Concepts of Existential Pain Meaning and purpose: The one whos knows the why can stand almost any how

Transkript

1 Concepts of Existential Pain Meaning and purpose: The one whos knows the why can stand almost any how Two roots: Religion/ spirituality European philosophy and psychology ( Frankl (untill ca 1960) (ex: Kierkegaard, ( 1980 ) For instance: E. Yalom: Four existential (painfull) questions Death Freedom Existential isolation Meaninglessness

2 Does it mean anything? ( 1996 ) S.R.Cohen s cancer investigation 254 cancer patients with or without active disease were asked about subjective, global quality of life and: Physical symptoms Psychological symptoms Existential questions Feeling of emotional support The most important for quality of life were the existential questions and most for the patients with active disease

3 Vignette: Lack of existential anchoring A 40 year old man had powerful chronic pain after an accident. He was limited in his physical expression, dependent on help from others, and he had to sleep for long hours and lie down a lot. He was constantly and heavily medicated, he experienced everything through a medical fog, which he believed he could never escape. When the pain increased, his only thoughts was of committing suicide. He felt that there was something positive back to him, and he believed that the sum of pain meant that life was not worth living. The man was constantly sad and without initiative, did nothing to change his situation or his life's content. During treatment he spoke often of when he "took the ticket" and he was very hard to get to at the psychological level. There was no meaning to find anywhere.

4 Vignette: Existential surplus A 35-year-old patient was treated at the pain clinic after a year before to have been involved in a serious accident that had rendered him partially paralyzed. He had gone through nearly a year of rehabilitation, and he had to look forward to a life as a disabled person with severe pain. Despite the this bad fate, that would normally and naturally make people sad and uncertain about the future, this patient was happy and confident. He seemed to look forward to the rest of his life. When questioned, he told that he had worked with the Mongolians (Down syndrome) and mentally disabled youth for several years and through this work he had fundamentally learned that life can unfold in many ways and can be full of joy, when lived with the conditions you are given. Joy of life is not a matter af position, status or economics, but lies elsewhere, he said,

5 Faith is a basic condition of human life even atheists have a life of faith "Since mankind has existed, wherever life has been, there also has been the faith that gave the possibility of living. Faith is the sense of life, that sense by virtue of which man does not destroy himself, but continues to live on. It is the force whereby we live. If Man did not believe that he must live for something, he would not live at all. Tolstoy

6 The existential field: Three domains We know of three unfolded 3 domains when we talk about meaning in life: Secular eksistential orientering (i.e thoughts of meaning and purpose in life) Spirituality (i.e. individual strivings Religiosity (i.e. theistic faith) There is a real difference between those who know they believe and those who believe they know..

7 Example 1. The enchanting feeling of being alive when looking up on the stars in a clear night - can be placed in the middle - every elaboration in words or deeds are drawing to a side (cultural elaborated as existential, spiritual, religious) (Context, culture) Secular Secular existential orientation (Body) Spirituality Religion Spirituality Religion

8 Example 2. What happens after personal death - is usually elaborated in all three domains. - It is not one question, it is three Secular sorrow,history Spiritual Spirituality (Context, culture) Secular existential orientation (Body) Religion

9 Example 3. There is no non-belief without a specific notion of, what is not believed in The opposite of any meaning making belief would be meaning making ignorance Spirituality Spirituality (Context, culture) Secular existential orientation Secular existential orientation (Body) Religion Religion This is the premises for taken the domains serious because there is never

10 Rigshospitalets Patient Faith Investigation (parts in Danish) Patient faith (2005/2006) i pct. Values survey (1999) i pct. Significancea How often do you thing of meaning and purpose in life? ( 220 ) 47 ( 370 ) 36 *** Often Sometimes Rarely Never ( 165 ) 35 ( 62 ) 13 5 (23) ( 410 ) 41 ( 190 ) 19 4 (43) Uanset om du går i kirke eller ej, vil du da mene du er: ** Et troende menneske Et ikke troende menneske Overbevist ateist ( 330 ) 72 ( 100 ) 22 6 (31) ( 723 ) 77 ( 171 ) 18 5 (51) Tror du på et liv efter døden? Andel ja-svar 48 (205) 38 (328) *** Tror du på reinkarnation? Andel ja-svar 22 (93) 17 (157) *** a p-værdierne gælder forskelle mellem samples og er alle kontrolleret for alder, køn og amtsfordeling. P-værdierne dækker hele spørgsmålets svarfordeling. Ordinal og logistisk regression * = signifikant forskel på 5 procentsniveau **= signifikant forskel på 1 procentsniveau ***= signifikant forskel på 5 promilleniveau Ausker, N., la Cour, P., Busch, C., Nabe-Nielsen, H., & Mørk Pedersen, L. (2008). Danske hospitalspatienter intensiverer eksistentielle tanker og religiøst liv (in Danish). (Danish hospital patients intensifies their existential thoughts and religious life).

11 Rigshospitalets Patienttroundersøgelse Patienttroundersøgelsen (2005/2006), i pct. Værdiundersøgelsen ( 1999 ) Signifikante forskelle til Patienttroundersøgelsena Hvor ofte går du i kirke? Går i kirke en gang om måneden eller mere 14 (63) 12 (121) *** Does it happen that you pray, meditate or something alike? 62 (290) 51 (515) Hvor ofte beder du til Gud bortset fra ved Gudstjenester? * Hver dag En gang om ugen eller mere Mere end en gang om måneden 17 ( 77 ) 12 ( 55 ) 5 (22) 12 ( 121 ) 8 ( 81 ) 4 (40) Er der ting du ville have gjort anderledes i dit liv? Andel ja-svar 50 (231) a p-værdierne gælder forskelle mellem samples og er alle kontrolleret for alder, køn og amtsfordeling. P-værdierne dækker hele spørgsmålets svarfordeling. Ordinal og logistisk regression * = signifikant forskel på 5 procentsniveau **= signifikant forskel på 1 procentsniveau ***= signifikant forskel på 5 promilleniveau Ausker, N., la Cour, P., Busch, C., Nabe-Nielsen, H., & Mørk Pedersen, L. (2008). Danske hospitalspatienter intensiverer eksistentielle tanker og religiøst liv (in Danish). (Danish hospital patients intensifies their existential thoughts and religious

12 Rigshospitalets Patienttroundersøgelse Patienternes oplevelse af forandring af livsværdier og religiøsitet under sygdom. Angivet i procent, afrundede værdier, antal respondenter i parentes Patienttro- Undersøgelsen (2005/2006) Mænd Kvinder Sig, køn Sig. alder pa MEANING Think more of meaning during disease Think more Think the same Think less ( 248 ) 53 ( 207 ) 44 3 (12) *** *.oo FAITH Turned more og less believing during illness Mere troende Det samme Mindre troende 8 (39) 90 (420) 1 (6) ** *.oo Belief in life after death Tror mere Det samme Tror mindre 2 (10) 95 (430) 3 (12) Belief in reincarnation Tror mere Det samme Tror mindre 1 (5) ( 406 ) 95 4 (16) a Disse p-værdier er beregnet ved binominale tests med forventning om ligelige fordelinger mod mere og mindre = signifikant forskel på 5 procentsniveau, gammatest **= signifikant forskel på 1 procentsniveau, gammatest ***= signifikant forskel på 5 promilleniveau, gammatest Ausker, N., la Cour, P., Busch, C., Nabe-Nielsen, H., & Mørk Pedersen, L. (2008). Danske hospitalspatienter intensiverer eksistentielle tanker og religiøst liv (in Danish). (Danish hospital patients intensifies their existential thoughts and religious life). Ugeskrift for Læger, 170,

13 Clinical perspectives Do not be like a bull in a China shop! 1. The patients experience of change in the areas and the actual measures often do not comply. The patients may be very involved and need to discuss thoughts, they on a attitude measure would deny to belive in. In fact, that might be the change 3. The youngest group is very active on all variables. This is the group without religious upbringing meaning no easy accessable language and images (for cognitive refraiming) and no feeling of community around questions of existence (no social frame). 5. There seem to be special challenges concerning women, when their illness turns real serious. Issues that gave life meaning before loose relevance. A red signing flag, calling for special attention 7. The illness period around three months seems to be the most intensive in these areas. It is not often reflected.

14 The concept of Quest A mature worldview is a natural component of a ( Allport ) mature personality. When you grow older and change, you might consider that your worldview also will change. ( Batson ) Worldviews should be ever expanding and integrating more and more of lifes mysteries. ( Allport ) Doubt is a natural ingredient. Are we able to talk about it? We can not live without a worldview

15 In the clinic: ASK! (Ferrell, 2007) Faith, Belief, Meaning. "Do you consider yourself spiritual or religious? "Do you have spiritual

16 The Grid Being able to talk! Meaning making Knowing: Understandin gs Doing: Intensity Being: Importance Existential issues Spirituality Religiousity

17 Examples of questions on meaning making and illness relating to the structure of the conceptual grid Meaning making Secular existential orientation Spirituality Religiosity Knowing: Cognitions To what extend do you find life meaningful even in the condition of pain? How and why - or why not? During your illness, to what extend have you though of life governed by energies or forces greater than you? How do you understand or reject such principles? Has suffering from illness influenced the way you think about religious issues? If any, on which issues have you grown less certain and on which issues have you grown more certain? Doing: Practice During your illness, to what extend are you able to do the activities that you value most in life? Are there obstacles to spend time with the activities you really value? After being ill, do you have a greater need to confirm your being-in-the-universe, for example by meditation, listening to music or being alone in nature? Do you spend time in such activities? While being ill, have you felt a greater need to attend church, to pray or to read religious scriptures? Have you actually changed your time spend in such activities? Being: Importance To what extend are you trying to live your life according to your ideals even during this period of pain? Does these ideals still provide meaning for you? If you consider you have a spiritual side, how important seem such spirituality to be during this period of crisis? Do you obtain any personal comfort or strength from these dimensions of life? If you have any religious elements in your worldview, to what extend can this strengthen or weaken your ability to go through this period of illness? If any, what elements of religion are particularly important for you in this situation?

18 Plissit-model adapted from Jack Annon (1976) P -ermission: See and acknowledge the clients praxis (all personel) L imited I nformation: Giving simple common information (little less personel) S pecific S uggestions: Practical advice and exercises I intensive T herapy: The existential/ pastoral session (expert/specifically trained personel)

19 Spirituel/religious treatment forms Existential, spiritual or religious practice that can be made possible Done with a trained person Psychoterapy with spiritual integration Religious/spiritual/secular values support, encouragement, supervision Spiritual, benign reframings Confession Done alone Meditation Visualizations of spiritual character Letter writing to God Art Music Done with others in groups Reading of common texts (? prayer Prayer (participatory Ritual Blended forms (meditation, prayer, ritual etc)