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Research Articles
Published: 2020-12-05

Sense of life, existential psychotherapy and COVID-19

Bukovinian State Medical University
Bukovinian State Medical University
Bukovinian State Medical University
existential humanism psychotherapy autopsychotherapy intellectual vaccination sense of life logotherapy psychoanalysis psychiatry anti-psychiatry lifestyle rehabilitation COVID-19


In the modern theory and practice of consulting the search for the meaning of life, prevention, and treatment ("intellectual vaccination"), the existential direction is not represented at all, although its need is obvious and has the right to life. Existential crises can be based on death, serious illness, transitional periods - positive and negative in personal life and professional activity, making irreversible decisions, sudden isolation, searching for the meaning of life, and all this, which is already becoming, we hope, a temporary basis - this is COVID 19. The main content of existentialism testifies that it is indeed one of the most worldly, personality-oriented directions of modern psychological science, which seeks to explain the essence of man in indissoluble unity with all the structures of its existence. Existential psychotherapy - psychological assistance based on the mind, respect, and active knowledge of the therapist of all the features and aspects of the individual being (existence) of the patient's personality, without the intention to find out the pathological or ineffective characteristics of his life, behavior, and activity. The humanistic potential is significant, which affirms a person as a self-sufficient person. The authors gave examples of the application of the method of existential psychotherapy in the rehabilitation of patients with postcovid syndrome and other pathological conditions.
Analyzing the thoughts and actions of our patients, we have in practice received confirmation of the scientific works of scientists dealing with the problem under study. Promising areas can also be considered the creation of the school "Existential psychotherapy in the rehabilitation of patients with post-coid syndrome", the holding of a conference on the topic "Existential psychotherapy in the development and rehabilitation of recovering from COVID-19", the opening of a "humanitarian vaccination room" and others.
Taking into account modern trends in society, existential psychotherapy has a great future in the cognitive, therapeutic areas, as well as in the rehabilitation of sick and post-sighted convalescents.
Separately, it should be noted that all the data they use in this article is given taking into account the time frame until February 14, 2021.


The urgency of the problem of using existential psychotherapy in counseling and therapeutic practice during the pandemic COVID-19 is beyond doubt. The need for existential choice as a special type of personal activity is proved by the facts of increasing neurotic problems in people of the modern world. The basis of existential choice is the idea of finding the meaning of life, and the task of psychotherapy - to help the patient to realize and find their meaning in life. There are two reasons for interest in existential psychotherapy. First, to join the world-renowned existential movement and psychotherapy to bring the patient to life, through «intellectual vaccination,» the desire to live and fight for one's life. Today, the idea of a person when the threat of COVID-19 hangs over him is inadequate and ambiguous, so the task of psychotherapeutic practice here is obvious.

Analysis of recent research

The main works on existential psychotherapy and the meaning of life belong to J.-P. Sartre [10], L. Binswanger, W. Frankl [13], R. May [8], D. Budgetal [1], Emmy van Dorzen [4], R. Laingu [5], C. Muddy [ 7], I. Yalom [16] and others. In the domestic theory the issues of existential techniques were devoted to the works of G.O. Ball, I.S. Bulakh, O.O. Demchuk [3], G.V. Chuiko [14], OV Zolotukhina-Abolina [5], OS Chaban and OO Haustova [15], OG Parkulab [11], and others.

The aim of the article is to present the scientific novelty, theoretical and practical significance of the studied issues in the prevention, treatment and rehabilitation of patients during the COVID-19 pandemic in the postpartum period.

Presentation of the main research material

The year 2020 with its coronavirus (СOVID-19), like a sword and lightning, hit the world and affected each of us - and we will feel all this for a long time, but will we be able to counteract this trouble and how will we do it? After all, this is a global crisis in all spheres of human life, caused by the new coronavirus SARS-CoV-2, first detected on December 31, 2019, which causes a special infectious disease that has negatively affected not only the economy of each country but also everyday life. man and especially his somatic and mental health. therefore, the statement of Harvard University professor Gennady Fuzailov (February 4, 2021) about why human organisms react so differently to SARS-CoV-2 that it seems as if our patients have different diagnoses is very correct. In this context, it should be added that scientists have recently discovered a South African virus and the Brazilian strain P.1 - from which the vaccine may not protect, and now we know about almost 4,000 new strains.

COVID-19 is not only an infectious but also an immunological disease that carries immunological risks to humans. The more severe and prolonged the course of coronavirus disease, the more pronounced the impact on the psychological state and psyche is observed in the patient. The state of panic, fear of a person further exacerbates tissue hypoxia, reduces blood oxygenation and puts additional strain on the already overloaded cardiovascular system and beyond. Timely and qualified psychological support of the doctor from whom the patient receives medical care is extremely important in such situations. Responsiveness, restraint, tact on the part of medical staff is an important component in the treatment and rehabilitation program of covid patients. For this purpose, psychological crisis services have already been established (NGO «Ukrainian Association of Specialists in Overcoming the Consequences of Psychotraumatic Events», «Providing psychological assistance to vulnerable groups during and after quarantine due to the COVID-19 pandemic»). patients, etc.

Recent publications have increasingly reported an increase in the incidence of mental disorders such as depression, anxiety disorders and post-traumatic stress disorder; aggression, domestic violence, violence, suicide, addiction to alcohol, drug addiction, etc. [15]. The United Nations emphasizes the need for measures to protect people's mental health, as the "panic virus" is worse than coronavirus infection. Those who only hope for a vaccine have already lost. Undoubtedly, the people of Ukraine need to be prepared for vaccination, and to do so skillfully, professionally, without unnecessary fuss. Therefore, we want to show that through existential psychotherapy it is possible to prepare people to understand and acquire the meaning and significance of life, and this is one of the steps to recovery, life and health.

We offer «intellectual vaccination» as a person's motivation for the meaning of life. One of these areas, namely the formation of the meaning of life, is existential psychotherapy.

Existential (Latin existentia - existence) psychotherapy - psychological care based on the mind, respect and active knowledge of the therapist of all features and aspects of individual life (existence) of the patient's personality, without intending to clarify the pathological or ineffective characteristics of his life, behavior and activities [4]. The French philosopher Jean-Paul Sartre wrote: «Perhaps there are times more beautiful, but this time is ours; we only have this life to live. There is a lot of «disgusting, dark, sticky» in this life, a lot of meanness and insignificance, but to call a spade a spade is to defeat them». Ludwig Binswanger, Swiss psychiatrist: «There is no single space and no single time, but there are as many times and spaces as there are subjects.» Salvadore Muddy, a professor of psychology at the University of California, commented on the psychological patterns of forming an existential personality - free, responsible, self-reliant: «If a person works, starts a family, joins clubs, has parties, falls in love - it's all because that these are forms of activity that make sense to her in some way, we can no longer avoid the question, why do we get out of bed in the morning?» [14]. Well-known existential psychologist Irwin Yalom outlined the range of this direction: a person's attitude to time, life and death; problems of freedom, responsibility and choice of destiny; problems of communication, love, faith and loneliness. The main thing is - the meaning of human life, the conditions of his stay, change and loss [16].

People are looking for the meaning of their lives. They ask themselves (though not always consciously) the most important questions about being: Who am I? Is life worth living? Does it make sense? Will I be able to fulfill my human calling? The tendency, if not to systematic considerations on this topic, then at least to experience such problems is among the universal possibilities of human nature. Each of us is primarily responsible for what he is and what he becomes. As Sartre argued, «man is nothing but what he does of himself.» This is our own choice. From the responsibility for my I we have nowhere to go, as not to leave myself.

Existentialism emerged as a reflection of the social and spiritual crisis of civilization. The social world in this case is «false». Man truly exists only in solitude, alone with God, his own death, the absurdity of existence. A fundamental characteristic of man is the appeal to the future, freedom. Man chooses himself. The deep crisis of European culture and the very existence of European humanity made many thinking people of that time think about the change of spiritual landmarks and values ​​caused by the course of history itself, concerning the world of life, feelings of orientation of the individual, ie its very existence. The cultural and historical preconditions for the formation of existentialism include the collapse of moral norms and values ​​in the minds of millions of Europeans in the twentieth century, the spread of nihilism in society, the crisis of religious tradition, the real destruction of all foundations that history has not yet known. Industrial civilization was able to conquer the whole Earth, conquer the Moon, prepare for a flight to Mars, but was unable to create their spiritual values.

Austrian psychologist and psychiatrist Victor Frankl (1906-1998), the founder of logotheory and logotherapy, said: «There is nothing in the world that would help a person cope with adverse conditions as effectively as the belief that the meaning of life exists», «Could would you tell me in one sentence what is logotherapy? At least, what is the difference between psychoanalysis and logotherapy?», «In logotherapy a patient can sit on a chair, but must listen to things that are not usually listened to», «I saw the meaning of my life in helping others see the meaning in their lives ; believed that the driving force of human behavior and personal development is the search for the Logos, the meaning of life, which should be carried out by a particular person for his own needs». Lack of meaning creates a state of existential vacuum in humans, which is the cause of neurosis. Optimism - because it is a belief in the possibility of man, all that is best in him. Tragic - because very often evil in a person is stronger, it is preferred. «When we oppress an angel in ourselves, he turns into a devil» («Subconscious God») [7].

The main thesis of the doctrine of the meaning of life - human life can not lose its meaning under any circumstances; the meaning of life can always be found. According to Frankl's theory, meaning is not subjective, man does not invent it, but finds it in the surrounding reality, in what is of value to it. He emphasized that the lack of meaning in life or the inability to realize it leads to neurosis, creates a state of existential frustration. Neuroses often occur when a person realizes the futility of his life, the emptiness of existence. At the heart of such common phenomena as depression, delinquency, alcoholism, drug addiction, moral decline, is the lack of meaning in life, which can be partially compensated by a person's desire for power, sex, desire for money. Exploring the possibilities of correcting behavior, representatives of humanistic psychology focus on the development of people's awareness of their responsibility for their own behavior, which is based on awareness of themselves and their place in the world. We need to help people cope with daily demands, help them understand that they are not helpless victims, they have a choice and must be responsible for their actions even when they are unable to change the situation [13].

Rollo May (1909-1994) can be called one of the key figures not only in American but also in world psychology; he was one of the leading existential psychologists in the United States. Over the years as a psychotherapist, May has developed a new concept of man. His approach was based more on clinical experiments than on cabinet theory. Man, from the point of view of R. May, lives in the present, for him what is happening here and now is relevant in the first place. In this only true reality, man forms himself and is responsible for who he ultimately becomes. Reflecting on the fundamental differences between a mentally healthy person and a sick person, May came to the following conclusions. Many people, he thought, lacked the courage to face their destiny face to face. Attempts to avoid such a confrontation lead to the fact that they sacrifice mostly of their own free will and try to avoid responsibility by declaring the original lack of freedom of action. Not wanting to make a choice, they lose the ability to see themselves as they really are and become preoccupied with feelings of insignificance and alienation from the world. Healthy people, on the other hand, challenge their destiny, value and protect their will, and live a real life that is honest with themselves and others. They realize the inevitability of death, but they lack the courage to live today [14].

Each person (ontological) is given three days to live. The first day - everything that happened before «yesterday». The second day is today. He is very rich and contradictory, full of love and hate, good and evil, wealth and poverty, servant and slave, healthy and sick, attractive and abandoned, strong-willed and free, generous and greedy, etc. And when a person goes to the doctor (not to the pathologist) while waiting for the vaccine, he is happy that life has succeeded. Remember, this can be the best day of your life. Today is life. And the third day - do not plan anything global. However, as we can imagine, our students and patients, the hospital's medical staff, are waiting for us. We are all at the forefront of the fight against the disease. All without exception. For example, R. May (when he was a little over thirty) suffered from tuberculosis and spent three long years in a sanatorium… A person affected by a physical or mental illness, according to the scientist, should be an active participant in the treatment process. R. May began to introduce this principle into his clinical practice, educating patients in the ability to analyze themselves and correct the actions of the doctor [8].

The main unit of study in psychotherapy is the «problem» with which the patient came. This unit of study, rather - the existence of two individuals (patient and doctor) in the world, which is currently represented by the therapist's room [14]. One of the prominent representatives and founder of the «antipsychiatry» is Ronald Laing (1927-1989), a professional psychologist and psychiatrist. Proponents of antipsychiatry see their task in exposing human violence against people in all its forms. «Mentally healthy» people are not really healthy, and psychotics are not as crazy as they seem. Schizophrenia is not interpreted by him as a disease, not even as a violation of certain mental functions, but as a stage in the process of natural healing, entering the realm of «health». Laing not only calls for «learning from schizophrenia», which in his view becomes a guide to other states of consciousness, closed to the «everyday man», but also organizes one of the world's first «alternative clinics» for psychotic patients, where he achieves great success in treatment [12]. In his work «Conversation with Children» Laing considers early childhood as the «natural state» of man, which is lost with the emergence of social norms, conventions, even with mastery of language. In all psychoanalysts, childhood plays a crucial role in an individual's life, but in Laing it becomes a «lost paradise» from which adults are banished. They need to learn to perceive the world from their own children, to whom all the secrets of existence are still revealed. Children are so sincere and real - not a single false emotion, children feel even the slightest falsehood, they have not yet learned to hide feelings. Therefore, to admire the immediacy of the child is natural for any adult [5].

James Budgetal (1915-2008), a legend of world psychology and psychotherapy, states: "A patient is a person who has not coped with life's problems, but not because he is unable to do so (and therefore the psychotherapist will decide for her), but because she has not gone her own way and, accordingly, a psychotherapist can help her reconsider her lifestyle. It is important to remember that there is a secret in every person that no one can ever fully know. Therefore, the "patient's secret" must be defined and respected - it will protect against many dangerous illusions.

Life can be lived quietly, calmly, without any deviations and cataclysms, but the best moments of life go to those who are crazy in life. Expressiveness - "a measure by which a person tends to allow others to really know themselves in this situation" [1].

Irwin Yalom - American psychologist, psychotherapist, doctor of medical sciences, professor of psychiatry at Stanford University, points out that psychological help is more necessary in those situations when normal anxiety turns into neurotic.

Let's illustrate this situation with the example of anxiety that arises due to human existential vulnerability to death. Anxiety is considered normal if people use the existential threat of death for their own benefit as an instructive experience and continue to develop. Particularly striking are the cases when a person who has learned about a deadly disease begins to live more consciously, to live his life productively and creatively. Evidence of neurotic anxiety is psychological defenses. For example, a terminally ill person experiencing neurotic anxiety may risk their lives unjustifiably by exhibiting manic heroism. Fear of death is of great importance in the inner experience of man, and the attitude to death affects his life and psychological development. Awareness of death can be a positive impulse, the strongest catalyst for serious life changes. However, the awareness of death is always painful and alarming, so people tend to create different psychological defenses. The purpose of existential psychotherapy is to feel that you are truly alive again, and perhaps for the first time. This means that a person knows himself, that he lives among the limitations and possibilities of human life, participates in it with all his heart, lives in such a way that life brings him the greatest pleasure (4, p.5).

Traditionally, existential dimensions are presented in the form of the following four: physical (Umwelt), social (Mitwelt), personal (Eidenwelt) and spiritual (Uberwelt). The spiritual dimension associated with our attitude toward the faith, ideas, values, and principles we live by is particularly distinctive. It is a dimension of our holistic vision of life and ideological position, which determines how we act in other dimensions and how we understand the world. Regulating life in the natural dimension will not solve all problems, but it is often the first step we take towards a more complete assessment of life in all its aspects. The ability to be in harmony with the natural world - and with your own body, and with the biological and physical environment outside it - is a key condition for further development. The ability to maneuver between extremes in this area gives a person the greatest strength that can be gained, - says Emmy van Dorzen [4], professor, doctor of medicine, doctor of philosophy and psychology, practicing existential psychotherapist, director of the New School of Psychotherapy and Counseling in London. «Life is worth living.» There are many things in life: sadness and joy, loyalty and betrayal, love and hate. «We live somewhere between Heaven and Hell,» says E. van Dorzen, «probably because our lives are so differently influenced ethically and religiously. To protect yourself, you can burrow into a hole and tremble there like a Wise Sandpiper. In order not to notice and not to cause pain, you can breathe less often and quieter, as do, for example, Indian yogis. You can imagine a beautiful parallel world or rush headlong into the world, full of temptations of thrills, but all this will not save us from the need to LIVE: build relationships, make sense, sacrifice and choose... Nothing makes us as vulnerable as the desire to fully warn themselves» [4]. Life appears before us in all its fullness and truth.

«Intelligent vaccination», in our opinion, in the sense of existential psychotherapy for postpartum patients means that the psychotherapist and the patient go from fears and anxiety, emotions and hope to finding and finding meaning in life.

There must be a fundamental agreement of intent between the psychotherapist and the patient. It is essential for the therapist to consider the experience and behavior to which the patient seeks to come as a result of psychotherapy, in principle desirable and acceptable. Psychotherapy, according to Laing, is to «throw away» everything that stands between the psychiatrist and the patient: props, masks, roles, lies, protections, anxieties and projections - that is, everything that is traditionally used in relationships. Psychotherapy should remain a constant attempt of two people to restore the fullness of human existence through the relationship between them, and interconnected individuals - through experience and behavior [14].

Over the last year of the spread of coronavirus disease, we have seen, on the example of our hospital, that patients with other previously acquired diseases get COVID-19 symptoms, and the coronavirus finds the most «painful» place among them and «attacks» there. By treating such patients who trusted us, cooperated with us and believed in us, we developed our own psychotherapeutic approaches. Here are some examples.

Patient B., 76 years old, had COVID-19 in the hospital. As he told us, at the age of ten after the operation for complicated appendicitis he was in a coma for several days in the district hospital. «All the medical staff fought for my life». I knew I was dying, and I didn't want my family to see me leave this world. There were many conscious thoughts: «Who am I, why did you come to this world, what did you do and what did you not have time to do…». The surgeon often visited me, and when I began to recover, he offered to play checkers with me. I lost then (he just didn't calculate my strength), and then I started «winning» from the doctor - as I later found out, the doctor wanted to know if I had a thirst for life. But it was already psychotherapy, which left a mark on me for life and motivated me to become a doctor, a therapist. I already then realized the meaning of life.

Patient G., a 48-year-old teacher, has severe coronavirus pneumonia in the infectious department: fever, oxygen mask on her face, injections into her abdomen to thin the blood, and bruising of her fingers and nails. Her husband recently died of coronavirus, his nails also turned blue before he died, and she realized that her earthly life was over. The patient asked the nurses to help send text messages to their relatives, friends, acquaintances with the following words: «I'm going, say goodbye and forgive!». In response, she received encouraging wishes to fight and recover. After a while, the woman recovered and sent new text messages: «Good afternoon. I was there, but decided to return. I hug and kiss, your G. The meaning of my life is to survive.» And what turned out to be the main thing for us in this situation - the patient asked that a doctor be with her and they could communicate. It's hard to comment…

Examples of autopsychotherapy: thoughts and actions of people who knew they were going to die and still did something. Patient L., 18 years old, put on a brand new blouse, took out her make-up bag, a mirror and painted her lips, corrected her hair… Her meaning of life: «I want to lie in the grave beautiful, because no one will do it better than me.»

Patient D., 35 years old. When one of the authors of this article entered the ward in the morning, he saw that his patient was lying on a mattress under the bed. As she said, whether in a dream or maybe in a delirium, death came to her ward. And to deceive her, the woman moved under the bed. It is important in this situation: to be a mediator between the patient and death.

All patients who underwent autopsychotherapy, fortunately, recovered, and only later laughed happily at themselves - all have not only the meaning of life, but also action, the desire to live. We doctors, already in the role of psychotherapists, induced «intellectual vaccination» in our patients in order to develop their own «mental vaccine», and we noticed that it worked. It already produces its «mental antibodies», especially in difficult moments of life, in conditions of stress and anxiety, and encourages life. And the more sincere we are in our relationships with patients, the more it helps them.

We, doctors, medical workers, when communicating with patients, the question arises: what did I learn from this patient, what did I learn from him? Sure: there must be feedback: doctor - patient - doctor. We have no right to let the patient shut himself in, he must reach out to us. Give the patient everything he asks for at that moment, in that situation - this is very important for him. If we treat with pills, potions, etc. from 7 to 30 days, then existential psychotherapy affects the whole life, and we have nowhere to go from it. And if, according to the results of tests, we managed to reduce anxiety at least a little (which initially went both ways), for which we used the famous «Questionnaire on generalized anxiety GAD-7» [15], and in the «lifeline» [9] - to continue for a while the fullness of life, it is already our common significant achievement together with the patient. We share the opinion that in the minds of every person there are niches in which angels live, and if any of the niches turns out to be empty, the devil will occupy that cavity.

In connection with the above, it is appropriate to mention the sculptural group «Kharita», known as the monument to Mercy (opened in December 1910 [11]), located in the park area on the territory of Chernivtsi city children's clinical hospital (formerly Fisherkinder Hospital). It is the only monument of mercy in Ukraine, dedicated to humanity and love of neighbor, which symbolizes compassion, maternal care and tenderness for sick children. On the back of the monument you can read the famous Latin expression: «Mens sana in corpore sano», which means «In a healthy body a healthy spirit». Come, look, pray and think! Humanity, compassion, mercy, sincerity and trust in the doctor-patient relationship, a kind word and a gentle look, faith and the desire to heal have no less effect than medicine. So let's be merciful!

It is gratifying to note that the patients with postcovid syndrome mentioned earlier have already recovered, but our communication with them has not been interrupted. We told them about our meaning of life, they - about their own. We called such conversations «intellectual vaccination». If during the acute period of the disease their main goal was to survive, then in the postcoptic period they make quite grandiose plans that even relatives and friends are surprised by their activity. According to our observations, there were no more atheists among these patients when they asked, «Lord God, help!» - to which we mentally replied: «Help yourself to make it easier for God to help you!». They are grateful to all the medical staff, especially to the nurses who were at the forefront of the «covid front.» Remember Socrates – «It is impossible to heal the body without healing the soul.»

Given the current trends in society, existential psychotherapy has a great future in the cognitive, therapeutic spheres, as well as the rehabilitation of patients, including postcocious recovering. The lateral and clinical thinking of the physician is important. Being at the patient's bedside is the ability to intuitively, as if inwardly, capture the clinical picture as a whole and relate it to similar previous observations. Lateral thinking deals with non-standard perception, it does not ignore or replace logical thinking, but promotes the search for and emergence of new alternative ways of action and thus increases the number of new opportunities for man [2].

The personal history of the psychotherapist and his involvement in the therapeutic process must be open: the therapist and the patient - you are just two and no one else, you can and should go in communication to «you», and only the truth (completeness and truth) should prevail; and even if you notice «some deviations» in your patient's statements, forgive him, he just wants to be better than he is - the line of defense works. The truth is not what you want, but what you have been able to prove in silence. We focus not only on achieving the goal of psychotherapy, but also on the needs of the patient. It is also important to work with the patient's family, which not only experiences the consequences of his illness, but also influences the patient's reactions and behavior.

Conclusions and prospects

The relevance of the topic of the article is due to the fact that in modern stressful life, where COVID-19 came as an uninvited guest, the self-worth of a person as a person in need of appropriate medical, psychological and therapeutic approaches to life comes to the fore. As UN Secretary General Antonio Guterres stated on January 26, 2021, the outbreak of COVID-19 is getting out of control, the vaccine does not solve this crisis. A large-scale outbreak of a dangerous and far from studied infection has a negative impact on people and society around the world. The current COVID-19 pandemic causes societal psychological reactions such as stress, anxiety and fear, aggression, loss of landmarks and plans for the future. suicide.

The article is not about looking at life from the side, but trying to dive into this life (a life of fullness and truth) and help change this life for the better - both for yourself and your clients and patients.

In the existential approach, the most important thing is that it is possible to create the meaning of life, and that it makes sense to do it. We, the authors of this article, together with patients try to awaken, evoke and form in them the meaning of life through «intellectual vaccination». Thus, «intellectual vaccination» is an attempt to inject into the human mind the meaning of life, on the basis of which not the biological organism, but the human mind produces its «intellectual vaccine» and with it, constantly updated, paves the way of life.

Analyzing the thoughts and actions of our patients, we have in practice received confirmation of the scientific work of scientists dealing with the studied issues. Promising areas include the establishment of a school «Existential psychotherapy in the rehabilitation of patients with postcocious syndrome», a conference on «Existential psychotherapy in the development and rehabilitation of convalescents during COVID-19», the opening of a «humanitarian vaccination room» and more.

Given the current trends in society, existential psychotherapy has a great future in the cognitive, therapeutic spheres, as well as the rehabilitation of patients and postcovid recovering.


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