There is one concept in medicine which is prominent, the symptom. The omnipresence of the symptom seems, however, not to be reflected by an equally prominent curiosity aimed at investigating this concept as a phenomenon. In classic, traditional or conventional medical diagnostics and treatment, the lack of distinction with respect to the symptom represents a minor problem. Faced with enigmatic conditions and their accompanying labels such as chronic fatigue syndrome, fibromyalgia, medically unexplained symptoms, and functional somatic syndromes, the contestation (...) of the symptom and its origin is immediate and obvious and calls for further exploration. Based on a description of the diagnostic framework encompassing medically unexplained conditions and a brief introduction to how such symptoms are managed both within and outside of the medical clinic, we argue on one hand how unexplained conditions invite us to reconsider and re-think the concept we call a “symptom” and on the other hand how the concept “symptom” is no longer an adequate and necessary fulcrum and must be enriched by socio-cultural, phenomenological and existential dimensions. Consequently, our main aim is to expand both our interpretative horizon and the linguistic repertoire in the face of those appearances we label medically unexplained symptoms. (shrink)

This study represents an existential-phenomenological investigation of the experience of being accepted in individuals who have undergone psychiatric institutionalization. Written protocols of narrative accounts were collected from nine individuals drawn from a partial hospitalization programme, with the analysis of these narratives revealing seven basic constituents of the focal experience. The paper concludes with a discussion of the clinical implications of these findings for understanding this experience as it relates to psychotherapy with individuals who experience severe mental illness symptoms (...) and/or stigma. (shrink)

Individuals in late adulthood are often confronted with difficulties and challenges that elicit existential questions and doubts, including religious doubts. Although research has shown that unresolved religious doubts increase the risk for depression, it remains unclear how they are related to each other in late adulthood and which mechanisms are underlying this relationship. Therefore, in a longitudinal study of 329 older adults aged 65-99 and living in a nursing home, the relation between religious doubt and depressive symptoms was (...) explored as well as the mediation effect of rumination on this relationship. The results confirmed the relation between religious doubt and the experience of depressive symptoms, with a bidirectional influence over time. However, the findings indicated that this reciprocal relationship was not mediated by rumination. The study highlights the importance of identifying older adults who experience religious doubt and who are at risk for or suffer from depressive symptoms. (shrink)

While there is a great deal to agree with in the essay Expanded Terminal Sedation in End-of-Life Care there is, we think, a need to more fully appreciate the humanistic side of both palliative and end-of-life care.1 Not only does the underlying philosophy of palliative care arguably differ from that which guides curative medicine,2 dying patients are in a uniquely vulnerable position given our cultural disinclination towards open discussions of death and dying. In this brief response, we critically engage Gilbertson (...) et al ’s essay and seek to contextualise the perspective they put forward. According to Cassell, we should distinguish between pain and suffering.3 The former often gives rise to the latter, but suffering has other causes. This includes existential distress, indicating that, unlike pain, suffering is not simply physiological phenomena. Suffering involves the disintegration of the person, meaning that it can impact patient autonomy. Certainly, that a patient is suffering does not equate to a lack autonomy. Nevertheless, we should take care when making decisions in circumstance where the integrity of our embodied personhood is under threat, something that is clearly the case for those who are dying, particularly those who have refractory symptoms while doing so. Generally speaking, refractory symptoms are those which are intractable. They persist despite attempts at palliation. While this implies that such symptoms—and the suffering they cause—cannot be reversed this is not necessarily the case. Not only can the symptoms experienced by dying patients change …. (shrink)

Marjolaine Deschênes | : C’est surtout de Joan C. Tronto que les ambassadrices du care se réclament en France, davantage que de Carol Gilligan. Je montre ici qu’une certaine tendance du discours français sur le care peut être diagnostiquée comme le symptôme d’une culture désenchantée, dépouillant le monde non de ses dieux, mais de ses dimensions esthétique, artistique et imaginative. Le renversement que ce discours tend à opérer, de la figure morale de l’autonomie à celle de la vulnérabilité, illustrerait ce (...) « symptôme ». C’est plus précisément l’idée du care comme « maintien du monde » chez Tronto que je critique, puisque l’auteure exclut de ces activités les domaines esthétique, artistique et intellectuel. Je discute trois auteures ayant déjà critiqué cette notion de care, qui chacune font progresser mon propos vers ce que je considère être un oubli du monde « existentiellement » habitable chez la philosophe. Enfin je contribue à combler ce qui manque dans la théorie de Tronto, soit un horizon esthétique et une réflexion sur le langage qui s’encastre dans une herméneutique du soi. Je me penche alors sur un care qui consiste à veiller sur la « fragilité du langage politique » chez Paul Ricoeur. Je conclus que s’agissant de faire du care une valeur publique à la fois féministe et soucieuse non seulement de la vie, mais aussi du monde, les activités artistiques, intellectuelles et éducationnelles sont de loin les plus efficaces, contrairement à ce que Tronto semble penser. | : In France, the ambassadresses of care ethics mainly align themselves with Joan C. Tronto’s theory—rather more than with Carol Gilligan’s. Here I want to state that a certain tendency of French discourse of “care” might be diagnosed as a symptom of a disenchanted culture, since it strips the world of its aesthetic, artistic, and imaginative dimensions. I contend that we can find the best illustration of this symptom when that discourse tends to shift from the moral figure of autonomy to the moral figure of vulnerability. More precisely, I aim to challenge Tronto’s idea of “care” as a “maintaining of the world”, since she excludes from it the areas of aesthetics, the arts, and intellectual activities. I shall discuss three authors who have already criticized Tronto’s notion of “care”. Each of them presents an opportunity for me to refine my reflection on what I consider to be Tronto’s disregard for an existentially liveable world. Finally, I help to fill in what is lacking from Tronto’s theory —that is to say, an aesthetic horizon and a real reflection on language, a reflection framed by a hermeneutics of the self. To this end, I focus on a “care” consisting in keeping watch over the “political language’s fragility” in Paul Ricoeur. I conclude by stating that if we really want to make “care” a public value, this feminist value should be concerned not only with life, but also with world. Artistic, intellectual, and educational activities are by far the most efficient at making such a value public. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.3 (2002) 285-286 [Access article in PDF] Depersonalization and Feelings of Unreality:Significant Symptoms With a Variety of Meanings Kjell Modigh Evaluations and diagnostic procedures in clinical psychiatry depend mainly on how the patient communicates his or her subjective experiences and on the psychiatrist's ability to understand that message. This is critical not only for understanding and offering proper treatment, but also for developing diagnostic (...) classifications. Hence the paper by Radovic and Radovic deals with an important topic, aiming to clarify the variety of meanings of the closely related terms unreality and depersonalization. The latter occurs as a symptom in connection to some psychiatric disorder and also constitutes a separate syndromeI agree with the authors that the rather intense renewing of the diagnostic criteria is seldom balanced by corresponding ambitions to analyze and improve the distinctness of the words for the experiences and symptoms which define the diagnoses.It is indeed a difficult task to demarcate what should be included in the concepts feelings of unreality and depersonalization and even to decide whether they are synonyms or distinguishable. There is at least one clear agreement in the different diagnostic systems: psychotic, delusional experiences are excluded. The border between unreality feelings with largely intact reality-testing ability and psychotic disorders with grossly disturbed reality-testing is, however, not absolute and patients with psychotic disorders may of course experience feelings of unreality or depersonalizationThe authors present a useful scheme by which different meanings of derealization are separated and that also points out the differences between depersonalization and derealization, although they are mutually dependant. Category (a), which come closest to depersonalization, includes experiences related to the self, whereas category (c) refers to impressions that the external world is unreal. Category (b), in their scheme, refers to altered bodily sensations: "the body part of the self" (Are there any body parts of the self? Perhaps all psychoanalysts would not agree).In my view, this scheme is useful and corresponds to clinical realities. Symptoms belonging to category (a) can, for instance, occur in affective disorders of almost psychotic depth, due to a [End Page 285] pathologically changed self-esteem. Symptoms belonging to category (b)—experiences of having moved outside one's own body—mainly belong to the diagnostic category dissociative disorders and can be understood as defense reactions to earlier traumatic experiences. The self escaped from the body during repeated experiences of sexual abuse. The diagnosis of depersonalization disorder consequentlybelongs to the group of dissociative disorders. Conditions where the outer world seems unreal (category [c]) can occur when the amount of internal stimuli is increased beyond what is possible to handle and therefore the capacity to recognize the environment is limited. So is the case in severe panic anxiety. Feelings of unreality as part of grief reactions may also belong, at least partly, to category (c): when dramatic and emotionally unacceptable events occur in the environment. As the authors point out, expressions of unreality feelings during grief more often can be understood as metaphors or existential reflections. In conclusion, categories -(a) and (c) can serve to separate depersonalization experiences with different psychopathologic origin, although they are closely related.As a second step, the authors examine how the terms unreal and feels unreal can be understood. Two interpretations of unreal, "nonexistent" and "artificial," have high psychiatric relevance; a third meaning, relating to "quality," mainly has linguistic connections to the experiences on unreality and depersonalization. The word feels communicates the experience of something that appears unreal although the subject has an intact ability of reality testing.The authors propose an additional interpretation, which they describe as a quasisensory experience. They give the example that dreams with unrealistic contents in some meaning, probably related to their intensity, appear "real." A further connection to dreams is that a situation, when awake, may have dreamlike qualities because of intensity or similarities to fragments of dreams. Events that occur in an unusual sequences, for example, corresponding to ones aims and wishes ("to good to be true") perhaps have similarities to dreamlike experiences. One may... (shrink)

Research has shown that addressing and integrating the existential dimension in treatment settings reduce symptoms like anxiety, depression and substance abuse. Healthcare chaplains are key personnel in this practice. A nationwide, cross-sectional survey influenced by a mixed-methods approach was used to examine the attitudes, practices, understanding and perceptions of mental health professionals, including healthcare chaplains, regarding the value of addressing the existential dimension in treatment programmes. The existential group practice was led by the healthcare chaplains as (...) an integrated part of specialist mental health services. A positive and open attitude towards addressing the existential dimension was identified among the informants. Despite this, a small gap between attitude and practice was reported. Existential, religious and spiritual concerns are reported as part of the existential dimension and as relevant topics to be discussed in specialist mental health services. The findings indicate that the existential group practice could have a positive influence on the co-leaders’ competence to address existential, religious and spiritual concerns; however, this should be further investigated. (shrink)

Existential psychotherapy places pivotal significance upon the inter-relational aspects of human experience. By so doing, the therapeutic relationship itself becomes the principal means through which the client’s presenting symptoms and disorders are disclosed as direct expressions and outcomes of the client’s overall “way of being” rather than as isolated and disruptive impediments. At the same time, existential therapy emphasises the actual relationship that emerges between psychotherapist and client and argues that it is via the contrast and comparison (...) of this lived experience with that of their ‘wider world’ experience that clients can find the means to reconsider and reconstruct their “ways of being”. This paper seeks to demonstrate that, as well as their shared aims and methods of enquiry, it is the mutual emphasis upon inter-relatedness as a foundational value for human enquiry that reveals substantive and intriguing points of connection between existential psychotherapy and phenomenological enquiry. The paper furthermore argues that existential psychotherapy might best be viewed as a clearly formulated expression of phenomenological enquiry. (shrink)

This article explores affectivity, temporality, and their interrelation in patients who contracted COVID-19 during the first wave of the pandemic in Sweden and with symptoms indicative of post-COVID-19 Condition (PCC) that remained one year after the infection. It offers a qualitative phenomenological philosophy analysis, showing how being ill with acute COVID-19 and with symptoms indicative of PCC can entail a radically altered self-world relation. We identify two examples of pre-intentional (existential) feelings: that of listlessness and that of (...) not being able to sense what is real and not real, both of which, in different ways, imply a changed self-world relation. We offer an analysis of intentional feelings: how the fear of not “returning” to one’s previous self and the hope of such a return weave together the present and the absent, as well as the past and the future, in ways that make the future appear as constricted, disquieting, or lost. We argue that a phenomenological differentiation among experiences of living with symptoms indicative of PCC—through attention to the way intentional affectivity and pre-intentional affectivity help shape the embodied self’s attunement to the world—is apt to yield a better understanding of the variations within these experiences and contribute to clinical practice. (shrink)

This article explores the patient experience of medically unexplained symptoms (MUS) from an existentialist standpoint. Drawing on the work of Jean-Paul Sartre and Simone de Beauvoir, I explore their concepts of existential situation, existential project, authenticity, and praxis. I then analyze the situation of MUS patients in the current cultural and institutional context, elucidating that a lack of explanation for their symptoms puts MUS patients in an existential bind. I illustrate the effects of the experience (...) of MUS on patients’ existential projects. Last, I develop an ethical response in the existentialist tradition from the perspective of patients, providers, and society at large. I argue that there is a collective responsibility to foster conditions more conducive to authentic patient well-being and to improve the experience of patients with medically unexplained symptoms. (shrink)

This essay compares Freud’s and Heidegger’s concept of Angst. Heidegger’s and Freud’s interpretations are guided by different aims: A) in “Inhibition, Symptom and Anxiety” Freud tries to define the concept of anxiety as a main element in neurosis; B) Heidegger’s notion plays a major role in gaining the existential meaning of Dasein. Despite the differences, this essay claims that it is possible to discover a common anthropo-existential interpretation. Anxiety marks the anthropological and existential passage from the non-distinction (...) of the pre-subjective life to the distinction that emerges from the progressive differentiation of the subject from the world. From such a distinction originates the conflict between the tendency to regain non-distinction and the necessity of multiplicity. In Freud, anxiety is the price for the renunciation of indistinction; in Heidegger, anxiety is encountered when this price is recognized as unavoidable. This is the core problem that this study takes into account in order to show the existential and anthropological role of anxiety. I will proceed with an analysis of Freud’s interpretation of anxiety, and then with the Heideggerian notion. The third part points out the affinity between them. Furthermore, the paper focuses on the dis-chronic temporality that characterizes the trauma of birth. In order to show the latter, we compare the temporalities of trauma and aesthetic experience. To perform this temporal analysis, the text adopts a phenomenological viewpoint. (shrink)

As is well known, one of the central “existential” goals of Nietzsche’s philosophy was to combat the No-saying attitude to life,1 which he took to be an expression of what he variably called physiological exhaustion, decadence, or sickness.2 This No-saying—which he contrasted with his ideal of life affirmation 3—he supposed to lie at the core of various philosophical and religious views such as Christianity, Buddhism, and Schopenhauerian Pessimism. All, in one way or another, shared in his view that element (...) of the ascetic ideal that preaches that “life: it’s no good” or is a “wrong road”.Not less known is Nietzsche’s characteristic way of dealing with such value judgments... (shrink)

Because it focuses primarily on the sick body (disease), medicine ignores many of the concerns and needs of sick people. By listening to the stories of patients in the clinic, on the Internet, and in published book form, health care providers could gain a better understanding of the impact of disease on the person (illness), what it means to patients over and above their physical symptoms and what they might require over and above surgery or chemotherapy. Only by familiarizing (...) themselves with the entire emotional landscape of illness, which includes fear, anger, shame, guilt, and above all loneliness, can the healthy—medicine as well as society in general—hope to heal in a comprehensive manner. (shrink)

The prospective study follows college students after the 9/11 attacks. Based on evidence and trauma-related theories, and guided by reports on positive and negative reactions and meaning-related actions among Americans after 9/11, we explored the seemingly contradictory, yet meaning-related pathways to posttraumatic growth and posttraumatic stress disorder symptoms , indicating the sense of deep interconnectedness and deep conflict. The final model showed that 9/11 emotional turmoil triggered processes of assimilation, as indicated in pathways between prayer coping and perceived spiritual (...) and social support, and of accommodation, as indicated in the pathway of spiritual struggle. Both pathways were directly associated with PTG in the follow-up. Perceived spiritual and social support contributed to lower levels of PTSD symptoms, whereas spiritual struggle had an opposite impact on symptoms; both effects were mediated through optimism but in opposite directions. The study suggests the interplay of complex crisis-related phenomena following meaning-laden collective trauma that presented existential challenges, involving coping, optimism, deep conflict, and deep interconnectedness. (shrink)

Psychedelics have shown promise as a treatment for depression. Although there is some debate, a popular view is that psychedelics produce their benefits in an experience-dependent manner. This is the view that a depressed person gets better, inter alia, because of the experience she has had on psychedelics. Among the various questions that treatment for depression with psychedelics raise, one of the most important is: By what mechanism do these drugs reduce symptoms? If the experience-dependent view is correct, the (...) answer, at least on the personal level of explanation, lies in the phenomenology. In this paper, borrowing mainly from Ratcliffe’s account of depression, I offer such an answer. I argue that psychedelic experiences involve a surge of existential feelings, which can revise the depressed person’s diminished sense of possibility and restore their ability to be affected by the world. I explain how this occurs via a change in the sense of reality linked to the subjective effects of psychedelics. This, I suggest, is the personal level mechanism or process behind psychedelic-assisted psychotherapy for depression. (shrink)

ABSTRACT This paper investigates from a phenomenological perspective the origins of self-illness ambiguity. Drawing on phenomenological theories of affectivity and selfhood, I argue that, as a phenomenon which concerns primarily the ‘personal self’, self-illness ambiguity is dependent on distinct alterations of affective background orientations. I start by illustrating how personhood is anchored in the experience of a specific set of non-intentional affects – i.e. moods or existential feelings – alterations of which are often present in mental ill-health. Also through (...) the exploration of the phenomenology of acute and long-term anxiety, I suggest that self-illness ambiguity originates in the presence of moods or existential feelings that are in tension with the ones that structure the person’s experience prior to the onset of the illness or when its symptoms are not experienced. More specifically, I claim that due to their ability to ‘block’ or ‘suspend’ some of the person’s affective and cognitive responses, such affective orientations may unsettle one’s self-defining evaluative perspective, leading to uncertainty and doubting about one’s personal self. (shrink)

Deep Brain Stimulation (DBS) represents a key area of neuromodulation that has gained wide adoption for the treatment of neurological and experimental testing for psychiatric disorders. It is associated with specific therapeutic effects based on the precision of an evolving mechanistic neuroscientific understanding. At the same time, there are obstacles to achieving symptom relief because of the incompleteness of such an understanding. These obstacles are at least in part based on the complexity of neuropsychiatric disorders and the incompleteness of DBS (...) devices to represent prosthetics that modulate the breadth of pathological processes implicated in these disorders. Neuroprostheses, such as an implanted DBS system, can have vast effects on subjects in addition to the specific neuropsychiatric changes they are intended to produce. These effects largely represent blind spots in the current debate on neuromodulation. Anthropological accounts can illustrate the broad existential dimensions of patients’ illness and responses to neural implants. In combination with current neuroscientific understanding, neuropsychiatric anthropology may illuminate the possibilities and limits of neurodevices as technical “world enablers”. (shrink)

Background One of the objectives of medicine is to relieve patients' suffering. As a consequence, it is important to understand patients' perspectives of suffering and their ability to cope. However, there is poor insight into what determines their suffering and their ability to bear it. Purpose To explore the constituent elements of suffering of patients who explicitly request euthanasia or physician-assisted suicide (EAS) and to better understand unbearable suffering from the patients' perspective. Patients and methods A qualitative study using in-depth (...) face-to-face interviews was conducted with 31 patients who had requested EAS. The grounded theory approach was used to analyse the data. Results Medical, psycho-emotional, socio-environmental and existential themes contributed to suffering. Especially fatigue, pain, decline, negative feelings, loss of self, fear of future suffering, dependency, loss of autonomy, being worn out, being a burden, loneliness, loss of all that makes life worth living, hopelessness, pointlessness and being tired of living were constituent elements of unbearable suffering. Only patients with a psychiatric (co)diagnosis suffered unbearably all the time. Conclusions Unbearable suffering is the outcome of an intensive process that originates in the symptoms of illness and/or ageing. According to patients, hopelessness is an essential element of unbearable suffering. Medical and social elements may cause suffering, but especially when accompanied by psycho-emotional and existential problems suffering will become ‘unbearable’. Personality characteristics and biographical aspects greatly influence the burden of suffering. Unbearable suffering can only be understood in the continuum of the patients' perspectives of the past, the present and expectations of the future. (shrink)

The article presents an analysis of the main aspects of the Christian theology of childhood based on the works of outstanding theologians of the 20th century: Dietrich Bonhoeffer, Hans Urs von Balthasar, Karl Rahner, Paul Tillich, and Jurgen Moltmann. The preoccupation with understanding the figure of the child in Western Christianity is motivated by several factors: the undeniable importance of theology as a tradition of interpreting the existential constraints of the human condition, the deep influence of Christian teaching on (...) secular concepts of childhood, as well as the need to stand in defense of theological knowledge against its reactionary appropriation. It is proposed to begin reflection on the problems of the theology of childhood with the question of secularization, which Bonhoeffer characterized as the world's coming of age. The symptoms of such maturation are a crisis of responsibility in an atomized society, powerlessness, and despair from being doomed to remain in a self-closed system moving towards its own destruction. In the eyes of theologians, the figure of the child turns out to be a symbol of the incompleteness of the history of the world and, in the context of Christian eschatology, of the possibility of saving humanity. For a world that has lost its historical dimension, the child comes across, in Moltmann's words, as a metaphor of hope. Theology emphasizes the intrinsic value and uniqueness of every individual childhood experience, while at the same time seeing it as an analogy of the universal relationship between the human community and God. The model of this relationship implies not only acceptance of the world and its law, but also reprehension leading to liberation from the law in divine love. In theological interpretations the Christian imperative to be like children appears as the cornerstone of universal ethics and political practice, which is necessary for humanity to overcome the catastrophic historical situation. (shrink)

Major depression is a prevalent mental disorder that leads to persistent negative mood and tremendous suffering in affected individuals. However, the biological realization of this disorder and associated symptom clusters remain poorly understood. Recently, phenomenological accounts of major depressive disorder and contributions to the emerging predictive processing account have provided valuable insights into the phenomenological and neuro-functional components that lead to manifestations of major depressive episodes. The purpose of this paper is to weave together these different strands of research to (...) develop a predictive processing account of major depressive disorder. In doing so, I will relate personal-level descriptions of associated phenomenal experiences to a sub-personal-level predictive processing account of the functional realization of major depression. I will argue that pervasive symptoms of the disorder, which include a diminished sense of agency, fatigue, social withdrawal, and rumination, are integrated by existential feelings of loss and impossibility. These phenomenal experiences, I will argue, are associated with dysfunctional processes of prediction error minimization, which are characterized by an overall decrease of the causal contributions of active inference and by distorted precision estimates. The emerging account promises to contribute to a better understanding of the complex processes that give rise to depressive experiences. (shrink)

An increasing number of academic papers, newspaper articles, and other media representations from all over the world recently bring climate change’s impact on mental health into focus. Commonly summarized under the terms of climate or ecological emotions, these reports talk about distress, anxiety, trauma, grief, or depression in relation to environmental decline and anticipated climate crisis. While the majority of psychology and mental health literature thus far presents preliminary conceptual analysis and calls for empirical research, some explanations of ecological emotions (...) are already offered. They mainly draw from psychoanalysis and depth existential and humanistic psychology, as well as social psychology and address the relationship between ecological emotions and individual engagement in climate action. While these studies suggest building on individual resilience if concerned by ecological emotions, we argue that this only addresses their acute symptoms and not the social causes. Based upon our literature research, we show that in an individualistic society such as the liberal ones, feelings of individual responsibility are fostered, and this also applies to climate activism. (shrink)

The purpose of this study is to analyze the experience of hope that appears in a parent's blog presenting everyday life while caring for a child with Trisomy 18 (Edwards syndrome). The author, Rebekah Peterson, began her blog on 17 March 2011 and continues to post information on her son Aaron's care. The analysis of hope in the blog is carried out using a mixed methodology: initial and focused coding using Charmaz's constructed grounded theory and elements of Colaizzi's method. Each (...) aspect of hope is coded through the blog author's statements, from which three main aspects of hope emerge: hope for the longest possible presence of Aaron with his family, hope for control over situations, pain, and symptoms, and existential facets of hope. These various aspects reveal to what extent the experience of hope is unique. Additionally, analyzing the experience of parental hope uncovers the additional problem of inappropriate communication by health care professionals (HCPs) in intensive care units, particularly when discussing the termination of causal treatment. The problem may be solved through proper education for HCPs and serious consideration of parental involvement in order to properly elaborate guidelines on this issue. The three main aspects of parental hope discussed in this paper might expand knowledge on the issue, helping HCPs to better understand the parents' experience of care and to help sustain parental hope in pediatric palliative care. (shrink)

As in the United States, the Dutch conversation about assisted suicide emerged primarily in the context of cancer. At least in that context, before acceding to a request for assistance in dying, caregivers must be sure that the person has made a voluntary and carefully considered request, and that her suffering is unbearable and without prospect of improvement. The Dutch have recently been trying to use those criteria in the context of Alzheimer's disease. Given the wave of Alzheimer's cases poised (...) to crash onto wealthy countries, along with emerging technology to detect the disease process before symptoms appear, we should be grateful to the Dutch for that attempt. As a newcomer to this discussion, however, I was struck that those criteria may have a somewhat odd result. A patient with Alzheimer's disease can easily meet the conditions in the early stage of the disease, when one usually has the mental capacity to request assistance in dying and to make the case that one's existential suffering is unbearable. If one is in the late stage, though, it can be much harder to get such assistance because one does not have that capacity. (shrink)

In the Thirties, European personalism was an inspirational philosophical movement, with its birthplace in France, but with proponents and sympathizers in many other countries as well. Following the Second World War, Christian-Democratic politicians translated personalistic ideas into a political doctrine. Sometimes they still refer to personalism, but most often this reference is little more than a nostalgic salute. In the mainstream of Anglo-Saxon political philosophy, there are practically no references to personalistic philosophers. Is personalism exhausted as a philosophy or political (...) ideology? Yes and no. Paul Ricoeur, writing in Esprit , summed up the situation like this: “personalism is dead”, but he was careful to mention a “return of the person”. Indeed, no tradition or movement can simply perpetuate itself. It must, in order to continue making history, always abolish itself as a `system' so as to make room for the unsaid and the unthought in its tradition, an idea that Mounier also fervently believed in.To better situate the current discussion of personalism, however, it is necessary to look back to the original characteristics of personalism in the Thirties. As a response to the crisis provoked by the economic depression, failing democracy and existential uncertainty, there arose in France a number of `non-conformist movements' who labelled themselves personalistic. They did not constitute a unified movement with a commonly shared theory. It was rather a collection of `personalisms'. The article by the historian Christian Roy about the ecological personalism of Bernard Charbonneau and Jacques Ellul sheds interesting light on the multiple origins of French personalism, which is all too easily identified with the work of Maritain and Mounier alone. The work of Jacques Maritain, and the network of writers and artists surrounding him, undoubtedly remains a significant historical reference point when speaking of personalism.Another group was formed around Alexandre Marc who, along with Raymond Aron, Arnaud Dandieu, Daniel-Rops and Denis de Rougemont, kept the journal Ordre Nouveau alive for five years . They elaborated the idea of federalism as a way out of liberalism and totalitarianism. The most important and durable group, however, was formed by the movement and journal Esprit, founded in 1932 by Emmanuel Mounier and George Izard. In order to stress the historical importance of Esprit, we are including here a testimony from 1982, written by Paulette Mounier, the founder's wife, in which she looks back on 50 years of Esprit. After the war, some new and related groups formed, such as Economy and Humanism around Louis-Joseph Lebret. An historical survey of the dissemination of personalistic centres and movements, not only in France but over all of Europe, would be material for a stimulating historical research project. In this issue, there will also be mention of, among others, the Prague personalism of Jan Patocka and Vaclav Havel, the Leuven personalism of Louis Janssens, and the Polish personalism of Tadeusz Mazowiecki and others. But this list is far from exhaustive.What unites these various branches of the personalistic tree? It is a certain conception — or better perhaps: a certain attitude to the human person. Personalists were not seeking in the first instance a new academic theory about the person, but rather a practical philosophy of engagement. In the Thirties, quite a few personalists finished their university studies and chose not for an academic career but for non-conformist, demanding and vulnerable commitments with limited financial means. What motivated them? Primarily a strong sense that the time in which they were living was a turning point, one which was being ignored by the academic world. They interpreted the diverse economic, political and cultural crisis phenomena as symptoms of a more global crisis of civilization which demanded a response through radical change.Hence a certain rhetoric of a `new order', `spiritual revolution', `radical reform' and `rebirth'. But the rhetoric was supported by innovative ideas regarding political federalism, the third way economy and human alienation. The motivation for all this derived from a strong commitment to defend the concrete human person against the arrogance of systems, bureaucracies and ideologies, while at the same time avoiding the pitfalls of individualism — the reason why some personalists always qualified personalism as `communitarian'.In fact, much of what presents itself as communitarian philosophy today is a retrieval of personalistic themes from the Thirties applied to the current situation, a situation which is also interpreted by communitarians as a global cultural crisis. One should not forget, however, that alongside and sometimes opposed to the communitarian theme with its call to bring people back to their communitarian roots, personalists underscored the priority of metaphysics over politics, a theme that can likewise be found in the writings of personalistic dissidents in Eastern Europe. In the words of Mounier in Qu'est-ce que le personnalisme : “personalism combines faith in a certain human absolute with a progressive historical experience”.To what extent is personalistic thinking still relevant today? Its current relevance will be examined in three ways. In the first section, a number of articles are presented which illustrate the active presence of personalistic thought in the domains of politics and applied ethics. Vaclav Havel sent one of his recent addresses in which he links the theme of human rights with that of a world spirituality. His article is preceded by an introduction by Guido Van Heeswijck, situating Prague personalism.The need for an orientational philosophy of the person is not only manifest today in the political arena. Developments in economics, ecology, health care, the media, technology and in the world of the professions have had an extraordinarily large impact on the human person's lifeworld. The whole area of applied ethics requires a dynamic and orientational concept of the person. The contributions by Paul Schotsmans and Luk Bouckaert are seeking a personalistic point of departure for applied ethics. The more historical article by Christian Roy on ecological personalism has been included in the first section because it can be inspiring for an environmental ethics.The second section is more philosophical. To what extent does the `personalistic' conception of the person put forward in the Thirties still have any relevance today, following the waves of structuralism, post-structuralism and postmodernism? Paul Ricoeur's article, Approaching the Human Person — originally published in Esprit in 1990 and now translated for the first time — can be seen as a reference text. Ricoeur shows in what sense the concept of the person must be broadened in order to continue functioning. The person as `narrative identity' can only write history through the medium of language and institutions. Starting from very different assumptions, the articles by Louis Janssens & Joseph Selling and the analysis of Roland Breeur also explore the idea that a person is what he is only when his identity is opened up, touched by an exteriority or conceived as a focal point . It is this radical openness and vulnerability that gives the person its historical and transcendent dynamic, and prevents us from encapsulating it in existing systems, theories and power relations. The connection with Emmanuel Levinas and his hermeneutic of the idea of the infinite is an obvious one to draw.The third section contains a historical survey in which a number of active `personalistic' centres and journals are presented.Various European centres that appeal explicitly to some form of personalistic thinking were posed the following questions: What is the main historical reference to personalism at your centre? and How do you implement, today, a personalist credo in your work? John Dick organized the responses to these questions under a number of headings. This survey aims to provide not so much an exhaustive but a representative picture of the ways in which European personalism lives on as a mosaic of centres engaged in everyday history. (shrink)

Rising economic inequality has put capitalism on trial globally. At the same time, existential environmental threats worsen while corporations continue to pollute and distort government policy. These twin crises have converged in calls to revamp government and economic systems and to revisit socialism, given up for dead only 30 years ago. In Capitalism and the Environment, Shi-Ling Hsu argues that such an impulse, if enacted, will ultimately harm the environment. Hsu argues that inequality and environmental calamities are political failures (...) – the result of bad decision-making – and not a symptom of capitalism. Like socialism, capitalism is composed of political choices. This book proposes that we make a different set of choices to better harness the transformative power of capitalism, which will allow us to reverse course and save the environment. (shrink)

The integrated model of mental health recommends nowadays the collaboration between psychiatrists, psychotherapists and clinical psychologists. It is currently the agreed model in the managed health care system in the West and research has shown that mixing the medical model with the psychological model both in theory and practice elicits the best outcomes and guides the client towards recovery. In this paper I will challenge this view on a particular area of psychopathology, mild and moderate depression and anxiety, showing that (...) in these particular situations, 15-20 sessions of psychotherapy are sufficient and efficient for recovery and there is no further need for medicating the client, unless the client himself desires this particular type of psychiatric approach. I will also focus on a target group, pregnant women who fear toxic reactions for the fetus and don’t consider taking antidepressant and anxiolytic medication out of fear of adverse reactions. I will also explore the ethical implications of prescribing these target groups medication against their will. CBT, REBT and Existential Psychotherapy are effective options to treat both the symptoms and causes of mild and moderate anxiety and depression, whilst exercise, nutrition and mindfulness meditation can also be effective treatments. Since medications such as antidepressants have recently become the treatment of choice in United States with a 147.5% increase in antidepressant prescription rates between 1990 and 1998 and with a 10.9% decrease in the utilization of psychotherapy, my paper aims to balance this approach in the favour of psychotherapy as a first choice option. (shrink)

The virtual annuls all suspension of time that could, through its tragic or stylistic character, confer to time an existential value. This condition is contrasted with time as it functions in dreams. On the grounds of these observations it is shown that there are resemblances between “autistic” symptoms and the virtual world.

Background How often does refractory suffering, which is suffering due to symptoms that cannot be adequately controlled, occur at the end of life in modern palliative care? What are the causes of such refractory suffering? Should euthanasia be offered for refractory suffering at the end of life? We sought to shed light on these questions through interviews with palliative care specialists. Methods Semi-structured interviews with six nurses and six doctors working in palliative care in five Norwegian hospitals. Transcripts were (...) analysed with systematic text condensation, a qualitative analysis framework. Results Informants find that refractory suffering is rare, and that with palliative sedation satisfactory symptom control can nearly always be achieved at the end of life. However, the process of reaching adequate symptom control can be protracted, and there can be significant suffering in the meantime. Both somatic, psychological, social and existential factors can contribute to refractory suffering and potentiate each other. However, informants also place significant weight on factors pertaining to the organization of palliative care services as contributing to insufficient symptom control. Conclusions If refractory suffering is indeed rare, then this arguably weakens a common prima facie argument for the legalization of assisted dying. However, the process of reaching adequate symptom control can be protracted and involve significant suffering. The experiences of palliative care clinicians constitute important empirical premises for the assisted dying debate. The study points to several areas in which palliative care can be improved. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:"A Mother's Love"Katie L. GholsonWho is going to teach my daughter about becoming a woman?" S said to me. S was 38 and diagnosed with ovarian cancer. She and her husband were high school sweethearts, and she had a young son and a daughter. She had been told that there was no cure for her cancer, and at the point of meeting her, very little was able to be (...) done to manage her symptoms.As a mother of a young daughter, I was humbled by the question she asked me. Her daughter was 12 and was just beginning to learn about becoming a woman. The anticipatory grief of not having the opportunities to care for one's own children in the crucial moments of their development was devastating to S. Her ability to name what she grieves the most was profoundly sad to me and the other team members who witnessed it.As a palliative care chaplain, I am used to sad and tragic cases, but this one felt different. S and I had [End Page 80] a lot in common. I am also 38, married to my high school sweetheart, and I have a son and a daughter. Of course, it was not just these reasons that I felt a connection to S. It was also the tangible despair I felt when I was with her. As a chaplain, I am trained to meet people where they are and not to hurry them from a place of despair and anguish. I visited with S nine different times and watched the progression of her existential distress. Her distress was not always linear. Some days, it took a backseat and other days, it was front and center, but I was there to be a witness to whatever she was thinking and feeling, and a lot of times, it was inexpressible grief.S did not want to meet with "palliative care" initially. She was terrified of her diagnosis and believed that there were treatments that would give her back the life she desired. She was fierce and determined. S was also religious and believed that there was a miraculous cure for her that would allow her the time she desired to spend with her children and her husband. S was a softball mom and loved to watch her daughter play. While in the hospital, she missed many games, and this weighed on her.Along with being an athlete, S's daughter was very artistic and made S a bouquet of paper flowers. Each flower contained an encouraging phrase. S opened one while I was in her room. She had lost her hair, much of her body weight, and was wearing a hospital gown, but when she opened the flower, her daughter had written, "You are beautiful, Mom." In that moment, two 38-year-old women understood that beauty transcends outward appearances. S was beautiful: her story, her life, and her courage.S loved to walk around the hallway of her unit. I think she felt if she could keep moving, she could stay alive. She was able to take a walk outside a few times while she was inpatient and getting fresh air was very positive to her. These walks not only gave her the ability to widen her environmental space, but they also gave her space to think and consider the difficult situation she was faced with. I accompanied her on one of her walks. It was while we walked next to each other that she was able to finally share with me that she was afraid. She told me that the fear of not getting home, and the fear of death was overwhelming. I find that sometimes people can be vulnerable when they are not feeling interrogated by a medical team staring at them as they lay in a hospital bed. The "normal" activity of taking a walk and being side-by-side humanized the experience and I think S felt that at that moment, she could talk to me human-to-human—like friend-to-friend.When S finally decided to go home on hospice, I collected some legacy project supplies. I went to the hospital... (shrink)

Background: Dignity is a fundamental concept in healthcare. The symptoms of multiple sclerosis have a negative effect on dignity. Understanding of lived experience of dignity in people with multiple sclerosis is crucial to support dignity in practice. Research aim: The aim was to explore the sense of dignity experienced by people with multiple sclerosis. Research design and participants: An interpretative phenomenological analysis design was adopted, using data collected through face-to-face interviews with 14 participants. Ethical considerations: The study was approved (...) by the faculty Ethical Committee (No. EC 1828/2016). Findings: Four interconnected superordinate themes emerged from analysis: Loss of a fully-fledged life: Violating the dignity-of-self; To accept and fight: Promoting the dignity-of-self; Contempt and rudeness: Indignity-in-relation; and Those who know and see, help: Promoting dignity-in-relation. The loss of former fully-fledged life has a dramatic impact on integrity and impaired dignity-of-self. Accepting illness and changed identity impaired by multiple sclerosis was the step that the participants considered to be important for reacquiring the sense of dignity. The participants encountered misunderstandings, prejudices, embarrassment, insensitive remarks, labelling, unwillingness and impersonal treatment as indignities. Acceptance of their condition, needed support, the feeling of being part of a group, sensitivity and the sharing of problems had a positive effect on their dignity. Discussion: Continual changes in functional ability threaten an individual’s identity and were experienced as violations of dignity. Based on this, participant’s dignity-of-self was not a moral, but much more existential value. Acceptance of changed identity and fighting spirit were important for restoring their dignity-of-self. The misunderstandings, prejudices and unwillingness had a negative impact on their dignity-in-relation. On the other side, support from others in fighting promoted their dignity-in-relation. Conclusion: Dignity is manifested as a complex phenomenon of lived experience of people with multiple sclerosis and also an umbrella concept for providing good quality of person-centred care. (shrink)

In the revisionist part of the book, Bortolotti aims at defending a non-pathologising view of delusions, according to which they not only compromise but support our agency. By construing delusions as meaningful protective responses, the author attempts to decouple delusionality from pathology. Nevertheless, it is not clear how, according to her approach, delusions could foster agency. Even when seen as a “way of life” and not as psychiatric symptoms, the defensive nature of delusions undermines the person’s sense of agency, (...) for the symptom or defence mechanism never stems from the person themselves. Notwithstanding the benefits delusions might bring along, they seem to display their own intentionality to the detriment of the agent. Here, I suggest that insights from the authenticity debate in psychiatry could support Bortolotti’s revisionist aim and benefit her discussion on identity beliefs. For this purpose, I introduce the concept of self-illness ambiguity (Sadler, 2007) and compare de Haan’s notion of existential stance (2020) and Stanghellini’s concept of position-taking (Stanghellini et al., 2023) to argue that the person’s agency resides in their ability to take a stance on their (psychiatric) condition, especially when struggling with questions of authenticity. Finally, I explore why one cannot just get rid of a delusion and why, when one attempts to, it feels urgent to replace it. (shrink)

People suffering from Obsessive-Compulsive Disorder (OCD) do things they do not want to do, and/or they think things they do not want to think. In about 10 percent of OCD patients, none of the available treatment options is effective. A small group of these patients is currently being treated with deep brain stimulation (DBS). Deep brain stimulation involves the implantation of electrodes in the brain. These electrodes give a continuous electrical pulse to the brain area in which they are implanted. (...) It turns out that patients may experience profound changes as a result of DBS treatment. It is not just the symptoms that change; patients rather seem to experience a different way of being in the world. These global effects are insufficiently captured by traditional psychiatric scales, which mainly consist of behavioural measures of the severity of the symptoms. In this article we aim to capture the changes in the patients’ phenomenology and make sense of the broad range of changes they report. For that we introduce an enactive, affordance-based model that fleshes out the dynamic interactions between person and world in four aspects. The first aspect is the patients’ experience of the world. We propose to specify the patients’ world in terms of a field of affordances, with the three dimensions of broadness of scope (‘width’ of the field), temporal horizon (‘depth’), and relevance of the perceived affordances (‘height’). The second aspect is the person-side of the interaction, that is, the patients’ self-experience, notably their moods and feelings. Thirdly, we point to the different characteristics of the way in which patients relate to the world. And lastly, the existential stance refers to the stance that patients take towards the changes they experience: the second-order evaluative relation to their interactions and themselves. With our model we intend to specify the notion of being in the world in order to do justice to the phenomenological effects of DBS treatment. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophers, Carers, and Psychodramatic GamesCorinne Gal (bio), Alexandre Chapy (bio), Marielle Fau (bio), and Muriel Guaveia (bio)Dear Jonathan D. Moreno,Thank you for the honor of taking the time to comment on the work we do. It is very meaningful for us to be able to talk with you.We, too, see a big difference between philosophers and carers (in the broadest sense) who deal with the suffering of patients and (...) try to find methods to help them. But, if theory is at the service of the clinic, it becomes a formidable asset to refine our therapeutic methods and better understand what is happening to our patients.Indeed, patients suffering from psychosis, severe neurosis … are difficult to accompany and “recalcitrant to therapy by word alone” to use your terms. It is on this point that Ludwig Binswanger distanced himself from psychoanalysis. Binswanger ran a sanatorium in Switzerland (the Bellevue Clinic) and took in patients suffering from this type of psychological pathology. Aware that “the divan” and the analysis of the transference (unconscious) made little progress, he sought other ways of understanding his patients. The work of Edmund Husserl, the founder of the phenomenological movement, and then the work of Martin Heidegger1 fascinated him because they attempted to answer fundamental questions about being. The patients we work with ask themselves and us the same question: What is being? How can we feel existence within ourselves? Binswanger then created daseinsanalysis as an analysis of existence in which he was able to develop, among other dimensions, what he called “artists’ gestures,” including the possibility of (physical) contact with the patients. The body regained existential importance in the therapy.There are also strong similarities between psychiatric phenomenology and the work of Jacob Levy Moreno (2014, p. 214). We would like to quote your work: “ Nonetheless, there were links between them. Heidegger and J.L. shared preoccupation with personal authenticity and meaning [End Page 230] just enough to be considered part of the trends that led to postwar existentialism and fueled the new humanistic psychology, NTL, and encounter groups.”Jacob Levy Moreno’s working methods are much more powerful, allowing us to work as closely as possible with bodily feelings, since the body involved in the action is so present in psychodrama. Because, to this question of being posed by our patients, is linked the body as a felt, sensing body: the body that I am (which differs from the object body). Schizophrenic patients often express, and this is a terrible suffering, that they no longer feel anything, that they no longer feel they exist, that they no longer feel emotions or feelings. They do not know how to be in the world and with others. For us it is a fundamental symptom, as much as hallucinations. We link it to the loss of natural evidence (Blankenburg, 1991), the loss of contact with reality (Minkowski, 1929). Most of the time, in psychodrama, we “externalize” what the patients feel in different roles played by players, which allows us to work at the heart of each person’s difficulties in interaction. Trained in psychodrama by Anne Ancelin Schützenberger, we have to our credit a set of techniques to support the expression of psychodramatic play, a sort of “toolbox.” Depending on the context, the moment of the patient, our own state, we open our toolbox and try to choose and use the technique that best fits the needs of the game, of what we understand about the difficulty of the protagonist or the group. We do not do anything systematic, we are craftsmen. We have chosen to present a very simple game, without any technique used, except for the initial soliloquy, with a stabilized patient suffering from paucisymptomatic forms of schizophrenia. This is to demonstrate how the possibility of encounter, constitutive of existence, is a fundamental dimension of psychodrama.We thank you for the examples you have given us, they will be a source of inspiration and will fill our toolbox.To John Nolte:We thank you very much for your comments which honor us.The aim of the article was to present how the encounter in... (shrink)

In recent years a large empirical literature has appeared on suffering at the end of life. In this literature it is recognized that suffering has existential and social dimensions in addition to physical and psychological ones. The non-physical aspects of suffering, however, are still understood as pathological symptoms, to be reduced by therapeutical interventions as much as possible. But suffering itself and the negative emotional states it consists of are intentional states of mind which, as such, make cognitive (...) claims: they are more or less appropriate responses to the actual circumstances of the patient. These circumstances often are such that it would rather be a pathological symptom not to be sad and not to suffer. Suffering, therefore, is sometimes and to some extent a condition to be respected. Although I do not dispute that the alleviation of suffering is the main aim of palliative care, in pursuing that aim we should acknowledge a constraint of realism. (shrink)

A number of practices at the end of life can causally contribute to diminished consciousness in dying patients. Despite overlapping meanings and a confusing plethora of names in the published literature, this article distinguishes three types of clinically and ethically distinct practices: double-effect sedation, parsimonious direct sedation, and sedation to unconsciousness and death. After exploring the concept of suffering, the value of consciousness, the philosophy of therapy, the ethical importance of intention, and the rule of double effect, these three practices (...) are defined clearly and evaluated ethically. It is concluded that, if one is opposed to euthanasia and assisted suicide, double-effect sedation can frequently be ethically justified, that parsimonious direct sedation can be ethically justified only in extremely rare circumstances in which symptoms have already completely consumed the patient’s consciousness, and that sedation to unconsciousness and death is never justifiable. The special case of sedation for existential suffering is also considered and rejected. (shrink)

Deep Brain Stimulation (DBS) is a relatively new, experimental treatment for patients suffering from treatment-refractory Obsessive Compulsive Disorder (OCD). The effects of treatment are typically assessed with psychopathological scales that measure the amount of symptoms. However, clinical experience indicates that the effects of DBS are not limited to symptoms only: patients for instance report changes in perception, feeling stronger and more confident, and doing things unreflectively. Our aim is to get a better overview of the whole variety of (...) changes that OCD patients experience during DBS treatment. For that purpose we conducted in-depth, semi-structured interviews with 18 OCD patients. In this paper, we present the results from this qualitative study.We list the changes grouped in four domains: with regard to (a) person, (b) (social) world, (c)characteristics of person-world interactions, and (d) existential stance. We subsequently provide an interpretation of these results. In particular, we suggest that many of these changes can be seen as different expressions of the same process; namely that the experience of anxiety and tension gives way to an increased basic trust and increased reliance on one’s abilities. We then discuss the clinical implications of our findings, especially with regard to properly informing patients of what they can expect from treatment, the usefulness of including CBT in treatment, and the limitations of current measures of treatment success. We end by making several concrete suggestions for further research. (shrink)

In this paper the author presents two different modes of relationship between phenomenological psychopathology and philosophy. The dominant mode conforms to the medical-psychiatric discourse which takes pathological time experiences as negative deviations from the ‘normal’ and ‘adequate’ equivalent. In this mode phenomenological description of ‘disturbed’ time experiences requires philosophy to provide an insight into the ‘essence’ of time and an essentially adequate experience of time. Only such a philosophical insight can deliver a valid reference point for investigating what is really (...) missing in pathological time experiences. This philosophical reference point can either consist in a metaphysical-normative concept of time and time experiences, or in a transcendental concept of how normal and abnormal time experiences are constituted in the inner consciousness of time. There is another mode of relationship which conforms to Freud’s discovery that pathological symptoms are not just negative alterations of the ‘normal’ but hide an own ‘meaning’. The author makes the case for the use of philosophy to unveil the specific kind of meaning in pathological experiences of time. She refers to existential philosophy in this respect, and in particular to its concept of Angst as a fundamental philosophical experience. This allows for a hermeneutic approach to ‘disturbed’ time experiences. What looks from a pure psychiatric perspective to be a mere ‘disorder’ of the ‘normal’, becomes understandable as a specific form of ‘suffering from one’s own temporality’. She argues that people with disturbed time experiences are especially sensitive to anxiety-laden experiences of what it means to be temporal, whilst ‘normal’ people can screen them out in favor of a ‘mentally undisturbed’ everyday life. (shrink)

Many new mothers question the nature of their motherly love after birth. This affectionate relationship towards the infant is commonly called bonding in everyday speech, clinical practice and research. Bonding may not sufficiently describe the mother’s emotional response to the infant and does not capture the ambivalence and struggle to develop maternal affection of many women. This study aims to explore the phenomenon of disturbed maternal affection through the clinical case of one mother who experienced severe and prolonged disturbances. Two (...) in-depth interviews led to a descriptive phenomenological analysis. The mother developed depressive symptoms from not feeling enough for her child, not the opposite, as is often hypothesized. We describe and discuss crucial constituents of her experience, such as ambivalence, remoteness, boredom, guilt, and the looming repetition of parenting patterns, and a solution resulting from therapy-enhanced reflection on motherhood vis-à-vis early life patterns, sociocultural expectations and existential predicaments. (shrink)

In The Crisis of the European Sciences and Transcendental Phenomenology, Husserl expands his philosophical horizon to include the question about the genuine meaning of human existence. Understanding the crisis of the European sciences as a symptom of the crisis of European philosophy and as an expression of the life-crisis of European humanity, and interpreting European science, philosophy, and humanity as representative of their global-historical counterparts, Husserl argues that the life-crisis of European humanity is reflective of the critical condition of global-historical (...) humanity. The crisis of “European” life emerges as a crisis of human existence, and Husserl’s phenomenology unfolds as a search for an answer to the question not only about the sense of the life-world but also about the meaning of human life. Thus phenomenology, as care for humanity, shares with existentialism, as a humanism in the broadest sense, the conviction that human beings live in a world not in which life makes sense, but in which they must make sense of life. Accordingly, the genuine essence of human existence is not passively “given” but actively “taken,” since it involves an entelechy that constitutes itself in an evolutionary achievement, and it is the evidentiary result of an existential struggle for meaning against annihilating forms of meaninglessness, namely, irrationalism, positivism, and skepticism. This paper examines Husserl’s hermeneutical-historical approach to the question about the meaning of human existence and suggests an understanding of phenomenology as a form of humanism, and perhaps even as a unique kind of “existentialism,” that is, an ethical philosophy that takes absolute moral responsibility for the presuppositionless application of reason to life.En La crisis e las ciencias europeas y la fenomenología trascendental, Husserl expande su horizonte filosófico a fin de incluir en él la pregunta por el auténtico sentido de la existencia humana. Al entender la crisis de las ciencias europeas como un síntoma de la crisis de la filosofía europea y como una expresión de la crisis vital de la humanidad europea, y al interpretar la ciencia, la filosofía y la humanidad europeas como representativas de sus contrapartes históricas y globales, Husserl argumenta que la crisis vital de la humanidad europea refleja la condición crítica en que se encuentra la humanidad en perspectiva histórica global. La crisis de la vida “europea” emerge como una crisis de la existencia humana, y la fenomenología de Husserl se despliega como la búsqueda de una respuesta a la cuestión no sólo del sentido del mundo de la vida, sino también del significado de la vida humana. La fe-nomenología, como cuidado de la humanidad, comparte con el existencialismo, entendido como un humanismo en el sentido más amplio, la convicción de que los seres humanos viven en un mundo en el cual no es que la vida tenga sentido sino que ellos deben dar sentido a la vida. En consonancia, la auténtica esencia de la existencia humana no está pasivamente “dada” sino que es activamente “tomada”, ya que ella envuelve una entelequia que se constituye en una realización evolutiva, y que es el resultado evidenciador de un combate existencial por el significado contra las formas de sinsentido que son aniquiladoras, a saber: irracionalismo, positivismo y escepticismo. Este ensayo examina la aproximación histórico-hermenéutica de Husserl a la cuestión del significado de la existencia humana, y sugiere una comprensión de la fenomenología como una forma de humanismo, y quizá incluso como un tipo único de existencialismo; esto es, como una filosofía ética que asume una responsabilidad moral absoluta en la aplicación sin presupuestos de la razón a la vida. (shrink)

This paper traces the shift from the age of realism to the age of virtualism we are currently witnessing. To do so, I draw on older theories announcing this advent (mostly Baudrillard in Simulacra and simulation. Transl. Sheila Glaser. University of Michigan, Ann Arbor, 1994 [1981]; Serres in Atlas. Édition Julliard, Paris, 1994; Virilio in The vision machine. Transl. Rose J. Indiana UP, Bloomington, 1994). I will describe how AI destabilizes fundamental distinctions upon which reality is built—such as the difference (...) between truth and fiction, between existence and simulation, between the actual and the potential, between game and everyday life, between person and avatar. Against the backdrop of a broader notion of the virtual (drawing on Deleuze in The actual and the virtual. Transl. Eliot Ross Albert in Parnet C Dialogues. Bloomsbury, London, pp 148–152, 2006 [1996]), I will read current realist theories (Chalmers in Reality plus—virtual worlds and the problems of philosophy. Allen Lane, London in 2022; Gabriel in Why the world does not exist. Transl. Gregory S. Moss. Polity, Cambridge, 2015; Ferraris in Positive realism. Zero Books, Arlesford, 2015; Meillassoux in After finitude—an essay on the necessity of contingency. Transl. Brassler R. Bloomsbury, London, 2008) as symptoms of the ongoing shift (rather than countermeasures against it), because they result in an inability to do justice to the epistemic and existential changes resulting from the erosion of the foundations of reality. The consequences of this shift are hard to predict and can only partially be outlined in this paper, which will end in a cautious attempt to do so (chapters 5 and 6). Starting off with a brief overview on this topic (chapter 1), I will trace the reasons for my diagnosis focusing first on what I call the “age of reality” currently coming to an end (chapter 2), then on why virtuality cannot be subsumed under reality (chapter 3), then how virtuality is currently replacing reality (chapter 4). (shrink)

This study examines how hunger narratives and performances contribute to a reconsideration of neglected or prohibited domains of thinking which only a full confrontation with the body's heterogeneity and plasticity can reveal. From literary motif or psychosomatic symptom to revolutionary gesture or existential malady, the double crux of hunger and disgust is a powerful force which can define the experience of embodiment. Kafka's fable of the "Hunger Artist" offers a matrix for the fast, while its surprising last-page revelation introduces (...) disgust as a correlative of abstinence, conscious or otherwise. Grounded in Kristeva's theory of abjection, the figure of the fraught body lurking at the heart of the negative grotesque gathers precision throughout this study, where it is employed in a widening series of contexts: suicide through overeating, starvation as self-performance or political resistance, the teratological versus the totalitarian, the anorexic harboring of death. In the process, writers and artists as diverse as Herman Melville, Percy Bysshe Shelley, Christina Rossetti, George Orwell, Knut Hamsun, J.M. Coetzee, Cindy Sherman, Pieter Breughel, Marina Abramovic, David Nebreda, Paul McCarthy, and others are brought into the discussion. By looking at the different acts of visceral, affective, and ideological resistance performed by the starving body, this book intensifies the relationship between hunger and disgust studies while offering insight into the modalities of the "dark grotesque" which inform the aesthetics and politics of hunger. It will be of value to anyone interested in the culture, politics, and subjectivity of embodiment, and scholars working within the fields of disgust studies, food studies, literary studies, cultural theory, and media studies. (shrink)

This study seeks to understand the subjective experience or lived world typical of patients with Parkinson’s disease. It uses qualitative methodology, grounded in a hermeneutic-phenomenological perspective, to consider lived experience in a small sample of 7 individuals. The analysis identified four themes that appear to be characteristic of the experience of PD: A) Denial, B) Emotion and symptom expression, C) Volitional and spontaneous action, and D) Alteration of temporal perspective. Concepts from existential-phenomenological philosophy were used to reflect upon these (...) themes to achieve a synthetic account of the subjective experience of PD. The findings of the study are compared to other findings in the phenomenological literature, and suggestions for further research are posed. (shrink)

One of my main points in this study is that the knowledge of orthodox medical theory is an incomplete guide for practical action when relating to our patients' specifically human problems. By following a holistic perspective on patients' health and on our medical enterprise we will be more efficient as doctors. This standpoint is illuminated by means of two case reports. Instead of focusing on symptoms as such and letting them refer to orthodox medical theory, I explicitly relate to (...) the patients as if they are conveying a personal meaning by means of experienced symptoms. The experience of illness could be a successful strategy on the existential level although destructive on the technical biological level. A holistic theory of health can give doctors a good conceptual base when relating to people whose presented illnesses are to be regarded explicitly as their way of making themselves understood. The doctor's understanding of the patient's illness, of the theory of health, and of how health is regained, is dependent on the doctor's having the courage to reduce the distance to the patient, the courage to participate and be changed. (shrink)

Pregnancy has a profound impact on individuals’ lives, yet the subjective experience is often absent from the discourse on reproductive rights and ethics. Although pregnancy is an epistemically transformative experience, phenomenology can help us describe common structures in the many different subjective experiences of pregnancy. Doing so shows us that the effects of pregnancy go beyond the physical symptoms; they invade the experience of the self and the world and transform identity. If someone wants to formulate an argument against (...) abortion, they will have to include the existential impact of pregnancy. In this paper I will further explore the impact of pregnancy through a phenomenological analysis of birth and birthmothers and show that the existential impact of pregnancy does not cease to exist after birth. Giving birth fundamentally changes the world of the pregnant person and leads to irreversible changes in identity. Their world will never return to the way it was before pregnancy. Arguments against abortion would have to take these existential implications into account as well. Finally, I will argue that a similar argument will also become relevant in the discourse on ectogenesis. (shrink)

The phenomenological method, characterized by the suspension of judgment (epoché), has helped analyzing the subjective experience of patients affected by mental disorders. Psychiatry, dealing with the human being itself in its complexity and unicity, is placed between the biological positivistic attempt, for which the symptoms of mental illness are a mere consequence of brain dysfunctions and the phenomenological-existential approach, inclined to consider the symptoms as meaningful phenomena of the person’s subjective experience. Eugène Minkowski, Ludwig Binswanger, Arthur Tatossian, (...) Kimura Bin, Henri Maldiney and Hubertus Tellenbach are fundamental authors in the phenomenological psychopathology of depression; they described the alterations of the lived time, space, body and others experienced by the depressed. Starting from the main theoretical contributions of the authors, we will focus on the psychopathology and discuss the key themes of clinical depression: guilt, poverty and hypochondriasis. Finally we will focus on the typus melancholicus construct. (shrink)

Practitioners of palliative medicine frequently encounter patients suffering distress caused by uncontrolled pain or other symptoms. To relieve such distress, palliative medicine clinicians often use measures that result in sedation of the patient. Often such sedation is experienced as a loss by patients and their family members, but sometimes such sedation is sought as the desired outcome. Peace is wanted. Comfort is needed. Sedation appears to bring both. Yet to be sedated is to be cut off existentially from human (...) experience, to be made incapable of engaging self-consciously in any human action. To that extent, it seems that to lose consciousness is to lose something of real value. In this paper, I describe how sedation and the question of intentionally bringing about sedation arise in the care of patients with advanced illness, and I propose heuristics to guide physicians, including Christian physicians, who seek to relieve suffering without contradicting their profession to heal. (shrink)

At the intersection of “the theological” and “the political,” the situatedness of the sovereign dictates the task and method of political theology. It is the sovereign, in particular, positioned between “the theological” and “the political,” that is responsible for existentializing what is theologized and what is politicized through the power of sovereignty. Through this sovereignty, the sovereign creates, defines, and oversees all the existential dimensions of a theological-political environment, especially with respect to exclusiveness and inclusiveness, marginalization and belongingness, and (...) what is accomplished by the state of exception. To understand the nuances of what a sovereign is and how sovereignty operates, as the one that develops the state of exception through an act of exception, this essay will examine the explicit and implicit political theologies articulated by Carl Schmitt and Giorgio Agamben, in an effort to construct Slavoj Žižek’s political theology from Schmitt’s sentiment about “the one who decides on the exception” and Agamben’s conceptualization of “ zoē ” and “ bios. ” From Schmitt and Agamben, Žižek’s political theology makes use of the dialectic and references to notions of symptom and trauma, which ultimately culminates in a religious-oriented understanding of the sovereign's act of exception as the “theologico-political suspension of the ethical.”. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:From the Patient's Perspective:Engaging With the OtherGiovanni Stanghellini*, MD, DPhil Honoris Causa (bio)Homo homini salusOne century after the first conference gathering first-generation clinical phenomenologists in Zurich in 1922, today's psychiatry is far from exploring phenomena from the patient's perspective—that is, "letting-be" the Other, and "giving or compromising"—that is, engaging with the Other (Doerr-Zegers, 2022).The motto of phenomenology has been since its beginning "To things themselves!". Edmund Husserl—the founder of (...) phenomenology in the field of philosophy—exhorted to go back to the things themselves, that is, to render self-evident in fully fledged intuitions that what is usually given in preformed abstractions like "concepts," "judgments," "truths," and so on (Husserl, 1970).Clinical phenomenology has taken up Husserl's motto and added another: "To understand is to cure." Put together, the result is: "To cure is to understand the things themselves." But what does exactly mean "To the things themselves"? And what does it mean "to understand"? What is the use of understanding in the clinical setting? And, ultimately, what does the "cure" consist of?What Are the "Things Themselves" in PsychiatryIn the clinical setting, the "things themselves" (Stanghellini & Ikkos, in press) are the patients' own experiences, that is the patient's psychopathological world as experienced in the first person's perspective—what clinical phenomenology calls the "phenomena." Clinical phenomenology's very conception of the object of psychiatry, that is the patient's abnormal experiences lived in the first-person perspective and embedded in anomalous forms of consciousness and existential patterns, has been vastly oversimplified by current assessment procedures (Stanghellini, 2013). Today, there is a risk that clinical blinkering results in clinicians being only able to view the symptoms relevant to diagnosis and classification and excludes the scrutiny of the diverse and varied nature of what is really there in the patient's experience—the essential prerequisite to understanding his/her condition (Stanghellini & Broome, 2014). This oversimplification has been reinforced by reliance on techniques (e.g., an emphasis on behavioral symptoms and on reliability rather than validity) that are unable to capture the subtle distinctions [End Page 287] in experience that constitute the essentials of the "things themselves" in psychopathology, and to acknowledge that what the patient manifests is not a series of mutually independent, isolated symptoms, but rather certain meaning-structures of interwoven experiences, beliefs, and actions, all permeated by biographical details (Nordengaard & Parnas, 2013).The Problem of the Causes and Meanings of PhenomenaTo go to the "things themselves"—to "let them be"—we should acknowledge that to understand is neither to interpret nor to explain. It is not to interpret, i.e. to attribute a meaning, that is, to replace a manifest content, considered superficial and misleading, with a latent content, considered profound and authentic. Psychiatry as a branch of bio-medicine (as it is known) does not principally deal with meanings, but certainly not because it aims to the "things themselves." Psychiatry first and foremost deals with the causes of phenomena, that is, it tries to explain (scire per causas)—not to understand. The dream of psychiatry is to trace the causes of the symptoms to neutralize the symptoms in statu nascendi. Psychiatry is (would like to be) a science of the mechanisms leading to the formation of mental symptoms.Compared with the intentions of psychiatry, the intentions of psychological hermeneutics, which deals with revealing the meanings of phenomena, may seem a relief and progress, at least if seen from a "humanitarian" angle. The dream of psychology—or at least of certain psychology (such as that of psychoanalytic inspiration)—is to bring to light the authentic meaning of a symptom. Hermeneutic psychology, for example, a psychoanalytic one, is (would like to be) an archaeology of the symptom, unearthing its profound significance.I am not arguing against explanations and interpretations per se, rather underscoring the way these may stand in the way of engaging with the patient in a third mode of approaching clinical phenomena, that is understanding. Both psychiatry's attempts at explanation and hermeneutic psychology's attempts at interpretation may suffocate... (shrink)

This book is a critical attempt to approach world cinema in a new global frame that updates the national frame of territorial cinemas and the transnational frame of their interplay. The global frame implies the reintegration of border-crossing forces onto the postpolitical plane of troubled globalization with two ethical facets: the soft ethical inclusion of differences in multicultural, neoliberal systems and their hard ethical symptoms of fundamentalist exclusion and terror. Reflecting both, global cinema is formulated as staging crucial challenges (...) that today's globalism and its antinomies bring to the notions of subjectivity and community. Many films indeed depict the antagonism between the inclusive global system and its excluded remnants, allegorizing the impossible political change in various modes of catastrophe and nihilism. A global community often takes on a totalized network of sovereign violence and (counter)terror stuck in the impasse of utopian imagination. Yet some films suggest alternative ethics irreducible to collective politics when abject figures, deprived of social subjectivity and rights, become contingent agents of existential 'gift-giving' by fostering commonality without community, solidarity without unity. The psychoanalytic notion of abjection is redefined here as both the biopolitical mode of bare life and its potential for the ethical agency that opens atopian, if not utopian, networking on the edge of the global regime beyond the problematic 'soft/hard' ethics of tolerance/violence or pity/hate. This precarious yet precious abject agency is explored through a vast net of globally circulating contemporary films and a core cluster of political, ethical, and psychoanalytic philosophies. (shrink)

continent. 1.1 : 3-13. / 0/ – Introduction I want to propose, as a trajectory into the philosophically weird, an absurd theoretical claim and pursue it, or perhaps more accurately, construct it as I point to it, collecting the ground work behind me like the Perpetual Train from China Mieville's Iron Council which puts down track as it moves reclaiming it along the way. The strange trajectory is the following: Kant's critical philosophy and much of continental philosophy which has followed, (...) has been a defense against horror and madness. Kant's prohibition on speculative metaphysics such as dogmatic metaphysics and transcendental realism, on thinking beyond the imposition of transcendental and moral constraints, has been challenged by numerous figures proceeding him. One of the more interesting critiques of Kant comes from the mad black Deleuzianism of Nick Land stating, “Kant’s critical philosophy is the most elaborate fit of panic in the history of the Earth.” And while Alain Badiou would certainly be opposed to the libidinal investments of Land's Deleuzo-Guattarian thought, he is likewise critical of Kant's normative thought-bureaucracies: Kant is the one author for whom I cannot feel any kinship. Everything in him exasperates me, above all his legalism—always asking Quid Juris? Or ‘Haven’t you crossed the limit?’—combined, as in today’s United States, with a religiosity that is all the more dismal in that it is both omnipresent and vague. The critical machinery he set up has enduringly poisoned philosophy, while giving great succour to the academy, which loves nothing more than to rap the knuckles of the overambitious [….] That is how I understand the truth of Monique David-Menard’s reflections on the properly psychotic origins of Kantianism. I am persuaded that the whole of the critical enterprise is set up to to shield against the tempting symptom represented by the seer Swedenborg, or against ‘diseases of the head’, as Kant puts it. An entire nexus of the limits of reason and philosophy are set up here, namely that the critical philosophy not only defends thought from madness, philosophy from madness, and philosophy from itself, but that philosophy following the advent of the critical enterprise philosophy becomes auto-vampiric; feeding on itself to support the academy. Following Francois Laruelle's non-philosophical indictment of philosophy, we could go one step further and say that philosophy operates on the material of what is philosophizable and not the material of the external world. [1] Beyond this, the Kantian scheme of nestling human thinking between our limited empirical powers and transcendental guarantees of categorical coherence, forms of thinking which stretch beyond either appear illegitimate, thereby liquefying both pre-critical metaphysics and the ravings of the mad in the same critical acid. In rejecting the Kantian apparatus we are left with two entities – an unsure relation of thought to reality where thought is susceptible to internal and external breakdown and a reality with an uncertain sense of stability. These two strands will be pursued, against the sane-seal of post-Kantian philosophy by engaging the work of weird fiction authors H.P. Lovecraft and Thomas Ligotti. The absolute inhumanism of the formers universe will be used to describe a Shoggothic Materialism while the dream worlds of the latter will articulate the mad speculation of a Ventriloquil Idealism. But first we must address the relation of philosophy to madness as well as philosophy to weird fiction. /1/ – Philosophy and Madness There is nothing that the madness of men invents which is not either nature made manifest or nature restored. Michel Foucault. Madness and Civilization. The moment I doubt whether an event that I recall actually took place, I bring the suspicion of madness upon myself: unless I am uncertain as to whether it was not a mere dream. Arthur Schopenhauer. The World as Will and Idea, Vol. 3. Madness is commonly thought of as moving through several well known cultural-historical shifts from madness as a demonic or otherwise theological force, to rationalization, to medicalization psychiatric and otherwise. Foucault's Madness and Civilization is well known for orientating madness as a form of exclusionary social control which operated by demarcating madness from reason. Yet Foucault points to the possibility of madness as the necessity of nature at least prior to the crushing weight of the church. Kant’s philosophy as a response to madness is grounded by his humanizing of madness itself. As Adrian Johnston points out in the early pages of Time Driven pre-Kantian madness meant humans were seized by demonic or angelic forces whereas Kantian madness became one of being too human. Madness becomes internalized, the external demonic forces become flaws of the individual mind. Foucault argues that, while madness is de-demonized it is also dehumanized during the Renaissance, as madmen become creatures neither diabolic nor totally human reduced to the zero degree of humanity. It is immediately clear why for Kant, speculative metaphysics must be curbed – with the problem of internal madness and without the external safeguards of transcendental conditions, there is nothing to formally separate the speculative capacities for metaphysical diagnosis from the mad ramblings of the insane mind – both equally fall outside the realm of practicality and quotidian experience. David-Menard's work is particularly useful in diagnosing the relation of thought and madness in Kant's texts. David-Menard argues that in Kant's relatively unknown “An Essay on the Maladies of the Mind” as well as his later discussion of the Seer of Swedenborg, that Kant formulates madness primarily in terms of sensory upheaval or other hallucinatory theaters. She writes: “madness is an organization of thought. It is made possible by the ambiguity of the normal relation between the imaginary and the perceived, whether this pertains to the order of sensation or to the relations between our ideas” Kant's fascination with the Seer forces Kant between the pincers of “aesthetic reconciliation” – namely melancholic withdrawal – and “a philosophical invention” – namely the critical project. Deleuze and Guattari's schizoanalysis is a combination and reversal of Kant's split, where an aesthetic over engagement with the world entails prolific conceptual invention. Their embrace of madness, however, is of course itself conceptual despite all their rhizomatic maneuvers. Though they move with the energy of madness, Deleuze and Guattari save the capacity of thought from the fangs of insanity by imbuing materiality itself with the capacity for thought. Or, as Ray Brassier puts it, “Deleuze insists, it is necessary to absolutize the immanence of this world in such a way as to dissolve the transcendent disjunction between things as we know them and as they are in themselves”. That is, whereas Kant relied on the faculty of judgment to divide representation from objectivity Deleuze attempts to flatten the whole economy beneath the juggernaut of ontological univocity. Speculation, as a particularly useful form of madness, might fall close to Deleuze and Guattari’s shaping of philosophy into a concept producing machine but is different in that it is potentially self destructive – less reliant on the stability of its own concepts and more adherent to exposing a particular horrifying swath of reality. Speculative madness is always a potential disaster in that it acknowledges little more than its own speculative power with the hope that the gibbering of at least a handful of hysterical brains will be useful. Pre-critical metaphysics amounts to madness, though this may be because the world itself is mad while new attempts at speculative metaphysics, at post-Kantian pre-critical metaphysics, are well aware of our own madness. Without the sobriety of the principle of sufficient reason we have a world of neon madness: “we would have to conceive what our life would be if all the movements of the earth, all the noises of the earth, all the smells, the tastes, all the light – of the earth and elsewhere, came to us in a moment, in an instant – like an atrocious screaming tumult of things”. Speculative thought may be participatory in the screaming tumult of the world or, worse yet, may produce its spectral double. Against theology or reason or simply commonsense, the speculative becomes heretical. Speculation, as the cognitive extension of the horrorific sublime should be met with melancholic detachment. Whereas Kant's theoretical invention, or productivity of thought, is self -sabotaging, since the advent of the critical project is a productivity of thought which then delimits the engine of thought at large either in dogmatic gestures or non-systematizable empirical wondrousness. The former is celebrated by the fiction of Thomas Ligotti whereas the latter is espoused by the tales of H.P. Lovecraft. /2/ – Weird Fiction and Philosophy. Supernatural horror, in all its eerie constructions, enables a reader to taste treats inconsistent with his personal welfare. Thomas Ligotti Songs of a Dead Dreamer. I choose weird stories because they suit my inclination best—one of my strongest and most persistent wishes being to achieve,momentarily, the illusion of some strange suspension or violation of the galling limitations of time, space, and natural law which forever imprison us and frustrate our curiosity about the infinite cosmic spaces beyond the radius of our sight and analysis H.P. Lovecraft. “Notes on Writing Weird Fiction” Lovecraft states that his creation of a story is to suspend natural law yet, at the same time, he indexes the tenuousness of such laws, suggesting the vast possibilities of the cosmic. The tension that Lovecraft sets up between his own fictions and the universe or nature is reproduced within his fictions in the common theme of the unreliable narrator; unreliable precisely because they are either mad or what they have witnessed questions the bounds of material reality. In “The Call of Cthulhu” Lovecraft writes: The most merciful thing in the world, I think, is the inability of the human mind to correlate all its contents. We live on a placid island of ignorance in the midst of black seas of infinity, and it was not meant that we should voyage far. The sciences, each straining in its own direction, have hitherto harmed us little; but some day the piecing together of dissociated knowledge will open up such terrifying vistas of reality, and of our frightful position therein, that we shall either go mad from the revelation or flee from the deadly light into the peace and safety of a new dark age. Despite Lovecraft's invocations of illusion, he is not claiming that his fantastic creations such as the Old Ones are supernatural but, following Joshi, are only ever supernormal. One can immediately see that instead of nullifying realism Lovecraft in fact opens up the real to an unbearable degree. In various letters and non-fictional statements Lovecraft espoused strictly materialist tenets, ones which he borrowed from Hugh Elliot namely the uniformity of law, the denial of teleology and the denial of non-material existence. Lovecraft seeks to explore the possibilities of such a universe by piling horror upon horror until the fragile brain which attempts to grasp it fractures. This may be why philosophy has largely ignored weird fiction – while Deleuze and Guattari mark the turn towards weird fiction and Lovecraft in particular, with the precursors to speculative realism as well as contemporary related thinkers have begun to view Lovecraft as making philosophical contributions. Lovecraft's own relation to philosophy is largely critical while celebrating Nietzsche and Schopenhauer. This relationship of Lovecraft to philosophy and philosophy to Lovecraft is coupled with Lovecraft's habit of mercilessly destroying the philosopher and the figure of the academic more generally in his work, a destruction which is both an epistemological destruction and an ontological destruction. Thomas Ligotti's weird fiction which he has designated as a kind of “confrontational escapism” might be best described in the following quote from one of his shortstories, “The human phenomenon is but the sum of densely coiled layers of illusion each of which winds itself on the supreme insanity. That there are persons of any kind when all there can be is mindless mirrors laughing and screaming as they parade about in an endless dream”. Whereas Lovecraft's weirdness draws predominantly from the abyssal depths of the uncharted universe, Ligotti's existential horror focuses on the awful proliferation of meaningless surfaces that is, the banal and every day function of representation. In an interview, Ligotti states: We don't even know what the world is like except through our sense organs, which are provably inadequate. It's no less the case with our brains. Our whole lives are motored along by forces we cannot know and perceptions that are faulty. We sometimes hear people say that they're not feeling themselves. Well, who or what do they feel like then? This is not to say that Ligotti sees nothing beneath the surface but that there is only darkness or blackness behind it, whether that surface is on the cosmological level or the personal. By addressing the implicit and explicit philosophical issues in Ligotti's work we will see that his nightmarish take on reality is a form of malevolent idealism, an idealism which is grounded in a real, albeit dark and obscure materiality. If Ligotti's horrors ultimately circle around mad perceptions which degrade the subject, it takes aim at the vast majority of the focus of continental philosophy. While Lovecraft's acidic materialism clearly assaults any romantic concept of being from the outside, Ligotti attacks consciousness from the inside: Just a little doubt slipped into the mind, a little trickle of suspicion in the bloodstream, and all those eyes of ours, one by one, open up to the world and see its horror [...] Not even the solar brilliance of a summer day will harbor you from horror. For horror eats the light and digests it into darkness. Clearly, the weird fiction of Lovecraft and Ligotti amount to a anti-anthrocentric onslaught against the ramparts of correlationist continental philosophy. /3/ – Shoggothic Materialism or the Formless Formless protoplasm able to mock and reflect all forms and organs and processes—viscous agglutinations of bubbling cells—rubbery fifteen-foot spheroids infinitely plastic and ductile—slaves of suggestion, builders of cities—more and more sullen, more and more intelligent, more and more amphibious, more and more imitative—Great God! What madness made even those blasphemous Old Ones willing to use and to carve such things? H.P. Lovecraft. “At the Mountains of Madness” On the other hand, affirming that the universe resembles nothing and is only formless amounts to saying that the universe is something like a spider or spit. Georges Bataille. “Formless”. The Shoggoths feature most prominently in H.P. Lovecraft's shortstory “At the Mountains of Madness” where they are described in the following manner: It was a terrible, indescribable thing vaster than any subway train – a shapeless congeries of protoplasmic bubbles, faintly self -luminous, and with myriads of temporary eyes forming and un-forming as pustules of greenish light all over the tunnel-filling front that bore down upon us, crushing the frantic penguins and slithering over the glistening floor that it and its kind had swept so evilly free of all litter. The term is a litmus test for materialism itself as the Shoggoth is an amorphous creature. The Shoggoths were living digging machines bio engineered by the Elder Things, and their protoplasmic bodies being formed into various tools by their hypnotic powers. The Shoggoths eventually became self aware and rose up against their masters in an ultimately failed rebellion. After the Elder Ones retreated into the oceans leaving the Shoggoths to roam the frozen wastes of the Antarctic. The onto-genesis of the Shoggoths and their gross materiality, index the horrifyingly deep time of the earth a concept near and dear to Lovecraft's formulation of horror as well as the fear of intelligences far beyond, and far before, the ascent of humankind on earth and elsewhere. The sickly amorphous nature of the Shoggoths invade materialism at large, where while materiality is unmistakably real ie not discursive, psychological, or otherwise overly subjectivist, it questions the relation of materialism to life. As Eugene Thacker writes: The Shoggoths or Elder Things do not even share the same reality with the human beings who encounter them—and yet this encounter takes place, though in a strange no-place that is neither quite that of the phenomenal world of the human subject or the noumenal world of an external reality. Amorphous yet definitively material beings are a constant in Lovecraft's tales. In his tale “The Dream-Quest of Unknown Kadatth” Lovecraft describes Azathoth as, “that shocking final peril which gibbers unmentionably outside the ordered universe,” that, “last amorphous blight of nethermost confusion which blashphemes and bubbles at the centre of all infinity,” who, “gnaws hungrily in inconceivable, unlighted chambers beyond time”. Azathoth's name may have multiple origins but the most striking is the alchemy term azoth which is both a cohesive agent and a acidic creation pointing back to the generative and the decayed. The indistinction of generation and degradation materially mirrors the blur between the natural and the unnatural as well as life and non-life. Lovecraft speaks of the tension between the natural and the unnatural is his short story “The Unnameable.” He writes, “if the psychic emanations of human creatures be grotesque distortions, what coherent representation could express or portray so gibbous and infamous a nebulousity as the spectre of a malign, chaotic perversion, itself a morbid blasphemy against Nature?”. Lovecraft explores exactly the tension outlined at the beginning of this chapter, between life and thought. At the end of his short tale Lovecraft compounds the problem as the unnameable is described as “a gelatin—a slime—yet it had shapes, a thousand shapes of horror beyond all memory”. Deleuze suggests that becoming-animal is operative throughout Lovecraft's work, where narrators feel themselves reeling at their becoming non-human or of being the anomalous or of becoming atomized. Following Eugene Thacker however, it may be far more accurate to say that Lovecraft's tales exhibit not a becoming-animal but a becoming-creature. Where the monstrous breaks the purportedly fixed laws of nature, the creature is far more ontologically ambiguous. The nameless thing is an altogether different horizon for thought. The creature is either less than animal or more than animal – its becoming is too strange for animal categories and indexes the slow march of thought towards the bizarre. This strangeness is, as aways, some indefinite swirling in the category of immanence and becoming. Bataille begins “The Labyrinth” with the assertion that being, to continue to be, is becoming. More becoming means more being hence the assertion that Bataille's barking dog is more than the sponge. This would mean that the Shoggotth is altogether too much being, too much material in the materialism. Bataille suggests that there is an immanence between the eater and the eaten, across the species and never within them. That is, despite the chaotic storm of immanence there must remain some capacity to distinguish the gradients of becoming without reliance upon, or at least total dependence upon, the powers of intellection to parse the universe into recognizable bits, properly digestible factoids. That is, if we undo Deleuze's aforementioned valorization of sense which, for his variation of materialism, performed the work of the transcendental, but refuse to reinstate Kant's transcendental disjunction between thing and appearance, then it must be a quality of becoming-as-being itself which can account for the discernible nature of things by sense. In an interview with Peter Gratton, Jane Bennett formulates the problem thusly: What is this strange systematicity proper to a world of Becoming? What, for example, initiates this congealing that will undo itself? Is it possible to identify phases within this formativity, plateaus of differentiation? If so, do the phases/plateaus follow a temporal sequence? Or, does the process of formation inside Becoming require us to theorize a non-chronological kind of time? I think that your student’s question: “How can we account for something like iterable structures in an assemblage theory?” is exactly the right question. Philosophy has erred too far on the side of the subject in the subject-object relation and has furthermore, lost the very weirdness of the non-human. Beyond this, the madness of thought need not override. /4/ - Ventriloquial Idealism or the Externality of Thought My aim is the opposite of Lovecraft's. He had an appreciation for natural scenery on earth and wanted to reach beyond the visible in the universe. I have no appreciation for natural scenery and want the objective universe to be a reflection of a character. Thomas Ligotti. “Devotees of Decay and Desolation.” Unless life is a dream, nothing makes sense. For as a reality, it is a rank failure [….] Horror is more real than we are. Thomas Ligotti. “Professor Nobody's Little Lectures on Supernatural Horror”. Thomas Ligotti's tales are rife with mannequins, puppets, and other brainless entities which of replace the valorized subject of philosophy – that of the free thinking human being. His tales such as “The Dream of the Manikin” aim to destroy the rootedness of consciousness. James Trafford has connected the anti-egoism of Ligotti to Thomas Metzinger – where the self is at best an illusion and we plead desperately for someone else to acknowledge that we are real. Trafford has stated it thus, “Life is played out as an inescapable puppet show, an endless dream in which the puppets are generally unaware that they are trapped within a mesmeric dance of whose mechanisms they know nothing and over which they have no control”. An absolute materialism, for Ligotti, implies an alienation of the idea which leads to a ventriloquil idealism. As Ligotti notes in an interview, “the fiasco and nightmare of existence, the particular fiasco and nightmare of human existence, the sense that people are puppets of powers they cannot comprehend, etc.” And then further elaborates that,“[a]ssuming that anything has to exist, my perfect world would be one in which everyone has experienced the annulment of his or her ego. That is, our consciousness of ourselves as unique individuals would entirely disappear”. The externality of the idea leads to the unfortunate consequence of consciousness eating at itself through horror which, for Ligotti, is more real than reality and goes beyond horror-as-affect. Beyond this, taking together with the unreality of life and the ventriloquizing of subjectivity, Ligotti's thought becomes an idealism in which thought itself is alien and ultimately horrifying. The role of human thought and the relation of non-relation of horror to thought is not completely clear in Ligotti's The Conspiracy Against the Human Race. Ligotti argues in his The Conspiracy Against the Human Race,that the advent of thought is a mistake of nature and that horror is being in the sense that horror results from knowing too much. Yet, at the same time, Ligotti seems to suggest that thought separates us from nature whereas, for Lovecraft, thought is far less privileged – mind is just another manifestation of the vital principal, it is just another materialization of energy. In his brilliant “Prospects for Post-Copernican Dogmatism” Iain Grant rallies against the negative definition of dogmatism and the transcendental, and suggests that negatively defining both over-focuses on conditions of access and subjectivism at the expense of the real or nature. With Schelling, who is Grant's champion against the subjectivist bastions of both Fichte and Kant, Ligotti's idealism could be taken as a transcendental realism following from an ontological realism. Yet the transcendental status of Ligotti's thought move towards a treatment of the transcendental which may threaten to leave beyond its realist ground. Ligotti states: Belief in the supernatural is only superstition. That said, a sense of the supernatural, as Conrad evidenced in Heart of Darkness, must be admitted if one's inclination is to go to the limits of horror. It is the sense of what should not be- the sense of being ravaged by the impossible. Phenomenally speaking, the super-natural may be regarded as the metaphysical counterpart of insanity, a transcendental correlative of a mind that has been driven mad. Again, Ligotti equates madness with thought, qualifying both as supernatural while remaining less emphatic about the metaphysical dimensions of horror. The question becomes one of how exactly the hallucinatory realm of the ideal relates to the black churning matter of Lovecraft's chaos of elementary particles. In his tale “I Have a Special Plan for This World” Ligotti formulates thus: A: There is no grand scheme of things. B: If there were a grand scheme of things, the fact – the fact – that we are not equipped to perceive it, either by natural or supernatural means, is a nightmarish obscenity. C: The very notion of a grand scheme of things is a nightmarish obscenity. Here Ligotti is not discounting metaphysics but implying that if it does exist the fact that we are phenomenologically ill-equipped to perceive that it is nightmarish. For Ligotti, nightmare and horror occur within the circuit of consciousness whereas for Lovecraft the relation between reality and mind is less productive on the side of mind. It is easier to ascertain how the Kantian philosophy is a defense against the diseases of the head as Kant armors his critical enterprise from too much of the world and too much of the mind. The weird fiction of both Lovecraft and Ligotti demonstrates that there is too much of both feeding into one another in a way that corrodes the Kantian schema throughly, breaking it down into a dead but still ontologically potentiated nigredo. The haunting, terrifying fact of Ligotti's idealism is that the transcendental motion which brought thought to matter, while throughly material and naturalized, brings with it the horror that thought cannot be undone without ending the material that bears it either locally or completely. Thought comes from an elsewhere and an elsewhen being-in-thought. The unthinkable outside thought is as maddening as the unthought engine of thought itself within thought which doesn't exist except for the mind, the rotting décor of the brain. /5/ - Hyperstitional Transcendental Paranoia or Self -Expelled Thought Weird fiction has been given some direct treatment in philosophy in the mad black Deleuzianism of Nick Land. Nick Land along with others in the 1990s created the Cyber Culture Research Unit as well as the research group Hyperstition. The now defunct hyperstitional website, an outgrowth of the Cyber Culture Research Unit, defined hyperstition in the following fourfold: 1-Element of effective culture that makes itself real. 2-Fictional quantity functional as a time-traveling device. 3-Coincidence intensifier. 4-Call to the Old Ones. The distinctively Lovecraftian character of hyperstition is hard to miss as is its Deleuzo-Guattarian roots. In the opening pages of A Thousand Plateaus Deleuze and Guattari write, “We have been criticized for over-quoting literary authors. But when one writes, the only question is which other machine the literary machine can be plugged into”. The indisinction of literature and philosophy mirrors the mess of being and knowing as post-correlationist philosophy, where philosophy tries to make itself real where literature, especially the weird, aims itself at the brain-circuit of horror. The texts of both Lovecraft and Ligotti work through horror as epistemological plasticity meeting with proximity as well as the deep time of Lovecraft and the glacially slow time of paranoia in Ligotti. Against Deleuze, and following Brassier, we cannot allow the time of consciousness, the Bergsonian time of the duree, to override natural time, but instead acknowledge that it is an unfortunate fact of existence as a thinking being. Horror-time, the time of consciousness, with all its punctuated moments and drawn out terrors, cannot compare to the deep time of non-existence both in the unreachable past and the unknown future. The crystalline cogs of Kant's account of experience as the leading light for the possibility of metaphysics must be throughly obliterated. His gloss of experience in Prolegomena to any Future Metaphysics could not be more sterile: Experience consists of intuitions, which belong to the sensibility, and of judgments, which are entirely a work of the understanding. But the judgments which the understanding makes entirely out of sensuous intuitions are far from being judgments of experience. For in the one case the judgment connects only the perceptions as they are given in sensuous intuition [....] Experience consists in the synthetic connection of appearances in consciousness, so far as this connection is necessary. Here it is difficult to dismiss the queasiness that Kant's legalism induces upon sight for both Badiou and David-Menard. Kant's thought becomes, as Foucault says when reflecting on Sade's text in relation to nature, “the savage abolition of itself”. For Badiou, Kant's philosophy simply closes off too much of the outside, freezing the world of thought in an all too limited formalism. Critical philosophy is simply the systematized quarantine on future thinking, on thinking which would threaten the formalism which artificially grants thought its own coherency in the face of madness. Even the becoming-mad of Deleuze, while escaping the rumbling ground, makes grounds for itself, mad grounds but grounds which are thinkable in their affect. The field of effects allows for Deleuze's aesthetic and radical empiricism, in which effects and/or occasions make up the material of the world to be thought as a chaosmosis of simulacra. Given a critique of an empiricism of aesthetics, of the image, it may be difficult to justify an attack on Kantian formalism with the madness of literature, which does not aim to make itself real but which we may attempt to make real. That is, how do Lovecraft's and Ligotti's materials, as materials for philosophy to work on, differ from either the operative formalisms of Kant or the implicitly formalized images of Deleuzian empiricism? It is simply that such texts do not aim to make themselves real, and make claims to the real which are more alien to us than familiar, which is why their horror is immediately more trustworthy. This is the madness which Blanchot discusses in The Infinite Conversation through Cervantes and his knight – the madness of book-life, of the perverse unity of literature and life a discussion which culminates in the discussion of one of the weird's masters, that of Kafka. The text is the knowing of madness, since madness, in its moment of becoming-more-mad, cannot be frozen in place but by the solidifications of externalizing production. This is why Foucault ends his famous study with works of art. Furthermore extilligence, the ability to export the products of our maligned brains, is the companion of the attempts to export, or discover the possibility of intelligences outside of our heads, in order for philosophy to survive the solar catastrophe. To borrow again from Deleuze, writing is inseparable from becoming. The mistake is to believe that madness is reabsorbed by extilligence, by great works, or that it could be exorcised by the expelling of thought into the inorganic or differently organic. Going out of our heads does not guarantee we will no longer mean we cannot still go out of our minds. This is simply because of the outside, of matter, or force, or energy, or thing-in-itself, or Schopenhauerian Will. In Lovecraft’s “The Music of Erich Zahn” an “impoverished student of metaphysics” becomes intrigued by strange viol music coming from above his room. After meeting the musician the student discovers that each night he plays frantic music at a window in order to keep some horridness at bay, some “impenetrable darkness with chaos and pandemonium”. The aesthetic defenses provided by the well trained brain can bear the hex of matter for so long, the specter of unalterability within it which too many minds obliterate, collapsing everything before the thought of thought as thinkable or at least noetically mutable on our own terms. Transcendental paranoia is the concurrent nightmare and promise of Paul Humphrey's work, of being literally out of our minds. It is the gothic counterpart of thinking non-conceptually but also of thinking never belonging to any instance of purportedly solid being. As Bataille stated, “At the boundary of that which escapes cohesion, he who reflects within cohesion realizes there is no longer any room for him” Thought is immaterial only to the degree that it is inhuman, it is a power that tries, always with failure, to ascertain its own genesis. Philosophy, if it can truly return to the great outdoors, if it can leave behind the dead loop of the human skull, must recognize not only the non-priority of human thought, but that thought never belongs to the brain that thinks it, thought comes from somewhere else. To return to the train image from the beginning “a locomotive rolling on the surface of the earth is the image of continuous metamorphosis” this is the problem of thought, and of thinking thought, of being no longer able to isolate thought, with only a thought-formed structure. [1] One of the central tenets of Francois Laruelle's non-philosophy is that philosophy has traditionally operated on material already presupposed as thinkable instead of trying to think the real in itself. Philosophy, according to Laruelle, remains fixated on transcendental synthesis which shatters immanence into an empirical datum and an a prori factum which are then fused by a third thing such as the ego. For a critical account of Laruelle's non-philosophy see Ray Brassier's Nihil Unbound. (shrink)