Existential Psychiatry and Psychotherapy

Abstract

Spandler and Thomas trace the philosophical and historical tradition of existential psychiatry in the setting of the contemporary British National Health Service. While there is ‘little evidence of explicit existential thinking or practice within mental health social work or mental health nursing in the UK’, and the influence of figures such as R.D. Laing has ‘waned’, aspects of existential thought are nonetheless still present, especially in the field of existential psychotherapy. A key problem has foregrounded itself in building progressive existential psychiatric perspectives into mainstream health work: ‘there is a potential conflict between teaching a specific psychotherapeutic “treatment” or “model” and the cultivation of open-minded enquiry which is central to cultivating an existential sensibility’. Equally the term ‘treatment’ is ‘anathema’ for many existentially oriented practitioners since it indicates a biological understanding of health. In contrast, ‘[o]ver the last 40 years, there has been a profound shift in the values and epistemology of psychiatry, further away from a concern for contexts and meanings to a preoccupation with more biologically focused theories of causation and the management of risk’. Notwithstanding this, while existential approaches remain neglected, there is evidence that an ‘existential sensibility’ still has value in the field.