{ "schema_version": "uw.editorial_geo.v1", "representation_profile": "lossless_source_sections", "local_stage_only": true, "catalog_id": "DEP-21-N03", "article_index": "DEP-21-N03", "language": "en", "headline": "An existential approach: responsibility, mortality, isolation, and one's own values", "description": "An existential approach: responsibility, mortality, isolation, and one's own values", "short_answer": "After substance-related harm, a person may ask more than “How do I stop?” They may ask, “What could make tomorrow worth getting up for?”, “Whom can I tell?”, or “Which choices are actually mine?” These questions matter. They do not prove an inner void, a cause of addiction, or a duty to discover a grand purpose before receiving care. Here an existential approach means attending gently to mortality, freedom within real limits, responsibility, human connection, and values. Such a conversation may accompany medical and social help; it does not replace them.\n\nIrvin Yalom, Viktor Frankl, and Søren Kierkegaard wrote in different eras and genres. They do not supply one unified technique. Yalom describes a stance in psychotherapy, Frankl his account of the person and logotherapy, and Kierkegaard a religious text about suffering and an invitation. We ask what their distinct ideas can illuminate and where a philosophical conversation must stop. The examples below are invented situations, not patient histories.", "short_answer_source": { "kind": "explicit_about_h2", "role": "lead", "start_utf16": 379, "end_utf16": 1394, "sha256_utf8": "5337c9cac49dbd9b91c7fa3336fcb98bf813e57b3ecf8b352a4bb9ea09ec4047" }, "headline_source": { "role": "h1_heading", "start_utf16": 2, "end_utf16": 85, "sha256_utf8": "1c36151e3e16ea28b51ec1734af42ec98b5065431738347ddf8d6f24146724ea" }, "entities": [], "questions": [ { "q": "What this article is about", "a": "After substance-related harm, a person may ask more than “How do I stop?” They may ask, “What could make tomorrow worth getting up for?”, “Whom can I tell?”, or “Which choices are actually mine?” These questions matter. They do not prove an inner void, a cause of addiction, or a duty to discover a grand purpose before receiving care. Here an existential approach means attending gently to mortality, freedom within real limits, responsibility, human connection, and values. Such a conversation may accompany medical and social help; it does not replace them.\n\nIrvin Yalom, Viktor Frankl, and Søren Kierkegaard wrote in different eras and genres. They do not supply one unified technique. Yalom describes a stance in psychotherapy, Frankl his account of the person and logotherapy, and Kierkegaard a religious text about suffering and an invitation. We ask what their distinct ideas can illuminate and where a philosophical conversation must stop. The examples below are invented situations, not patient histories.", "source_spans": [ { "role": "h2_heading", "start_utf16": 351, "end_utf16": 377, "sha256_utf8": "a53bdb09d3d545eddde325393d7fae0fb8be199cef905ef433da14435f905db9" }, { "role": "h2_answer", "start_utf16": 379, "end_utf16": 1394, "sha256_utf8": "5337c9cac49dbd9b91c7fa3336fcb98bf813e57b3ecf8b352a4bb9ea09ec4047" } ], "block_ids": [ "p0004", "p0005" ], "source_segment_index": 1 }, { "q": "I. A person's question exceeds a diagnosis but does not cancel one", "a": "“Nothing matters to me” can arise alongside exhaustion, shame, pain, fear of losing a relationship, depression, substance effects, sleep loss, or a sense of meaninglessness. One sentence cannot settle the cause. In [Yalom's introduction](https://www.yalom.com/gift-of-therapy-introduction/), death, isolation, meaning, and freedom are four concerns important to **his** psychotherapy perspective. He also says that explicit discussion of them is relevant only for some patients and at some stages. “What is hardest right now?” is therefore a better opening than “Your real problem is fear of death.”\n\nWhen substance use is involved, distress can be discussed while sleep, pain, mental health, and use are professionally assessed. No one has to establish a “spiritual cause” to ask for care. New or worsening symptoms call for suitable clinical assessment. A philosophical frame can help someone listen to a story, not diagnose it. The person may prefer another language for what matters: relationships, work, health, faith, or simply getting through today safely.", "source_spans": [ { "role": "h2_heading", "start_utf16": 1399, "end_utf16": 1465, "sha256_utf8": "21dea2ae7fc42490019e4eba229be9120a3aaa3927361d644757f37a363cf825" }, { "role": "h2_answer", "start_utf16": 1467, "end_utf16": 2530, "sha256_utf8": "a72ea49413433ff07f0ead6cacf05855d8023e72db7cd3413edb772425081022" } ], "block_ids": [ "p0007", "p0008" ], "source_segment_index": 2 }, { "q": "II. Frankl's freedom “for what” is not power over every circumstance", "a": "In Frankl's [*Ten Theses about the Person*](https://www.viktorfrankl.org/texts.html), presented by the Viktor Frankl Institute from a 1950 lecture in a revised English translation, responsibility is linked to what freedom is *for*. This is his philosophical proposal: an action can be considered in light of what a person values, beyond immediate relief or another person's order. It is not experimental proof of what causes addiction. The text also speaks of a person's dignity apart from usefulness. A diagnosis or an unsuccessful attempt to change substance use does not make that dignity disappear.\n\nThe limit is crucial. A person may lack safe housing, money, transport, a clinician, or any safe way to resist coercion. Intoxication, dangerous withdrawal, or an acute mental health condition can also impair the capacity to weigh options. “You choose everything” would wrongly put a violent person's acts and systemic barriers on the one who is harmed. A more accurate question is: *What step is genuinely available within today's limits, and what help could expand the available options?*", "source_spans": [ { "role": "h2_heading", "start_utf16": 2535, "end_utf16": 2603, "sha256_utf8": "2672bec4fa0820aaef0a57edbbd4a59af694e068571d6d3a7fbbda0abd527e85" }, { "role": "h2_answer", "start_utf16": 2605, "end_utf16": 3699, "sha256_utf8": "09ff70976bc0f4509b03e1651be3979e28c864513daad2cfffdc553f2f768762" } ], "block_ids": [ "p0010", "p0011" ], "source_segment_index": 3 }, { "q": "III. Responsibility for a step is different from blame for harm", "a": "Responsibility can be useful when it is concrete and feasible: arranging a consultation, telling a clinician about a concerning symptom, asking a capable adult to take over a child's care while help is sought. Even those actions depend on connection, money, language, safety, and health. Responsibility need not be a solo feat. It does not prove that the person caused the violence, poverty, trauma, or illness affecting them. If no step is accessible yet, the response is to seek support and change conditions, not add shame.\n\nImagine a woman told, “If you really want a different life, just talk to your partner.” The partner threatens her and checks her phone. She does not owe anyone a courage test through a joint confession. A safe way to make contact and a separate route to protection come before a philosophical talk about responsibility. The [NHS account of domestic abuse](https://www.nhs.uk/live-well/getting-help-for-domestic-violence/) supports taking threats seriously; its British services and legal arrangements cannot be promised elsewhere. Outside an emergency, an adult's participation in another person's help is voluntary. The person exposed to harm may seek their own help without securing an abusive partner's agreement to a family conversation.", "source_spans": [ { "role": "h2_heading", "start_utf16": 3704, "end_utf16": 3767, "sha256_utf8": "61b1170cf39e09822e1da010e626d0ed0e9efb131d61eb2bf752f54e28138c4f" }, { "role": "h2_answer", "start_utf16": 3769, "end_utf16": 5038, "sha256_utf8": "5c39ea1719661920f14c46e0328160945c035085229e6470dce2e30024d6c591" } ], "block_ids": [ "p0013", "p0014" ], "source_segment_index": 4 }, { "q": "IV. Mortality can clarify today; it is no order to live as if tomorrow will not come", "a": "Yalom includes death among concerns that sometimes surface in therapy. Thinking about life's limits may help someone notice a specific value: time with a child, a letter, work, or rest without pain. Thoughts of death may also appear with grief, depression, dangerous illness, or an immediate risk of self-harm. The word “death” alone cannot tell us whether this is a philosophical conversation or a need for assessment and protection. No one has to produce a “correct” insight; mortality is not a motivational shock treatment.\n\nIn an imagined scene, a friend says after an illness, “Time is running out, you must fix your whole life.” Someone exhausted after treatment hears one more demand. A gentler offer might be, “What actually matters this week, and what can wait? Can I help with one concrete task?” If an adult's or child's life or safety is in immediate danger, local urgent help comes first. Exercises about meaning, forgiveness, and death can wait.", "source_spans": [ { "role": "h2_heading", "start_utf16": 5043, "end_utf16": 5127, "sha256_utf8": "4e1c4d720964074f8703bf8510a6d5b3ac197f0f737ebd5fe183c39cf905d24e" }, { "role": "h2_answer", "start_utf16": 5129, "end_utf16": 6088, "sha256_utf8": "77713f75aade6eb342d1b449bd2da5212dbd20cd62b424bb3649d77c02637c92" } ], "block_ids": [ "p0016", "p0017" ], "source_segment_index": 5 }, { "q": "V. Isolation is not proof that someone cannot love", "a": "Yalom treats existential isolation as a human concern and the real therapeutic relationship as a part of the work. Someone may have company and still feel profoundly misunderstood; someone else may be alone because no safe person is nearby. Neither situation establishes an “inability to be close” or a duty to join a group. Stigma may deepen isolation; at other times privacy protects a person from pressure and exposure. These questions involve actual people and circumstances, not only the abstract word “connection.”\n\nIt helps to ask permission: “Is there anyone you would want to contact today? What would you want to share, and what would you keep private?” A clinician, acquaintance, social worker, group, or spiritual adviser may be possible, or none may feel right now. No helper should promise absolute secrecy. Before sharing sensitive information, ask about their role, records, and local exceptions. No one must disclose a diagnosis publicly or trust a group to demonstrate that their loneliness is real.", "source_spans": [ { "role": "h2_heading", "start_utf16": 6093, "end_utf16": 6143, "sha256_utf8": "e2d10c146af61b5379d145ae32a9613272d4207cae466c0323a9f4b38d537d16" }, { "role": "h2_answer", "start_utf16": 6145, "end_utf16": 7162, "sha256_utf8": "a1f5c23df30b13c81d1af1ec5b4a301e1853873515c82e1b846ee726de919883" } ], "block_ids": [ "p0019", "p0020" ], "source_segment_index": 6 }, { "q": "VI. Values may become visible in small decisions", "a": "For Frankl, meaning connects with what freedom is directed *toward*. For Yalom, meaning is among the concerns that a therapist and patient may explore without imposing an answer. Both perspectives leave room for what matters to this person. Neither source establishes that a grand “life mission” must be defined before treatment. A person need not even use the word “meaning.” A starting preference might be keeping a child with a capable adult, maintaining work, sleeping, relieving pain, being truthful with one safe person, or spending ten minutes on a valued activity.\n\nSuppose a man says, “I don't know why I would change my use.” Rather than test his love for his family, one might ask, “What would you like to preserve even while you are uncertain about a long-term decision? What is in the way today?” If the answer is housing, money, pain care, or safety, the work begins with those conditions. Values must not become a new accusation: limited resources can make the same action unavailable at one time. A values list never entitles someone else to demand instant abstinence or that a prescription be abandoned.", "source_spans": [ { "role": "h2_heading", "start_utf16": 7167, "end_utf16": 7215, "sha256_utf8": "66396c143f23f358c182a1d1ce389a69ea10fa722e3537e6c1ce14a8cbcc051e" }, { "role": "h2_answer", "start_utf16": 7217, "end_utf16": 8337, "sha256_utf8": "f828a2b06e08361afecfc81747c2d8b2b0f7ad049b478ed7048721fb6743dbb1" } ], "block_ids": [ "p0022", "p0023" ], "source_segment_index": 7 }, { "q": "VII. Kierkegaard's historical voice and the risk of moralising", "a": "In “The Invitation,” included in [Kierkegaard's writings translated by Lee M. Hollander](https://www.gutenberg.org/cache/epub/60333/pg60333-images.html), a Christian invitation is offered to sufferers before an accusing inquiry into whether they caused their misfortune. This is a historical religious context, not a universal protocol for substance use care. Kierkegaard writes about Christ and religious salvation; a person with another faith or no faith may use entirely different language. Helpers can take one narrow question from the comparison: “Am I turning my offer into an inquiry about whether this person deserves help?” That does not turn a theological promise into a medical one.\n\nThe comparison does not erase the effects of someone's actions or forbid a later discussion of them. It changes the sequence. Life-threatening danger, illness, violence, and a child's need for care do not wait for moral confession. In a safer setting, an adult can decide whether to discuss harm done, responsibility, and rebuilding trust. Faith, repentance, forgiveness, and community membership are not admission fees for medical assessment.", "source_spans": [ { "role": "h2_heading", "start_utf16": 8342, "end_utf16": 8404, "sha256_utf8": "0ee770f8c35df39a6cd65c97f1f7ad5c73f97c8e960326feda14136b6530a65e" }, { "role": "h2_answer", "start_utf16": 8406, "end_utf16": 9544, "sha256_utf8": "085ea14b8b02e2d822867722fcac479f7b727fb1e28f874a284ae559b01e4616" } ], "block_ids": [ "p0025", "p0026" ], "source_segment_index": 8 }, { "q": "VIII. What one study tested, and what it did not", "a": "In [a study by Latifian, Esmaeili, and Mihan](https://pubmed.ncbi.nlm.nih.gov/42421126/), 60 patients in an Iranian psychiatric hospital had both a mental disorder and a co-occurring substance use disorder. They were recruited by convenience and then assigned to two groups of 30. The authors reported lower anxiety and perceived rejection in the existential group psychotherapy arm than in the control arm, with an assessment two months later. This is a limited signal for those outcomes in that setting. The abstract and publisher record we could read do not establish sustained remission of substance use, a replacement for medication, or the same effect across substances, ages, and health systems. Calling a method “existential” does not establish it as a proven treatment for every case.\n\nThe [U.S. National Institute of Mental Health](https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health) separately notes that substance-related and other mental health symptoms can overlap, requiring coordinated professional assessment. The practical inference is modest: if existential topics help someone speak and stay engaged with care, they can be discussed with a qualified professional as part of an individual plan; if they do not help, no one must persist out of duty. Ask about a professional's training and experience with substance use and co-occurring conditions, the actual language, cost, waiting time, and way to contact them. A method name or attractive questionnaire does not establish that suitable care is available.", "source_spans": [ { "role": "h2_heading", "start_utf16": 9549, "end_utf16": 9597, "sha256_utf8": "415d51aebeff7ec6cbb1c9470f732e011d78d85d8be8a45c9401e87aa470f68f" }, { "role": "h2_answer", "start_utf16": 9599, "end_utf16": 11145, "sha256_utf8": "28869edecb37d49e1129bbe6268a409f27749a33f4888fc5f0b9c66f8a26b5f5" } ], "block_ids": [ "p0028", "p0029" ], "source_segment_index": 9 }, { "q": "IX. Medical care does not wait for a finished purpose", "a": "For diagnosed opioid use disorder, the [U.S. CDC guidance to clinicians](https://www.cdc.gov/overdose-prevention/hcp/clinical-care/opioid-use-disorder-treating.html) recommends offering or arranging medication treatment. Lack of psychosocial care, or declining it, should not delay this. That is neither an individual prescription nor a rule for every substance. It does show a clear direction: discussing values is not an entry requirement for indicated medical care. Other conditions require their own assessment, and a person may ask for help before they feel certain of a deeper purpose or complete readiness.\n\nA prescribed medication, its benefit, physical adaptation, and a substance use disorder are distinct questions. Using antidepressants as one example, the [Royal College of Psychiatrists](https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/antidepressants) explains that withdrawal symptoms may reflect the body's adaptation and do not automatically amount to addiction. This article cannot decide whether any particular medicine should be stopped. Do not change doses yourself, attempt withdrawal at home, or replace treatment with “meaning work”; discuss concerns with the prescriber or pharmacist. If care is expensive, distant, unavailable in your language, or requires a long wait, name that as a real barrier and ask about local options without assuming one will be found.", "source_spans": [ { "role": "h2_heading", "start_utf16": 11150, "end_utf16": 11203, "sha256_utf8": "f51583c74cf86cfec65af97a7c312c48fec847fbcd2346148701525e9db32cdc" }, { "role": "h2_answer", "start_utf16": 11205, "end_utf16": 12610, "sha256_utf8": "817676bee5e98b01382dc16bf5d389c1cd5fbc9de7b8cd082655964e7bc6b255" } ], "block_ids": [ "p0031", "p0032" ], "source_segment_index": 10 }, { "q": "X. Safety and actual care set the limit of the conversation", "a": "New sudden confusion **itself** calls for immediate contact with a local emergency medical service. Do not wait for disorientation, a second severe sign, sobriety, or an explanation in terms of an “existential crisis” ([NHS on sudden confusion](https://www.nhs.uk/symptoms/confusion/)). If poisoning or overdose is suspected, contact the local emergency medical service immediately, even before symptoms appear ([NHS on poisoning](https://www.nhs.uk/conditions/poisoning/)). An immediate threat to an adult's or child's life or a risk of self-harm also calls for local urgent help first. This article gives no home protocol or foreign telephone number.\n\nWith threats or violence, seek a separate safe route to protection; a joint values discussion with someone threatening the person is not a first step. If a child depends on an adult, **an actually available, capable adult** must take over care while help is sought; a phone answer alone is not supervision. A child is not a substance-use monitor, medicine keeper, go-between, interpreter, or required comforter. Consent, privacy, mandatory reporting, age, and custody rules depend on location. Ask a qualified local service, without assuming absolute confidentiality or a guaranteed result.", "source_spans": [ { "role": "h2_heading", "start_utf16": 12615, "end_utf16": 12674, "sha256_utf8": "4424c7718439050ae03f1a29ac84fc50277b111f91a504456b42a52a3d50c111" }, { "role": "h2_answer", "start_utf16": 12676, "end_utf16": 13920, "sha256_utf8": "c5b4c3cc0d78ab5158c1870121810f75e1151a5413c4e635c035dc28dfc7e8e5" } ], "block_ids": [ "p0034", "p0035" ], "source_segment_index": 11 }, { "q": "What this means in practice", "a": "Begin with two separate questions rather than a grand purpose. First, safety: “Is there new sudden confusion, suspected poisoning, immediate danger to me or a child, or violence now?” For a medical emergency, contact the local emergency service immediately; with violence, seek a separate safe route to protection. Second, after safety: “What question about my health, substance use, or life do I want to ask someone competent? How can I actually reach them in my language, at a manageable cost and wait, and with a clear account of privacy?”\n\nA first contact can be plain: “I'm concerned about my substance use and how I feel. I want to discuss medical and psychological options without having to prove complete readiness or find a purpose first. What can you assess? What limits apply to confidentiality, and what will it cost?” If the only feasible step today is checking opening hours, arranging capable adult care for a child, or writing down a question, that is still a step. No article can promise that this conversation will change the person's condition immediately or secure a service. They may decline the existential frame and seek another kind of help.", "source_spans": [ { "role": "h2_heading", "start_utf16": 13925, "end_utf16": 13952, "sha256_utf8": "cac0025fb51e434450b9925cf9a4977d85e79dc5ce2542d61d4355abea0cdd54" }, { "role": "h2_answer", "start_utf16": 13954, "end_utf16": 15119, "sha256_utf8": "6f81786633cfd183bb3ca9b422e7a2e47ff9a9d947ed5dbbc84710a6b1fbd170" } ], "block_ids": [ "p0037", "p0038" ], "source_segment_index": 12 }, { "q": "Key quotation", "a": "> “responsibility includes the what for of human freedom” — Viktor Frankl, a short passage from thesis 5 in [*Ten Theses about the Person*](https://www.viktorfrankl.org/texts.html). It states his view, not a measure of blame or a clinical promise.", "source_spans": [ { "role": "h2_heading", "start_utf16": 15124, "end_utf16": 15137, "sha256_utf8": "b118466bf32094406f875582a1606883eea0c734aab123a1fe6f5352d863995a" }, { "role": "h2_answer", "start_utf16": 15139, "end_utf16": 15386, "sha256_utf8": "a6d1c54f9f45370968abeb82eb5e22d3e7f030cce4794050227a9e7dfec60636" } ], "block_ids": [ "p0040" ], "source_segment_index": 13 }, { "q": "Connections between traditions", "a": "- **Frankl and Yalom.** In thesis 5, Frankl asks what freedom is *for* and links it to responsibility. In his [book introduction](https://www.yalom.com/gift-of-therapy-introduction/), Yalom considers mortality, isolation, meaning, and freedom in the therapist–patient relationship, while warning against imposing a topic. Both resist reducing a person to a symptom. Yet Frankl's philosophical anthropology and Yalom's individual therapeutic stance do not form one proven SUD treatment.\n- **Kierkegaard and Yalom.** Kierkegaard's historical Christian “Invitation” objects to asking a sufferer a blaming question before offering help. Yalom describes therapy attentive to relationship rather than driven by theory. The point of resemblance is *how* help is offered. Their grounds differ: Kierkegaard's Christian promise and Yalom's clinical experience. Neither authorises making faith, a conversation about death, or a predetermined meaning a condition of medical care.\n\nThis map compares named texts and limits. Similar words do not establish one unified existential doctrine or clinical effectiveness.", "source_spans": [ { "role": "h2_heading", "start_utf16": 15391, "end_utf16": 15421, "sha256_utf8": "dfc0387d996bf1ade440e38a114e456de1bcae05b8a3c016d2a665a9d38fbc05" }, { "role": "h2_answer", "start_utf16": 15423, "end_utf16": 16524, "sha256_utf8": "d3ccd1ab186542abb4db4cddd46bfd0ed7497cec36a8f0e136e6f0d8fe010fe1" } ], "block_ids": [ "p0042", "p0043" ], "source_segment_index": 14 }, { "q": "Sources and limits", "a": "- [Viktor Frankl Institute, *Ten Theses about the Person*](https://www.viktorfrankl.org/texts.html): 1950 lecture in Vesely/Nolland's 2021 English translation, revised August 2026, based on Hogrefe 2016. Theses 3–5 and 10 are used as the author's concepts; historical medical claims are not adopted as current practice. The quotation is brief.\n- [Irvin Yalom, introduction to *The Gift of Therapy*](https://www.yalom.com/gift-of-therapy-introduction/): the author's text on his site; web-page date unestablished. Read for his concerns, therapeutic relationship, and the limits he names for his own practice; not an addiction-treatment trial. The epigraph is a short excerpt.\n- [Søren Kierkegaard, *Selections from the Writings of Kierkegaard*](https://www.gutenberg.org/cache/epub/60333/pg60333-images.html): *Preparation for a Christian Life / The Invitation*, Lee M. Hollander's translation, University of Texas 1923; Gutenberg release 2019, update 2024. Narrow original paraphrase of a Christian invitation without prior blame, not a medical source or cure promise.\n- [Latifian, Esmaeili, and Mihan, BMC Psychology](https://pubmed.ncbi.nlm.nih.gov/42421126/): primary study published 9 July 2026. Only the abstract and publisher record were read, not its full protocol. Iranian hospital, 60 people in two groups of 30, a two-month assessment, anxiety and perceived rejection outcomes; no inference of long-term SUD remission. Publisher rights are CC BY-NC-ND 4.0; only facts and original brief synthesis are used.\n- [NIMH, co-occurring substance use and mental disorders](https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health): U.S. public overview, reviewed March 2025. Supports coordinated assessment and possible treatment; neither a diagnosis of the reader nor a promise of local access.\n- [CDC, treatment of opioid use disorder](https://www.cdc.gov/overdose-prevention/hcp/clinical-care/opioid-use-disorder-treating.html): U.S. clinician page, 9 April 2024. Limited to diagnosed OUD and avoiding delay of indicated medication treatment for lack of psychosocial care; not a prescription for this reader.\n- [Royal College of Psychiatrists, antidepressants](https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/antidepressants): U.K. professional public overview, published March 2025. Distinguishes physical adaptation from addiction using antidepressants as an example; no withdrawal plan.\n- [NHS, poisoning](https://www.nhs.uk/conditions/poisoning/): U.K. page, reviewed 12 June 2025; urgency on suspicion before symptoms without exporting U.K. numbers or home instructions.\n- [NHS, sudden confusion](https://www.nhs.uk/symptoms/confusion/): U.K. page, reviewed 28 May 2024; new sudden confusion itself needs immediate medical evaluation.\n- [NHS, domestic violence and abuse](https://www.nhs.uk/live-well/getting-help-for-domestic-violence/): U.K. page, reviewed 23 June 2026; safety when there are threats. Local services, law, consent, privacy, and reporting duties require local verification.\n\nNo whole pages, protocols, scales, tables, or abstracts have been reproduced. Philosophical and religious texts are not clinical-outcome evidence. Clinical expert, native Thai, local legal, and human acceptance reviews have not been run.", "source_spans": [ { "role": "h2_heading", "start_utf16": 16529, "end_utf16": 16547, "sha256_utf8": "f91f16500d95114ea5dd62762b302ab95f247ca4f49fe0affb04993b09f0a299" }, { "role": "h2_answer", "start_utf16": 16549, "end_utf16": 19820, "sha256_utf8": "f937aec58ce29d0e103b058b16086ddb6a19b4dd152b6e0aecf813900b97234f" } ], "block_ids": [ "p0045", "p0046" ], "source_segment_index": 15 }, { "q": "Tags", "a": "existential approach, Viktor Frankl, Irvin Yalom, Søren Kierkegaard, responsibility, mortality, isolation, meaning, values, substance use disorder, medical care, child safety", "source_spans": [ { "role": "h2_heading", "start_utf16": 19825, "end_utf16": 19829, "sha256_utf8": "1331275bc537b4c2bf1e46f7275677967515342e30b572e6852fa6f51b831fe8" }, { "role": "h2_answer", "start_utf16": 19831, "end_utf16": 20005, "sha256_utf8": "057518049bc7baf4b5aab5e722943bb43a63fb860076250cbaa9a4a5a4e02256" } ], "block_ids": [ "p0048" ], "source_segment_index": 16 }, { "q": "About the authors", "a": "Andrey Zarinsh — author and founder of United Wisdom. He explores inner transformation, the unity of traditions, intercultural dialogue, and contemporary spiritual discipline. Instagram: @andrey.zarinsh.\n\nMaria Evilkut — co-author of United Wisdom. Alongside her research, she seeks to test these ideas in practice and observe how principles of unity and mutual understanding work in real life between people and cultures. Instagram: @ilkutki.", "source_spans": [ { "role": "h2_heading", "start_utf16": 20010, "end_utf16": 20027, "sha256_utf8": "e120452a2b9952200310f55df00e52d0bbd068d32bba8a322511ed65e3d4967d" }, { "role": "h2_answer", "start_utf16": 20029, "end_utf16": 20472, "sha256_utf8": "a909a5be3206496a5832c139d32d3d32c2d2720a0cd4d5a3c8cd4f315e84ac24" } ], "block_ids": [ "p0050", "p0051" ], "source_segment_index": 17 }, { "q": "Content date", "a": "15 October 2026. 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Read for his concerns, therapeutic relationship, and the limits he names for his own practice; not an addiction-treatment trial. The epigraph is a short excerpt.", "read_scope_kind": "verbatim_bibliography_entry", "read_scope_span": { "role": "bibliography_entry", "start_utf16": 16893, "end_utf16": 17223, "sha256_utf8": "7deaa7c4b523629b1c966bf3923aa53cbd7bf593e40d8d7959e96c28ebd48f66" }, "shared_entry_urls": [] }, { "id": "src_4d56bfb654442386", "title": "Viktor Frankl Institute, *Ten Theses about the Person*", "url": "https://www.viktorfrankl.org/texts.html", "source_spans": [ { "role": "markdown_link", "start_utf16": 2617, "end_utf16": 2689, "sha256_utf8": "f35407d6fb4427c990d4360ffe0400d7c6b20c623d79375cda432b8bd404a20a" }, { "role": "markdown_link", "start_utf16": 15247, "end_utf16": 15319, "sha256_utf8": "f35407d6fb4427c990d4360ffe0400d7c6b20c623d79375cda432b8bd404a20a" }, { "role": "markdown_link", "start_utf16": 16551, "end_utf16": 16648, "sha256_utf8": "889234627f6bcd30008555ed2187ae73abc5a043ab974a1d62708778acf9b2c5" } ], "read_scope": "- [Viktor Frankl Institute, *Ten Theses about the Person*](https://www.viktorfrankl.org/texts.html): 1950 lecture in Vesely/Nolland's 2021 English translation, revised August 2026, based on Hogrefe 2016. Theses 3–5 and 10 are used as the author's concepts; historical medical claims are not adopted as current practice. The quotation is brief.", "read_scope_kind": "verbatim_bibliography_entry", "read_scope_span": { "role": "bibliography_entry", "start_utf16": 16549, "end_utf16": 16892, "sha256_utf8": "2c7397914ca09e5631c777732c3344d43b2a407a66b42bc403b66e87441275a6" }, "shared_entry_urls": [] }, { "id": "src_a035cf388056a1ce", "title": "NHS, domestic violence and abuse", "url": "https://www.nhs.uk/live-well/getting-help-for-domestic-violence/", "source_spans": [ { "role": "markdown_link", "start_utf16": 4621, "end_utf16": 4718, "sha256_utf8": "8a2ae419e4a04b04cd9108197c8f5f42f8bbf75b200224be63794fb699a77020" }, { "role": "markdown_link", "start_utf16": 19327, "end_utf16": 19427, "sha256_utf8": "c834bdb83fed46e51c560771892cc0e139c8612811c9b374932f82f51aafe049" } ], "read_scope": "- [NHS, domestic violence and abuse](https://www.nhs.uk/live-well/getting-help-for-domestic-violence/): U.K. page, reviewed 23 June 2026; safety when there are threats. Local services, law, consent, privacy, and reporting duties require local verification.", "read_scope_kind": "verbatim_bibliography_entry", "read_scope_span": { "role": "bibliography_entry", "start_utf16": 19325, "end_utf16": 19581, "sha256_utf8": "8e26e5471fd04d15446ff79c0b4c3114d0fac9ea48d569376d81872f1660ff97" }, "shared_entry_urls": [] }, { "id": "src_7cb108316fa9cf06", "title": "Søren Kierkegaard, *Selections from the Writings of Kierkegaard*", "url": "https://www.gutenberg.org/cache/epub/60333/pg60333-images.html", "source_spans": [ { "role": "markdown_link", "start_utf16": 8439, "end_utf16": 8558, "sha256_utf8": "0766760c7f3bf2e00e6d661fb33933828d24a318997ff187fc1387887a1479ab" }, { "role": "markdown_link", "start_utf16": 17226, "end_utf16": 17356, "sha256_utf8": "d57af0a31826112c74556636b8ce942827dbbb6ab01c852ddcdf6ee2f1c6c99d" } ], "read_scope": "- [Søren Kierkegaard, *Selections from the Writings of Kierkegaard*](https://www.gutenberg.org/cache/epub/60333/pg60333-images.html): *Preparation for a Christian Life / The Invitation*, Lee M. Hollander's translation, University of Texas 1923; Gutenberg release 2019, update 2024. Narrow original paraphrase of a Christian invitation without prior blame, not a medical source or cure promise.", "read_scope_kind": "verbatim_bibliography_entry", "read_scope_span": { "role": "bibliography_entry", "start_utf16": 17224, "end_utf16": 17617, "sha256_utf8": "6e091da6b5c7ba68a6f66ba52f0b1827e66cb3dd1ab14f8fa0d70bbd25f93d78" }, "shared_entry_urls": [] }, { "id": "src_b01223c42ab5cf3b", "title": "Latifian, Esmaeili, and Mihan, BMC Psychology", "url": "https://pubmed.ncbi.nlm.nih.gov/42421126/", "source_spans": [ { "role": "markdown_link", "start_utf16": 9602, "end_utf16": 9687, "sha256_utf8": "4132cc7e2cb76c55765678ab04c35fb9e472b43ecbc3e5406abc6f89252a28c3" }, { "role": "markdown_link", "start_utf16": 17620, "end_utf16": 17710, "sha256_utf8": "5869affdb27fd24f807fd06d79204c8822f22faaa70ae854c0892bcb219cf66c" } ], "read_scope": "- [Latifian, Esmaeili, and Mihan, BMC Psychology](https://pubmed.ncbi.nlm.nih.gov/42421126/): primary study published 9 July 2026. Only the abstract and publisher record were read, not its full protocol. Iranian hospital, 60 people in two groups of 30, a two-month assessment, anxiety and perceived rejection outcomes; no inference of long-term SUD remission. Publisher rights are CC BY-NC-ND 4.0; only facts and original brief synthesis are used.", "read_scope_kind": "verbatim_bibliography_entry", "read_scope_span": { "role": "bibliography_entry", "start_utf16": 17618, "end_utf16": 18065, "sha256_utf8": "04ff6f644836abd8e3fc93f76928586bf2cb6cfb976d487242d6568054c41017" }, "shared_entry_urls": [] }, { "id": "src_ccd9c1d7863aff81", "title": "NIMH, co-occurring substance use and mental disorders", "url": "https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health", "source_spans": [ { "role": "markdown_link", "start_utf16": 10398, "end_utf16": 10512, "sha256_utf8": "934003207934451a6c1770e6d8ae79187fdb8d47dd87a5f6a092c104ec72f4e7" }, { "role": "markdown_link", "start_utf16": 18068, "end_utf16": 18195, "sha256_utf8": "801fa3b04f344d99b7cfe1dc477733e78829793a48b144c1ce9d03f45e3eb90b" } ], "read_scope": "- [NIMH, co-occurring substance use and mental disorders](https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health): U.S. public overview, reviewed March 2025. Supports coordinated assessment and possible treatment; neither a diagnosis of the reader nor a promise of local access.", "read_scope_kind": "verbatim_bibliography_entry", "read_scope_span": { "role": "bibliography_entry", "start_utf16": 18066, "end_utf16": 18360, "sha256_utf8": "fdc1861a37edd945d84a301576f899ba4c5f32594e225ab44eff9a8308083e41" }, "shared_entry_urls": [] }, { "id": "src_d7a377a386f6456c", "title": "CDC, treatment of opioid use disorder", "url": "https://www.cdc.gov/overdose-prevention/hcp/clinical-care/opioid-use-disorder-treating.html", "source_spans": [ { "role": "markdown_link", "start_utf16": 11244, "end_utf16": 11370, "sha256_utf8": "3297a555cb333891740795680648b9a06830bfdecde6871a444515d90bf783d4" }, { "role": "markdown_link", "start_utf16": 18363, "end_utf16": 18495, "sha256_utf8": "7c455003194979db7912c9c236075e7a73c76c3c91cb2c3c524c70ca424066f1" } ], "read_scope": "- [CDC, treatment of opioid use disorder](https://www.cdc.gov/overdose-prevention/hcp/clinical-care/opioid-use-disorder-treating.html): U.S. clinician page, 9 April 2024. Limited to diagnosed OUD and avoiding delay of indicated medication treatment for lack of psychosocial care; not a prescription for this reader.", "read_scope_kind": "verbatim_bibliography_entry", "read_scope_span": { "role": "bibliography_entry", "start_utf16": 18361, "end_utf16": 18676, "sha256_utf8": "56ddb27824576a38667b6ce212d6c3ba9187dcae7735ac47f4f561dbaa751fe6" }, "shared_entry_urls": [] }, { "id": "src_94a0b44caef70374", "title": "Royal College of Psychiatrists, antidepressants", "url": "https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/antidepressants", "source_spans": [ { "role": "markdown_link", "start_utf16": 11974, "end_utf16": 12088, "sha256_utf8": "c89401bd9e7afb2a7d631f4ec9ca15e0c6d97b039ece71502d100ff6a38c5ba8" }, { "role": "markdown_link", "start_utf16": 18679, "end_utf16": 18810, "sha256_utf8": "95f0ffed4fadc9f04d432f336f8de4a3d4717604b6fb56ac764037b89cc4e66c" } ], "read_scope": "- [Royal College of Psychiatrists, antidepressants](https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/antidepressants): U.K. professional public overview, published March 2025. Distinguishes physical adaptation from addiction using antidepressants as an example; no withdrawal plan.", "read_scope_kind": "verbatim_bibliography_entry", "read_scope_span": { "role": "bibliography_entry", "start_utf16": 18677, "end_utf16": 18974, "sha256_utf8": "bbc221fc964671aff40de5468d002690e48621c21b6d2620ac8d196583302ec3" }, "shared_entry_urls": [] }, { "id": "src_6740eb80d2b869e3", "title": "NHS, sudden confusion", "url": "https://www.nhs.uk/symptoms/confusion/", "source_spans": [ { "role": "markdown_link", "start_utf16": 12895, "end_utf16": 12960, "sha256_utf8": "f91753f8007c43d53eacad43baa4b28af2d4e3cb72d72723cb2b19e523419cad" }, { "role": "markdown_link", "start_utf16": 19163, "end_utf16": 19226, "sha256_utf8": "84cc8ab1ba394157a504b9ae6ce1a61a9020a807463fcbb5105d1dd21d960a46" } ], "read_scope": "- [NHS, sudden confusion](https://www.nhs.uk/symptoms/confusion/): U.K. page, reviewed 28 May 2024; new sudden confusion itself needs immediate medical evaluation.", "read_scope_kind": "verbatim_bibliography_entry", "read_scope_span": { "role": "bibliography_entry", "start_utf16": 19161, "end_utf16": 19324, "sha256_utf8": "54b65a17b11130f6c6551a8b49aa1c1d7ae711c0a29e8e3e5c1d02b1f0d6d46b" }, "shared_entry_urls": [] }, { "id": "src_10790fb1fab48f9a", "title": "NHS, poisoning", "url": "https://www.nhs.uk/conditions/poisoning/", "source_spans": [ { "role": "markdown_link", "start_utf16": 13088, "end_utf16": 13148, "sha256_utf8": "b01a118452cd50f553e20e323183325c1a1c7e35b85916ff02e594e3cd8a5d5a" }, { "role": "markdown_link", "start_utf16": 18977, "end_utf16": 19035, "sha256_utf8": "4df8a92091531b6a767c67412d798b2ba441449a7c75ce3f1df2da2181151083" } ], "read_scope": "- [NHS, poisoning](https://www.nhs.uk/conditions/poisoning/): U.K. page, reviewed 12 June 2025; urgency on suspicion before symptoms without exporting U.K. numbers or home instructions.", "read_scope_kind": "verbatim_bibliography_entry", "read_scope_span": { "role": "bibliography_entry", "start_utf16": 18975, "end_utf16": 19160, "sha256_utf8": "ac2fde3732f76ad277c44cde162a9a183e3727b9d55cb41802a8a912a220ff99" }, "shared_entry_urls": [] } ], "retrieval_limits": [ "This local GEO representation applies only to the specified source article version and its SHA-256.", "Qualifications, sources and attributions remain in the full sections and byte-identical Markdown copy.", "No new source research was conducted in this GEO stage." ], "master_sha256": "bd020057988cff731be00ad1f58d7fa1843d30eb07a369e7101ba0cabb39d203", "provenance": { "raw_reader_sha256": "bd020057988cff731be00ad1f58d7fa1843d30eb07a369e7101ba0cabb39d203", "ru_master_sha256": "bbf25d5ea561d6ee6a68f51c6bd7e9bafd3dcc94ad884d1e451df5b3e351c464", "reader_path": "outputs/uw-addictions-corpus-20261013/articles/DEP-21-N03/ARTICLE_EN.md", "review_pointer": "outputs/uw-addictions-corpus-20261013/articles/DEP-21-N03/INDEPENDENT_REVIEW.json", "review_sha256": "2534b542677d8d3ca7be0fcfe3c2d2d52ecad329307c5d82e11ed06f2787ad21", "clean_md_relative_filename": "GEO.en.md", "body_length_utf16": 20525, "source_segments": [ { "kind": "opening", "index": 0, "heading": null, "start_utf16": 0, "end_utf16": 348, "sha256_utf8_raw_slice": "5274eaf853ff1027d49acbcf72a0bb3c1d920076fccb52a032418459d2301dc2" }, { "kind": "h2_section", "index": 1, "heading": "What this article is about", "start_utf16": 348, "end_utf16": 1396, "sha256_utf8_raw_slice": "c3390fedd8b404d27ccd04d50b1499ea811e54e8f6b54ed19d2c1bcef87f4357" }, { "kind": "h2_section", "index": 2, "heading": "I. A person's question exceeds a diagnosis but does not cancel one", "start_utf16": 1396, "end_utf16": 2532, "sha256_utf8_raw_slice": "590efe173f78fe7027cb894f6c4b0ae18fd380ccd77851293eb01352d562447b" }, { "kind": "h2_section", "index": 3, "heading": "II. Frankl's freedom “for what” is not power over every circumstance", "start_utf16": 2532, "end_utf16": 3701, "sha256_utf8_raw_slice": "bd93262c7844bbbe893472246b9a14f15be7929f6d3af1516a1c3c97f2cd345e" }, { "kind": "h2_section", "index": 4, "heading": "III. Responsibility for a step is different from blame for harm", "start_utf16": 3701, "end_utf16": 5040, "sha256_utf8_raw_slice": "080e13cff629c8ba6c8c94a5372f864a4c0bd6d035296cf8662e4107e3029408" }, { "kind": "h2_section", "index": 5, "heading": "IV. Mortality can clarify today; it is no order to live as if tomorrow will not come", "start_utf16": 5040, "end_utf16": 6090, "sha256_utf8_raw_slice": "95441ca5f8c04d7a0697c70d308556d81a605bb5f40df3fdfe7c47faf978e2a1" }, { "kind": "h2_section", "index": 6, "heading": "V. Isolation is not proof that someone cannot love", "start_utf16": 6090, "end_utf16": 7164, "sha256_utf8_raw_slice": "bbc60ae3a37b7cfb8b0684271489ca2d495c23d536e4dc1f3c8e4996d7684971" }, { "kind": "h2_section", "index": 7, "heading": "VI. Values may become visible in small decisions", "start_utf16": 7164, "end_utf16": 8339, "sha256_utf8_raw_slice": "8bd3b6cd792fc55fa1c3a3c507022b8870c370cc236327409a965adc052dad09" }, { "kind": "h2_section", "index": 8, "heading": "VII. Kierkegaard's historical voice and the risk of moralising", "start_utf16": 8339, "end_utf16": 9546, "sha256_utf8_raw_slice": "03c29c3f253603b80806efb37750c499756cced46a8c61e997192de42dd79ceb" }, { "kind": "h2_section", "index": 9, "heading": "VIII. What one study tested, and what it did not", "start_utf16": 9546, "end_utf16": 11147, "sha256_utf8_raw_slice": "5d4bf429b71db51f700719e49e38fd42cec2390e1fd98c67c9d2dc93f0fcee0e" }, { "kind": "h2_section", "index": 10, "heading": "IX. Medical care does not wait for a finished purpose", "start_utf16": 11147, "end_utf16": 12612, "sha256_utf8_raw_slice": "809a4e7e274d5e451671e43fa65842628d8f7e7be9516b5bf23dd836a21b009b" }, { "kind": "h2_section", "index": 11, "heading": "X. Safety and actual care set the limit of the conversation", "start_utf16": 12612, "end_utf16": 13922, "sha256_utf8_raw_slice": "93b23284c6294d99e34e7a363b6b728146c10220afb6c82b1661ec5016b63e5f" }, { "kind": "h2_section", "index": 12, "heading": "What this means in practice", "start_utf16": 13922, "end_utf16": 15121, "sha256_utf8_raw_slice": "6384d64655c4a3c6b4f6d575a6542b89969852e55e01f4f9049c2f0c6e1c7fad" }, { "kind": "h2_section", "index": 13, "heading": "Key quotation", "start_utf16": 15121, "end_utf16": 15388, "sha256_utf8_raw_slice": "847dd83b93005ed57dae5a618c28d42170cb022a3a58b55dd24707ba7c5463c0" }, { "kind": "h2_section", "index": 14, "heading": "Connections between traditions", "start_utf16": 15388, "end_utf16": 16526, "sha256_utf8_raw_slice": "0e2613651239f649289bd3b807b16e7e60376a566ebc560c5b208e2b30128190" }, { "kind": "h2_section", "index": 15, "heading": "Sources and limits", "start_utf16": 16526, "end_utf16": 19822, "sha256_utf8_raw_slice": "75780e2cb5a869f58f9c96c3b180ae01cf06778e84d5bd6fdac6f1588286ca39" }, { "kind": "h2_section", "index": 16, "heading": "Tags", "start_utf16": 19822, "end_utf16": 20007, "sha256_utf8_raw_slice": "6a32097687ca47dcef83681fc73ef03b09532078f7608744183df45ca2cdc3fe" }, { "kind": "h2_section", "index": 17, "heading": "About the authors", "start_utf16": 20007, "end_utf16": 20474, "sha256_utf8_raw_slice": "7f2c55b3d985b2ff0954e621b3217fe32891672c02a87cda804088b53cfe4d60" }, { "kind": "h2_section", "index": 18, "heading": "Content date", "start_utf16": 20474, "end_utf16": 20525, "sha256_utf8_raw_slice": "f9bd0a641904a0d6c0f16f31cd23f04a7752d5698fb1d7c7eab8f86e42f4dd91" } ], "common_blocks_module_sha256": "6cf638661a819f960c39d08058bf6d0d0696e8b816f677d95b389f5f1d11e4d2" } }