Anders Lindseth

A journey in quest of meaning : a hermeneutic-phenomenological study on living with memories from intensive care

BACKGROUND In a short-term perspective, a high incidence of psychological problems linked to memories from intensive care has been found in survivors of critical illness. Little is known about what kinds of memories patients might carry with them and what it is like to live with memories from intensive care as years go by. AIM The aim of this study was to explore the meaning of living with memories from intensive care. METHODS A hermeneutic-phenomenological approach. In-depth interviews with ten former intensive care patients 10 years after their admission. FINDINGS Memories of bodily sensations and memories containing strong emotions were surprisingly well kept. Memories residing in the body at a prereflective level and that could be awakened without being triggered by will or conscious thought comprised an important segment of the memory spectrum. Complaints such as panic attacks and anxiety were strongly linked to these kinds of memories and experienced as flashbacks of frightening experiences that entailed strong emotions. Some informants still strove to understand experiences and reactions. Living with these memories and flashbacks was interpreted as a journey in quest of meaning. Having someone and something to live for implied strength on the journey. The presence of close relatives at the bedside provided strength to go on and someone with whom to share experiences afterwards. CONCLUSION A period of critical illness and intensive care stay for treatment may leave durable traces in the patients life. Finding meaning of existential and ontological nature seems to be of decisive significance for how people fare in their lives after having lived through intensive care treatment. The identified journey in quest of meaning points to the need for follow-up programmes, and we must acknowledge close relatives as important resources for the patient both at the bedside and in the subsequent process of discovering meaning in lived experience.

Women Physicians’ Narratives About Being in Ethically Difficult Care Situations in Paediatrics:

This study is part of a comprehensive investigation of ethical thinking among male and female physicians and nurses. Nine women physicians with different levels of expertise, working in various wards in paediatric clinics at two of the university hospitals in Norway, narrated 37 stories about their experience of being in ethically difficult care situations. All of the interviewees’ narrations were concerned with problems relating to both action ethics and relation ethics. The main focus was on problems in a relation ethics perspective. The most common themes in an action ethics perspective were overtreatment and withholding treatment. The more experienced physicians reasoned differently from the group of less experienced physicians and they coped with pressure in different ways. The less experienced physicians disclosed their professional experience yet seemed uncertain, while putting on an air of certainty, but the more experienced physicians disclosed both their professional and personal experience of caregiving and they seemed to allow themselves to feel uncertain in their certainty. Both groups emphasized a need for deep discussion between colleagues about their being in ethically difficult care situations.

Nurses' narrations about suicidal psychiatric inpatients

Seventeen Norwegian and two Danish registered nurses specialized in psychiatric nursing narrated their experiences in caring for suicidal psychiatric inpatients. The interview texts were transcribed and interpreted using a phenomenologic-hermeneutic method, inspired by the philosophy of Ricoeur. Two main themes with subthemes were found Distance, which included compassion without emotional identification, mistrusting the patient, being responsible for the patients actions, feelings of guilt, rejecting the patient, being rejected by the patient, and focus on the nurse, and Closeness, which included compassion with emotional identification, trusting the patient through contact, responsibility for the patient making his or her own agenda, being rejected by the patient, temporarily, listening to the patient, and focus on the patient. These findings were interpreted in relation to the ethical demand made on the nurses in their interaction with suicidal patients.

''Being somewhere else'' * delusion or relevant experience? A phenomenological investigation into the meaning of lived experience from being in intensive care

Patients’ experiences of having been “elsewhere” during intensive care than in the intensive care unit (ICU) has traditionally been placed in a context with described pathological circumstances, such as brain dysfunction, and labeled with terms such as “unreal” and “delusional”. The aim of the study was to look more closely into this type of experience by turning to its meaning as reflected on by patients themselves. Through a phenomenological investigation based on follow-up and interviews with three patients, we found that the “delusions” were in fact filled with meaning. They mattered to the patients and were not to be dismissed as unreal because they were so inherently real in the lived body. The experiences were grounded in the patients lifeworld and could be interpreted as expressions of basic aspects related to being human in the world. The phenomenological term “lived mood” emerged as one such aspect to which intensive care patients appear to surrender more readily than man does in daily existence. The notion of “being somewhere else” as meaningful and relevant experience challenges the explanatory model whereby such experiences are placed in a context with brain dysfunction.

The meaning of being in ethically difficult care situations in pediatrics as narrated by male registered nurses

The meaning of being in ethically difficult care situations in pediatrics as narrated by male registered nurses

On the Possibility of Establishing a Metascientific Foundation for Psychoanalysis

Psychoanalysis cannot fulfill the demands of testability as required by the natural sciences. Nevertheless one should not dismiss it as a pseudoscience. In this essay a metascientific basis is established which will do justice to psychoanalysis. In support of Hans-Georg Gadamer’s philosophical hermeneutics, an explication of hermeneutical science and a presentation of psychoanalysis as a practical-hermeneutical science are attempted. Psychoanalysis is thereby designated as a method of interpretation and integration of human spontaneous behavior. As a scientific theory, it elucidates an inner dialogue between the conscious ideations and the unconscious impulses or behavior tendencies in the human being. Its hypotheses are hermeneutical rules which are to be used by a metainterpreter, the therapist.

Reality, Psychoanalysis, and Hermeneutical Science

It is a difficult and demanding but also an interesting task to answer the commentaries upon my essay, because they treat very different and important aspects of the problem of a hermeneutical foundation of psychoanalysis as a science. Almost all the commentators have concerned themselves with two themes, and it therefore seems to me particularly important to explicate them in greater detail. The first point is of a general, the second of a somewhat more specific nature, the former being the concept and the possibility of a hermeneutical science as such, and the latter the concept of a therapeutical inner dialogue. These are more closely related to each other than one might first expect and are of central importance for philosophy as well as for psychology.