Anticipatory grief: an existential model for spiritual care

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<ul><li><p> Int. J. Appl. Psychoanal. Studies 7: 143151 (2010)Copyright 2010 John Wiley &amp; Sons, Ltd DOI: 10.1002/aps</p><p>International Journal of Applied Psychoanalytic StudiesInt. J. Appl. Psychoanal. Studies 7(2): 143151 (2010)Published online 13 April 2010 in Wiley InterScience(www.interscience.wiley.com) DOI: 10.1002/aps.237</p><p>Anticipatory Grief: An Existential Model for Spiritual Care</p><p>ALAN E. GATEWOOD</p><p>ABSTRACT</p><p>This project sought through spiritual care, demonstrated in an intentional small group process, to promote theological refl ection about meaningful living. The desired effect was to know the fact of ones death to be an impetus for life.</p><p>Methodology entailed determination of issues the participants wanted addressed as well as delineation of the mechanics of the phenomenon of anticipatory grief. The project showed a positive correlation between a constructive sense of anticipatory grief and a sense of meaning for life. Copyright 2010 John Wiley &amp; Sons, Ltd.</p><p>Key words: anticipatory grief, existential model, spiritual care</p><p>INTRODUCTION</p><p>This project is an attempt to propose a model for Spiritual Care based on Existential Philosophy, Theology, and Psychology. It is this writers contention that this model may provide parishioners a way to get at their anxieties and work through them with a sense of meaning for life that will give them courage for their living. Anxiety is the proper starting place.</p><p>Martin Heidegger has noted that the characteristics of everyday existence are to be described in terms of our feelings (1962, p. 108). Everyday existence is permeated by some mood: fear, anxiety, joy, tranquility. Feeling is the funda-mental mode of existence, and anxiety is the fundamental feeling for Heidegger, precisely because it is directed toward our being-in-the-world as such. That is why anxiety is more fundamental to human existence than fear. Fear is always defi nite. Anxiety, conversely, results in an existential vacuum the threat of non-being.</p><p>Irvin Yalom asks a similar question, How can we combat anxiety? He then answers, By displacing it from nothing to something (1980, p. 43). This then is the work of anticipatory grief. By raising awareness of the dynamics of antici-patory grief, one can make something to really fear something specifi c, identifi -</p></li><li><p>Gatewood144</p><p> Int. J. Appl. Psychoanal. Studies 7: 143151 (2010)Copyright 2010 John Wiley &amp; Sons, Ltd DOI: 10.1002/aps</p><p>able and therefore something to deal with at last. The alternative to this awareness of something is the dread of nothing which thrusts one into the existential vacuum. There one has no constructive work to do, no meaning or joy can be discerned for living. Nevertheless, by introducing the dynamics of anticipatory grief, one can begin to build meaningful living and dying. Viktor Frankls logotherapy assumes three senses of meaning: (1) freedom of will, (2) will to meaning, (3) meaning of life (1967, p. 2). This writer will present a case for using Frankls logotherapy for creating meaning in spiritual care.</p><p>PSYCHOLOGY, DEATH AND EXISTENTIALISM</p><p>Viktor Frankl</p><p>In the sense of dramatic experience Viktor Frankl epitomizes existential psycho-therapy. Drawing on his personal experience as a prisoner in the concentration camps of Dachau and Auschwitz, Frankl has a special sensitivity to the spirits confrontation with suffering, death and meaning. It should come as no surprise that he stresses that one can transcend suffering and fi nd meaning in life beyond self. Frankl fi nds most folk are self-absorbed . . . so concerned for self that they cant see anything beyond self to give value or meaning to self (1967, p. 46). This self-absorbtion is the major obstacle to therapy. Frankl practices a special technique derefl ection to divert a patients gaze away from self. The technique is simple in principle and consists of little more than telling the patient to stop focusing on self and to search for meaning outside of self.</p><p>Frankl is a philosopher, psychiatrist and some might say, a moralist. His logotherapy is, as the name implies, an intricate philosophy theory. Logotherapy is not indicative of any word but of the word meaning. It is based on an explicit philosophy of life. More specifi cally, it is based on three fundamental assumptions which form a chain of inter-connected links: (1) Freedom of Will </p><p>Man is not free from conditions . . . But he is and always remains, free to stand toward these conditions; He always retains the freedom to choose his attitude toward these conditions; he always retains the freedom to choose his attitude toward them. (Frankl, 1967, p. 5)</p><p>This ability to detach from self vis--vis ones condition is termed by Frankl the noetic (spiritual) dimension.</p><p>(2) The Will to Meaning The more a man aims at pleasure by way of direct intention, the more he misses his aim (Frankl, 1967, p. 14).</p><p>In this way Frankl argues against Freuds basic laws of motivation, the homeo-stasis principle. The pleasure principle acts to maintain homeostasis and has as its fundamental goal the removal of tension. Frankl believes the homeostasis theory fails to explain many central aspects of human life. What one needs, says </p></li><li><p>145Anticipatory grief</p><p> Int. J. Appl. Psychoanal. Studies 7: 143151 (2010)Copyright 2010 John Wiley &amp; Sons, Ltd DOI: 10.1002/aps</p><p>Frankl, is not a tensionless state but rather a striving and struggling for some worthy goal (1963, p. 166). The truth is, for Frankl, that the pleasure-principle view of human motivation is always self-defeating. The more one seeks happi-ness, the more it eludes one. It is to this concern Frankl says, Happiness ensues; it cannot be pursued (1967, p. 146).</p><p>(3) The Meaning of Life While no logotherapist prescribes a meaning he may well describe it . . . in short our task is to resort to a phenomelogical inves-tigation of the immediate data of actual life experience (Frankl, 1967, p. 15). An important element of this third assumption is that even in a situation where man is deprived of both creativity and receptivity, he can still fulfi ll a meaning in his life (1967, p. 17). It is precisely when facing such a fate, when being con-fronted with a hopeless situation, that man is given a last opportunity to fulfi ll a meaning to realize even the highest value, to fulfi ll even the deepest meaning and that is the meaning of suffering.</p><p>Frankl is aware of the many clinical issues, yet he maintains in all his work a singular accent on meaning in life. When Frankl speaks of the existential vacuum, he refers to a state of meaninglessness; and when he speaks of therapy, he refers to the process of helping a person fi nd meaning. I appreciated Irvin Yaloms articulation of Frankls will to meaning as the guiding principle of the mature adult. Yalom says, Frankl is careful to distinguish between drives (for example, sexual or aggressive) that push a person from without, and strive that pulls a person from within (1980, p. 445). Stiving indicates that one is oriented toward something outside of self (self-transcendent). Also it indicates that one is free free to accept or deny the goal that is before us. To strive is to the future as opposed to the drive from relentless forces behind one (past, present). Meaning is essential for life, Frankl claims. That is an existential decree for this man that transcended the prison camp at Auschwitz.</p><p>Though Frankl stresses that each individual has a meaning that no on else can fulfi ll, these unique meanings fall into two categories: (1) what one accom-plishes or gives to the world in terms of ones creations, and (2) ones stand toward suffering, toward a fate that one cannot change. These meaning systems can be called creating experiential and attitudinal. Of these two, it is the second that stands as distinctive among other therapies and even among some existential psychotherapists.</p><p>Frankls personal life experiences in Auschwitz demanded that he think deeply about the relationship of suffering and meaning. This experience gives his words special power and credibility. Survival in such extreme circumstances would seem to depend upon ones being able to discern meaning in ones suffer-ing. Frankl speaks of meaning coming from a childs photograph, the memory of a wife, a yet to be completed manuscript that could help others fi nd meaning (1963, p. 57). A common saying today is Suffering can make you bitter or better. That captures Frankls spirit. Even fi nally, when there is no hope of escape from suffering and death, Frankl says that there is meaning in demonstrating to others, to God, and to oneself that one can suffer and die with dignity (1963, </p></li><li><p>Gatewood146</p><p> Int. J. Appl. Psychoanal. Studies 7: 143151 (2010)Copyright 2010 John Wiley &amp; Sons, Ltd DOI: 10.1002/aps</p><p>p. 21). There is hope against hope for meaningful living in the experience of death.</p><p>Frankls logotherapy has two basic techniques: (1) De-refl ection, which was alluded to earlier, is intended to counteract the compulsive inclination to self-observation. Frankl cautions that such ignoring or de-refl ection can only be attained to the degree to which the patients awareness is directed toward posi-tive aspects. (2) Paradoxical intention which consists of reversal in the patients attitude toward his symptoms and enables him to detach himself from his neu-rosis. Here the patient is asked to experience and exaggerate (hyperpole and humor are essential ingredients for paradoxical intention) ones symptoms. This technique helps one detach oneself from ones symptoms; it allows one to view oneself dispassionately, even humorously; above all, it allows one to appreciate that one infl uences in fact, even creates ones symptoms.</p><p>These two techniques are applicable even in the dread of death. For, even in the anticipation of death, life does not lose its meaning; for this meaning does not consist in preserving anything for the future, but rather storing it in the past (Frankl, 1963, p. 84).</p><p>Again one must ask, does death then completely cancel out meaning? No. Frankl explains: As the end belongs to the story, so death belongs to life. If life is meaningful, then it is so whether it is long or short (1967, p. 128). Further pursuing Frankls metaphor, one would have to testify to the power of a short story. Also one must admit to the impotence of a meaningless voluminous work. The simple truth is life is fi nite and death is the limit of that fi neteness. It is then not the quantity but the quality of life, lived toward death, that deter-mines meaningful living.</p><p>Death is a limit of fi nite being. One is not free from the conditions of fi ni-tude therefore, the dilemma of death. But, says Frankl, he is and always remains, free to take a stand toward these conditions; he always retains the freedom to choose his attitude toward them (1967, p. 82). One is free, for Frankl, to rise above the plane of somatic existence. At this point a new dimension can be determined one can enter the dimension of the noetic (spiri-tual). Here one becomes capable of taking a stand not only toward the world but also toward oneself. In short, writes Frankl, we interpret man in terms of a being capable of detaching himself from himself, leaving the plane of biologi-cal and psychological, passing into the space of the noological. In a stronger still statement, Frankl asserts that human existence is, in its essence, noetic. This is a crucial issue for Frankl, for transcending oneself signifi es the very act of existing. This tension between self and self-transcendence is what Frankl calls noodynamics. Noodynamics, claims Frankl, leaves to man the freedom to choose between fulfi lling or declining the meaning that awaits him. This tenet means that existence is authentic only to the extent to which it points to something that is not itself. Thus for Frankl, being human cannot be its own meaning. Frankl then concludes this case with words familiar to Scripture, One fi nds himself only to the extent to which he loses himself in </p></li><li><p>147Anticipatory grief</p><p> Int. J. Appl. Psychoanal. Studies 7: 143151 (2010)Copyright 2010 John Wiley &amp; Sons, Ltd DOI: 10.1002/aps</p><p>the fi rst place. Nevertheless, again one may ask, what of death? (Frankl, 1967, pp. 134138).</p><p>Even through death, life does not lose its meaning for Frankl. Logotherapy centers on issues such as dying and suffering. This need not give it a pessimistic black eye, for essentially, what we deal with is an optimistic position; namely, the potentially meaningful (Frankl, 1967, p. 87). Logotherapy helps one con-front (not try to escape) pain, death and guilt the tragic triad of human existence. These three are inescapable in the human condition and the more one tries to deny them, the more one entangles oneself in additional suffering. One exercises freedom from the triad by becoming responsible (response-able) and by being open to the noological.</p><p>What works against the will to meaning is the penultimate concern, the will to pleasure. Of this conceptual drive, developed and articulated by Freud, Frankl says, Pleasure is primarily and normally not an aim but an effect, let us say a side effect (1967, p. 146). In other words, pleasure establishes itself auto-matically as soon as one has fulfi lled a meaning or realized a value. It is upon such statements that Frankl fi nally says:</p><p>The striving to fi nd a meaning in life is a primary motivational force in man. In logo-therapy we speak in this context of a will to meaning in contradiction to both the pleasure principle and the will to power principle. Actually pleasure is not the goal of human strivings but rather a by-product of the fulfi llment of such strivings; and power is not an end but a means to an end. (1963, p. 77)</p><p>What of Frankl and anticipation? Though he never speaks of anticipatory grief as such, Frankl speaks of striving and searching. These two are indicative of an intense and intimate involvement initiated by the individual. For Frankl, one is not driven by some instinctive drive, but one senses the signifi cance in striving. One is not pushed by something, but pulled toward something. Whereas one might merely expect pleasure as likely to come about, Frankl would, for this writer, anticipate meaning as taking place in the present to be open to that possibility, to live life with that freedom and openness is to live an authentic life of anticipation, For striving is to the future as opposed to the drive from forces from the past (Frankl, 1967, p. 84). One must strive to take a stand (it takes intentionality and vitality), but one can merely expect pleasure.</p><p>It is not for naught, this writer would argue, that Frankls original title, From Death-Camp to Existentialism, was changed to Mans Search for Meaning. To search (strive) is not to passively await something as likely to happen (expecta-tion), but to act on the possibility that something is in the process of coming or becoming (anticipation). For Frankl, one does not merely expect life to end, but one anticipates fi nitud...</p></li></ul>

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