In this article, building on and extending Jaspers' concept of the "patient's attitude toward his illness" we draw attention to the active role that the person, as a self-interpreting agent engaged in a world shared with other persons, has in interacting with his/her basic disorder and in the shaping of psychopathological syndromes. This person-centered approach helps us to see patients as meaning-making entities rather than passive individuals and their attempt at self-understanding as not necessarily pathological and potentially adaptive. We describe 3 contemporary resources for a person-centered psychopathology: dialectical psychopathology, contemporary approaches to the meanings-causes debate, and value-based practice. Each of these provides a theoretical framework and practical resources for understanding the diversity of schizophrenic phenotypes, including symptom presentation, course, and outcome as a consequence of the different ways people with schizophrenia seek to make sense of the basic changes in self and world experiences. A person-centered approach, in building on patients' individual values and experiences as key aspects of their selfunderstanding of their psychosis, supports recovery and development of self-management skills.
Abstract:To understand suffering is to understand what it means to be human. Suffering focuses our attention on our vulnerability, which we would rather ignore or deny. As health care professionals (HCP) we need to be able to listen, to attune and be empathic to the suffering patient. If we act as an "enlightened witness" we provide a safe place for a suffering patient to grieve their loss and be vulnerable. This is skilled and demanding work, it is also important to tend to our own needs through a practice of self-care and reflection to prevent burn-out and compassion fatigue. The topic of adverse childhood experiences (ACE), which are common in the general population, are addressed in the second part of this paper. Their effects are profound, and increase with the degree of maltreatment. The maltreatment and suffering of these children usually remains hidden into adulthood beneath years of shame and denial. One aspect of our job in health care is to help patients acknowledge, experience, and bear the reality of life with all its pleasures and heartache. In order to do this well, we need to keep in touch with our own humanity, but also continue to take care of ourselves.Keywords: suffering; meaning; healing; grieving; enlightened witness; spiritual; adverse childhood experiences; healthcare professional Avoiding ChangeWhen we see a nurse, or a doctor we want to be cured. We want them to remove, or correct our problem. A surgeon's knife cuts out an inflamed appendix. The patient is happy, she has survived, and her scar will not show on the beach. She returns to her family, friends, job, and all that makes up a life. She is essentially unchanged back to normal. We all like to be cured; we want to return to our regular life. We want to avoid change [1]. Suffering and LossIn most human suffering, there is often nothing to see. We all suffer at some time or other in our lives; it is usually related to love or loss. We fall in love, we get rejected. As we move through our lives loved ones die, or dreams disappear. We feel it to the core of our being, if we can allow it.Suffering is a state of distress associated with a symptom or an event that threatens our integrity [2]. We become fearful of the significance of a symptom, or how an event may affect our future. The perceived negative meaning may involve the actual or perceived loss of one's integrity or autonomy. The interpretation and the ensuing anxiety will be unique and personal even in an identical situation [3]. It is caused by the loss or threatened loss of what we most cherish [4]. To understand suffering is to appreciate what it is to be human. In contrast to pain, suffering is our experience of being cut off. No matter what we do, we have lost touch with our vital center, the deep well of our being. The loss of love or the life-altering implications of serious disease for instance, enforce change into our lives. How do we heal that suffering?
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