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The paper describes a conceptual model that illuminates why existential issues are an essential element of history taking and need to be addressed in clinical practice. There are four layers in the encounter with the patient: (1) the analysis of the clinical syndrome; (2) the investigation of the way the patient relates to her condition; (3) analysis of the way the psychiatric condition affects this latter relation (example: demoralization as depressive symptom affects the way the patient relates to her depression); and (4) investigation of the way the personality of the patient affects her relation to the clinical condition. Existential factors play a role in layer (4) and maybe crucial not only for understanding the patient but also for compliance and effectiveness of interventions. The paper will relate to other attempts to an integral view on patient care and will describe efforts to implement this view in clinical practice and residency training. [Copyright &y& Elsevier]

Building forth on earlier work in which I have argued for the self-relational nature of human psychopathology, this presentation will investigate whether self-relatedness is also fundamental for the study of the neuronal mechanisms that underlie human psychopathology. Self-relatedness refers to the self-referential structure of human experience and action. It is concept with some philosophical importance, because it helps to avoid an unattractive instrumentalist (and ultimately Cartesian) view of the brain, in which the brain is either seen as the executive organ of a hidden player (the ego) (dualism) or as the engine of the complicated machinery we call man (materialistic monism). It will be shown how self-relatedness is implied at two levels of investigation in neuroscience: [(1)] the level of first order attitudes and experiences such as basis moods, affective dispositions and body memory; and [(2)] the level of second order processes that are implied in (self) regulation, integration and insight. To support this hypothesis I will build forth on the work of neuroscientists and philosophers like Damasio, Edelman, Thompson, Noë, Jack & Roepstorff. Differences and similarities between the concepts of self-relatedness and of self-organization will be pointed out. [ABSTRACT FROM AUTHOR]