In this opinion piece, Emily Scanlan suggests that psychologists should be open to using ideas based around philosophies like existentialism, when treating patients. These ideas should also be given more prominence for psychology students, she says.
When I hear some of my clients talk about depression, I find myself standing in a desert. It looks red and hot with burning sand and sharp winds. There is nothing in this place but despair. Nothing will grow here.
I sat with one of these clients just this week.
“Is it so bad to wish that my life had meaning?” the client asked. “All I wanted was to contribute something but everywhere I turn people are motivated by greed and ego. The world isn’t interested in my ideas. I spend all my energy coping with the pain of rejection.”
This client is male, highly intelligent and sensitive. He’s been trying to build a charity. He sees this work as his “calling”, but it’s been a long time since it bore fruit. He has a resounding thought: “I don’t belong here.” This client in the desert could be understood as the “existential client”. He wants to find meaning in his life or give up on it altogether.
Here’s the problem: many psychologists make it through to registration without substantial training in philosophy-based questions around meaning and purpose. This can mean that clinical psychologists are maybe too careful of going beyond the bounds of what is measurable and statistically valid. Yet this is exactly where the existential client needs to go.
It takes courage to endure this constant evolving but it may lead to finding a purpose or calling.
I am grateful for my studies in government at the University of Sydney which included ancient Greek philosophers such as Aristotle, Plato and Socrates. Sociology brought in the existentialists: Jean-Paul Sartre, Simone de Beauvoir and Friedrich Nietzsche.
This crew boldly asserted that nothing is for certain and meaning is what you make of it. Defining the existential approach is difficult as theorists disagree on much. Bridging it to therapy is even harder. However, the existentialists would agree with my client that yes, the world is meaningless, random and chaotic. Death is inevitable and its timing uncertain and anxiety provoking. In addition to these hardships, we are ultimately alone.
For a small number of clients this world view makes sense. Some philosophical enquiry about not finding a point to their lives can be deeply therapeutic.
The therapist can approach the existential angst with respect: “So you wanted there to be a point to your life. What did that look like?”
In the clinical setting, most clients are helped very much by cognitive behavioural therapy techniques that seek to name mental processes so they can be considered and treated. Here, my client might be said to have a tendency towards catastrophising and negativity bias.
But for the client in the desert, labelling his thinking in this way would be a further degradation in a world where he already feels misunderstood. His desire to understand the point of his life is real, not a glitch in his brain.
Fortunately, existentialism isn’t just brutal realism. It throws us a lifeline with the concepts of “authenticity” and “freedom”.
The authentic self is not predetermined by genes or roles (such as mother, engineer). Rather, Sartre says we are “condemned to be free”, which means we are perpetually having to rechoose or recommit ourselves to who we are and what we do. We create our own meaning through relationships, spirituality, work, even connection with the Earth (such as gardening or harvesting).
It takes courage to endure this constant evolving but it may lead to finding a purpose or calling. It also provides hope and resilience that can be life sustaining. As Nietzsche puts it: “He who has a why to live can bear almost any how.”
A connection between resilience and existential meaning has also been found by researchers Mascaro and Rosen (2005) from the Department of Psychology at Texas A&M University, in the United States. Their study of a non-clinical young adult population reported that individuals with high levels of meaning tend to have fewer symptoms of depression, are more stable and more motivated.
Earlier this year, the University of Sydney Alumni Council asked me to talk to the veterinary science students about mental health.
The faculty was interested in ways to build resilience in this highly intelligent group, many of whom felt they had a calling to work with animals but were unprepared for the pressures of the profession. Many struggled with depression in the early stages of their career.
Professor James T Webb, who founded Supporting Emotional Needs of the Gifted , observed existential depression to be more common in very bright children and adults. He says they can be “intense, sensitive, idealistic, and this can help them create good things”. However, he adds: “This can also lead to frustration, disillusionment and unhappiness.”
Webb found that this cohort benefits from an exploration and strengthening of meaning “so that they do not feel alone and helpless in a world that seems so paradoxical, arbitrary, and even absurd”.
Universities offer subjects to students from all disciplines that encourage philosophical inquiry into meaning and purpose. The University of Sydney incorporates discussion of these ideas into its broader study units. Internationally, Harvard, Stanford and Pennsylvania University offer these subjects as part of a movement towards positive education (emphasising individual strengths and personal motivation to promote learning).
It’s my hope that as existential theory gains traction in tertiary institutions, in particular the health and science faculties, clinical psychologists will embrace these ideas and include them more easily in their practice. Certainly, I believe that the existential can, in some cases, both complement and deepen other treatment models.
When I recognise the existential client in front of me, I feel a heavy sense of responsibility. This person wants desperately to make a contribution. Their experience of depression is crippling them and the world is all about rejection.
“The way you describe your life right now, it feels like it has become a desert,” I say. “I hear you telling me you are tired and you want out. I will stay with you on this journey but you must keep walking. Slowly but surely there will be shoots and soft green leaves and sprays of colour and you will find yourself waking up in a place that you want to be in.”
Emily’s ideas struck a chord with many of our readers. Here are some of their responses.
Nice to read something for a change not merely praising the University's researching at the frontiers of effective science and implementing the leading, bleeding edge of efficient technology. To my mind, philosophy is needed today more than ever as an indispensable corrective to the tunnel vision of the modern scientific mind-set.
Emily Scanlan skips over mentioning that, besides the famous Sartre and, to a lesser extent, de Beauvoir, there are other important initiators of an existential orientation in philosophical thinking, including Sören Kierkegaard, Karl Jaspers and Martin Heidegger. Indeed the latter two, as philosophical friends in the 1920s, were protagonists of an existential philosophy in Germany long before Sartre took up their lead -- giving, of course, a different interpretation.
Dr Michael Eldred (PhD ’84 MSc ’75 BSc Hons ’74)
As a psychologist and careers coach/counsellor, I regularly check out the meaning of work with my clients , so it is refreshing to hear another psychologist raise these matters. Often it’s the meaning of life too and although I don’t quite go to Emily’s philosophical depths, I am certainly aware of them.
Thanks Emily - this was a joy to read and I have already passed it on to some clients and my intern psychologists.
Ann Wilson (BA ’62) Member Australian Psychological Society (MAPS)
This spoke to me very strongly, since I had been a Philosophy student in my undergrad and postgrad years at three universities, ending up at Sydney in 1991.
My experience of depression, long undiagnosed, but finally recognised in 1996 with the beginnings of treatment by several GPs, psychologists and a psychiatrist that year, was definitely one of a bewildering loss of purpose despite being in a truly wonderful relationship and having a secure permanent part time job in the public service.
Recovery took a very long time, after a new psychiatrist in a different city recognised that the depression was "tripped" into bipolar disorder, and changed my medication in 2009.
Meaning and purpose have returned, along with happiness and gratitude for being alive.
Romaine Rutnam (PhD ’91)
Thanks for such a lucid and concise discussion bridging depression and existentialism; an unexpected fresh spring day!
Caroline Langley (BSc ’80)
I agree with Emily Scanlan that much can be gained for clients and psychologists when working within an existential orientation. Although what this orientation is exactly seems difficult to define. Perhaps even more so, when compared to cognitive behavioural approaches, which appear to possess clearly delineated therapeutic steps.
Although Ms Scanlan writes of the 'existential client', is there an additional question? How to incorporate an existential approach with each client?
As Irvin Yalom has suggested, practitioners understand that clients' realisation of finiteness often engenders a change of perspective. Research indicates that the therapeutic alliance (relationship) contributes greatly to change. Clients are often afflicted by choice and the responsibility this brings, and the majority of clients are seeking better understanding of and meaning in their lives.
Clients come to psychologists for a myriad of reasons. Perhaps as psychologists, we are already involved in 'the existential angst' without always being aware of it.
Stewart Stubbs (MHlthSc(ChildAdolHlth ’09) Member Australian Psychological Society (MAPS)
I just wanted to say how good it was to read Emily's piece on the need for a more philosophical approach in psychology. I'm in my sixties now so have been doing this for a very long time. When I was a baby psychologist I loved the idea of formulae and recipes for counselling. As time has worn on though I find myself more and more aware that the standardized evidence-based therapies we are currently using treat are no panacea. Yet they are sold to doctors as if they were. I often get referrals for a patient to have Cognitive Behaviour Therapy (CBT), not counselling, as if CBT is the only thing a psychologist can do. I say to them, antibiotics are terrific, but is that the only thing you do with patients?
The religion of CBT and evidence-based therapy rules our lives, and I think it fails a great many patients. I seem to get a lot of people who have tried it all but have not found relief. I now take a more existential approach and the work becomes alive and relevant all of a sudden. I now have the great pleasure of working with a young musician for whom I have been struggling to develop an alternative way through persistent and treatment-resistant anxiety. He's responding well, but my greatest delight was when he told me at the end of a session that "we're jamming!". I love that as a descriptor for the work we do. He meant we are making something good together. Jamming... making a piece of music together that is unique and relevant and is contributed to by both of us.
Our problem is that only certain sorts of therapeutic work are capable of being standardized and given a gold standard evidence base. So we are missing out on lots of great opportunities and directions for development as a profession.
Dr Suzanne Alder (MM PainMgt ’09) (MAPS)
In her recent article in SAM (‘On My Mind’, Issue 3, Sem 1, 2016), psychologist Emily Scanlan expresses a hope that existential therapies will “gain traction” in clinical practice. She suggests that “training in philosophy–based questions” should be included in postgraduate clinical course work, asserting that “many psychologists make it through to registration without substantial training in philosophy-based questions around meaning and purpose. This can mean that clinical psychologists are maybe too careful of going beyond the bounds of what is measurable and statistically valid. Yet this is exactly where the existential client needs to go.”
I argue that, conversely, existentialism’s tenets and concepts are pernicious to psychotherapy because of their fundamentally anti-scientific nature, and I present my objections here in reply (pdf).
Megan F McDonald (BA '86)
I really appreciated this article as it’s a topic rarely talked about. A spiritual faith or perspective on life gives it meaning and personal courage to accept our role. As a sensitive person who has suffered serious clinical depression in the past, I can really empathise with Emily’s client. Talking through issues is so much more effective than medication in treating depression (in my opinion). How wonderful to have a psychologist such as Emily who recognises that! Resilience to bounce back from rejection is not given to all of us from birth or through our upbringing but it can be developed with a positive attitude. It took me very many years to overcome my tendency to get depressed - it’s hard but possible.
(Name withheld by request)
Photography by Nuran Zorlu