SEVEN PAPERS ON EXISTENTIAL ANALYSIS ... - Wagner College

Existential Pathology and Therapy
Like nearly all terms in psychiatry and clinical psychology, the term 'pathology' is borrowed from
medicine. Pathology implies a lesion of some sort. Yet nothing is dysfunctional when someone's
world changes. In and of itself, the new world has nothing positive or negative about it, because
in general, the things that comprise one's world are not objects of valuation. The effects of an
accident or physical illness will also introduce changes which also affect one's existence, but
only, in the first place, by way of their influence on the body one has. All the same, I will retain
the expression "existential pathology" to characterizes the change in world that causes a person
to suffer. A person becomes a patient when his world has changed, and in such a way that he
cannot appreciate it and therefore rejects it. The source of existential pathology is refusal of
world.
What can existential therapy mean? Perhaps someone, the patient, has gone looking for
an inner world and, assuming that he thinks he has found one, has elaborated a solipsistic illusion
of processes and structures to account for his experience. Most patients will have had at least
one such experience in traditional psychotherapy, or they will have become accustomed to
thinking in terms of intrapsychic events. In any event, the person suffers because his world has
changed and he cannot live in it. He may seek understanding of what has happened. Existential
therapy has no interest in modifying behaviour or bringing about change. It focuses, rather, on
how the patient understands what has already changed.
Existential Change
Existential therapy illuminates and confirms existential change, that is, that change in the
patient's world has occurred and how it has changed. Why the patient's world has changed
may be of great interest, but it is not an issue of existential therapy.
What does a change in world mean? Again, allow me to revert to the first-person. My
existence is always at play, but ordinarily the lineaments of my world remain fairly stable. I seem
to see that things are more or less the same day after day. The determinacy of things is for the
most part steady and their use remains more or less fixed. But when, for example, I am
unexpectedly visited by a friend whom I have not seen for a long time, the world changes
entirely; or I am married or am confirmed in a religious rite; or I am told I have cancer or that my
mother has died; or I am fired from my job or I realize I have gotten old; or I am awarded a Ph.D.
or realize I don't love my wife any more . . .. I may welcome the new world and accept it. In
instances of existential pathology, however, I refuse the changed world. My lived time is so
dramatically different that I do not know what time it (the world) is or, better, I do not know what
time I am. It may take me hours, weeks or years to fully grasp what has changed.
It is my view that the period of gradual understanding of the change of one's world has
been mistaken for a slow process of change. On analogy with physical growth and maturation,
psychologists have called this development, which they have contrasted with deterioration or
involution. Existential psychology challenges the notion of development, which, like so much in
modem psychology, is based on the Cartesian model of physical structures, and organic
functions and processes. Of course, my world is always changing in small, indiscernible ways, but
as in the examples given above, it may change dramatically all at once, and during the period
that follows, I come to understand what has changed – or I do not, and there is an instance of
existential pathology. It is clear that my world may change as a result of bodily processes or an
accidents, but it also changes in ritual and sacrament, in conversion or change of belief
(religious, moral or political), and in so-called mystical experiences. Existence may also change
in existential therapy.