Concepts of pathology, as treated by the traditions of clinical psychology and psychiatry, define what is ‘normal’ and ‘abnormal’ in human behaviour. Various psychological paradigms exist today, each emphasising diverse ways of defining and treating psyopathology. Most commonly utilised is the medical model which is limited in many respects, criticised for reducing patients problems to a list of pathological symptoms that have a primarily biological base and which are to be treated behaviourally or pharmacologically (Schwartz & Wiggins 1999). Such reductionistic positivist ways of viewing the individual maintain the medical discourse of ‘borderline personality’, schizoid’, ‘paranoid’ or ‘clinically depressed’, often failing to address the wider socio-
ltural environment of the individual. Pilgrim (1992) suggests that such diagnostic pidgeon-holing does not enhance humanity, nor aid those who are dealing with the distressed individual to find meaning. It also neglects to consider life beyond the physical, failing to address the more philosophical questions that abound from our very existence.
Existential psychiatry and psychology arose in Europe in the 1940’s and 1950’s as a direct response to the dissatisfaction with prevailing efforts to gain scientific understanding in psychiatry (Binswanger 1963). Existentialism is the title of a set of philosophical ideas that emphasise the existence of the human being, the lack of meaning and purpose in life and the solitude of human existence. Existentialism stresses the jeopardy of life, the voidness of human reality and admits that the human being thrown into the world, a world in which pain, frustration, sickness, contempt, malaise and death dominates (Barnes 1962). How one positions oneself in that world becomes the focus for existential notions of pathology, a responsibility that is present for
every human being, not one confined to the ‘mentally ill’. In this sense the human being is ‘response-able’ to the existential predicament that is life and the necessary struggles that arise through negotiating these conditions in every lived moment.
In this essay I will give a brief outline of the history of existential thinkers, then discuss how the existential challenge emphasises one’s freedom of choice of being-in-the-world and how ultimately one must take responsibility for how one reacts to the givens of existence. I will outline how these predicaments of life can precipitate anxiety, guilt, inertia and the loss of will; that facing the responsibilities to the ‘givens’ and choices in existence can cause ontological anxiety, a natural reaction to living authentically, and the problems incurred when one avoids tackling these predicaments and contradictions, thus living inauthentically or choosing to withdraw into a solitary world. The existential notion of pathology will be contrasted with that
of the positivist approach.
During the Second World War existentialism found it’s zenith of popularity, a time when Europe was in crisis, faced with mass death and destruction. Existentialism provides a moving account of the agony of being thrown into the world, perhaps appealing the times of intense confusion, despair and rootlesssness caused by the War and it’s aftermath. In the 19th century existential thought is found in the writings of Soren Kierkegaard (1813-1855), Friederich Neitzche (1844-1900), Fyodor Dostoyevoski (1821-1881) and later Jean-Paul Satre (1905-1980), all of whom were opposed to the predominant philosophies, and scientific dogmas, of their time and committed to exploring the experience of reality in a passionate and personal manner.
The birth of modern existentialism can be attributed to Martin Heidegger (1889-1976), who’s thinking was applied to psychiatry, psychotherapy and psychoanalysis by Karl Jaspers (1883-1969), Ludwig Binswanger (1881-1966) and Medard Boss (1903- 1990). The movement attempted to gain a sense of the subjective phenomena of mental illness using existential concepts (Owen 1994). In America psychotherapists May and Yalom (1984) formulated their unique type of existential psychotherapy, as did Frankl (1963) in Austria
th logotherapy, and also Laing (1960), working with schizophrenics, in the anti-psychiatry movement in Britain.
Ironically many of the writers celebrated as existentialists deny to be grouped together as one school of thought, agreeing wholly on all concepts, thus a diverse collection of tenets are represented under the umbrella of existentialism.
Arising from a deeply philosophical root of ideas existentialism explores the experience of existence, asking what does it mean to be in this world. Concerned with ontology, rather than aetiology, existential theorists avoid