Although there has been a focus on problematic issues related to health care services and complaints made by patients, individuals who suffer from medically unexplained syndromes continue to report being epistemically marginalized or excluded by health professionals. The aim of this article is to uncover a deeper understanding of the what‐ness of experiencing being naked in the eyes of the public while waiting to be recognized as ill. Therefore, a phenomenological approach was chosen to inductively and holistically understand the human experience in this context‐specific setting. Semi‐structured interviews were conducted with two men and six women between 25 and 65 years of age, who had been on sick leave for more than 52 weeks. Their symptoms were consistent with Exhaustion Disorder (ICD‐10, F43.8A). The meaning of the interviewees' lived experience was explored using a life‐world approach to phenomenological reflection and writing. The participants described their experience of encountering the general practitioner as taking part in a battle. Feeling distrusted by others seemed to result in disconnection from their habitual lifeworld, which in turn triggered a shame reaction. Additionally, the study showed a possible distrust related to several communication levels within the health care system, which influenced the recovery process negatively. Lack of experienced support can lead to exacerbated feelings of distress. Accordingly, the psychosocial experience of being ill might be as important as its unknown aetiology. Therefore, in the context of these interpersonal relations, both norms, values, and attitudes, and issues of power need to be considered and addressed properly.
The search for causal explanations in medically unexplained syndromes such as burnout has not been resolved by evidence-based medicine. A biomedical model encourages a reductionist diagnostic practice and a dualist split between physical and psychological symptoms. Therefore, diagnosing and treating these syndromes remains a challenge. Depression is a common aspect in burnout and, as a result, clinicians often diagnose burnout patients as depressed. The Norwegian government expects medical efficiency to reduce sick leaves. Medically treating depression has a documented effect. This practice may pose threats to the increasing number of individuals experiencing burnout. The clinical guidelines in evidence-based medicine mirror what counts as knowledge in medical inquiry, which in turn shapes attitudes towards individual patients. The aim of this article is 2-fold: firstly, to assess how the values that accompany the biomedical paradigm affect clinical care, and secondly, to replace the biomedical model with a genuine person-centred approach. In the study described, an existential phenomenological method was applied. Eight individuals, who experienced burnout, were included. They had been on long-term sick leave (>1 year) due to symptoms of fatigue and pain and fulfilled the criteria for Exhaustion Disorder (ICD-10, F43.8A). Their symptoms were not medically explained, and almost all the participants were labelled as depressed. Four themes emerged that described how they experienced living with burnout: "unhomelike being in the world," "the limit of diagnosis," "naked in the eyes of the public," and "a path to hopelessness." I identify 2 main problems; firstly, the mismatch between the patient's experience of his or her illness and the doctor's interpretation of the condition can lead to ineffective treatment. Secondly, the interviewees struggled to be recognized as ill. Thus, the inherent values in the biomedical paradigm might have serious implications for the medical care of patients with burnout.
Sufferers from burnout might experience a sincere bonding to their lost lifeworld, which can result in their holding on to their previous worlds while simultaneously trying to unleash themselves. In this article, four experiential dimensions are presented in discussion with the phenomenological insights provided by Merleau-Ponty. These dimensions are “Trapped in the present body,” “the balancing act,” “precious moments of joy,” and “this is my Lifeworld now.” In the rehabilitation process, the participants demonstrated deliberate choices and reflective self-cultivation to adjust to their present situation. The illness seemed to promote a search for meaning—and out of the existential chaos, a “new” habitual body might appear. The study provides invaluable information about the rehabilitation process and the need for humanistic interventions.
Rationale, aim, and objective An increasing number of patients are on sick leave from work due to fatigue‐ and pain‐related symptoms that could indicate burnout. The aetiology is unknown, and recently, it has been considered whether burnout should be a distinct medical diagnosis or “just” a form of depression. Little attention has been given to these individuals' experiences. Therefore, we conducted a phenomenological study to explore burnout from a first person perspective. The aim of the study was to obtain a deeper understanding of burnout as phenomenon. Theoretical perspective and method We are inspired by Merleau‐Ponty's phenomenological approach and gestalt theory. The phenomenological focus is to attend to the embodied consciousness of the lived experience of being human. An interpretative phenomenological analysis (IPA) was chosen to uncover how the interviewees made meaning of their situation. Six individuals who had been on sick leave at 50% to 100% for at least 3 months due to fatigue‐ and pain‐related symptoms were interviewed. Results Four narrative phases mirroring burnout as a temporal sequence stood out: achievement, pressure, psychosomatic collapse, and personal meaning and reorientation. We identified several interruptions to contact, which seemed to boost the interviewees' ability to continue striving beyond their limits. The results of this study contribute to a deeper understanding of how complex factors might influence individual vulnerability and lead to a fatigue reaction. Conclusion The findings indicate that lack of recognition of the interviewees' illness may have affected the healing process. When understanding burnout as an intersubjective, lived, contextual, and temporal experience, it is important to take the implications of such factors into consideration for both medical theory and clinical practice. On the basis of our findings, we argue that reducing burnout to a form of depression will neither solve the problem of its unknown aetiology nor provide for meaningful individual health care.
Several years ago, I decided to examine the philosophical and cultural roots of my therapeutic activities. I was aware of how different ontological perspectives-and in turn methodological choices related to the epistemological question "how do we know"-could affect the therapeutic encounter. There might be some hundred different approaches to psychotherapy but the crucial division between the psychotherapies is not between the "schools" but mainly between what I will refer to as the positivist and the post-positivist or constructivist paradigms. Those years ago, I lacked a clear orientation and became aware that I was vacillating between different methods. I also thought I was able to work without the intention of healing my clients if I just stayed with what was happening in the process. When I realised that, in reality, I did actually have an intention of healing, I decided to explore to see what philosophical theories I might be working from. During this process I wondered about the nature of my underlying motivations for the ontological and epistemological choices I had made in my search for answers to the fundamental questions that are either implicitly or explicitly contained in the way I practice gestalt psychotherapy. Today, psychological theory has become more of a philosophical worldview to me, or a way of thinking and perceiving-more than a taught theory about psychological interventions. In reviewing the path I have followed, I have over time come to know several different traditions in psychotherapeutic practice and, consequently, my opinions about important therapeutic concepts have changed, becoming both extended and refined. With my desire to heal, came a tendency to see myself as being able to know what was best for my clients. This attitude, I suppose, is still prominent in many clinical encounters. For instance, Cognitive Behavioural Therapy (CBT) is the
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