Existential loneliness: An attempt at an analysis of the concept and the phenomenon

Abstract

Background:

According to ethical guidelines, healthcare professionals should be able to provide care that allows for the patients’ values, customs and beliefs, and the existential issues that are communicated through them. One widely discussed issue is existential loneliness. However, much of the debate dealing with existential loneliness concludes that both the phenomenon and the concept are quite vague.

Aim:

To clarify what constitutes existential loneliness, and to describe its lived experiences. A further aim was to provide a definition of existential loneliness that can function as a tool for identifying the phenomenon and for differentiating it from other kinds of loneliness.

Method:

A literature review including theoretical and empirical studies. Different search strategies were used to gather the articles included in the study. The analysis of the empirical studies had an interpretative approach. The articles were also analysed with the aim of providing a definition of existential loneliness. This was done by means of criteria such as language, uniqueness, theory and usefulness. This study is not empirical and does therefore not require an ethics review.

Results:

The analysis resulted in two main characteristics. The first one was perceiving oneself as inherently separated (disconnected) from others and from the universe. The second one brings out emotional aspects of EL, such as isolation, alienation, emptiness and a feeling of being abandoned. The empirical findings were divided into two categories: experiences of EL and circumstances in which EL arises. A definition of EL is also suggested, based on the two main characteristics identified.

Conclusion:

In order to meet patients’ needs, it is an ethical duty for healthcare staff to be able to recognise experiences of EL, that is, to communicate with the patients about these experiences in an appropriate manner. This in turn demands knowledge about existential issues and skills to deal with them.

Keywords

Concept analysis empirical approaches existential loneliness literature review older people care person-centred care

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References

Greisinger

Lorimor

Aday

et al. Terminally ill cancer patients. Their most important concerns. Cancer Pract 1997; 5: 147–154.

Ågren Bolmsjö

. Existential issues in palliative care. PhD Thesis. Faculty of Medicine, Lund University, Lund, 2002.

WHO Expert Committee on Cancer Pain Relief and Active Support Care. Cancer pain relief and palliative care: report of a WHO expert committee [meeting held in Geneva from 3 to 10 July 1989]. Geneva: World Health Organization, 1990.

Udo

. The concept and relevance of existential issues in nursing. Eur J Oncol Nurs 2014; 18: 347–354.

Kitson

Marshal

Bassett

et al. What are the core elements of patient-centred care? A narrative review and synthesis of the literature from health policy. J Adv Nurs 2013; 69: 4–15.

Rämgård

Blomqvist

Peterson

. Developing health and social care planning in collaboration. J Interprof Care 2015; 29: 354–358.

Andersson

Hallberg

Edberg

. Old people receiving municipal care, their experiences of what constitutes a good life in the last phase of life. Int J Nurs Stud 2008; 45: 818–828.

Beck

Törnquist

Broström

et al. Having to focus on doing rather than being-nurse assistants’ experience of palliative care in municipal residential care settings. Int J Nurs Stud 2012; 49: 455–464.

Bolmsjö

. Existential issues in palliative care: interviews of patients with amyotrophic lateral sclerosis. J Palliat Med 2001; 4: 499–505.

10.

Bolmsjö

Edberg

A-K

Lilja Andersson

. The use of drama to support reflection and understanding of the residents’ situation in dementia care: a pilot study. Int J Older People Nurs 2014; 9: 183–191.

11.

Sand

Strang

. Existential loneliness in a palliative home care setting. J Palliat Care 2006; 9: 1376–1387.

12.

International Council of Nurses. The ICN code of ethics for nurses. Geneva: International Council of Nurses. 2012.

13.

Rogers

CR.

On becoming a person: a therapist’s view on psychotherapy. New York: Houghton Mifflin Company, 1991, pp. 283–4, p. 125 ff.

14.

Ettema

Derksen

van Leeuwen

. Existential loneliness and end-of-life care: a systematic review. Theor Med Bioeth 2010; 31: 141–169.

15.

Conn

Isaramalai

Rath

et al. Beyond MEDLINE for literature searches. J Nurs Scholarsh 2003; 35: 177–182.

16.

Nyström

Dahlberg

Segesten

. The enigma of severe mental illness: a Swedish perspective. Issues Ment Health Nurs 2002; 23: 121–134.

17.

Erdner

Magnusson

Nyström

et al. Social and existential alienation experienced by people with long-term mental illness. Scand J Caring Sci 2005; 19: 373–380.

18.

Nyström

. Aphasia – an existential loneliness: a study of the loss of the worlds of symbols. Int J Qual Stud Heal 2006; 1: 38–49.

19.

Erdner

Andersson

Magnusson

et al. Varying views of life among people with long-term mental illness. J Psychiatr Ment Health Nurs 2009; 16: 54–60.

20.

Sekse

Raaheim

Blaaka

et al. Life beyond cancer: women’s experiences 5 years after treatment for gynaecological cancer. Scand J Caring Sci 2010; 24: 799–807.

21.

Ozanne

Graneheim

Strang

. Finding meaning despite anxiety over life and death. J Clin Nurs 2013; 22: 2141–2149.

22.

Österlind

Ternestedt

Hansebo

et al. Feeling lonely in an unfamiliar place: older people’s experiences of life close to death in a nursing home. Int J Older People Nurs 2017; 12: 1–8.

23.

Larsson

Rämgård

Bolmsjö

. Older persons’ existential loneliness, as interpreted by their significant others – an interview study. BMC Geriatrics 2017; 17: 138.

24.

Sjöberg

Beck

Rasmussen

et al. Being disconnected from life: meanings of existential loneliness as narrated by frail older people. Aging Ment Health 2017; 17: 1–8.

25.

Jensen

Allen

. A synthesis of qualitative research on wellness-illness. Qual Health Res 1994; 4: 349–369.

26.

Gerring

. Social science methodology: a criterial framework. Cambridge: Cambridge University Press, 2001, pp. 65–86.

27.

Carnap

. The logical foundation of probability. Chicago, IL: The University of Chicago Press, 1971, pp. 3–8.

28.

Nordenfelt

. On the nature of health: an action-theoretic approach. 2nd revised ed. Dordrecht, The Netherlands: Kluwer Academic Publishers, 1995, p. 11.

29.

Avieli

Mushkin

Araten-Bergman

et al. Aging with schizophrenia: a lifelong experience of multidimensional losses and suffering. Arch Psychiatr Nurs 2016; 30: 230–236.

30.

Brülde

Fors

. Den svenska ensamheten: om hur olika former av ensamhet påverkar vårt välbefinnande [The Swedish loneliness: how different forms of loneliness affect our well-being]. In: Bergström

Johansson

Oscarsson

et al. (eds) Fragment. Gothenburg: SOM Institute, University of Gothenburg, 2015, pp. 47–61.

31.

Yalom

. Existential psychotherapy. New York: Basic Books, 1980, p. 29 ff, p. 353, 354.

32.

Brownlee

. A human right against social deprivation. Philos Quart 2013; 63: 199–222.

33.

Sand

. Existential challenges and coping in palliative cancer care: experiences of patients and family members. PhD Thesis, Karolinska Institutet, Solna, 2008.

34.

Nilsson

Nåden

Lindstrom

. The tune of want in the loneliness melody: loneliness experienced by people with serious mental suffering. Scand J Caring Sci 2008; 22: 161–169.

35.

Granerud

Severinsson

. The struggle for social integration in the community – the experiences of people with mental health problems. J Psychiatr Ment Health Nurs 2006; 13: 288–293.

36.

Davidson

Living outside mental illness: qualitative studies of recovery in schizophrenia. New York: New York University Press, 2003, p. 152 ff.

37.

Erdner

Nyström

Severinsson

et al. Psychosocial disadvantages in the lives of persons with long-term mental illness living in a Swedish community. J Psychiatr Ment Health Nurs 2002; 9: 457–463.

38.

Brülde

. Lycka och Lidande. Begrepp, metod och förklaring [Happiness and suffering. Concepts, method and explanation]. Lund: Studentlitteratur, 2007.

39.

Svenaeus

. Sjukdomens mening: det medicinska mötets fenomenologi och hermeneutik [ The meaning of illness: the phenomenology and hermeneutics of the medical encounter ]. Stockholm: Natur och Kultur, 2003, p. 66 ff.

40.

Heidegger

. Varat och tiden, del 2 [Being and Time, part 2]. Göteborg: Daidalos, 1993, p. 15ff.

41.

Lützén

Blom

Ewalds-Kvist

et al. Moral stress, moral climate and moral sensitivity among psychiatric professionals. Nurs Ethics 2010; 17: 213–224.

42.

Sartre

Being and nothingness: an essay in phenomenological ontology. New York: Philosophical Library, 1971, p. 531 ff.

43.

Buber

. I and Thou. New York: Charles Scribner’s Sons, 1970.

44.

Freire

Pedagogik för förtryckta [Pedagogy of the oppressed]. Stockholm: Gummesson, 1972, p. 89 ff.

45.

Moustakas

CE.

Loneliness. Englewood Cliffs, NJ: Prentice-Hall, 1961, p. 33 ff.

46.

Lindenauer

. Loneliness. Int J Emot Educ 1970; 10: 87–100.

47.

Francis

. Loneliness: measuring the abstract. Int J Nurs Stud 1976; 13: 153–160.

48.

Olson

. An introduction to existentialism. New York: Dover Publications, 1962, p. 196.