The Case for Viewing Mental Health Through an Existential Lens
Why am I here?
What is the meaning of life — my life?
Despite our many differences, this existential crisis is one state we all share. No matter how well we inhabit the material world, we all suffer from a universal anxiety which is a byproduct of our meaningless existence. Every existential philosopher, from Kierkegaard to Nietzsche to Sartre, agreed we are born with no purpose and hence, are bound to feel anxious.
In a darker analogy, we may think of our lives as a small streak of wakefulness existing between a deep sleep in our mother’s womb to finally going back to an endless sleep when we die. In between, as we are awake now, lies a timeline of conflicts between our state of ‘being’ and its assured end, which gets befogged with more comprehensible conflicts relating to relationships, work, love, and health.
The idea of being truly alone in the world, the purposelessness of life, and the inevitability of death act as reminders of the many unfinished businesses we may have and create a vacuum that we avoid by ‘keeping ourselves busy.’ However, the deep-rooted bio-social desires of living in harmony with others, and with ourselves, exist in every person. When these aims are pummelled by existential conflicts such as death, loneliness or hostility — anxiety, often amplified by external factors, ensues and becomes pathological — a symptom.
Existential psychology, then, views mental health distress as a natural response to this amplified anxiety. In his work with people with a range of issues such as depression, personality disorders and terminal illnesses like cancer, Dr. Irvin D. Yalom, a pioneer in existential psychotherapy, noted a distinct pattern common to all his patients. He found that each person who came to therapy — behind their presenting complaints — shared a longing to have and maintain meaningful and nurturing relationships with others. Instead, they often ended up using their interpersonal relationships as a shield against deeply rooted existential anxieties.
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Largely speaking, these existential anxieties follow us throughout our lives: isolation — the tendency to realize that we enter, inhabit and leave the world alone; freedom — that we are bound to be free of any structure and are solely responsible for the choices we make; meaninglessness — our constant search for coherence and purpose to fill our voids; and lastly, the obviousness of our death. Underneath our regular lives, we are always subconsciously trying to fight these conflicts while making sense of our existence.
Caught in the ubiquity of this dread and meaninglessness, we harbor an innate capacity to create our own meaning, noted Austrian existential psychologist and a survivor of the Holocaust, Viktor Frankl, in his memoir, Man’s Search for Meaning. During his time in Nazi concentration camps, Frankl witnessed the execution of his own family and a debilitating state of humanity.
He described in the memoir how even in the most horrifying environment and in the face of foreseen death, it was the survivors’ capacity to induce meaning in their lives that kept them striving on. Even though their identities had been physically and psychologically stripped off, propaganda couldn’t snatch away their will to make a choice.
It was this very will Nancy had to learn to exercise when she found herself on her therapist’s couch with dysfunctional relationships and bouts of generalized anxiety disorder — she didn’t know that the cause filtered down to an existential crisis. “I was anguished, but I could never understand the reason behind my mess. I felt worthless and hopeless,” Nancy says. In therapy, Nancy and her therapist worked together to gain illuminating insights into her pain. “The thing that I really liked about my therapist’s approach was that she always viewed my symptoms, not as something negative, but valid responses to the ‘threat to my existence,’” she says.
“We worked together on my anxiety attacks and traced it back to the absence of meaning in my life. I wasn’t happy because I wasn’t doing what truly made me happy,” Nancy adds. Over the course of six months, her therapist used an existential approach to help her cultivate this awareness into Nancy and to face concepts such as meaninglessness and isolation. “Understanding my own fear of having an unfulfilling life helped me overcome this emotional turmoil,” she says, reflecting that what was important for healing was to maintain a balance between acknowledging ‘gaps’ in meaning in her life and creating her own meanings to fill them.
Like Nancy, many experience mental ill-health because of dangers — represented by panic attacks, suicidal ideation, depressive episodes — posed to their ‘being in the world,’ their larger motive of staying alive and thriving. But since we do not register such triggers as existential threats, our minds respond to them with ‘sickness.’
The theory that mental illnesses are solely ‘brain disorders’ remains debatable to this day; the existential perspective poses strong arguments against it. It views anxiety as a normal emotional response to the fundamental and shared crisis which is underneath the variety of disorders that we observe.
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For example, post-traumatic stress disorder can be seen as a vicious attack on a person’s being. Trauma represents an assault on the person’s right to live and shatters their experience of their place in this world. As a result, they develop symptoms of avoidance, severe anxiety, nightmares and/or flashbacks, all as a response to this assault. Relatedly, in his book, Sanity, Madness and the Family, Dr. R.D. Laing, a pioneer in schizophrenia research, concluded that schizophrenia, if seen ontologically, is nothing but a defense invented by the patient to live in an unlivable world.
Such a perspective creates a necessity for the emergence of an approach like existential psychology. It looks at people well beyond their presenting symptoms due to the underlying assumption that we are all engaged in a constant battle with concerns central to our existence. Existential psychotherapy, therefore, nurtures an outlook that views a person in human terms, in terms that relate to their being, rather than behavioral expression. The ultimate goal of therapy is to make the person resolve existential conflicts that are translated into their ‘symptoms.’
Komal Kaira, a Navi Mumbai-based psychotherapist who uses an existential approach in her work, explains this process: “We are pattern-seeking animals and we do so to make sense of the world around us. Parallel to it lies making meaning out of them. The goal of therapy is to make people realize their freedom to make their own meanings and choices.” And, to do so, Kaira attempts to dig deeper into her clients’ psyches. “While some usual therapies work on the surface level by changing the person’s irrational thoughts and beliefs, using an existential approach requires me to get past the person’s presenting complaints and explore how their existential inquiries got converted into these signs,” she explains.
“The choice to explore this perspective often depends on the client, although I still like to explore concepts like death anxiety with all my clients. It gives them a way to find out what truly matters to them and how they would like to lead their lives,” Kaira adds. “It leaves an impact on me, too. Working with existentialism brings about our own confrontations with issues, as we (therapists) are not immune to it. And so it helps us reach a genuine level of empathy with the client, and what better element is there to effective therapy.” Yalom considers the role of the therapist as depowered, referring to the client-therapist relationship as “fellow travelers” in this journey. There are no techniques, no authority, no advice — just an effective therapeutic relationship based on empathy and a non-judgmental attitude.
No one is spared from existential dilemmas, but we are free to take a stand against them. Struggling with such conundrums, we tend to deny reality, deny death, by creating our own defense mechanisms — building an idealistic image of ourselves, engaging in compulsive behaviors or becoming a workaholic. These defenses may tone down the existential anxiety but also reinforce its permanence and imminent emergence. Awareness, and then the confrontation of such conundrums, through the determined creation of meaning nurses healing, or as Yalom puts it, “though the physicality of death destroys us, the idea of death saves us.”