Healing the Sick Person: an Existential Approach to the Art and Science of Psychiatry: The Person and the Anxiety of Meaninglessness

We are estranged from that which tells us who we are and why we are here. The anxiety of meaninglessness relates to a loss of ultimate concern which gives meaning to our activities, especially our struggles. We can endure anything when it has a purpose; without one we are unable to perform even the implest of tasks. Without a central purpose, we are driven from devotion to one object, to another  and another, as in each case we find either the meaning vanish or that what was a state of creativity, turn to indifference or aversion. The anxiety which arises, as the finite mind is met with paradox, is the result of the growing awareness of separateness and lack of universal participation.

Coming to consciousness, becoming oneself entails a self-affirming act on meeting one’s nonbeing. the encounter brings about a realization of separation; one  realizes one’s position as an individual participant within the whole. The anxiety is a barrier which, through the act of self-affirmation, is taken into oneself and thereby becomes the driving force urging the person to act heroically.

During infancy, one might imagine there being, in psychoanalytic terms, a state of primary narcissism. The person here is continuous with the larger structure and in a state of unconscious wholeness. This wholeness would be felt as good and eternal, it being an aspect of the creative self-affirmation of all existence emerging from the void. At birth the person is endowed with certain characteristics and a set of life circumstances. It is a pluripotential state from which one brings oneself into existence as one relates to what the fates bring.

The infant awakens to himself as a separate entity through hunger. His structure has to incorporate other structure be it material or psychological into itself. The psychophysiological event of anxiety that comes with hunger is the trigger and the core of the demands for food and affection.

The person develops into himself as a separate entity as he meets anxiety at each developmental level. At each stage he is met with the facts of his finitude and separation from the totality. He finds himself standing alone on his strength. Freud,Bowlby, Mahler, Klein, and many others have described what they see as occurring during the period of child development. The early history is clearly important as it forms the foundations of the personality and because one is usually never as weak and dependent on others.

 One becomes who one is, in the exercise of one’s will. The truth about oneself is revealed in one’s choices, in what one does. The choices may be limited: our freedom is finite. But it is freedom none-the- less to become what we will.

At times, in the course of one’s life, however, one may try to forge ahead heroically but is rendered impotent by the paradoxical quality of our finite existence. One’s efforts are not enough and meets oneself as weak, powerless, and insignificant. To avoid despair one is driven to find greatness in oneself or borrow it from a powerful other.

The fact of our existential position remains and emerges with the full force of anxiety and despair whenever it is reawoken by disappointment. As outlined by Self-Psychology, a fragmented, regressive state ensues as once again the illusion is seen through and the person attempts to retreat from the overpowering experience. Occurring in small increments however, the confrontation with one’s limits allows one the opportunity to overcome his condition in reality. Onecomes to a growing awareness of oneself. In one’s solitude one is also able to see the other, not as a mirror providing one with an image of oneslf, nor as a source of power and direction, not even as a twin who enables him to love and accept himself. In the end one is alone in being oneself not as an image or a role, not living on borrowed strength and love. One is the truth of one’s own will.

In terms of drives, we can understand the situation as involving the sublimation of prerational forces. There areyearnings within us that seek expression. The task in life might be seen as, not so much a refinement or redicection of these yearnings from their original aims, but rather the discovery and creation of rational objects to give them fulfillment.

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