'I am just a shadow of who I used to be'-Exploring existential loss of identity among people living with chronic conditions of Long COVID.

Identity loss and (re)construction forms a central debate in sociology of chronic illness. Living with chronic/persistent health conditions may raise questions about how disruptions can touch upon and further threaten the very roots of existence, by which people reflexively perceive a coherent and stable sense of 'being-in-the-world'. Whilst medical sociologists have shown interest in 'existential loss' in chronic illness, this question remains largely underexplored. Adopting a qualitative study on Long COVID (LC) as an example, this article illuminates existential identity loss as a deeply painful experience of losing body as a fundamental medium to retain continuity and consistency of one's narratively constructed identity. Interviews with 80 LC sufferers in the UK revealed that living with persistent and often uncertain symptoms and disruptions can cause the loss of biographical resources and resilience, making it difficult to reflexively understand their own being within the world. Their dynamic responses to LC also highlighted how sufferers' longing for a narratively coherent self can profoundly shape the ongoing construction of their identity in chronic health conditions. These insights into the complicated and often hard-to-express existential pain of identity loss can also nurture more holistic understandings of and support for LC and chronic illness more broadly.

Spiritual health under the wartime: existential aspects.

OBJECTIVE: Aim: To study the spiritual health in existential dimensions, as well as the meaning, value, and emotional components of spiritual health of Ukrainians under the wartime. PATIENTS AND METHODS: Materials and Methods: The theoretical and methodological framework of the paper is represented by the works of scholars in classical existentialism, contemporary philosophers, psychologists, medical psychologists, theologians, sociologists, etc. The complex nature of the issue necessitated the use of interdisciplinary approaches, philosophical, general scientific and special sociological methods of gathering, processing and analyzing information. RESULTS: Results: The article analyzes the perception of spirituality and spiritual health related to mental and social aspects in the philosophy of classical existentialism and existential-humanistic psychology. The paper justifies the heuristic potential of these approaches for maintaining spiritual health of Ukrainians, which is based on holistic approaches to human beings and their spiritual frames. The article represents the results of sociological research by the Institute of Sociology of the National Academy of Sciences of Ukraine, the Scientific Research Institute of Social and Economic Development of the City, and a survey of the PhD students of the Bogomolets National Medical University (N=103) made by the authors, representing the results of statistical treatment of the spiritual health characteristics: emotional, value and meaning components. CONCLUSION: Conclusions: The study has shown that the deterioration of mental health indicators of Ukrainians during the war is not accompanied by corresponding negative trends in their spiritual health. However, further research on this issue is necessary, including studies among respondents from other age groups (faculty, staff of the Bogomolets National Medical University).

The Experiences of Post-ICU COVID-19 Survivors: An Existential Perspective using Interpretative Phenomenological Analysis.

COVID-19 has highlighted the vulnerability of intensive care unit (ICU) patients and the negative sequelae associated with ICU treatment. While the potentially traumatic impact of ICU is well documented, less is known about the ICU survivor's subjective experience and how it influences life post-discharge. Existential psychology addresses the universal concerns of existence, including death, isolation, and meaninglessness, and offers a holistic view of human experience beyond diagnostic categories. An existential psychological understanding of ICU COVID-19 survivorship may therefore provide a rich account of what it means to be among the worst affected by a global existential crisis. This study employed interpretive phenomenological analysis of qualitative interviews with 10 post-ICU COVID-19 survivors (aged 18-78). Interviews were structured on existential psychology's 'Four Worlds' model that explores the physical, social, personal, and spiritual dimensions of human experience. The essential meaning of ICU COVID-19 survival was conceptualised as 'Trying to Reconnect with a Changed Reality' and consisted of four themes. The first, Between Shifting Realities in ICU, described the liminal nature of ICU and the need to ground oneself. The second, What it Means to Care and Be Cared For, captured the emotive nature of personal interdependence and reciprocity. The third, The Self is Different, described survivors' struggle to reconcile old and new selves. The fourth, A New Relationship with Life, outlined how survivors' experiences shaped their new worldviews. Findings evidence the value of holistic, existentially informed psychological support for ICU survivors.

Voiceless and vulnerable: An existential phenomenology of the patient experience in 21st century British hospitals.

Current health policy, high-profile failures and increased media scrutiny have led to a significant focus on patient experience in Britain's National Health Service (NHS). Patient experience data is typically gathered through surveys of satisfaction. The study aimed to support a better understanding of the patient experience and patients' expression of it through consideration of the aspects of the patient experience on NHS wards which are by their nature impossible to capture through patient satisfaction surveys. Existential phenomenology was used to develop an in-depth exploratory narrative, expressed through the voices of the participants. Data collection involved in-depth face-to-face interviews with 12 purposively sampled participants, with analysis by means of hermeneutics. Though the individuality of each experience was apparent and cannot be overemphasised, common factors emerging from the data included uncertainty and unexpectedness, suffering and finitude, the futility of feedback and bureaucracy and absurdity. Overall, participants demonstrated how their individual personalities and expectations affected their response both to illness or injury and to their hospital admissions, highlighting feelings of vulnerability and voicelessness as a response to hospitalisation. The findings of this study provide useful insight into the patient experience on British hospital wards, and the value of an existential-phenomenological approach is demonstrated.

Ontological insecurity in the post-covid-19 fallout: using existentialism as a method to develop a psychosocial understanding to a mental health crisis.

In the wake of the Covid-19 pandemic we are witnessing a significant rise in mental illness diagnosis and corresponding anti-depressant prescription uptake. The drug response to this situation is unsurprising and reinforces the dominant role (neuro)biology continues to undertake within modern psychiatry. In contrast to this biologically informed, medicalised approach, the World Health Organisation (WHO) issued a statement stressing the causal role of psychological and social factors.Using the concept of ontological insecurity, contextualised within the WHO guidance, the interrelation of psychological and social factors is illuminated, and a psychosocial framework is produced as a means of understanding the mental health consequence of the post-Covid-19 fallout.The psychosocial framework generated provides a rationale to revise and reprioritise how we engage with the biopsychosocial model that is intended to underpin modern psychiatry. This framework establishes a connection between psychological and social theory which are too often addressed as disparate terrains within mental health services and policy creation.

Carrying Death: A Qualitative Study of Women's Bodily Perceptions After Their Baby Died in Utero.

When a child dies in utero death becomes an integrated part of the mothers living body and this complex experience places a heavy existential and bodily burden on a woman experiencing stillbirth. This study uses a phenomenological approach with focus groups and individual interviews and data is discussed within a theoretical existential framework. Interviews of six women who experienced stillbirth within a range of 5 years were performed in Denmark. The participants experienced the dissonance of carrying death in their living body, expressed heightened existential considerations, a sense of transgression and of feeling trapped in an unbearable situation, and an experience of both dislocation from their body and an extreme bodily awareness. The study generates new knowledge and understanding of the how stillbirth is experienced as incomprehensible and as a violent bodily invasion of death with deep existential impact.

Existential suffering in the day to day lives of those living with palliative care needs arising from chronic obstructive pulmonary disease (COPD): A systematic integrative literature review.

BACKGROUND: The impact of living with palliative care needs arising from COPD disrupts an individual's existential situation. However, no comprehensive synthesis of existing research has been published to determine the presentation and impact of existential suffering. AIM: To provide a synthesis of existing evidence on existential suffering for those living with palliative care needs arising from COPD. DESIGN: This is an integrative review paper, undertaken using the methodological approach developed by Soares and reported in accordance with PRISMA guidelines. Data analysis was undertaking using an integrated convergent synthesis approach. DATA SOURCES: Nine electronic databases were searched from April 2019 to December 2019. A second search was undertaken in January 2021 to identify recently published papers meeting the inclusion and exclusion criteria. No date restrictions were imposed. Only papers published in the English Language were considered for inclusion. Empirical research papers employing qualitative and/or quantitative methodologies and systematic literature reviews were included. Articles were accepted for inclusion if they discussed any component of existential suffering when living with COPD and palliative care needs. RESULTS: Thirty-five papers were included within this review comprising of seven systematic reviews, 10 quantitative studies and 18 qualitative studies. The following themes relating to existential suffering were found: Liminality, Lamented Life, Loss of Personal Liberty, Life meaning and Existential isolation. The absence of life meaning, and purpose was of most importance to participants. CONCLUSIONS: This review suggests existential suffering is present and of significant impact within the daily lives of those living with palliative care needs arising from COPD. The absence of life meaning has the most significant impact. Further research is required to understand the essential components of an intervention to address existential suffering for this patient group, to ensure holistic palliative care delivery.

Meanings of "the existential" in a Secular Country: A Survey Study.

"The existential" is a concept that many people use albeit associated with different meanings. In order to increase research-based insight into the meaning of "the existential," we conducted a questionnaire study in Denmark in 2018 in which we asked 1.106 Danes of various age, gender, educational and geographical background about personal associations linked to "the existential." Factor analysis of the answers resulted in three different groups of meaning: (1) essential meanings of life, (2) spirituality/religiosity and (3) existential thinking. The findings show that "the existential" serves well as an overarching construct potentially including secular, spiritual and religious meaning domains, at least within the European context.

Phenomenological and existential contributions to the study of erectile dysfunction.

The current medical approach to erectile dysfunction (ED) consists of physiological, psychological and social components. This paper proposes an additional framework for thinking about ED based on phenomenology, by focusing on the theory of sexual projection. This framework will be complementary to the current medical approach to ED. Our phenomenological analysis of ED provides philosophical depth and illuminates overlooked aspects in the study of ED. Mainly by appealing to Merleau-Ponty's Phenomenology of Perception, we suggest considering an additional etiology of ED in terms of a weakening of a function of sexual projection. We argue that sexual projection can be problematized through cognitive interferences, changes in the 'intentional arc', and modifications in the subject's 'body schema'. Our approach further highlights the importance of considering the 'existential situation' of patients with ED. We close by reflecting briefly on some of the implications of this phenomenological framework for diagnosis and treatment of ED.

How Giving Birth Makes Sense: A Questionnaire Study on Existential Meaning-Making Among Mothers Giving Birth Preterm or at Term.

BACKGROUND: Women's reflections on existential meaning-making in relation to giving birth may seem indistinct in maternity services and have not been thoroughly explored in secular contexts. However, research suggests that childbirth accentuates spiritual and existential considerations and needs even in secular contexts highlighting the importance of care for such needs in maternity care practices. The objectives of this study were two-fold: Firstly, to explore how first-time mothers, living in a secular context, experience their first birth in relation to existential meaning-making. Secondly, to describe the relationship between existential meaning-making reflections and gestational week at birth. METHODS: A nationwide cross-sectional study in Denmark based on the questionnaire "Faith, existence and motherhood" was conducted in 2011. Eight core items related to birth experience informed this study. The cohort was sampled from the Danish Medical Birth Registry and consisted of 913 mothers having given birth 6-18 months previously. Twenty-eight per cent had given birth preterm (PT) and 72% had given birth at full-term (FT). A total of 517 mothers responded. RESULTS: In relation to the birth of their first child, both FT and PT mothers answered, that they had existential meaning-making reflections. The consent to the 8 items ranged from 17 to 73% among FT mothers and from 19 to 58% among PT mothers. Mothers who gave birth preterm mainly identified the negative aspects of birth, whereas mothers, who gave birth at full-term, to a higher degree identified positive aspects. CONCLUSIONS: Findings suggest that not only traumatic birth events accentuate existential reflections, but that even normal childbirth to most mothers is an existential event. However, the quality of existential reflections differs when comparing normal and traumatic birth. The study points towards change in education and organization of maternity care to better care for existential needs and reflections specific to every new mother and birthing woman.

Towards the existentialist turn in IR: introduction to the symposium on anxiety.

This symposium is a follow-up to the 2019 CEEISA/ISA conference 'International Relations in the Age of Anxiety' held at the Faculty of Political Science, University of Belgrade, Serbia, in June 2019. The central piece in the symposium is the keynote address by Bahar Rumelili on the untapped potential of existentialism in IR followed by highly engaged responses by Felix Berenskötter, Karl Gustafsson, Brent Steele and Andreja Zevnik. In this introduction we first describe the context in which we organised the conference and our motivations to choose the topic of the age of anxiety. We also reflect on how the global pandemic, which erupted in January 2020, made our topic more relevant than ever before. We then briefly introduce each piece and discuss what we see as the key questions they raise.

Nowhere to run to, nowhere to hide: inescapable dread in the 2020s.

This article appraises Professor Rumelili's important central focus on anxiety by broadening the scope of the challenges the age of anxiety poses. With reference to recent events, such as the covid-19 pandemic and authoritarian politics, it argues that practices and strategies once thought to alleviate anxiety are now resources for it. The article concludes by calling for scholars to consider the possibility of anxiety as a structural feature of global politics, and organising our theoretical interventions, analyses, and politics around that constitutive feature. Ontological security, therefore, proves more elusive than ever before.

Searching for Meaning with Victor Frankl and Walker Percy.

Patients present to physicians searching for more than scientific names to call their maladies. They rather enter examination rooms with value-laden narratives of illness, suffering, hopes, and worries. One potentially helpful paradigm, inspired in part by existentialism, is to see patients on a search for meaning. This perspective is particularly important in the seemingly meaningless ruins of modernity. Here, we will summarize Victor Frankl's account of logotherapy found in his much-circulated book Man's Search for Meaning and assess the limitations imposed by his religious agnosticism. At best he can offer patients a finite, impersonal meaning this side of the grave. Following Kierkegaard's depiction of the religious sphere of existence, American novelist Walker Percy will be shown to supplement logotherapy with a theological mooring. The spiritual crisis of the modern world is treatable only by Christian faith supplying ultimate meaning. Taken together, Frankl and Percy show how Catholic physicians can be guides in their patients' personal searches for meaning. This paradigm may prove chiefly beneficial in goals of care conversations, encountering "aesthetic" patients living only for pleasure, and engaging patients amidst tragedy-ridden circumstances. Although only Christian faith will ultimately satisfy the search for meaning, we first of all need encouragement to take responsibility for seeking meaning, and confidence that even the most hopeless situation can become meaningful. SUMMARY: Victor Frankl's Man's Search for Meaning can enlighten clinical encounters for physicians to see patients on a search for meaning, particularly amidst suffering and tragedy in a post-modern world lacking transcendence. As shown in Walker Percy's literature, however, ultimate meaning can only be found in Christian faith where the Word became flesh and continues to dwell among us.

The curriculum of the plague.

The Covid-19 pandemic can be read as an eruption of the Real: a traumatic event that overwhelms our capacity for symbolization and exposes the fragility of the imaginary. Albert Camus addresses this traumatic dimension in his 1947 novel The Plague, in which he reserves a rather puzzling statement for the closing paragraph: A plague never disappears, he wrote, but can lie dormant only to reappear once again "for the education of men". What lessons can be learned from the pandemic we are experiencing right now? While Covid-19 is often discussed from a biological perspective, the magnitude of the tragedy raises questions far beyond the confines of the natural/medical sciences, questions about humanity, our limits and possibilities, and the transcendent. This article explores the potential educational aspect of the pandemic by framing the discussion in an exegetical reading of Camus' novel. Through this reading, it claims that even within the tragic reality of its effects, the present pandemic might bring to the fore the notion of an existential kind of learning-one that is deeply personal, that cannot be programmed or learned from direct teaching, and that connects us in relevant ways to the lives of others. At the same time, this reading is not oblivious to the practical needs around decision-making on the part of educational policymakers, administrators, and teachers. As the novel shows, tragic events create a demand for quick action, so a few practical principles for curriculum decision-making are also offered.

Max Weber's antinomies of the Fall: Paradisiacal ethics and the populist Zeitgeist.

This article points out that the way the biblical myth of the Fall has been interpreted in the Judeo-Christian tradition is a crucial heuristic in the works of Max Weber, an assessment that hitherto largely remained unnoticed. Nevertheless, Weber's understanding of everyday action is closely related to the various religious interpretations of what deprivations were suffered by humanity as a consequence of Adam's original sin and the paradisiacal yearning for salvation it engenders. Moreover, Weber's interpretation of the Fall is characteristic for his tragic sociology in the sense that it guarantees the freedom to subjectively create self-conscious meaning that is, however, no longer embedded in a context of common knowledge. His solution to this epistemological problem involves a Nietzschean heroic existentialism whereby individuals give personality to one's character by freely choosing their own values. Yet, he also realizes that many will not be able to choose by themselves and, therefore, will be attracted by charismatic leaders that can invoke a paradisiacal community of choice. Weber's modern antinomical interpretation of the Fall is still relevant today because it provides insight in the epistemological underpinnings of the contemporary populist Zeitgeist.

Karl Jaspers and Karl Popper: the shared legacy.

Jaspers and Popper have nothing in common beyond the legacy of Immanuel Kant's philosophy. Popper dismisses Jaspers 'existentialism' as nihilistic and historicist; Jaspers never cites Popper. Jaspers describes Kant as 'the philosopher for me'; Popper is an unorthodox Kantian whose critical rationalism put the finishing touch to Kant. For Kant, knowledge is not a simple copy of reality, but begins with reason's questioning. Jaspers and Popper too insist that theory has priority over observation. For Jaspers, 'there is already theory in every fact'; for Popper, 'every statement has the character of a theory'. Science begins with metaphysical Ideas which become scientific when tested in experience. They differ in Popper's rejection of induction in favour of falsification, while Jaspers tacitly accepts induction.

Effects of existential interventions on spiritual, psychological, and physical well-being in adult patients with cancer: Systematic review and meta-analysis of randomized controlled trials.

OBJECTIVES: To synthesize the evidence of existential interventions in adult patients with cancer. METHODS: Embase, MEDLINE, CENTRAL, CINAHL, PsycINFO, PSYNDEX, and the WHO ICTRP were searched up until 26 January 2018. Eligibility criteria for studies were (1) adult patients with cancer, (2) evaluation of existential interventions, (3) compared with active/non-active control, (4) assessing relevant spiritual, psychological, or physical outcomes, and (5) conducted as randomized controlled trials. Standardized mean differences (Hedges' g) were calculated, and meta-analyses were conducted using random effects models. Effects were aggregated within four time horizons (post-treatment; ≤3 months; ≤6 months; >6 months). Heterogeneity was assessed by forest plots and I2 . Risk of bias was assessed using the Cochrane Risk of Bias Tool. This review has been registered with Prospero (CRD42016042895). RESULTS: A total of 3461 records were identified, of which 30 unique studies (3511 participants) were included in the review and 24 studies were included in meta-analyses. Existential interventions showed significant effects on existential well-being (g = 0.52; CI[0.13; 0.91; k = 10; I2  = 85%) and quality of life (g = 0.21; CI[0.01; 0.42]; k = 17; I2  = 75%) at post-treatment, on hope at post-treatment (g = 0.43; CI[0.12; 0.74]; k = 12; I2  = 86%) and after 6 months (g = 0.25; CI[0.02; 0.48]; k = 3; I2  = 0%) and on self-efficacy at post-treatment (g = 0.50; CI[0.09; 0.90]; k = 2; I2  = 0%). No significant effects were found on the remaining outcomes and time points. Significant moderator effects were found for professional background of therapists, intervention concept, number of sessions, and setting. CONCLUSIONS: This systematic review and meta-analysis provides evidence that adult patients with cancer across all stages and types benefit from existential interventions. Future research should strive towards a higher standardization in particular with respect to outcome assessments.

The effects of Self-Book© art therapy on cancer-related distress in female cancer patients during active treatment: A randomized controlled trial.

OBJECTIVE: National attention on patients' cancer-related emotional distress produced a need for evidence-based, psychosocial interventions in oncology care. The purpose of this study was to evaluate the efficacy of Self-Book© art therapy for emotional distress and psychological well-being of female oncology patients during active oncology treatment. METHODS: Sixty consenting women with cancer were randomly assigned to either a 6-session Self-Book© art therapy program or standard care. A repeated measures randomized controlled trial design was employed. Data were collected by using the Distress Thermometer, Perceived Emotional Distress Inventory, Patient-Reported Outcomes Measurement Information System Brief Psychological Well-being test, and the Functional Assessment of Chronic Illness Therapy Spiritual Well-being. Measurements were obtained at baseline, week 3, week 6, and 1 to 2 months post intervention. RESULTS: Forty participants were included in the final analysis. No significant differences between groups were found for the primary outcome measures: emotional distress and psychological well-being. Greater improvements in Self-Book© art therapy participants' spiritual well-being were found compared with the standard care control participants (P = .02). CONCLUSIONS: Although no statistically significant differences were present between the groups for the primary outcomes, several positive trends were noted. Thirty percent of Self-Book© art therapy participants reported postintervention emotional distress scores that were below the abnormal range for emotional distress, compared with only 5% of standard care control participants, suggesting that Self-Book© art therapy may have clinical value. Further studies are recommended to better understand the therapeutic mechanisms of Self-Book© art therapy for enhancing psychological well-being.

Existentialism in Occupational Therapy: Implications for Practice, Research, and Education.

As the profession of occupational therapy enters a second century, its growth in an increasingly complex and globalized world requires an adaptive and diverse philosophical foundation. The existentialist school of thought offers a complementary focus, which enhances existing philosophical foundations of the profession and supports two major tenets: (1) humans as self-making beings always in the process of becoming and (2) emotions and feelings as foundations for being-in-the-world. This article explores these two themes both in the context of existentialism and occupational therapy, and then provides an examination of existentialist utility in occupational therapy practice, research, and education.