Embracing the Mystery – Accepting the Unknown
Health and Sickness – The Search for Meaning in All the Chaos

The existentialist approach to psychotherapy known as Daseinsanalyse was founded in the early 1970s by the Zurich psychiatrist Medard Boss (1903–1990), who borrowed many ideas from the phenomenology of Martin Heidegger. A method for interpreting life stories, this form of psychoanalysis considers human health and sickness from the existentialist point of view. Rather than examining the symptoms of illness and classifying states as either healthy or sick, it combines philosophical and medical anthropology with phenomenological approaches, in an attempt to determine the structures and histories of human existence. Instead of asking: What is illness? the question here is: In what way or how does something make us sick? And how free and open does the individual feel in his behavior and in expressing authentic emotions toward this state of being?

The aim is therefore to uncover the fundamental ontological structures of existence, i.e., the possibilities every human being has at his disposal, whether healthy or sick. In principle, the original human state is seen as one of neediness and dependency on finding meaning in life. For man as a being hard-wired for understanding the world around him can’t help but transform historical experience into something meaningful, “coping quasi-hermeneutically in order to be able to live” (Hans-Georg Gadamer).

Our experience of the world is thus always bound up with our interpretation of it and with the attempt to illuminate existence. The burden of human existence, and at the same time what distinguishes it, is that the human as a finite being is open to the world, at once “guilty” and insecure, but that he also has open access to his own being and to shaping the course of his existence. Born naked into a world whose meaning is ultimately always in question, the human must lead a “finite” existence, and yet he can still wonder about the essence, the meaning of that existence. In this paradoxical basic human state lies the answer to the question of why the human cannot rest content in his mere existence.

In the Daseinsanalyse approach, the focus is not on a worldview or a specific philosophical direction, but rather on a “basic attitude” that sees our vulnerability to sickness as part of a wider knowledge of our belonging to a world ruled by natural laws. Despite all the medical, psychological and psychotherapeutic means at our disposal, we have no power to influence these natural laws, which can fail us at any time, ending our lives. This view thus opposes any understanding of sickness based on exact science and lacking a concept of the fateful course of human events, and to which as a result what is tragic must appear primarily as a pathological case.

This method also takes a more holistic view of the human being, as opposed to one that over-interprets, over-symbolizes, psychologizes, moralizes, pathologizes, psychiatrizes, in short, “victimizes” every incident of sickness. A phenomenological viewpoint tends to see the human being in his entirety, i.e., in his possibility to become free and open to everything he encounters: especially in his exploitation of the existential elements from which he draws life—in his historicity, his freedom and openness; his spatial, temporal, gender, corporeal, mortal, predetermined participation in a shared world.

In existing, in “enduring” or leading an existence, the human being may have to deal with constrictions, limits or restrictions, so that he cannot live out all possibilities and therefore suffers as a result. He may then fall ill, with his entire being. His experiences of sickness and suffering—when ostensibly caused by neurotic, depressive moods and/or psychosomatic illnesses—can usually be seen as constituting a certain turning point in his life story in connection with an impossibility he has experienced for open, creative self-discovery and self-determination.

A unilateral scientific perspective might lose sight of what is specifically human in our bodily existence if it neglects to consider how that existence is a direct part of our penchant for examining and responding to all that we encounter. Boss speaks of a powerful “leap in thinking” that is only possible with a great deal of practice and which leads us away from our former scientific notions and back down to our grounding in what is in fact offered up to our senses, i.e., back to the phenomenon itself.

This approach, which begins with an intellectual appraisal of the essence of things or facts and represents the intellectually intuitive view of our being, in short, “acknowledging the riddle of life without trying to evade it with irrational considerations” (Robert Spaemann), leads to the question of whether sicknesses have a cognitive function. Might they be an important prerequisite for processes of finding meaning? A line from Goethe’s “Wilhelm Meister’s Apprenticeship” says: “Man cannot be happy until his unconditional striving limits itself.” Can we then conclude that human freedom and openness to develop, grow, mature, unfold, create, to find meaning and happiness is often only found in connection with borderline experiences, disorders, crises or sicknesses?

We can at least all relate to the following experience: when illnesses remind us of our frailty and mortality, we end up attaining higher consciousness of ourselves. This means that we can then say that the structure and order or disorder of our lives have a vital meaning in their own right.

And because sicknesses remind us of the importance of interpersonal relationships—with respect to our healing and also our dependency on others—we become more sharply attuned to our conscience. That conscience also speaks to us of the existential guilt that, as our vitality returns, calls to mind again our gifts and talents. Because an individual is able to recover his health and discover meaning in life when he finds what he feels to be the appropriate place in society for himself. This usually does not happen without some disappointment, without painful leave-taking, failure or voluntary sacrifice—all the harder in cases where we have not learned much else. But it can also mean to constructively participate in shaping a society that is then worth living for.

In sum, we can say that sickness and health can in Daseinsanalyse be put in an existential relation, in acknowledgement of the limits of human existence and the degree of openness for exploiting human opportunities. A path presents itself—marked by freedom and responsibility or the loss thereof. Whereby the latter may involve self-imposed limits or mandates—a distorted view of reality and truth, embedded and at some point firmly entrenched in one’s life story.

Whence does the sick human being draw the power for reorientation, a change of spirit, and a new sense of meaning? Taking advantage of temporary therapeutic help is no longer taboo today. Apart from the various schools of therapy, the main thing is the attitude of the therapist, which can be described as a benevolent, corrective, generous, encouraging and “courteous restraint,” as a kind of companionable support. Psychotherapeutic sessions aided by transfer and counter-transfer techniques hence offer a focus on the personal understanding of the self and existence. This is especially the case when the suffering of the individual during crisis in growth and maturity is so great that inhibitions, fear, guilt, emptiness, disgust, anger, rage, aggression against others and the self are no longer experienced openly in everyday life, or when they inundate the individual with negative feelings. Withdrawal, loneliness, low spirits and dejection, despair and pain can conspire to narrow our experiences and behavior, corresponding to a life pattern that pursues the inner aspiration to make good on an old “debt.” It is like doggedly trying to hold onto only one side of the paradoxical truth of life.

In order to overcome the sort of autonomy and heteronomy that are inappropriate for the individual, it would appear important in the therapeutic session and in reliving past experiences to look once again at where the individual’s energies are paralyzed or not brought to bear on the “unreasonable demands” of life. A memory in and of itself usually brings with it a burst of energy with which we can see things in a new light. This can be the first step in taking on the battle, the challenge and the path, as a way of overcoming the urge to hold onto desire, envy, hatred, drives and addictions in order to move toward other states of the soul, toward amazement, awe, devotion, longing and joy. An upset can give birth to a newly perceived feeling of dynamic coherence that continually culminates in a new development process.

The individual’s biographical past is initially not the main focus, but rather his current mastering of crisis situations. If it then still proves necessary to look into the past, the insight often emerges that behavior and attitudes displayed in former situations were actually quite useful, but that holding onto these in present-day life is presenting difficulties. What it’s mainly all about, though, is the existential context of a lived life story, i.e., the biographical significance of a possible sickness, whereby understanding and acceptance are sought for integrating, appreciating and overcoming the non-historical element (e.g., neurotic mechanisms) as an event that has become part of a life story. In the course of all of these anxiety-causing changes, greater awareness can be encouraged by steering attention to our sensitivity to our own bodily states. Only in this way can disruptive developments be detected early on and guarded against. This means that a corporeal awareness must be included as part of the process of experiencing a changed self-image—within the context of a new understanding of, and new frame of reference for, our relation to our world, i.e., one for which we take individual responsibility.

Rosemarie Henzler-Zens in: SZ, May 15, 1990