Purpose If medicine is to treat the whole person, existential issues are critical sources of suffering that must be addressed. Yet there is no agreed-upon standard for what issues qualify as existential suffering. Clinicians who understand the overarching concept of existential suffering are better able to recognize how existential suffering is experienced and expressed, which facilitates an appropriate response. The purpose of this paper is to synthesize how existential suffering is conceptualized and defined across four disciplines to demonstrate through a case example how existential suffering is experienced and how it manifests.
Methods We reviewed literature from philosophy, psychology, theology, and medicine to identify what constructs are central to and define existential suffering.
Results The following typology characterizes the major domains of existential suffering.
Meaning The human condition requires meaning, yet there is no inherent meaning to the world. We identified four subdomains of meaning that convey how persons construct and derive meaning: Purpose: The understanding of role and how it contributes to one's sense of meaning; Responsibility: For one's past, current situation and the maintenance of one's values; Hope: Hope relates to the ability to find a reason for continued existence; Absurdity: The experience of life without meaning, often demonstrated by life's randomness.
Freedom An essential feature of the human condition is to be free and make choices that direct and control one's life. Losing this freedom due to disability and death can cause suffering.
Isolation The experience of an unbridgeable gap between one's self and the rest of the world.
Death The fear of annihilation, at some level, gives rise to all of existential suffering.
Case Example A hospitalized 40-year-old woman with late-stage HIV was evaluated for her inability to walk and urinary incontinence. During the examination she asked, “Will I be this way forever?” She was tearful and complained that no one would tell her what was going on and that she was very scared. She is concerned that she won't be able to go home to the job she left. In this brief example we see evidence of existential concerns regarding freedom, purpose, and isolation. This case will be discussed in greater detail.
Conclusions Understanding the nature of a person's suffering leads to the appropriate therapy. Physicians can help by initiating the conversation, eliciting and attending to elements of existential suffering, and offering therapy or referring to therapists or chaplains for support.
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