms and
applications of the ideas surrounding recovery, but,
in general, it attempts to develop a social model
that moves away medical labels and empowers the
individuals going through mental health
experiences to regain control over their lives.
Recovery can be seen as a journey of healing and
transformation that enables a person with a mental
health problem to live a meaningful life and
achieve his/her full potential.
The essential elements of recovery revolve
around the individual reclaiming and redefining
their identity and defining the values important to
their retaining ownership of their own lives.
Laurie Jo Moore & Mila Goldner-Vukov: THE EXISTENTIAL WAY TO RECOVERY
Psychiatria Danubina, 2009; Vol. 21, No. 4, pp 453–462
Important values include hope, having a secure
base and support system, self-empowerment, self-
determination and inclusion in the process of
engagement with the mental health system, as well
as the development of wellness recovery action
plans (WRAPS) (Copeland 1992, 1994, 1997).
WRAPS are written by the patient/consumer in
collaboration with mental health clinicians and
they include a section in which patients/consumers
describe how they would like to be treated in the
event of a relapse, who should and should not be
contacted, what medications are helpful and which
medications have not been helpful and other
advance directives for their care.
Patients/consumers who are not making
clinical progress are often stuck in existential
conflicts. Progress along the path toward recovery
is not really possible without understanding and
addressing existential concerns. We found that in
existential group therapy for bipolar patients that it
was when existential issues were addressed in the
group process and patients confronted each other
to take responsibility for their well-being and the
effect their behavior had on others, that patients
really accepted these challenges and changed their
behavior (Goldner-Vukov et al. 2007).
Individuals with psychiatric conditions
struggle with the same existential issues all human
beings confront and yet, their experiences bring
these issues to focus in unique ways. By
understanding the underlying principles of
existential thinking clinicians can assist patients in
reclaiming a sense of ownership and meaning in
their lives. It is vital for mental health profes-
sionals to recognize that patients have the freedom
of choice about how to manage their lives and that
it is only when they decide to assume respon-
sibility for their life and their treatment that they
will make any progress toward their recovery.
Clinicians can assist patients/ consumers to
establish a secure base. Housing New Zealand and
the Ministry of Health both fund low cost housing
for individuals and families. Work Income New
Zealand provides financial benefits for individuals
and families and in addition they have
implemented a Workwise Program that places
employment specialists in mental health centers to
help patients/consumers find jobs. By offering
assistance and support, skills training, socialization
and occupational activities, clinicians can help
patients/consumers deal with their feelings of
isolation and regain confidence in their ability to
form friendships and belong and participate in life
in meaningful ways. The restoration of hope is an
area that deserves special attention.
When patients come to see clinicians they
frequently do not ask the questions that are really
on their mind nor do they talk about what really
concerns them. It is unusual for a person to go
directly to something close to their inner being
without taking a variety of paths forward while at
the same time they are asking themselves whether
or not you, their clinician, is someone who will
accept them, listen to them, be capable of
understanding their concerns and have anything of
value to offer them for the risk they take in making
themselves known. This is an essential step in
forming a collaborative relationship that supports
the self-empowerment and self-determination
important for recovery.
The archetype of a healer has been described
as a universal phenomena in human beings
(Campbell & Moyers 1991). When patients are
able to trust their clinician, feel safe and respected,
then the clinician/patient relationship allows the
activation of the patient’s internal healing belief
system. This gives patients a sense of hope. Hope
allows a relationship to develop in which the
patient and clinician are able together to
acknowledge and alleviate many of the deep issues
of suffering that people encounter in life.
Sometimes it is important to have a name for one’s
suffering. A cure is essential at times. Other times,
it is important for one’s suffering to be acknow-
ledged and for one’s courage to be recognised.
Existentialism in Philosophy
and Psychoanalysis
One of the most important values of existential
philosophy is authenticity. Authenticity is above
all a call to integrity, responsibility, and even to
heroism. It asks an individual to be true to his/her
inner self in the face of adversity no matter what
the cost. (Solomon & Higgins 1996). In the early
1900’s existential psychoanalysts began to emerge.
After a few decades without much activity,
Kierkegaard’s work was translated into other
languages and was taken up by the German Martin
Heidegger who became an exponent of
existentialism and the German psychiatrist Karl
Jaspers who coined the term “Existenzphilosophie
Laurie Jo Moore & Mila Goldner-Vukov: THE EXISTENTIAL WAY TO RECOVERY
Psychiatria Danubina, 2009; Vol. 21, No. 4, pp 453–462
(philosophy of existence)”. Existential psychoana-
lysts, philosophers, writers and artists developed
across Europe and spread to America as late as
1958 (May 1983).
Existentialism might be best conceived as a
philosophical movement that includes philoso-
phers, politicians, writers, artists, psychoanalysts,
psychologists and psychiatrists. Irvin Yalom is a
contemporary psychiatrist who has continued the
work of existential psychiatry (Yalom 1980).
Existential philosophers who emerged in the
aftermath of the horrors of WWII stressed that it
was individuals who gave meaning to their lives
and not the world who gave them meaning.
Defining Characteristics of Existentialism
The human existential dilemma is something
fixed in the depths of the human character (Becker
1973). The existential nature of human existence is
ontological, i.e., it is intrinsic to being human
(Tillich 1952). Human beings are free to make
decisions about life and are responsible for the
outcome of these decisions. This creates an
intrinsic anxiety or angst about the freedom to
make choices (Yalom 1980).
The principles of existentialism can be
summarized as follows: all human beings: 1) are
centered in themselves, 2) strive to preserve and
affirm their true being, 3) have a need for and the
choice of extending themselves to others, an action
that involves risk, 4) have the capacity for self-
awareness, 5) have the capacity to know them-
selves as subjects who have a world and to know
they are being threatened, and 6) have an
ontological foundation for consciousness based on
freedom (Tillich 1952).
Existential Phenomenology
A phenomenon is that which appears and
phenomenology is the study of appearances.
Existential phenomenology is a way human beings
have of understanding themselves and the world by
means of careful descriptions of experience. The
existential philosopher Edmund Husserl empha-
sized that experience could only be studied
subjectively, that is, human life could only be
viewed from the inside instead of pretending to
view it objectively from the outside. A basic
principle of phenomenology is the concept of
intentionality, that all phenomena involve both an
intending action and an intended object. In contrast
to the cognitive approaches already discussed,
existential phenomenology focuses on under-
standing individual experience as an attempt to
capture the essential meaning of existence. This
philosophical current was inspired by Martin
Heidegger who was influenced by the existential
work of Kierkegaard who contended that existence
was absolutely unique for each individual and the
phenomenological work of Husserl (Stewart &
Mickunas 1974, Luijpen & Koren 1969).
The Need for an Existential Approach
The current approach to psychiatric problems
is biopsychosocial, cultural and spiritual. We
suggest an existential approach is needed to
comprehend the wholeness of patients. Existential
phenomenology supports the uniqueness of each
individual and helps guide clinicians in
establishing a respectful therapeutic relationship
that is supportive of the recovery approach and the
self-determination of patients. The existential
approach presents the view that there are intrinsic
conflicts that result from the awareness and
confrontation of certain ultimate concerns that are
an inescapable part of human existence. The major
existential ultimate concerns are death, mean-
inglessness, isolation, and freedom. The fear of
death, for example, is so overwhelming that human
beings would not be able to function if this fear
was totally conscious. The conflicts people
experience and the defenses they develop around
existential ultimate concerns are generally
unconscious processes. They often become
conscious through the manifestation of
psychological symptoms, disorders or patterns of
behavior. In a therapeutic relationship that
recognizes existential issues, they are an important
part of understanding the foundation and
development of each unique individual person. In
this paper, we have chosen to focus on the
importance existential issues have in the
therapeutic relationship and in assisting individuals
to find hope and meaning that may allow a
successful negotiation of recovery. Existential
conflicts and defenses become an important part of
the therapeutic process of making what is
unconscious, conscious so individuals can achieve
a greater sense of mastery and control of their
lives. This is obviously a broad and ambitious
agenda and a full discussion of this is beyond what
this paper can address. In general, confrontation of
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the intrinsic, i.e., ontological givens of existence
can be painful and challenging but ultimately
Psychopathology and Existentialism
Psychiatric problems that are reflections of
existential issues are frequently seen in primary
care and psychiatry. They include: depression,
anxiety, pain, somatization, substance abuse, and
suicidality (Yalom 1980). An existential
perspective is helpful in understanding many
psychiatric symptoms and behaviors. Anxiety
emanates from an individual’s confrontation with
the ultimate concerns of existence. The
psychopathological manifestations are a graceless,
inefficient, and ineffective defensive mode of
coping with anxiety.
There are three types of existential anxiety
(Tillich 1952). 1) The anxiety of fate or death in its
pathological expression drives inidividuals to an
unrealistic need for security. This anxiety is
compounded to the degree that a person
individuates. Unconscious pathological manifesta-
tions of the need for security include obsessive,
compulsive and dependent behavior as well as the
narcissistic preoccupation with acquiring power
and wealth that underlies modern Western society.
2) The anxiety of emptiness and meaningless is
created by doubt based on separation and isolation.
In its pathological expression this anxiety drives
individuals toward an unrealistic need for certainty
or fanaticism. Problems with separation underlie
the dynamics of all insecure attachment disorders.
3) Human beings experience an anxiety of guilt
and condemnation. Its pathological expression this
anxiety drives individuals toward an unrealistic
need for perfection. The need for perfection can be
observed in patients who are obsessed about side
effects of medication and are trying to find a
‘perfect’ cure. People with eating disorders try to
find a perfect body and the drive for perfection
may be part of people’s character structure (Tillich
When these three types of anxiety are not
mastered and they are fulfilled or manifest in the
state of despair which is a condition of no hope
(Tillich 1952).
Existential Ultimate Concerns
Conflicts arise as ultimate concerns intrinsic to
human existence. Each individual faces the core
existential ultimate concerns in a highly
individualized way: death, freedom, isolation and
meaninglessness (Yalom 1980).
Death is the most obvious ultimate concern.
The core conflict is between the awareness of the
inevitability of death and the desire to continue
living (Spinoza in Elwes, 2008). Human beings
create defenses against the fear of death based on
denial. These defenses shape the human character,
influence the way individuals grow, falter, and fall
ill. There are two modes of existence: one of
forgetfulness of being ( a limited awareness of the
true nature of existential ultimate concerns
including death ) and one of mindfulness of being (
full awareness of the immences of death and
ultimate existential concerns) which is described as
authentic (Heidegger, 1996). The desire to
transcend death is so ultimate and profound that it
has been described as the source of all culture and
creativity (Becker, 1973). Humans attempt to
achieve immortality in the following ways: 1)
biologically through procreation, 2) theologically
through spiritual evolution, 3) creatively through
work and art, 4) experientially through intense life
dramas, adventures and experiences, and 5) by
immersing oneself in the forces of nature (Lifton
Rank believed a person was thrown back and
forth in the process of individuation between the
fear of life and the fear of death (Rank 1945). That
is, between two poles of possibility: the affirmation
of one’s autonomy, emergence and potential that
leaves one feeling unprotected and lonely and 2)
the fear of loss of individuality by being dissolved
back into the whole and becoming invisible (Rank
1945). People who individuate beyond conven-
tional limits have an increased fear of death
anxiety, an increased need for fusion and an
increased need for a sense of belonging (Tillich
1952). People who suffer from mental illness are
thrown into an unconventional life style,
completely beyond their own choosing and this
intensifies their fear of death and isolation.
Fear of Death
Human beings are out of nature but hopelessly
in it. Human beings are consciously aware of the
true human condition but instead remain only
partially conscious and play all sorts social games,
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and use psychological tricks that keep them far
away from the reality of death (Becker 1973). For
example, people end up leading unbelievable lives
when they are trapped in psychotic interpretations
of reality, when they are absorbed in the madness
of gambling and addictions and when they are
completely preoccupied with forms of acting out
and harming themselves and others in order to get
revenge for their suffering. One way to cope with
the fear of death is to pull back from the full
potential of life. Mental illness provokes the fear of
death and restricts an individual’s potential for
development (Maslow 1968). Every illness
provokes the fear of death. Mental illness clearly
increases the risk of suicide as an ultimate attempt
to escape a perceived destiny or suffering.
People who do not succeed in taking upon
themselves their existential anxieties, can escape
the state of despair by developing neurotic
symptoms. Neurosis is a way of avoiding the state
of non-being by avoiding being (Tillich 1952). One
of the manifestations of death anxiety is neurosis.
Manifestations of Death Anxiety
Success neurosis is seen when people are
striving to achieve success at any cost in order to
‘prove’ their immortality. Social phobia is the
result of problems with individuation and the lack
of development of social skills leading to social
anxiety. Substance abuse is a means of achieving
an altered state of consciousness as an escape from
confronting the realities of existence. In order to
avoid death anxiety people may develop a sense of
specialness, a belief in personal omnipotence
manifested by heroism, workaholism, narcissism, a
refusal to accept necessary treatment, and
rebellious behaviour in general. The belief in an
ultimate rescuer is the need to be found, protected,
and saved without asking for help. This is
manifested by collapse when a fatal illness
appears, depression when living in someone else’s
shadow, masochism, interpersonal difficulties and
failing to separate from a relationship with aging
parents (Yalom 1980). Psychiatric patients
probably stop taking their medication and relapse
as a result of a sense of specialness and a belief
that nothing is wrong with them because they have
an omnipotent power to heal themselves. In
addition, when faced with dilemmas they can’t
resolve, they may regress to a state of believing in
an ultimate rescuer and become helpless. Patients
often give up or stop taking medication and hand
themselves over to fate as a way of refusing to face
the challenges or destiny of their lives.
Freedom, Destiny and Responsibility
Yalom assumes that freedom refers to the
absence of an inherent design in life that leaves
one responsible for all one’s choices and actions.
Freedom refers to the absence of external structure.
The human being does not enter or leave a well
structured universe that has an inherent design.
Beneath human existence there is no ground, only
a void, an abyss, nothing (Yalom 1980).
Freedom gives human beings the ability to
modify destiny. Being responsible for life at the
deepest level establishes a foundation for an
individual’s identity and existence. From the
perspective of existential thinkers the individual is
entirely responsible for creating his/her self,
destiny, life predicaments, feelings, choices,
suffering and actions (Yalom 1980). Individuals
who reject responsibility for themselves, blame
other people or phenomena for their life situations
(May 1999).
It is not possible for human beings to be
responsible for their genetic makeup, their family
of origin, the state of the world around them or
many other things. But human beings are
responsible for what they make of their lives
(Tillich 1952). Despair arises from being unwilling
to be oneself (Kierkegaard 1954). Every falling
away from ourselves is a crime against nature and
leads to sickness (Maslow 1958).
The conflict in freedom is between the
encounter with groundlessness and the desire for
foundation and structure (Yalom 1980).
Manifestations of this conflict include a variety of
ways in which people can develop a psychic world
where they do not experience a sense of freedom.
Examples include a life dominated by compulsive
fears or dominated by paranoia in which the
individual’s feelings and thoughts are attributed to
others. The conflict around freedom and
responsibility can also be acted out in the
personality. For example, a hysterical personality
may be a way of pretending to be an innocent
victim, a borderline personality may be a way of
acting out loosing control, passive behavior may be
a way of not asking for help or comfort and
abusing alcohol and drugs may be an attempt to
escape responsibility and to live in an alerted state
of consciousness (Yalom 1980).
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Isolation refers to human being’s fundamental
separation from others and from the world. The
conflict is between absolute isolation and the
desire for protection and belonging (Yalom 1980).
Becoming an individual entails an eternal and
insurmountable loneliness (Kaiser 1965). The
major developmental task of existentialism is to
resolve the conflict between fusion and isolation.
Interpersonal and existential isolation are way
stations for each other. Human beings separate to
encounter aloneness but this allows them to return
to relationships to engage more deeply with others
(Yalom 1980).
Separation from the world, the experience of
feeling lost and lonely, is the intrinsic state of the
human condition that includes intrapsychic,
interpersonal and existential isolation. Anxiety
covers acceptance of the fact that human beings are
born alone and die alone. Manifestations of the
problem of isolation in Yaloms view include
certain manifestations of narcissism including the
Don Juan syndrome in which individuals are
unable to make a commitment to one person and
the behavior of disinhibited adolescents that may
express the child’s inability to tolerate the
separation and loneliness of adulthood (Yalom
1980). People who have been traumatized may
become trapped in their internal world of
psychological and physical pain to protect
themselves from further external trauma.
Hypochondriasis may be seen as an expression of
the fear of isolation where every physical pain
reactivates the psychological pain of having been
abandoned as an infant. As mentioned earlier, all
psychological issues related to attachment
disorders underlie the development of psychiatric
disorders including anxiety, depression, substance
use disorders and somatization. This reflects the
essential understanding of existentialists that the
negotiation of the conflict between fusion and
isolation is the major developmental task of human
Meaninglessness is the human confrontation
with an indifferent universe that compels
individuals to construct their own meaning (Yalom
1980). One solution is to cultivate a transcendental
relationship with what is divine (Buber 1965).
Secular sources of meaning include altruism,
devotion to a cause, or self-actualization (Camus
1989, Sartre 1954). Meaning falls into three
categories: 1) what one gives in creative work, 2)
what one takes in terms of experiences and 3)
one’s stand toward suffering and fate (Frankl
Meaning refers to our sense of purpose.
Meaninglessness is the chronic inability to believe
in the truth, importance, usefulness or interest
value of any of the things one is engaged in or can
imagine doing (Maddi 1970), Lack of meaning
perpetuates anxiety, isolation and despair.
Manifestations of meaninglessness include:
suicidality, alcohol or drug abuse, noogenic or
existential neurosis, depression, low self-esteem,
identity crisis, boredom, emptiness, apathy,
cynicism, and lack of direction. As a result of
being mentally unwell patients are frequently
drawn into an intense conflict about their purpose
in life. They are handicapped in their attempts to
engage in creative work and to take a stand toward
their suffering. They are hampered in finding
meaning in their experiences by the social stigma
of their illness and need intensive support to
overcome the toxic experiences of rejection they
suffer in their families and society.
How to Assess Existential Issues in Psychiatry
When assessing patients, clinicians need to
consider the presence of existential issues. It is
necessary to recognise that the biopsychosocial,
cultural and spiritual model does not sufficiently
encompass the realities of human suffering.
Clinicians need to consider existential issues in
patients who are treatment resistant and suffer, for
example, from anxiety, depression, somatization or
pain, suicidality and addiction. It should be
understood that there are layers of anxiety but that
the deepest level of anxiety is related to one’s
personal understanding of ultimate concerns.
Tillich (1952) states that underlying all anxiety is
the fear that one will not be able to preserve
oneself in the face of direct adversity. This
describes the experience of people ‘having a
nervous breakdown’, becoming overwhelmed by
depression, anxiety, mania or psychosis. Ultimate
concerns are universal and they are present in
every individual in every culture. These can be
approached by being present beside patients as
they encounter bewildering and shattering
experiences they cannot understand. In less overtly
profound situations ultimate concerns can be
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explored by listening to dreams and fantasies,
observing behaviour, and asking open-ended
questions about meaning. The goal of existential
assessment is to help patients understand and
remove or resolve obstacles to the crucial
questions of being.
Existential Approaches and Interventions
An existential approach is consistent with
good psychiatric practice and emphasizes being
empathetic and genuine. It suggests a willingness
to grasp the meaning of patients’ suffering.
Existential assessment is focused on the
dimensions of human existence in the here and
now and discourages an emphasis on the past.
Patients are encouraged to make authentic
decisions, to discover truly responsible ways of
dealing with life and the world and to think deeply
about their life situation. It is important to promote
the belief that patients can harness their anxiety
and use it constructively. For example, it is
productive for patients to see anxiety as an
opportunity to change and to achieve their full
potential. Clinicians can temper existential anxiety
by encouraging people to reach out to others, to
love and to participate actively in life (Tillich
After completing a comprehensive psychiatry
history we recommend that existential concerns be
included in the development of the psychiatric
formulation. Individuals will have different
encounters with ultimate concerns that play a role
in their vulnerability to develop psychiatric
disorders and shape the nature of their character
and their defensive structure. There is not
necessarily a 1:1 relationship between ultimate
concerns and psychiatric symptoms or disorders as
these conflicts may be experienced and expressed
in very individualized ways.
We recommend that patients identify their
most important life values and then rank their
values from the most to the least important.
Following this patients are asked to write down
their life goals linking them to their values. This
process highlights patients’ major ultimate
concerns and allows clinicians to help patients
understand their ultimate concerns and see how
they cope with their anxieties. This process allows
for therapeutic interventions when patients means
of coping are dysfunctional. For example, when a
patient ranks health as the most important value,
but does not attend to physical well-being at all
because of belief in being special. This person
could benefit from gentle confrontation and
perhaps shift to a more adaptive coping
Group therapy is especially helpful to teach
patients how their behavior is viewed by others,
how it makes other people feel, how it creates the
opinions others have of them and how it influences
their opinions of themselves. In addition group
therapy is especially helpful when peers confront
each other about therapy-avoiding behaviors and
behaviors that lead to the suffering of others due to
failure to assume responsibility for one’s actions
(Goldner-Vukov et al. 2007).
Clinicians need to foster an understanding in
patients that they participate in creating their own
destiny. Clinicians need to understand the role
patients play in their own dilemmas and find ways
to communicate these insights. The goal is
ultimately to support personal change by helping
patients understand that the cause of their suffering
is not always external, but may, in fact, be internal
and related to deeply human ontological concerns.
Existential Themes That Point Toward Answers
It is beyond the scope of this paper to address
the existential approach to all psychiatric
symptoms and disorders. Instead we have
attempted to give a broad overview of how
existential ultimate concerns may be involved in
the development of psychiatric symptoms and
disorders. We paid particular attention to how
existential issues apply to an effective therapeutic
relationship, and how they may be involved in
treatment resistence/ nonadherence. In this section
we will discuss themes that can help patients find
hope and meaning in their lives. These suggestions
involve atheist/ secular approaches such as that of
Yalom, naturalistic/Taoist/ mystical approaches
such as Alan Watts, the mythological approach of
Joseph Campbell and theological approaches of
religious beliefs suggested by Tillich, Buber,
O’Donohue and Frankl.
By helping patients to be honest in facing the
ultimate concerns that are causing or contributing
to their psychiatric problems, patients can first of
all begin to understand and know themselves more
deeply. The more patients are able to know
themselves and relate to their authentic true selves,
the more they are able to participate in life (Tillich
1952). In supporting patients to affirm and
preserve their own true inner beings, clinicians can
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Psychiatria Danubina, 2009; Vol. 21, No. 4, pp 453–462
help them find their own inner source of power. In
helping patients to develop the courage to be who
they are, to love and participate in life they can
begin to overcome their existential anxieties. The
degree of virtue people can attain in life is
determined by the degree to which they strive for
and affirm their own being (Tillich 1952). This is
not something that is beyond the grasp of people
suffering from psychiatric disorders.
Responding to the fear of death
and finding meaning
Joseph Campbell, the eminent mythologist,
says that myths are symbolic stories that reconcile
human beings to the harsh realities of life
(Campbell 1991). The first function of myths is to
point to transcendence of consciousness and the
unknown mystery of life. One universal myth
across the world is that of the hero or heroine who
is the personification of courage and strength and
undertakes a transforming vision quest. The
highest point of this quest is to confront death. The
hero or heroine is challenged to follow the wisdom
in their heart and not the contemporary
conventional wisdom that will lead them to hell.
The message of this myth is that the seat of the
soul is inside and that it is in the soul that the inner
and outer worlds meet. Each patient’s life is their
unique encounter with this myth and we need to
acknowledge and validate the courage our patients
require to follow the wisdom of their heart through
their terrifying experiences.
Campbell admonishes that if clinicians want to
help people in this world, they need to teach people
how to live in it. He says that what human beings
are seeking in life is all the experiences one can
possibly have of being alive. Myths are clues to the
spiritual potentialities of life. The spiritual and
mythological fulfillment of life is that you are here,
you exist, and you are alive (Campbell 1991).
Einstein reminds us that it was only to the
individual that the soul is given. (Einstein) Not to
the family, the church or society. It is only through
the authentic and unique true self that human
beings can discover the meaning of their lives.
Isolation and Belonging
Psychiatric patients loose connection with
their inner selves and with their environment. They
become isolated. Psychiatric symptoms per se
alienate patients from themselves and from others.
For example, people who dissociate, who shift
back and forth between devaluation and
idealization, between love and hate, loose
connection with themselves and have difficulties
establishing interpersonal relationships. The stigma
of mental illness, being unable to work and living
in poverty makes patients feel separated from their
families and society. People who are isolated and
disconnected often lack relationships that assist
them in integrating their experiences. Without
connections patients are subject to internal reality
states that become a substitute for real connections
with other people. In order to survive situations
that are overwhelmingly traumatic, patients often
develop a false self. When this false self speaks to
patients, they experience it as external and foreign.
When patients hear voices, for example, they are
listening to some part of themselves that begs for
understanding. When patients live in a false self
they search for something that can never be
Longing and belonging are instincts of the
soul (O’Donohue 1998). In interventions with
patients clinicians need to help them belong first to
their own soul and to see that real beauty is the
light that comes from within them (O’Donohue
1998). It is the challenge of clinicians to help
patients find the connections within themselves
and to offer them a therapeutic relationship that
will allow them to discover and develop new
aspects of themselves.
One of the deepest longings of the soul is to be
seen. There is no mirror in the world where one
can glimpse the soul. The honesty and clarity of
true friendship is the truest mirror. (O’Donohue,
1998) In therapeutic alliance with patients, it is the
role of clinicians to provide patients with such a
mirror. Clinicians need to help patients understand
that what appears to be only negative also contains
an opportunity for self-knowledge and self-
mastery. By encouraging patients to adopt an
attitude of hospitality and embrace that which is
difficult and awkward clinicians can help patients
to discover the positive meaning of their symptoms
and to validate their suffering.
Acceptance, Faith and Freedom
Whereas Western society has addressed some
ultimate concerns in terms of secular or religious
faith and beliefs, Eastern approaches have
emphasized naturalistic ways of approaching life
that don’t involve conceptualizing a supreme being
or entity. These include Taoism and Buddhism.
Laurie Jo Moore & Mila Goldner-Vukov: THE EXISTENTIAL WAY TO RECOVERY
Psychiatria Danubina, 2009; Vol. 21, No. 4, pp 453–462
Acceptance is a basic and profound principle of
eastern philosophical and spiritual beliefs. Radical
acceptance has become one of the foundations of
psychotherapy for complex emotional states in
severe personality disorders, Bipolar Disorder,
Schizophrenia and Schizoaffective Disorder. In
addition to being oneself and finding meaning in
life, acceptance allows people an additional layer
of being that may contribute to finding happiness.
In true acceptance of the self there is a mystery that
something so apparently simple can contain so
great a treasure. Is so happens that the very things
human beings are forever struggling to get away
from, to change and to escape are the very things
that hold the much desired secret. For example,
patients frequently want to destroy or get rid of
part of themselves that is wounded when, in fact,
the sad, angry, scared or helpless parts of them
deserve compassion and understanding. One’s
present self and situation at this moment contain
the whole secret (Watts 1940). Clinicians need to
help patients accept the state of their own soul
exactly as it is instead of trying to force themselves
into some other state that they imagine to be
superior. Faith is the willingness to give oneself to
life absolutely and utterly without making
conditions of any kind (Watts 1940). In doing this,
one can begin to overcome existential dilemmas.
Human beings are always trying to interfere
with their states of mind as they appear from
moment to moment imagining that something else
is better than what they experience (Watts 1940).
Instead, clinicians need to encourage patients to
allow the moment and all it contains freedom to be
as it is, to come and go in its own time and in
allowing the moment, which is what one is now, to
set onself free (Watts 1940). In doing this one can
realize that life as it is expressed in the moment has
always been setting you free from the very
beginning but you have chosen to ignore it and
tried to achieve something else. That is why total
acceptance is actually the key to freedom (Watts
Existential anxieties that emanate from the
ultimate concerns of existence can interfere with
the development, relationships, creative work and
self-actualization of mental health patients. The
anxiety of death and fate can lead to a
preoccupation with security. By teaching patients
to accept their true selves and find the courage to
love and participate in life, they may be able to
overcome this anxiety and not be controlled by it.
The anxiety of meaninglessness based on the fear
of isolation may drive patients toward fanaticism.
By establishing successful therapeutic relationships
with patients, clinicians can help them feel a sense
of belonging and move in and out of their fears
toward relationships that allow them to integrate
their traumatic and difficult internal experiences.
The anxiety of guilt and condemnation is a result
of the intrinsic state of freedom and it may drive
patients toward perfectionism. If clinicians can
teach patients to accept their lives and to give
themselves to life absolutely and utterly without
restraint, patients can find the key to their freedom
and the path to recovery in this kind of total
Changing perspectives and behaviours in a
process that involves many conversations and
dialogue amongst colleagues. We believe an
existential approach to treatment has benefits and
we invite future dialogue around this topic.
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Laurie Jo Moore, MD, ABPN, FRANZCP, Clinical Instructor
University of Auckland Faculty of Medical and Health Sciences
15 Pleasant View Rd, Panmure, Auckland, New Zealand
... Viewing the situation from the Buddhist perspective seems greater outlook because the contemplation on death or meaninglessness is a reminder to humankind that everything in this universe is impermanence. Thus, the mindfulness application on death in modern education with referring to the Buddhist approach may help to overcome the fear of death during the pandemic [23]. ...
... However, the main conflict exists between absolute isolation and the desire for belonging and protection. It was coined that interpersonal and existential isolation co-exists with each other despite human beings being separate to encounter aloneness [23]. On the other hand, the social isolation is a universal human experience that sometimes affects entire communities and reminds each individual of their need for connection [25]. ...
... He also discovered that freedom is all about the absence of external structure and it gives human being the strongest to amend destiny. He also argued that being responsible for life at the deepest level would bring a better understanding of the freedom and conflict in freedom [23]. The insights of freedom from the existential therapist point of view. ...
Full-text available
There has been a lot of talks lately about the need for a title/position to be a true leader among academics and researchers. Likewise, most people are confused about the title and the action of a leader in an organization. The words on the street are that most of the leaders believe in their titles, not in their actions, as well as in most of the research on leadership are characterized by fragmentation and conflicting nomenclatures. These confusions and conflicts must be solved through adequate reviewing and research studies. The primary goal of the study is to find out if the title is needed to be a leader and to identify the key qualities to be an action-oriented leader. The review is a stand-alone literature review conducted using the electronics databases such as EBSCO, DOAJ, RESEARCH LIFE, EMBASE and Google Scholar. The information on leadership, effective leadership positions and qualities of effective leaders was obtained after reviewing relevant research papers from these different journals. The present review shows some rough ideas on how to be an action-oriented leader without a title. It also showed that communication skills, trust, pragmatism, and relationship building are the most important qualities of leaders to enhance the personal power to gain organizational power, to be the most effective and dynamic leader, the present review suggests some requirement of additional skills such as trust, compassion, stability, hope, relationship and influential skills to make an impact in the 21st century leadership environment. Keywords: Leadership effective leadership leadership position & qualities of effective leaders
... Viewing the situation from the Buddhist perspective seems greater outlook because the contemplation on death or meaninglessness is a reminder to humankind that everything in this universe is impermanence. Thus, the mindfulness application on death in modern education with referring to the Buddhist approach may help to overcome the fear of death during the pandemic [23]. ...
... However, the main conflict exists between absolute isolation and the desire for belonging and protection. It was coined that interpersonal and existential isolation co-exists with each other despite human beings being separate to encounter aloneness [23]. On the other hand, the social isolation is a universal human experience that sometimes affects entire communities and reminds each individual of their need for connection [25]. ...
... He also discovered that freedom is all about the absence of external structure and it gives human being the strongest to amend destiny. He also argued that being responsible for life at the deepest level would bring a better understanding of the freedom and conflict in freedom [23]. The insights of freedom from the existential therapist point of view. ...
Full-text available
An existential crisis (EC) is a situation in which an individual provokes a storm of dread about the meaning, purpose, or value of life, and is unpleasantly disturbed by a series of thoughts in their lives. With the COVID-19 pandemic, the EC on humankind has further increased across the world. Although scholars have studied the effects of EC on humans, there are limited studies of the pandemic that induces EC in humans. The most neglected area in past research has been the lack of integration between different disciplines to find better solutions for EC disease. This study aims to identify the main factors that influence people’s psychological stigma due to crisis and examine how the previous studies’ contributions, evaluations, and insights on EC are interrelated and biased. This is an independent article based on a literature review. It took more than two months to review entire articles. As the guiding framework of the study, death and meaninglessness, loneliness and social isolation, freedom, and authenticity are emphasized succinctly to deliberate on EC. The study shows the limitations in views and findings with the previous studies, including the jargon related to CE. The experience of death, loneliness, and isolation amid the COVID-19 pandemic isn’t always alluring to many humankind as indicated in the study. Strong integration of psychology and Buddhism may offer the right solutions to overcome the EC during the pandemic. However, many studies, seminars, and conferences may need to be initiated by the respective academics and policymakers to advocate an integrated approach to the solutions for EC.
... Berger (1963) identified how one's social identity tends to reflect society's mirror-that is, societal attitudes and perceptions about whether I am worthwhile-and ultimately, how I see myself as a person. Moore and Goldner-Vukov (2009) highlighted the importance of addressing existential issues, such as being needs, to promoting mental health. They identify how individuals are often hampered in their search for meaning by the social stigma of their illness and by their experiences of rejection from society. ...
... It seems understandable that people with mental illnesses who do not see themselves reflected in society or who feel stigmatised, might seek out social environments in which there is (a) less perceived stigma; (b) a presence of social identities reflecting the possibility of recovery; and (c) a nurturing of one's sense of being using empathy, caring and compassion. Moore and Goldner-Vukov (2009) suggested that effective interventions require a genuine willingness to "grasp" the meaning of the suffering and to provide empathy and listening. We believe that the environment at NISA-supported by the presence of peer support workers who share similar lived experiencesmay provide the necessary existential support required to address members' being needs. ...
Full-text available
Introduction: Being, belonging and becoming are important theoretical constructs for occupational scientists and therapists, and for members of Northern Initiative for Social Action (NISA), located in northern Ontario, Canada. Collaborative research with service users guided the development of NISA and its evaluation tool: the 3B~S Scale. The aim of this paper is to share the results of the 2018 program evaluation. Methods: 113 participants completed a questionnaire consisting of the 3B~S Scale, demographic and program satisfaction questions, and open-ended questions. Quantitative analysis used descriptive statistics followed by ordinal logistic regression to determine the intersectional effects of gender, race and age on becoming and system impact outcomes. Open-ended responses were analysed thematically and triangulated with quantitative findings. Results: Participants agreed-to-strongly agreed that the program met their 3B needs (x = 4.20, SD = 0.24). Participants indicated strong satisfaction with the program (x = 4.38, SD = 0.66), and agreement that participating in the program reduced their reliance on other system-based services (x = 3.96, SD = 0.24). The regression revealed no significant differences in gender, race or age in predicting six of 10 outcomes examined; race was not significant for any outcome. Younger females were more likely to agree that the work they do is part of a larger community charitable purpose, the program is helping them to achieve their goals, and is increasing their involvement in community. Younger participants were more likely to agree that participation facilitated a return to school or employment than older participants. Conclusions: Occupation-based, mental health programs that address participants' being, belonging and becoming needs can contribute to improvements in perceived mental health and well-being, as well as to improved community and system usage outcomes. The NISA model provides a framework for clinically operationalising the 3B's and may provide a unique contribution to ongoing theoretical discussions of these constructs within occupational therapy and science.
... Counselors are increasingly challenged to value the ontological specificity of human subjects in order to perform effective counseling actions. As more people struggle to understand their existential problems, they turn to religious counseling for guidance and encouragement in making constructive decisions (Berman et al. 2006;Butÿenaitÿe et al. 2016;Längle & Probst, 2000;Moore & Goldner-Vukov, 2009;Ristiniemi et al. 2018;Vandyshev, 2015). Due to a lack of preparation and knowledge about existential experience issues, many of these religious counselors feel inadequate or even insecure when asked for counseling by people experiencing existential problems. ...
Full-text available
This article investigates counseling in a religious context while keeping human subjects’ existential realities in mind. The methodology, which combines Theology and Psychology, aims to provide an alternative approach to religious counseling by overcoming religious counselors’ tendency to limit human suffering to “spiritual symptoms” by utilizing religious cosmovisions structured in pre-established concepts and values. Furthermore, the approach focuses on the development of human subjects in terms of their quality of life through the spiritual and mental health pillars.
... When everyday life is challenged, thus we begin to think about our existence and what it means to be a human being (Yalom, 1980), causing us to reflect on the meaning of life on a deeper level and have doubts about our existence. In terms of young adults, these existential concerns can grow unmanageable and disrupt their daily lives, manifesting as anxiety, stress, and depression (Besharat et al., 2020;Moore & Goldner-Vukov, 2009). Young adults experiencing existential concerns try to understand how life should be handled and how life can be meaningful. ...
Full-text available
What enables well-being when experiencing existential concerns as a young adult is an under-explored area of research. In order to address young adults’ existential concerns and provide caring support that builds their resilience to meet life challenges, the purpose of the study is to describe the meaning of enabling well-being as experienced by young adults living with existential concerns. This phenomenological study is based on a reflective lifeworld research. Seventeen young adults, aged 17–27 years, were interviewed. The results is presented in an essential meaning and further explored with its variations and individual nuances of the phenomenon; enabling well-being. The essential meaning of enabling well-being, when experiencing existential concerns as a young adult, means finding a place to rest. Finding a place to rest means finding both movement and stillness in life to reflect upon one’s life story in order to understand oneself. The results also show that young adults enable their own well-being in many ways when experiencing existential concerns. When their existential concerns feel overwhelming, they need support from healthcare professionals. When young adults seek professional support, the professionals must be open and focus on the young adults’ life story to enable well-being. © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
... When discussing illness and care, Sulmasy [83] and others add the existential domain as an important fourth layer but with a focus on the transcendent (biopsychosocial spiritual model). A transcendental relationship with the divine is, however, not the only approach for the confrontation with meaninglessness [84]. Recent studies show that individuals, especially in West-and North-European secularized countries, also construct meaning based on secular sources such as altruism, selfactualization, family or work without the reference to spirituality or a religion [85]. ...
Full-text available
Based in evidence and theory, we state that facilitating and supporting people's meaning-making processes are health promoting. Hence, meaning-in-life is a salutogenic concept. Authors from various disciplines such as nursing, medicine, psychology, philosophy, religion and arts argue that the human search for meaning is a primary force in life and one of the most fundamental challenges an individual faces. Research demonstrates that meaning is of great importance for mental as well as physical well-being, and crucial for health and quality of life. Studies have shown significant correlations between meaning-in-life and physical health measured by lower mortality for all causes of death; meaning is correlated with less cardiovascular disease, less hypertension, better immune function, less depression and better coping and recovery from illness. Studies have shown that cancer patients who experience a high degree of meaning have a greater ability to tolerate bodily ailments than those who do not find meaning-in-life. Those who, despite pain and fatigue, experience meaning report better quality-of-life than those with low meaning. Hence, if the individual finds meaning despite illness, ailments and imminent death, well-being, health and quality-of-life will increase in the current situation. However, when affected by illness and reduced functionality, finding meaning-in-life might prove more difficult. A will to search for meaning is required, as well as health professionals who help patients and their families not only to cope with illness and suffering but also to find meaning amid these experiences. Accordingly, meaning-in-life is considered a vital salutogenic resource and concept. The psychiatrist Viktor Emil Frankl's theory of ‘Will to Meaning’ forms the basis for modern health science research on meaning; Frankl's premise was that man has enough to live by, but too little to live for. According to Frankl, logotherapy ventures into the spiritual dimension of human life. The Greek word "logos" means not only meaning but also spirit. However, Frankl highlighted that in a logotherapeutic context, spirituality is not primarily about religiosity - although religiosity can be a part of it - but refers to a specific human dimension that makes us human. Frankl based his theory in three concepts; meaning, freedom to choose and suffering, stating that the latter has no point: People should not look for an inherent meaning in the negative events happening to them, or in their suffering, because the meaning is not there. The meaning is in the attitude people choose while suffering from illness, crises etc. KEY WORDS Freedom to choose; Health; Human values; Meaning-in-life; Meaning-making; Spiritual care; Spirituality; Suffering; Well-Being; Will to Meaning;
... The existential domain focused on one's quest in life and allowed participants to explore what influences their self-identity constructs and how it often affects their wellbeing (Kang 2003;Higgs 2019). Such exploration was found very useful in recognizing the meaning of suffering and hope in participants' life, in exploring identity crisis, gender issues, sexual anxieties, social fears, and nature of loss and pain, affecting personal growth and recovery (Moore and Goldner-Vukov 2009). ...
Full-text available
Addressing existential and spiritual care needs, often remains a challenge in health education. Spirituality is a subjective human experience that shapes how individuals make meaning, construct knowledge, develop their own sense of reality, and bring personal and social transformation. To inspire health and social students at a London based University; learners were engaged into philosophical reasonings associated with the meaning to care. SOPHIE (Self-exploration through Ontological, Phenomenological and Humanistic, Ideological, and Existential expressions)-a reflective practice tool was applied during in-class activities from June 2019-2020. Using SOPHIE as a tool, students were encouraged to explore existential and ontological care aspects by engaging into transformative learning approaches. Participants identified their own existential and spiritual care needs by reflecting on their own meaning making process. SOPHIE enabled resilience and authenticity among learners as a reflexive discourse.
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Background Bipolar disorder is generally studied under the biological paradigm and hence the experiential structure in patients is less investigated. Currents study aims to explore mood changes in patients with bipolar disorder through the building blocks of their experiential structure: the lived space and the lived time. Methods This study was conducted using qualitative research methods. Data were collected and analyzed under the interpretive phenomenological analysis (IPA) framework. 13 Iranian individuals diagnosed with bipolar disorder I and II were selected in 2020 through purposive sampling. We conducted an online semi-structural interview via WhatsApp and Skype. Results Two superordinate themes were identified: (1) Dance of the light and changes in circumscription; and (2) Waves of eternity and lack of the time. Themes related to each of them were identified and reported in the phases of depression and mania. The first super-ordinate theme included these themes: Compactness and denseness: reduced perception of space and freedom, deliberate reduction of light and space, effect of lived space on perceived mental safety and coping strategies against the lived space in depression (in depression) and Increased space and a desire for more, unity with space: pleasure and appreciation and increased and finer perception of light in space (in mania). Slowness of time, anxiety, reduced activity and freedom, dissociation of time and becoming unreal and discontinuity of time: focus on the past (in depression) and time paradox and increased activity and pleasure and discontinuity of time: focus on present and future (in mania) were the themes identified in the second super-ordinate theme. Conclusions The lived space and time in patients change through different phases of the bipolar disorder. These changes which reflect shifts in their experiential structures can represent a different viewpoint on mood changes in bipolar disorder. Future studies can benefit from this phenomenological approach in developing novel psychological interventions.
The aim was to investigate older patient recovery (65 years+) up to two years following discharge from an intensive care unit (ICU) using the Recovery After Intensive Care (RAIN) instrument and to correlate RAIN with the Hospital Anxiety and Depression Scale (HAD). Methods An explorative and descriptive longitudinal design was used. Eighty-two patients answered RAIN and HAD at least twice following discharge. Demographic and clinical data were collected from patient records. Results Recovery after the ICU was relatively stable and good for older patients at the four data collection points. There was little variation on the RAIN subscales over time. The greatest recovery improvement was found in existential ruminations from 2 to 24 months. A patient that could look forward and those with supportive relatives had the highest scores at all four measurements. Having lower financial situation was correlated to poorer recovery and was significant at 24 months. The RAIN and HAD instruments showed significant correlations, except for the revaluation of life subscale, which is not an aspect in HAD. Conclusion The RAIN instrument shows to be a good measurement for all dimensions of recovery, including existential dimensions, which are not covered by any other instrument.
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This Open Access textbook represents a vital contribution to global health education, offering insights into health promotion as part of patient care for bachelor’s and master’s students in health care (nurses, occupational therapists, physiotherapists, radiotherapists, social care workers etc.) as well as health care professionals, and providing an overview of the field of health science and health promotion for PhD students and researchers. Written by leading experts from seven countries in Europe, America, Africa and Asia, it first discusses the theory of health promotion and vital concepts. It then presents updated evidence-based health promotion approaches in different populations (people with chronic diseases, cancer, heart failure, dementia, mental disorders, long-term ICU patients, elderly individuals, families with newborn babies, palliative care patients) and examines different health promotion approaches integrated into primary care services. This edited scientific anthology provides much-needed knowledge, translating research into guidelines for practice. Today’s medical approaches are highly developed; however, patients are human beings with a wholeness of body-mind-spirit. As such, providing high-quality and effective health care requires a holistic physical-psychological-social-spiritual model of health care is required. A great number of patients, both in hospitals and in primary health care, suffer from the lack of a holistic oriented health approach: Their condition is treated, but they feel scared, helpless and lonely. Health promotion focuses on improving people’s health in spite of illnesses. Accordingly, health care that supports/promotes patients’ health by identifying their health resources will result in better patient outcomes: shorter hospital stays, less re-hospitalization, being better able to cope at home and improved well-being, which in turn lead to lower health-care costs. This scientific anthology is the first of its kind, in that it connects health promotion with the salutogenic theory of health throughout the chapters. We here expand the understanding of health promotion beyond health protection and disease prevention. The book focuses on describing and explaining salutogenesis as an umbrella concept, not only as the key concept of sense of coherence.
This article describes a popular and effective self monitoring and response system that was developed in 1997 by 30 people who attended an eight day mental health recovery skills seminar in Vermont. They developed the system in response to their need for a structured way to use their wellness tools to relieve and eliminate their symptoms, and to stay well. While it was developed by and for people who are dealing with troubling emotional symptoms, the Wellness Recovery Action Plan can be used by anyone to deal with any kind of physical or emotional illness or issue. People who use the plan develop it by identifying tools or responses that will help them to relieve symptoms and/or enhance their wellness. They then use these tools to develop a Wellness Recovery Action Plan that includes: (1) a daily maintenance list, (2) identifying and responding to triggers, (3) identifying and responding to early warning signs, (4) recognizing when things are getting much worse and responding in ways that will help them feel better and (5) a crisis plan or advanced directive. The people who developed this plan emphasize that the plan must be developed by the person who will use it, although they can reach out to their supporters for assistance.
Philosophy and Literature 20.2 (1996) 487-491 Composing the Soul: Reaches of Nietzsche's Psychology, by Graham Parkes; xiv & 481 pp. Chicago: University of Chicago Press, 1994, $37.50 cloth, $19.95 paper. I cannot resist beginning this essay on Graham Parkes's study of Nietzsche's psychology with the first-person pronoun. Parkes provides an erudite and suggestive presentation of Nietzsche's views on the soul, according to which what we consider that most unitary element of human nature turns out to be the product of bringing together disparate and often conflicting independent agencies. He also provides valuable information about the sources of Nietzsche's thought, and details a number of connections between Nietzsche's ideas and his life. Yet, in a book of close to five hundred pages, Parkes self-consciously avoids the first-person pronoun altogether. He speaks of the "I," which is after all the subject of his book, but the I never speaks itself. Why? Because "what is important here are Nietzsche's ideas, rather than Parkes's"; also, because "the whole point of Nietzsche's psychology is to put the I in question, to prompt the question 'Who?' at its every appearance, to hear the polyphony behind the apparent univocality of the first person singular" (p. 310). Though not the first, Nietzsche was one of the most radical dissectors of the human soul. Where others had found unity, order, and indivisibility, Nietzsche uncovered an untidy, often uncontrolled multiplicity. Instead of a consistent, harmonious whole, he saw a messy complex of beliefs, desires, values, views, drives, affects, and habits, picked up at different times, from disparate, even incompatible sources, moving in different directions; far from fitting naturally into a union, these compete with one another for mastery and control of the person: "The belief which regards the soul as something indestructible, eternal, indivisible, as a monad, as an atomon . . . ought to be expelled from science," he wrote in Beyond Good and Evil. But, he continued, "between ourselves it is not at all necessary to get rid of the soul at the same time. . . . But the way is open for new versions and refinements of the soul-hypothesis; and such conceptions as mortal soul, and soul as subjective multiplicity, and soul as social structure of the drives and the affects want henceforth to have citizens' rights in science." The breakdown of the soul into independent and often conflicting parts has two radical consequences. First, it implies that some parts of our souls -- of our selves -- may remain hidden, obscured, suppressed or ignored by others, especially by those that achieve at least apparent dominance and can therefore speak in the first-person. In Nietzsche's political metaphor, they are like a governing class which speaks for the whole state. This, of course, is the central idea of depth psychology; and Parkes shows how both Freud and Jung were indebted to Nietzsche's pioneering geography of the soul. Second, to think that the soul is multiple is to think that it is not unalterable: its parts can affect one another; out of their conflict, new configurations are possible. Some parts can be cultivated or left to wither; others can be allowed to run wild or become domesticated; still others can be subordinated to one another or allowed to function in more or less equitable ways. The soul -- the person -- is not a preexistent unity; it is constructed, or, as Parkes, mindful of Nietzsche's deep involvement with music, puts it so well, composed. Parkes provides a brilliant catalogue of the metaphors (mineral, vegetal, animal, personal, and political) Nietzsche uses to describe the elements of the multifarious soul. He also produces a sort of recipe for their successful composition into a coherent whole. "Opening up" to as many conflicting drives as possible, we let them be mastered by one or more dominant ones and we subject their multiplicity to the discipline imposed by those ruling passions. Once that discipline becomes instinctive, active control is relaxed and, somehow, the multiplicity spontaneously orders itself. We become, again, natural (p. 377). Now, we know that Nietzsche spent much of his life "doing battle" with Socrates. He passionately despised the rational...
This book is a continuation of my Motivation and Personality, published in 1954. It was constructed in about the same way, that is, by doing one piece at a time of the larger theoretical structure. It is a predecessor to work yet to be done toward the construction of a comprehensive, systematic and empirically based general psychology and philosophy which includes both the depths and the heights of human nature. The last chapter is to some extent a program for this future work, and serves as a bridge to it. It is a first attempt to integrate the "health-and-growth psychology" with psychopathology and psychoanalytic dynamics, the dynamic with the holistic, Becoming with Being, good with evil, positive with negative. Phrased in another way, it is an effort to build on the general psychoanalytic base and on the scientific-positivistic base of experimental psychology, the Eupsychian, B-psychological and metamotivational superstructure which these two systems lack, going beyond their limits. (PsycINFO Database Record (c) 2012 APA, all rights reserved)