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

The anxiety of guilt can be seen as an offshoot of the anxiety of death in that the person’s actions may have consequences leading to her annihilation. It is not only the fates that determine the course of a person’s life but also her decisions, her actions. It is through the person’s actions that she becomes who she is. The peron is her life; this is the only life that person can have. Will she be able to create a life with meaning or one which she would rather have not lived? The burden of the universe is on one’s shoulders. There is more at stake than deciding on the validity of a value, it is one’s own concrete existence that is on the line.

Because life is concrete, because it is real, one may find at times that one is called upon to go against the universal norm. Life can be profoundly ambiguous, especially in those situations that matter most. In such circumstances one is never sure wether one is choosing for life and fulfillment or succumbing to some destructive influence. One may be compelled at times, in full appreciation of the ethical choice, to make an exception. There are times when rival goods make any choice result in evil. There may be so much to lose and one’s motivations so unclear that one is forced out of one’s ethical system. One is compelled to act outside the rules because they do not capture the truth about the concrete situation of oneself. One acts in an expression of pure will, fully responsible but having nothing to appeal to as a defense against condemnation. This in fact is our existential condition. It is our individual life that is at stake; it is our happiness. Perhaps the anxiety would not be as great if we didn’t know who we were, how we have acted. One’s past, if not one’s present, reveals the power one has over one’s destiny; given the ambiguity of existence, how is one to act with the totality of one’s being? It is so much easier to escape into self-righteousness or, conversely, lawlessness.

In the end who is there to convince? Who is it that one is trying to justify oneself to? Who is it that is sitting in judgement and hears the appeals to the Bible, Cosmopolitan, one’s parents or society?

The person creates his life; given the reality of ambivalence, can he ever be happy with what he, out of his circumstances, has brought into existence? Can he accept this?

The person is a paradox which is reflected in his will which drives him in separate directions. The  awareness of this condition is the experience of guilt. In affirming himself with the totality of his being, he takes on the nonbeing inherent in the act of becoming who he is. In being himself he accepts himself.

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