What is existential distress?

Text that reads: We ask a lot of questions about what is valuable and important

What does the term “existential” really mean? It may sound abstract, but in fact the concept is at the core of every decision we make.

As University of Guelph-Humber Psychology instructor Dr. Chris Lo defines it, existential distress concerns refer to questions of value: What is important to me? How do I live in a way that affirms these values? What is the quality of my life?

Those questions become both more urgent and more difficult to answer when a person is facing death. For years, Dr. Lo has researched the way patients diagnosed with terminal illness have grappled with these existential questions.

“When people are confronted with the end of life they essentially have to ask: ‘What do I want the rest of my time to look like?’” Dr. Lo said.

“We ask a lot of questions about what is valuable and important to you. Sometimes patients don’t feel like they’re worthwhile as people anymore, that their lives lack meaning or purpose and that they really don’t matter. Those are existentially distressing concerns that we’ve wanted to identify in order to offer people some relief.”

Pulmonary Hypertension

In the past, Dr. Lo has done significant work with patients who have been diagnosed specifically with advanced cancer. Now, with a research grant from the University of Guelph-Humber and research help from UofGH alumnae Tasmie Sarker and Orla Canning, Dr. Lo is investigating evidence of existential distress in patients dealing with diagnoses of pulmonary hypertension.

Pulmonary hypertension is a condition where a patient’s heart has to work harder due to high blood pressure in the arteries to the lungs. Treatments do exist and some forms of the condition can be stabilized well for many years, but the disease can also quickly worsen and become fatal.

Unlike those dealing with advanced cancer, people diagnosed with pulmonary hypertension must adapt to an illness that is more chronic and prolonged, and yet also paradoxically includes the risk of sudden death. Given these differences, Dr. Lo wondered how existential concerns might be expressed differently in these people. He and his team interviewed 15 pulmonary hypertension patients from a range of age groups, with a focus on exploring the kinds of existential issues that were on their minds.

Ultimately, Dr. Lo found that there were three major categories of concern: the experience of loss and mourning (including being unable to engage in meaningful activities and the feeling of lost life years due to illness); concerns about social relatedness (including disruptions to intimacy and personal connections because of this isolating condition); and finally, diminished feelings of self-worth.

For Sarker and Canning, the interview process was a difficult but deeply rewarding experience.

“This was my first time directly talking to participants or patients, so this was a new experience for me,” Sarker said. “What helped is that Chris is very encouraging and helped us open up a bit. And then after every interview, we would debrief with him.”

Future Applications

With this research, Dr. Lo is working toward developing a model for having an existential conversation with someone grappling with a life-altering diagnosis. The next step is a paper that will explain both what those conversations sound like and how to have them, with visual aids included to help the reader understand how deep these conversations can become.

The broader goal is to help people who are dealing with depression stemming from a serious medical diagnosis.

“If we can establish that these existential concerns are highly correlated to depression, then we can build up essentially a case that these are the causes of depression in this situation. And so if you want to treat depression, then you have to help people with these underlying concerns,” Dr. Lo said.

Most recently, Dr. Lo and Psychology Program Head Dr. David Danto have been exploring the formation of an existential psychology section within the Canadian Psychological Association to promote research, education, clinical practice and advocacy within this area.

For Sarker, meanwhile, this experience has only affirmed her passion for Psychology.

“Being able to build a rapport with patients will be helpful in my future, because I do want to counsel eventually,” she said. “It’s been an incredible learning experience.”

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