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Meaning and existential givens in the lives of cancer patients: A philosophical perspective on psycho-oncology

Published online by Cambridge University Press:  26 June 2014

Joël Vos
Joël Vos*
Affiliation:
Department of Psychology, University of Roehampton, London, United Kingdom
*
Address correspondence and reprint requests to Joël Vos, Department of Psychology, University of Roehampton, Holybourne Avenue, London, United Kingdom. E-mail: [email protected].
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Abstract

Objective:

Many cancer patients report changes in how they experience meaning in life and being confronted with life's limitations, understanding themselves as being vulnerable, finite, and free beings. Many would like to receive psychotherapeutic help for this. However, psychotherapy for these concerns often either focuses primarily on meaning in life (e.g., meaning-centered/logotherapy) or on existential givens (e.g., supportive–expressive therapy). The relationship between meaning in life and existential givens seems relatively unexplored, and it seems unclear how therapists can integrate them. The present article aims to explore the relationship between meaning and existential givens.

Method:

Martin Heidegger was a founder of existentialism, inspiring both meaning therapies and supportive–expressive therapies. Therefore, we systematically apply his understanding of these phenomena, elucidated by four elements in his central metaphor of “the house.”

Results:

(1) Walls: In everyday life, we construct ordinary meanings, like the walls of a house, to protect us from our surroundings, wind, and rain. (2) Surroundings (“existential givens”): Confronted with cancer, the meanings/walls of this house may collapse; people may start seeing their surroundings and understand that they could have built their house at a different location, that is, they understand the broad range of possibilities in life, their responsibility to choose, and the contingency of current meanings. (3) How to design, build, and dwell: People may design, build, and dwell in their house in different ways: they may lock themselves in their house of impermeable “ordinary meanings” and deny the existence of existential surroundings; they may feel overwhelmed by all possibilities and be unable to experience meaning; they may build the house as their true home, use life's possibilities, and listen to their true self by building permeable “existential meanings.” (4). Navigator: People may experience inner guidance to navigate in designing, building, and dwelling in this house.

Significance of results:

Meaning in life and existential givens are intertwined. Therefore, we suggest that it is necessary for psycho-oncologists to address both. Further clinical validation is required.

Keywords

Existential therapyMartin HeideggerMeaning in lifeMeaning-centered therapyPsycho-oncology
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 4 , August 2015 , pp. 885 - 900
Copyright
Copyright © Cambridge University Press 2014 

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References

REFERENCES

Agrimson, L.B. & Taft, L.B. (2009). Spiritual crisis: A concept analysis. Journal of Advanced Nursing, 65(2), 454–461.Google Scholar
Archer, R. (2006). Dual realities, the search for meaning: Psychodynamic therapy with physically ill people. London: Karnac.Google Scholar
Becker, E. (1997). The denial of death. New York: Free Press Paperbacks.Google Scholar
Beike, D.R. & Crone, T.S. (2012). Autobiographical memory and personal meaning: Stable versus flexible meanings of remembered life experiences. In The human quest for meaning: Theories, research, and applications, 2nd ed. Wong, P.T.P. et al. (eds), pp. 315–334. New York: Routledge.Google Scholar
Benner, P.E. (1994). Interpretive phenomenology: Embodiment, caring, and ethics in health and illness. Thousand Oaks, CA: Sage Publications.Google Scholar
Berman, M. (2009). The politics of authenticity: radical individualism and the emergence of modern society. New York: Verso Books.Google Scholar
Brandstatter, M., Baumann, U, Borasio, G.D., et al. (2012). Systematic review of meaning in life assessment instruments. Psycho-Oncology, 21(10), 1034–1052.CrossRefGoogle ScholarPubMed
Breitbart, W. (2005). Balancing life and death: Hope and despair. Palliative & Supportive Care, 3, 57–58.Google Scholar
Breitbart, W.S. & Alici, Y. (2009). Psycho-oncology. Harvard Review of Psychiatry, 17(6), 361–376.Google Scholar
Breitbart, W., Rosenfeld, B., Gibson, C., et al. (2010 a). Meaning-centered group psychotherapy for patients with advanced cancer: A pilot randomized controlled trial. Psycho-Oncology, 19(1), 21–28.Google Scholar
Breitbart, W., Rosenfeld, B., Gibson, C., et al. (2010 b). Meaning-centered group psychotherapy for patients with advanced cancer: A pilot randomized controlled trial. Psycho-Oncology, 19(1), 21–28.Google Scholar
Campbell, J. (1949). The hero with a thousand faces. New York: Pantheon Books.Google Scholar
Caputo, J.D. (1978). The mystical element in Heidegger's thought. New York: Fordham University Press.Google Scholar
Classen, C., Butler, L.D., Koopman, C., et al. (2001). Supportive–expressive group therapy and distress in patients with metastatic breast cancer: A randomized clinical intervention trial. Archives of General Psychiatry, 58(5), 494–501.Google Scholar
Clayton, J.M., Hancock, K., Parker, S., et al. (2008). Sustaining hope when communicating with terminally ill patients and their families: A systematic review. Psycho-Oncology, 17, 18.Google Scholar
Cole, B. & Pargament, K. (1999). Re-creating your life: A spiritual/psychotherapeutic intervention for people diagnosed with cancer. Psycho-Oncology, 8(5), 395–407.Google Scholar
Cooper, M. (2003). Existential therapies. London: Sage Publications.Google Scholar
Coward, D.D. (2000). Making meaning within the experience of life-threatening illness. In Exploring existential meaning. Optimizing human development across the lifespan. Ed. Reker, G.T. & Chamberlain, K. (eds.), pp. 157–170. Thousand Oaks, CA: Sage Publications.CrossRefGoogle Scholar
Coward, D.D. & Kahn, D.L. (2005). Transcending breast cancer: Making meaning from diagnosis and treatment. Journal of Holististic Nursing, 23, 264–283.Google Scholar
Fife, B.L. (1994). The conceptualization of meaning in illness. Social Science & Medicine, 38(2), 309–316.Google Scholar
Frankl, V. (1986). The doctor and the soul: From psychotherapy to logotherapy. London: Vintage.Google Scholar
Frankl, V. (1989). The will to meaning: foundations and applications of logotherapy. New York: Plume.Google Scholar
Frankl, V. (1998). Man's search for meaning: An introduction to logotherapy. London: Random House.Google Scholar
Frankl, V. (2000). Man's search for ultimate meaning. New York: Basic Books.Google Scholar
Fromm, E. (1941). Escape from freedom. New York: Rinehart.Google Scholar
Gentner, D. & Grudin, J. (1985). The evolution of mental metaphors in psychology: A 90-year retrospective. American Psychologist, 40(2), 11.Google Scholar
Greenberg, J., Koole, S.L. & Pyszszynski, T. (2004). Handbook of experimental existential psychology. New York: Guildford Press.Google Scholar
Hayes, S., Strosahl, K. & Wilson, K. (1999). Acceptance and commitment therapy. An experiential approach to behaviour change. New York: Guilford Press.Google Scholar
Heidegger, M. (1962). Die frage nach der technik . In Die technik und die kehre. Stuttgart: Verlag Gunther Neske.Google Scholar
Heidegger, M. (1969). Vom wesen der wahrheit. Tübingen: Max Niemeyer Verlag.Google Scholar
Heidegger, M. (1987). Einfuhrung in die metaphysik. Tübingen: Max Niemeyer Verlag.Google Scholar
Heidegger, M. (2000 a). Brief über den Humanismus. Stuttgart: Verlag Günther Neske.Google Scholar
Heidegger, M. (2000 b). Gelassenheit. Stuttgart: Verlag Günther Neske.Google Scholar
Heidegger, M. (2001). Sein und zeit. Tübingen: Max Niemeyer Verlag.Google Scholar
Heidegger, M. (2010). Phenomenology of intuition and expression. London: Continuum International Publishing Group.Google Scholar
Heidegger, M. & Hofstadter, A. (transl.) (1996). Building dwelling thinking. In Poetry, language, thought. New York: Harper Colophon Books. Available at http://mysite.pratt.edu/~arch543p/readings/Heidegger.html.Google Scholar
Henoch, I. & Danielson, E. (2009). Existential concerns among patients with cancer and interventions to meet them: An integrative literature review. Psycho-Oncology, 18(3), 225–236.Google Scholar
Irigaray, L. (1999). The forgetting of air in Martin Heidegger. Austin: University of Texas Press.Google Scholar
Janoff-Bulman, R. (1992). Shattered assumptions: Towards a new psychology of trauma. New York: The Free Press.Google Scholar
Janoff-Bulman, R. (2004). Posttraumatic growth: Three explanatory models. Psychological Inquiry, 15(1), 30–34.Google Scholar
Jaspers, K. (1925). Psychologie der weltanschauungen. Tübingen: Max Niemeyer Verlag.Google Scholar
Jaspers, K. (1973). Allgemeine psychopathologie. Berlin: Springer.Google Scholar
Jung, C.G. (1994). Psychologische typen. Olten: Walter Verlag.Google Scholar
Kang, K.A., Im, J.I., Kim, H.S., et al. (2009). The effect of logotherapy on the suffering, finding meaning, and spiritual well-being of adolescents with terminal cancer. Journal of the Korean Academy of Child Health Nursing, 15(2), 136–144.Google Scholar
Kashdan, T.B. & Rottenberg, J. (2010). Psychological flexibility as a fundamental aspect of health. Clinical Psychology Review, 30, 865–878.CrossRefGoogle ScholarPubMed
Kavanagh, A.M. & Broom, D.H. (1998). Embodied risk: My body, myself? Social Science & Medicine, 46(3), 437–444.Google Scholar
Kimble, M.A. & Ellor, J.W. (2000). Logotherapy: An overview. Journal of Religious Gerontology, 11(3), 9–24.CrossRefGoogle Scholar
King, L.A. & Hicks, J.A. (2012). Positive affect and meaning in life: The intersection of hedonism and eudainomia. In The human quest for meaning: Theories, research, and applications, 2nd ed. Wong, P.T.P. (ed.), pp. 125–142. New York: Routledge.Google Scholar
King, L.A., Hicks, J.A., Krull, J.L., et al. (2006). Positive affect and the experience of meaning in life. Journal of Personality and Social Psychology, 90, 179–196.Google Scholar
Kissane, D.W., Treece, C., Breitbart, W., et al. (2009). Dignity, meaning and demoralization: Emerging paradigms in end-of-life care. In Handbook of psychiatry in palliative medicine. Chochinov, H.M. & Breitbart, W. (eds.), pp. 324–340. New York: Oxford University Press.Google Scholar
Kruglanski, A.W. & Webster, D.M. (1996). Motivated closing of the mind: “Seizing” and “Freezing.” Psychological Review, 103(2), 263–283.Google Scholar
Langford, I.H. (2002). An existential approach to risk perception. Risk Analysis, 22(1), 101–120.Google Scholar
Lee, C.H. (2006). Effects of logotherapy with exercise on meaning of life, ego integrity and IADL in the elderly [summary only]. Taehan Kanho Hakhoe Chi, 36(5), 701–709.Google Scholar
Lee, V., Cohen, S.R., Edgar, L., et al. (2004). Clarifying “meaning” in the context of cancer research: A systematic literature review. Palliative & Supportive Care, 2(3), 291–303.Google Scholar
Lee, V., Cohen, S.R., Edgar, L., et al. (2006). Meaning-making intervention during breast or colorectal cancer treatment improves self-esteem, optimism, and self-efficacy. Social Science & Medicine, 62(12), 3133–3145.Google Scholar
Levinas, E. (1966). Totalité et infini: Essai sur l'extériorité. The Hague: Nijhoff.Google Scholar
Lukas, E. (2000). Logotherapy textbook: Meaning-centered therapy. Toronto: Li berty Press.Google Scholar
Maddi, S.R. (2012). Creating meaning through making decisions. In The human quest for meaning: Theories, research, and applications, 2nd ed. Wong, P.T.P. (ed.), pp. 3–26. New York: Routledge.Google Scholar
Maslow, A.H. (1970). Motivation and personality. New York: Harper & Row.Google Scholar
May, R. (1958). Existence: A new dimension in psychiatry and psychology. New York: Basic Books.Google Scholar
May, R. (1969). Love & will. New York: Norton.Google Scholar
May, R. (1975). The courage to create. New York: Norton.Google Scholar
Mils, J. (1997). The false dasein: From Heidegger to Sartre and psychoanalysis. Journal of Phenomenological Psychology 28(1), 10.Google Scholar
Moadel, A., Morgan, C., Fatone, A., et al. (1999). Seeking meaning and hope: Self-reported spiritual and existential needs among an ethnically diverse cancer patient population. Psycho-Oncology, 8(5), 378–385.Google Scholar
Morstyn, R. (2009). Merleau-Ponty and me: Some phenomenological reflections upon my recent bone marrow transplant. Australasian Psychiatry, 17(3), 237–239.Google Scholar
O'Connor, K. & Chamberlain, K. (2000). Dimensions and discourses of meaning in life: Approaching meaning from qualitative perspectives. In Exploring existential meaning. Optimizing human development across the lifespan. Ed. Reker, G.T. & Chamberlain, K. (eds.), pp. 75–92. Thousand Oaks, CA: Sage Publications.Google Scholar
Ott, M.J., Norris, J. & Bauer-Wu, S. (2006). Mindfulness meditation for oncology patients: A discussion and critical review. Integrative Cancer Therapies, 5(2), 98–109.Google Scholar
Park, C.L. (2012). Meaning and meaning making in cancer survivorship. In The human quest for meaning: Theories, research, and applications, 2nd ed. Wong, P.T.P. (ed.), pp. 521–538. New York: Routledge.Google Scholar
Plato, (2001). The collected dialogues of Plato. Hamilton, E. & Cairns, H. (eds.). Princeton, NJ: Princeton University Press.Google Scholar
Prager, E., Savaya, R. & Bar-Tur, Liora (2000). The development of a culturally sensitive measure of sources of life meaning. In Exploring existential meaning. Optimizing human development across the lifespan. Ed. Reker, G.T. & Chamberlain, K. (eds.), pp. 123–138. Thousand Oaks, CA: Sage Publications.Google Scholar
Pretz, J.E. & Sentman Totz, K. (2007). Measuring individual differences in affective, heuristic and holistic intuition. Personality and Individual Differences, 43, 10.Google Scholar
Reker, G.T. & Chamberlain, K. (eds.) (2000). Exploring existential meaning. Optimizing human development across the lifespan. Thousand Oaks, CA: Sage Publications.CrossRefGoogle Scholar
Reker, G.T. & Wong, P.T.P. (1988). Aging as an individual process: Toward a theory of personal meaning. In Emergent theories of aging. Birren, J.E. & Bengston, V.L. (eds.), pp. 214–246. New York: Springer.Google Scholar
Reker, G.T., Birren, J.E. & Svensson, C.M. (2012). Restoring, maintaining, and enhancing personal meaning in life through autobiographical methods. In The human quest for meaning: Theories, research, and applications, 2nd ed. Wong, P.T.P. (ed.), pp. 430–455. New York: Routledge.Google Scholar
Schneider, K.J. (2008). Existential–integrative psychotherapy. New York: Routledge.Google Scholar
Schnell, T. (2010). Existential indifference: Another quality of meaning in life. Journal of Humanistic Psychology, 50(3), 351–373.Google Scholar
Schroevers, M., Kraaij, V. & Garnefski, N. (2008). How do cancer patients manage unattainable personal goals and regulate their emotions? British Journal of Health Psychology, 13, 551–562.Google Scholar
Schulenberg, S.E. (2008). Logotherapy for clinical practice. Psychotherapy: Theory, Research, Practice, Training, 45(4), 447.Google Scholar
Scruton, R. (2014). The soul of the world. Princeton: Princeton University Press.Google Scholar
Sloterdijk, P. (2009). Du musst dein leben andern. Frankfurt: Suhrkamp.Google Scholar
Smith, J.E., Richardson, J., Hoffman, C., et al. (2005). Mindfulness-based stress reduction as supportive therapy in cancer care: systematic review. Journal of Advanced Nursing, 52(3), 315–327.Google Scholar
Sontheimer, K. (2005). Hannah Arendt: Der weg ein gross denkerin. München: Piper Verlag.Google Scholar
Soothill, K., Morris, S.M., Harman, J., et al. (2001). The significant unmet needs of cancer patients: Probing psychosocial concerns. Supportive Care in Cancer, 9(8), 597–605.Google Scholar
Spiegel, D., Bloom, J.R., Kraemer, H., et al. (1989). The beneficial effect of psychosocial treatment on survival of metastatic breast cancer patients: A randomized prospective outcome study. Lancet, 240, 888–891.Google Scholar
Steger, M.F. (2009). Meaning in life. In Handbook of positive psychology, 2nd ed. Lopez, S.J. (ed.), pp. 679–687. Oxford: Oxford University Press.Google Scholar
Steger, M. F. (2010). Experiencing meaning in life: Optimal functioning at the nexus of well-being, psychopathology, and spirituality. In The human quest for meaning, 2nd ed. Wong, P.T.P. (ed.), pp. 212–231. New York: Routledge.Google Scholar
Steger, M.F. (2012). Experiencing meaning in life: Optimal functioning at the nexus of well-being, psychopathology, and spirituality. In The human quest for meaning: Theories, research, and applications, 2nd ed. Wong, P.T.P. (ed.), pp. 212–231. New York: Routledge.Google Scholar
Svenaeus, F. (2000 a). The body uncanny: Further steps towards a phenomenology of illness. Medicine, Health Care, and Philosophy, 3(2), 125–137.Google Scholar
Svenaeus, F. (2000 b). Das unheimliche: Towards a phenomenology of illness. Medicine, Health Care, and Philosophy, 3(1), 3–16.Google Scholar
Taylor, S.E. (1993). Factors associated with meaning in life among people with recurrent cancer. Oncology Nursing Forum, 20, 1399–1407.Google Scholar
Tillich, P. (1952). The courage to be. New Haven: Yale University Press.Google Scholar
van Deurzen, E. (2008). Existential counseling and psychotherapy in practice. Los Angeles: Sage.Google Scholar
Visser, G. (1998). De druk van de beleving: Filosofie en kunst in een domein van overgang en ondergang. Amsterdam: SUN.Google Scholar
Visser, G. (2002). De vraag naar de zin van het leven. Wapenveld, 52(2), 15.Google Scholar
Visser, G. (2008). Gelatenheid: Gemoed en hart bij Meister Eckhart. Amsterdam: SUN.Google Scholar
Visser, G. (2014). Heidegger's vraag naar de techniek. Nijmegen: Van Tilt.Google Scholar
Vos, J. (2011). Opening the psychological black box in genetic counseling: A counselee-oriented, integrative approach on the impact of DNA-testing for breast and ovarian cancer on the lives of counselees. Ph.D. dissertation. Leiden: Leiden University.Google Scholar
Vos, M.S. & de Haes, J.C.J.M. (2007). Denial in cancer patients, an explorative review. Psycho-Oncology, 16, 13.Google Scholar
Vos, J., Craig, M. & Cooper, M. (in press). Existential therapies: meta-analyses of psychological outcomes. Journal of Consulting and Clinical Psychology. In press.Google Scholar
Wagner, J. (1995). Meditationen über gelassenheit: Der zugang des menschen zu seinem wesen im anschluss an Martin Heidegger und Meister Eckhart. Hamburg: Verlag Dr. Kovac.Google Scholar
Westerhof, G.J., Bohlmeijer, E. & Valenkamp, M.W. (2004). In search of meaning: A reminiscence program for older persons. Educational Gerontology, 30(9), 751–766.Google Scholar
Wilson, T.D., Lindsey, S. & Schooler, T.Y. (2000). A model of dual attitudes. Psychological Review, 107(1), 101–126.Google Scholar
Wong, P.T.P. (2010). Meaning therapy: An integrative and positive existential psychotherapy. Journal of Contemporary Psychotherapy, 40(2), 85–93.Google Scholar
Wong, P.T.P. (2012 a). Toward a dual systems model of what makes life worth living. In The human quest for meaning: Theories, research, and applications, 2nd ed. Wong, P.T.P. (ed.), pp. 50–69. New York: Routledge.Google Scholar
Wong, P.T.P. (2012 b). From logotherapy to meaning-centered counseling and therapy. In The human quest for meaning: Theories, research, and applications, 2nd ed. Wong, P.T.P. (ed.), pp. 666–695. New York: Routledge.Google Scholar
Wrathall, M.A. (2011). Heidegger and unconcealment: Truth, language, and history. New York: Cambridge University Press.Google Scholar
Yalom, I. D. (1980). Existential psychotherapy, Vol. 1. New York: Basic Books.Google Scholar
Yalom, I. D. (2008). Staring at the sun: Overcoming the terror of death. San Francisco: Jossey-Bass.Google Scholar
Yang, W., Staps, T. & Hijmans, E. (2010). Existential crisis and the awareness of dying: The role of meaning and spirituality. Omega: Journal of Death and Dying, 61(1), 53–69.Google Scholar
Young, J. (2002). Heidegger's later philosophy. Cambridge: Cambridge University Press.Google Scholar