Meier - Necessary Suffering.pdf Qualitative Studies Vol. 6, No. 1, 2021, pp. 116-141 ISSN 1903-7031 116 Necessary Suffering? - Investigating Existential Suffering in Youth through Everyday Experiences of Bad Conscience Joachim Meier1 1 Department of Psychology, Aarhus University, Bartholins Allé, 11, 8000 Aarhus C, Denmark The purpose of this article is to develop an account of existential suffering in youth. According to recent studies, a growing amount of young Westerners has come to suffer from mental disorders, stress, and a general lack of well-being. It is suggested however that the massive concern for young people's mental health might risk contributing to an increased pathologization of all kinds of suffering in youth. In continuation hereof the article aims at disclosing a suffering that is not pathological in kind but quite the contrary clings to existence. Based on interviews with three Danish high school students, regarding their experiences of bad conscience in their everyday lives, it is revealed how they suffer from matters conceivable as normative implications of fundamental conditions of existence such as freedom, finitude and the Other. In the end, critical concerns are raised regarding the normative evaluation of existential suffering as a necessity. That is, should we not always be against suffering? Keywords: existence; suffering; youth; pathologization; normativity; bad conscience Introduction In his poem “If Some Day Darkness Were Used Up,” the Danish poet Søren Ulrik Thomsen (2011, p. 26) writes: “if winter ended forever some March day all the world’s coldness would have to be housed in our own frozen souls” I remembered these lines during a grey albeit overly hot day in February while I entered the hall of a high school to conduct interviews and was greeted by a large banner that read “Joy- of-Life Week.” I asked around and found that the week was about sparking joy in an otherwise J. Meier: Necessary Suffering? - Investigating Existential Suffering in Youth Qualitative Studies 6(1), pp. 116-141 ©2021 117 dark time of the year. The students arranged competitions, sessions of live music, and inspirational talks on motivation. Although, these initiatives were difficult to oppose, Thomsen’s poem entered into my mind. Maybe it was the contrasting experience of the grey weather outside combined with the insisting demand to enjoy that was now flapping over my head. Maybe I was just not in a mood for either creating or receiving joy myself. Was I alone in this state? Maybe. Maybe I had read too much about how our time excludes negativity (e.g. Critchley & Cederström, 2010; Ehrenreich, 2010; Žižek, 2001). Maybe this was in fact a very telling example hereof. Maybe winter had forever ended. The joy-banner appears, however, to be in stark contrast to the large amount of recent reports regarding young people’s mental health. In a Danish context, for example, 40.5% of women between 16 and 24 years old now suffer from stress1 (Jensen et al., 2018). Among the 19-year-olds, 36% of women and 16% of men respond that they have had a mental disorder at some point (Ottosen et al., 2018). Among high school students, 56% of girls experience stress on a daily or weekly basis; 36% of boys do likewise (Pisinger et al., 2019) In addition, 20% of the girls and 15% of the boys have at some point considered suicide (Pisinger et al., 2019). On this and further basis researchers speak of “new forms of marginalization” (Görlich et al., 2019, p. 25), which do not only affect the youth of traditionally marginalized minorities but also the middle-class majorities that increasingly suffer from mental disorders, stress, and a general lack of well-being. The tendency is not restricted to Denmark but widespread in the Western world (Eckersley, 2011a, 2011b; Madsen, 2018; Twenge et al., 2019; Rose, 2006; Rose, 2019, p. 3). Hence, reviewing the mental health of youth, Richard Eckersley (2011a, p. 627) suggested that we ought to revise the dominating narrative of progress with a narrative that emphasizes their severely increasing problems of mental illness. The mental health of young people has thus become an object of massive worry, investigation, and intervention. Although concerns spring from good intentions, we may ask if the ‘hidden curriculum’ (Jackson, 1968) of many reports and interventions is that youths’ lives ought to be joyful and that it is wrong and worrying, if they are not (Madsen, 2017). From a more general perspective, critics have pointed to an increasing pathologization of ordinary vicissitudes in the human condition (Horwitz, 2011; Horwitz & Wakefield, 2005, 2007). In addition, that we, due to the dominance of the diagnostic language, are in risk of losing alternative languages of suffering (Brinkmann, 2014). For instance, studies have documented 1 Measured with Cohen’s Perceived Stress Scale (Jensen et al., 2018). J. Meier: Necessary Suffering? - Investigating Existential Suffering in Youth Qualitative Studies 6(1), pp. 116-141 ©2021 118 that interpersonal and moral understandings of suffering tend to be converted into biomedical treatments (Shweder et al., 1997). Thus, in Western cultures, where health2 has been endorsed as a “meta-value” (Greco, 2004, p. 1) and where “healthism”— that is, the tendency to prioritize health and prevent illness over anything else (Crawford, 1980)—has become a widespread orientation of life, we may lose sight of any discontent that accompanies, what Thomas Szasz (1961, p. 113) called the “problems in living”. In the current article, I add to these more general critiques of pathologization by offering and outlining an alternative account in which suffering can be understood as existential in kind. By disclosing how emotional suffering in youth can be experienced, and more fundamentally, why it necessarily clings to existence3, I aim to expand the coordinates that structure how we make sense of young people’s mental health. I use the notion of suffering in a broad sense to refer to a universal aspect of human experience that can be grouped into a variety of burdens ranging in its phenomenological intensities from milder forms of for example anxiety, guilt, sadness or unhappiness to more destructive and invalidating forms of distress (see Davies, 2012, p. 6). The scope of the article is those cases that one might call “milder” and which may be in risk of being pathologized by either young people themselves or people and professionals around them.4 When speaking specifically about existential suffering, I refer to suffering understood as related to fundamental existential conditions and vulnerabilities (e.g. Galvin & Todres, 2013, p. 98).5 Empirically, I explore suffering in youth through qualitative interviews regarding experiences of bad conscience in the everyday lives of three Danish high school students. 6 To suffer from a bad or guilty conscience is a painful yet familiar experience to most people. It is characterized by a critical self-evaluative consciousness (Welz, 2008, p. 54), where the self enters into conflict with itself, producing a divided experience of self as self-failure (Critzley, 2007, p. 22), which is accompanied by the emotions of shame and guilt (Howard, 2014). Bad conscience as well as the sense of guilt are among typical symptom criteria for 2 According to the World Health Organization, health is “a state of complete physical, mental and social well- being, and not merely the absence of disease or infirmity” (Aginam, 2002, p. 948). 3 Existence means to “stand out,” which can be rendered as to “stand outside oneself” (Joseph et al., 2011, p. 7). 4 It is essential to what has recently been called a ‘diagnostic culture’ that the diagnostic framework is no longer reserved for professionals but pervades the very ways ordinary people understand themselves and their problems (Brinkmann, 2016, p. 7). 5 Based on Martin Heidegger’s existential phenomenology, Galvin and Todres (2013, p. 99) develop a comprehensive and systematic account of 18 different kinds of existential suffering. My aim, however, is not to delineate different kinds of existential suffering, but to disclose how distress in youth can be understood as constituted in human existence. 6 Although I do not investigate more extreme cases of emotional distress, this does not mean, that I believe these to be always pathological diseases that cannot be made sense of within an existential context (see for example Aho, 2019; Halling & Nill, 1989). J. Meier: Necessary Suffering? - Investigating Existential Suffering in Youth Qualitative Studies 6(1), pp. 116-141 ©2021 119 clinical depression (e.g. Bech et al., 2001), and if interpreted alone through a diagnostic lens they could be reduced to mere symptoms hereof. I, on the other hand, take my lead from an existential theoretical framework in which conscience discloses one’s fundamental existential conditions (Heidegger, 2010, p. 259; Bojesen & Lindhardt, 1979, p. 185). Thus, in the analysis to come, the phenomenon of bad conscience serves as a prism through which existential suffering is illuminated. More accurately, it is disclosed how the distressing experiences of the participants may be rendered as normative implications of existential conditions in the form of freedom, finitude and the Other. I am aware that this could be interpreted as a legitimization of the increasing lack of well- being in youth, which it is definitely not. The ambition is not to invalidate young people’s suffering, but to show how at least some of it can be conceived of as existential in kind. If thus, as Martin Packer (2011, p. 5) states, qualitative research ought to have an “emancipatory” interest, the interest of the present paper consists not so much in reducing the suffering of a marginalized minority, but rather in disclosing the existential suffering of the majorities. In a culture that has made enjoyment mandatory (Žižek, 2001), and where human discontent is increasingly pathologized (Horwitz &Wakefield, 2007, 2005), I think this ambition actually holds an emancipatory potential. By disclosing existential suffering as a necessity, the paper also raises concerns regarding the normativity of young people’s suffering. Therefore, in the final section, I ask, if it is sound to define any suffering as a necessity? In response, I point to the phenomenon of approved suffering, which is elucidated from the interviews. The concept refers to a tendency among the students to find that there is distress in their lives of which they actually approve. In conclusion, I recommend that we ought to be more attentive to different kinds of suffering as well as the normativity suffering. Before moving on to these arguments, I begin by outlining more thoroughly the contemporary tendency to professionalize and pathologize young people’s suffering, and how this is accompanied by an implied normativity that render suffering as something that ought to be eliminated. Pathologization and its Normativity of Suffering According to the medical sociologists Allan Horwitz and Jerome Wakefield (2005), the explanation of the contemporary acceleration in mental diseases first and foremost “appears to lie in changes in the ways that physicians, mental-health professionals, and people themselves J. Meier: Necessary Suffering? - Investigating Existential Suffering in Youth Qualitative Studies 6(1), pp. 116-141 ©2021 120 characterize and diagnose their mental states” (pp. 40–41). Thus, following the thesis of patologization, what has increased, is not primarily the number of people suffering from mental diseases, but rather a growing tendency to interpret emotional distress within a diagnostic and pathological framework (Brinkmann, 2016). Thereby, the thesis of pathologization holds, we tend to pathologize ordinary human vicissitudes such as for example sadness, shyness, and anxiety (Horwitz, 2011; Horwitz & Wakefield, 2005, 2007; Lane, 2008; Orr, 2006). According to sociologist Nikolas Rose (2006), biomedicine has thus come to shape and dominate, how people in general make sense of their discontent. As Rose (2019, p. 9) recently pointed out, nowadays half of us is diagnosable over a lifetime, and it has become almost ‘abnormal’ to live one’s life without coming into the remit of psychiatry or talking to a professional about one’s mental troubles. With specific regard to youth, a recent report documented that, in 2017, 46% of 19-year- old Danish women had consulted a psychologist (Ottosen et al., 2018, p. 192)7. Worldwide, hundreds of school-based programs are addressing children’s and young people’s mental health (Due et al., 2014, p. 154). It is common to these programs to be based on professional treatment techniques, and several are used in universal versions that address everyone in a certain age group (Due et al., 2014). For example, the universal school-based prevention program ‘Depression in Swedish Adolescents’8 was founded on cognitive behavioral techniques designed to change thoughts, provide problem-solving strategies, and promote health activities (Garmy et al., 2019, p. 183). Likewise, from 2020 and on, ‘Life-coping’—a process whereby the student acquires knowledge, skills, and attitudes to become a healthy and competent individual—is included in the curriculum for primary and secondary education in Norway (Gjernes, 2020; Madsen, 2018). In Denmark, an official ‘stress panel’ has suggested to follow Norway’s example to prevent and deal with the widespread lack of well-being among children and young people. With regard to my own research, two psychoeducational posters hanging on the walls in the hallways of the high school, where I am conducting interviews, caught my attention. The one stating: “Depression is a mental illness – the symptoms can be cured with antidepressant medication” followed by detailed information on neurotransmitter reuptake. The headline of the other poster asserted: “Children’s learning are affected by stress” followed by information on how long-term stress results in reorganization of the brain. These posters, I think, discloses, how pathological understandings and language of mental health are no longer 7 Compared to 2009 the number was 30 % (Ottosen et al., 2018). 8 Depression in Swedish Adolescents is a modified version of the Adolescent Coping with Stress course (Garmy et al., 2019, p. 182). J. Meier: Necessary Suffering? - Investigating Existential Suffering in Youth Qualitative Studies 6(1), pp. 116-141 ©2021 121 delimited to psychological practices and psychiatric institutions but pervade the very ways in which young people and everyone else are stimulated to understand themselves and their distress (Rose, 2006, 2019). The critical paradox seems to be, that while an increasing number of assumingly ordinary young people seek out and are offered help, their problems are increasingly approached through professionalized and pathological understandings. Horwitz and Wakefield (2005, 2007) have accounted for the development of pathologization through the seminal changes in the practices of diagnosis following DSM III from 1980, in which criteria for diagnosis became descriptive instead of etiological. From DSM III and on, diagnosing became based on observable symptoms within a given period of time, and thereby personal circumstances, experiences, and biography were no longer considered essential (Horwitz & Wakefield, 2007, p. 9). Consequently, they argue, it has become almost impossible to separate symptoms of sadness from dysfunctional depressive disorders. For instance, one study in adolescent depression that do report the context of symptoms, finds that the single greatest trigger for presumed depression is “the breakup of a romantic relationship”, suggesting that a potentially large proportion of “disorders” are actually misclassifications of normal responses to significant life events (Horwitz & Wakefield, 2005, p. 51)9. On one hand, this inattention to the contextual aspects of a person’s suffering entails that the normativity of suffering is ignored. That is, any appropriate reasons for a person’s symptoms, such as a broken heart, personal losses, or a troubled economy, are not taken thoroughly into account. On the other hand, however, the diagnostic understanding of a person’s suffering implies a very strong normativity. Rather than being a mere descriptive science, psychiatry is a collection of techniques and strategies used to prevent and treat mental distress (Davies, 2012, p. 60; Kleinman, 2008). And as argued by medical anthropologist James Davies (2012, p. 59), it is by way of its clinical practices, which approach suffering as an encumbering and purposeless experience from which one should be liberated, that biopsychiatry advances its negative vision of suffering. “It is through the response, in other words, that the value of the experience is defined negatively” (Davies, 2012, p. 62). When suffering is interpreted and made sense of in a diagnostic framework, it invites for specific forms of interventions that aim to reduce the suffering. As Horwitz and Wakefield (2005) have described, people acting upon themselves within this framework “may naturally tend to monitor themselves for such symptoms, reframe their own experiences of sadness as signs of 9 Horwitz and Wakefield (2005, 42) distinguished between suffering “with” and “without cause”: “Without cause” means that the symptoms of depression were not associated with the sorts of environmental events that would appropriately lead to sadness”. J. Meier: Necessary Suffering? - Investigating Existential Suffering in Youth Qualitative Studies 6(1), pp. 116-141 ©2021 122 a mental disorder and seek professional help for their problems” (p. 57). If, for instance, I interpret my experience of distress as a clinical depression rather than sadness initiated by a broken heart, I would presumably be more prone to render it as a condition that should be treated, coped with, and preferably eliminated.10 In this section, I have accounted for tendencies to pathologize young people’s suffering and how this implies a normativity that render suffering as something that ought to be eliminated. The succeeding analysis challenges this vision. The aim is to disclose how young peoples’ experiences of emotional distress may be well reasoned in existential matters that cling to the human condition. Before moving on to the analysis, the subsequent section accounts for its existential theoretical outset and methodology. Toward an Existential Framework of Suffering The analysis below is based on an existential theoretical reading of qualitative interviews with three Danish high school students (names and identifying details are changed) that are part of a larger study concerning experiences of bad conscience among Danish high school students. Since the existential perspective does not represent a unified school of thought in neither philosophy (Kaufmann, 2016) nor psychology (van Deurzen et al., 2019, Cooper, 2011), I specify in more detail, what I mean by an existential framework by outlining three central assumptions, from which my methodology and analytical strategy take their lead. First and foremost, counter to the increasing pathologization of human vicissitudes accounted for above, an existential perspective provides opportunity to render suffering as an inevitable, necessary, and even edifying condition (e.g., Cooper, 2011, pp. 64–65; Macquarrie, 1972; Kierkegaard, 2013, 2014). Anxiety, for instance, as it will be spelled out more thoroughly below, is not conceived of as a pathological deviation but as something edifying that “every human being has to live through” (Kierkegaard, 2014, p. 187)11. Secondly, from an existential perspective, one cannot diagnose solely based on the duration of symptoms. The human being is always already a being-in-the-world (Heidegger, 2010, p. 10 This normativity of suffering cannot be narrowly attributed to a transformation of DSM. On a larger cultural background scale, the implied understanding of suffering within the diagnostic framework, seems closely associated with the modern imagination of the self as a rational agent that relates instrumentally to itself in a utilitarian logic of maximizing pleasures and minimizing pain (e.g., Bellah et al., 1985; Richardson et al., 1998; Taylor, 1992). Davies (2012, p. 59), for example, tracked our contemporary negative model of suffering back to the movement of Enlightenment, which, he argues, implied and promulgated a model of suffering that predominantly emphasized the iniquity and purposelessness of all human discontent. 11 Kierkegaard (2013) also analyzed despair as a general human condition. J. Meier: Necessary Suffering? - Investigating Existential Suffering in Youth Qualitative Studies 6(1), pp. 116-141 ©2021 123 113), and therefore a person’s symptoms cannot be rendered in isolation from its world. Further, this world is not one inhabited by a ‘neutral self’ (Taylor, 1989, p. 49), but by beings for whom the world has meaning and matters from the outset. To comprehend a person’s suffering, thus, one must understand the concrete lifeworld, relations, and contextual meaning of a person’s life. Therefore an existential perspective is closely associated with a phenomenological methodology (Joseph, Reynolds & Woodward, 2014, p. 6; Joseph & Reynolds, 2014), which is – quoting the phenomenologist van den Berg (1972, p.76)— “obsessed with the concrete”. Phenomenology thus is “the science of examples” (van Manen, 2017, p. 814), because it investigates concrete lived experience and situated human activity. In the present study, a phenomenological attitude was adopted by stimulating and focusing on the participants’ situation-bounded-descriptions of their experiences of bad conscience and its relation to their suffering and discontent. Third and final, within an existential framework, questions about the particular human being and its concrete experiences are, at the same time, questions about what it means to be human (Fernandez, 2018, p. 41). Martin Heidegger distinguished between an ontic and ontological level of existence (Heidegger, 2010, pp. 11–12). While the ontic level concerns the concrete experiences of a person, the ontological level regards the fundamental existential characteristics related to the concrete experiences. In these terms, the subsequent analysis is an ontic investigation of particular high school students; however, these particular beings also have a common ontological being. That implies that their experiences of bad conscience do not only refer to the students’ individual particularity, but moreover find their sources in common fundamental existentials. Accordingly, my analytical strategy has been to fluctuate between the participants’ concrete descriptions (the ontic) and the level of fundamental existential characteristics (the ontological). Whereas the phenomenological attitude has led my attention toward concrete and situated experiences, the existential perspective has informed a reading of these experiences as concrete embodiments of more fundamental existential sources of suffering. There is, as far as I know, no exhaustive list of human existentials (Køster and Fernandez, in press). However, despite different emphases, the existential perspective sensitizes an attention to overlapping existential matters such as freedom, choice, anxiety, finitude, responsibility, guilt, otherness etc. (e.g. Joseph et al., 2014, pp. 3–4). These matters belong to the human being as such. However, it is in youth that they are likely to become J. Meier: Necessary Suffering? - Investigating Existential Suffering in Youth Qualitative Studies 6(1), pp. 116-141 ©2021 124 explicitly present for the first time.12 Moreover, one could argue that young people are especially sensitive and receptive to certain existentials, such as choice, freedom and possibility by virtue of the openness that characterizes their situatedness. In this section, I have accounted for three basic existential assumptions that grounds my analytical strategy. The succeeding presentation is divided into two steps. First, idiographic descriptions of existential suffering related to bad conscience are extracted from the experiences of each of the three students. Secondly, I render their experiences within an existential theoretical framework, in order to illuminate more fundamental existential conditions of suffering (see also Finlay, 2009, p. 10; Halling, 2008). Simon: “Sweat on the forehead” Simon is an 18-year-old second-year high school student, who lives at home with both his parents. Simon describes experiences of “feeling low” and being in a “black hole” as well as physical reactions such as a “pressuring feeling on the chest”. These experiences, however, should be captured in their right context. Thus for years, Simon has been playing soccer at an elite level, however, at the time I met him, he had recently chosen to quit his sport. Simon’s sense of bad conscience circulates around his experiences of the omnipresent expectations from his parents and peers and his concerns of not living up to these. He feels he ought to “keep up a constant level within school” and that “you have to be active all the time and perform, but that is also a necessity.” In addition, he stresses, “I still live at home, so of course one has to do what one is told.” In particular, Simon expresses how his parents’ expectations and opinion of him are of great importance: “I would also like to look good in the eyes of . . . in the eyes of my father and mother . . . where I do not appear as a complete idiot.” Simon articulates a clear conception of his parents’ potential negative judgment of him in case he fails to live up to their standards and expectations. Toward the end of the interview, however, there is a rupture in Simon’s narrative, as he suddenly emphasized that “one cannot always just do what is expected.” I took notice of this only much later on after transcribing the interview, and I chose to contact Simon again to ask him, how his statement relates to his own life. Simon then told me about the defining choice he recently made to quit soccer at an elite level to gain more time in his life, even though his parents were “determined that [he] should continue.” 12 In youth, the human spirit awakens (Grøn, 2008, p. 15; Kierkegaard, 2014, p. 51). That is, the self is now able to relate to itself in one way but also in another. J. Meier: Necessary Suffering? - Investigating Existential Suffering in Youth Qualitative Studies 6(1), pp. 116-141 ©2021 125 “Me: What was it like to make that choice? Simon: It was a decision that I had been thinking about for a long time, so… when I finally made it, it wasn’t very hard . . . Or it was. I had some sweat on the forehead . . . That is, in order to get it done and to say that you want to quit and stuff like that. Me: The sweat on the forehead, what was it about? Simon: It might have been nervousness that you will get a little clumsy when you describe such a goodbye message to your coach. And maybe you will let him down when you say you are leaving. Me: Was anything else at stake? Simon: There was the sadness that I wouldn’t come to play my sport on the level, I have been used to, so that was a punch in the gut. [. . .] Simon: Also, I had a bad conscience toward some of my teammates with whom I had joined the club, but also toward my coach who had spent time and energy on me, so at that point, I felt guilty toward them”. Although Simon first tones down the difficulties, his account changes while he speaks, and he reveals that his decision was accompanied by “sweat on his forehead.” Simon discloses his distressing feeling of nervousness ahead of the decision as well as the “punch in the gut” following his awareness that he will not play on his former level. Elsewhere he adds that, before making his choice, he “still had the doubt: “Is it now the right thing to do?”” Simon also reveals a guilty conscience toward his coach and teammates. To suffer from a bad conscience, Simon describes, is mostly present at night while he is lying in his bed, and it is experienced as a “black hole” and embodied through a “pressuring feeling on the chest”. Simon’s choice seems marked simultaneously by the distress accompanying the uncertainty of his choice as well as a sense of guilt toward the specific people affected by it. In addition, it appears that Simon experiences fear of being polarized by his peers: “Because I have quit playing at an elite level, they [his classmates] do not look down on me, but they might look at me as one, who is losing his grip”. Thus, Simon describes that while he is “feeling low”, he senses that his classmates are performing high and “rushing” away from him. In spite of these feelings, Simon’s choice was not solely permeated by distress: J. Meier: Necessary Suffering? - Investigating Existential Suffering in Youth Qualitative Studies 6(1), pp. 116-141 ©2021 126 “Me: What is it like afterwards to have made that choice? Simon: It was so very liberating. I had just started high school, I had a girlfriend and so many things running around in my head, and I was used to training 6–7 times a week. So it felt like a liberation. Me: A liberation? Simon: Yes, but it was also a little sad because I was happy about the sport. And yes, it was a loss”. Simon oscillates between descriptions of liberation and loss when describing his choice. Thus, he refers to his loss in the same moment that he describes his sense of liberation. Maria: “I just couldn’t do both at once” Maria, a 17-year-old second-year high school student, lives at home with both her parents and her two little brothers. From her everyday life, Maria describes, among other things, “stressful periods” and “vicious circles” of self-blame. These experiences are also somehow closely connected to the context of choice. However, in a quite different way than in Simon’s case above. A pervasive theme in Maria’s experiences is her continuous weighing of priorities required of her in everyday life. A recurrent conflict of choice is that between friends and homework: “If one day you come home from school and have a lot of homework, but you also know that some from the class are going into town [to] eat somewhere in the evening. Then you have to choose one or the other, because both can be quite important, and if you make the wrong decision and think “maybe I should have done that assignment instead” and then you have a bad conscience for not doing it well enough”. Maria feels bad when she judges that she has made a wrong decision and finds that she ought to have prioritized differently. However, even when she agrees with her choices, she can still suffer from a guilty conscience. Thus, a while ago, she chose to stay home from her grandfather’s birthday to prepare for a larger assignment: J. Meier: Necessary Suffering? - Investigating Existential Suffering in Youth Qualitative Studies 6(1), pp. 116-141 ©2021 127 “On one hand, I was relieved that I had begun the assignment and had a good conscience about it. . ., so the bad conscience was that, you know, that your grandparents may not be around forever, and that they are getting old and then you just choose to stay home instead of visiting them. [. . .] It wasn’t that I regretted staying at home, but it was more that, I regretted that, I did not attend [the birthday], but I just couldn’t do both at once”. Maria expressed relief about her decision to stay home to begin her assignment. However, simultaneously, she experienced an unrest. She felt bad about letting down her grandparents, who will not be around forever. Thus, her guilty conscience was not due to what she actually did, but to what she did not do. Maria further explained how the absence of a deed could take presence as a nagging feeling: “It may well be that you have to make a choice between two things and you end up feeling guilt about whatever you choose not to. Just knowing that there is something, you have not been able to do or someone you have not seen can give you the sense of guilt that you have not really done what you should, I think. And it’s a bit uncomfortable”. The sense of guilt Maria described is defined by a not. Thus, her choice is accompanied by the uncomfortable sense of guilt that there is something that she ought, but is “not able to do”. Maria elaborates on how this can accelerate during, what she describes as “stressful periods”: “There are periods where you think that, then I did not manage to do this, and then I did not do that either. [. . .] In stressful periods, you think ok, I have to make all these things today and a lot of things tomorrow too, and then you do not make it, and then you can get a bad conscience about it. About not getting it done”. J. Meier: Necessary Suffering? - Investigating Existential Suffering in Youth Qualitative Studies 6(1), pp. 116-141 ©2021 128 Maria describes how these periods affects her by making her more prone to blame herself: “You go and think too much about things you did not get done and... Yes, then you might get into such a vicious circle and thoughts about yourself, and what you did not do, and what you did not attain”. Maria experiences inadequacy about the things she feels obligated to do but at the same time finds herself unable to do. During “stressful periods” this can turn into a “vicious circle” circulating around what she did not do and attain. Jonas: The brOther’s knocking Jonas, an 18-year-old second-year high school student, lives at home with his mother and occasionally with his much younger little brother, who by turns lives with his father and mother. Jonas describes experiences of “not being good enough”, of “boiling over inside”, and being in “a negative fog”. His parents recently went through a divorce, and when I met Jonas, this event strongly afflicted his everyday life. Jonas experiences of bad conscience was closely related to the situation of his little brother, who he had special concerns for because of the divorce: “Often, when I am at home with my mother, and the atmosphere becomes very poor, then I might feel such a bad conscience about that my brother has to be in that poor atmosphere.” Despite Jonas himself is affected by the situation he feels responsible for his brother. This was especially evident when Jonas described his failure to take care of him: “Jonas: Often if I feel, I don’t have the energy to be with my little brother, if he wants to be with me, I might have such a bad conscience about not being good enough, or feel that I am not good enough. Me: Okay, can we try to go into an example? Do you remember a day… Jonas: Sometimes it utterly boils over inside my head. My parents, they are suing… I don’t know if I said that before… but about where my little brother should live, and I think they are both pretty bad at being divorced, and that affects me. Therefore, some days it just boils over inside me, and I cannot manage anything. Then I just sit there eating, and then when I've eaten, I go up to my room, because I cannot stand J. Meier: Necessary Suffering? - Investigating Existential Suffering in Youth Qualitative Studies 6(1), pp. 116-141 ©2021 129 it anymore. Then I just have to be alone. [. . .] Then sometimes my little brother has knocked and it’s not as if I have told him that I don't feel like being with him. But sometimes I have told him that I would like to play cards with him afterwards or something like that and then it is. . . then I have fought with my mother and afterwards I have no energy to play cards or do anything with him. Then I can feel that it is all chaos and unmanageable”. When it “boils over” inside Jonas, and everything appears unmanageable, Jonas feels no energy to be with his little brother, and he finds himself not being good enough. This is deepened when Jonas fails to live up to his promise to his brother. He describes how the bad conscience accompanying such situations affects him and throw him into, what he later describes as a “negative fog”: “I can’t concentrate at all when I have a bad conscience, or when I’m in such a situation. It is completely impossible for me to sit and do homework. The only thing I can do is to sit and watch a movie or watch youtube and then it's youtube of poor quality, something that makes me not think about it. [. . .] Then I can't see at all that it is actually going ok, or that something is going ok, then it just becomes such a negative fog you get into. [. . .] It is often in the evening that it boils over, and that the fog is present… it is provoked when I do not have much energy, and then it is difficult to fall asleep”. Jonas experiences his bad conscience as a negative fog of thoughts about his inadequacies in relation to the demands of his life. To work through this fog of negativity, Jonas has consulted a psychologist, and he described how it helped to lessen his sense of bad conscience: “Jonas: I think that is one of the things I’ve indirectly benefitted from by going to a psychologist, putting myself a little more first and thinking “it’s okay, I’m just taking a break now, I need that”. J. Meier: Necessary Suffering? - Investigating Existential Suffering in Youth Qualitative Studies 6(1), pp. 116-141 ©2021 130 Me: So . . . maybe there is not as much conscience there, bad conscience as there has been? Jonas: No, I have learned to justify a little more that, I do not . . . justify my bad conscience and then not . . . then it is not as present anymore”. Jonas describes that he has learned to put himself first and justify himself and his needs in ways that have lessened his guilty conscience toward his brother. However, later on, Jonas tells about a recurring experience that complicates this picture: “The thing about me, that I have become more like cold about it and say that it is actually very fair, then I also sometimes have a little bad conscience about that . . . As if the bad conscience I originally had, it returns on the other side of the justification”. Despite his justification of himself, Jonas experiences a return of bad conscience “on the other side of the justification.” A troubled sense of conscience keeps coming back to him. When Jonas’s little brother knocks on his door, Jonas experiences an obligation to be with him, even though he does not always feel able to do so. Jonas expressed being divided between himself and the needs of his brother, which he cannot always meet and yet find difficult to ignore. Existential Suffering After voicing the participants’ experiences ideographically, I now turn to demonstrate how their concrete (ontic) experiences relate to more fundamental (ontological) characteristics. Based on central themes from the interviews, three existential sources of suffering are elucidated in the form (a) freedom, (b) finitude, and (c) the Other. These notions are borrowed from Søren Kierkegaard, Martin Heidegger, and Emanuel Levinas respectively and are accounted for more thoroughly below. The aim is to illuminate how existential suffering is a normative implication of each of these sources. Freedom and Anxiety The inconvenience of choice is a vital theme in both Simon’s and Maria’s accounts. At first hand, Simon seemed to experience his life as predetermined by the omnipresent expectations of his parents and peers. However, in the choice of quitting his sport, he experienced acting J. Meier: Necessary Suffering? - Investigating Existential Suffering in Youth Qualitative Studies 6(1), pp. 116-141 ©2021 131 against such expectations and faced a number of painful uncertainties. Would he regret his decision? Could his sense of loss over time grow greater than his feeling of liberation? How would his coach and teammates react to him? What about his parents at home and his peers at school? Would they judge him? Would they leave him behind? Simon could not know the outcome of his choice in advance. From an existential perspective, the pain of choice discloses a more fundamental difficulty in relation to freedom. Choice, thus, is intimately connected to the ontological fact that human beings exist as something that is not predetermined in advance (Joseph et al., 2014; Macquarie, 1972). The human self is not a fixed essence but free to relate to itself with an awareness of its freedom and possibilities. However, freedom comes with a price of distress. The normative implication of not having a fixed essence is anxiety. As Søren Kierkegaard’s (2014) famous determination goes, anxiety, as opposed to fear, does not refer to a definite object, because its object is nothing: “anxiety is freedom’s actuality as the possibility of possibility” (p. 51). Thus, anxiety discloses that humans are beings faced with a freedom or indefiniteness that they cannot escape (Grøn, 2008, p. 82). Therefore, anxiety is “the dizziness of freedom” (Kierkegaard, 2014, p. 75). Simon’s “doubt” and “sweat on the forehead” might indicate his encounter with the indefiniteness of his situation.13 Thus, Simon’s sweat and doubt can be interpreted as expressions of existential anxiety that discloses his freedom to actually do other than what is expected of him. Freedom thus makes the ontological precondition of his concrete choice. This precondition however is at the same time the ground of anxiety. Finitude and Existential Guilt For Maria, choice is also a key issue. However, her experiences do not seem to stem from the “dizziness of freedom” but, quite on the contrary, from its constraints. Maria’s troubles of choosing thus disclose how freedom is actually very limited. More accurately, Maria’s experience that she “couldn’t do both at once” as well as her “vicious circles” of inadequacy might be conceived of as examples of existential guilt. That is, her experience of “not being able” can be rendered as a derived ontic expression of the primordial being guilty (Heidegger, 2010, p. 272). According to Martin Heidegger (2010), guilt pervades all choices because in choice we are faced with the inadequacy of our existence: “freedom is only in the choice of the one, that is, in bearing the fact of not having chosen and 13 That the object of anxiety is nothing does not mean that anxiety does not relate to a specific situation, but that the situation it relates to is characterized by an indefiniteness (Grøn, 2008, s. 44). J. Meier: Necessary Suffering? - Investigating Existential Suffering in Youth Qualitative Studies 6(1), pp. 116-141 ©2021 132 not being able also to choose the others” (p. 273). Choice implies abandoning all other possible possibilities and thus mean the finitude of possibilities (Ceval, 2007). When Maria, for instance, prioritizes staying at home to study, she makes herself the ground of a nothingness by virtue of all that she is simultaneously unable to realize. From an existential perspective thus, the source of Maria’s inadequacy is not due to her personal incapacity but more fundamentally to the finitude of existence as such. This does not only regard the finitude of possibilities, but also a temporal finitude (Carel, 2007). The temporal finitude might explain, why Maria is more prone to experiencing “vicious circles” of inadequacy in “stressful periods” during which she feel obligated to “do all these things”. Likewise, the temporal finitude seems to worsen her bad conscience toward her grandparents in that they “may not be around forever”. Thus, every concrete choice to opt out is a consequence of the finitude of existence as such, which is the ultimate nothingness that structures existence (Heidegger, 2010). Possibilities and time continually cease to exist, and therefore, in a very literal sense, we are “continually dying” (Marx, 1992, p. 48). Existential guilt can be a source of suffering. Nevertheless, it is also a necessary condition for anything to be realized and for life to take shape. This became particularly evident in the case of Simon in which it was disclosed that his experience of liberation was dialectical dependent on his experience of loss. To feel liberation, Simon simultaneously had to “loose the possibility of himself” as an elite soccer player. Therefore, his choice was either pure loss or liberation, but permeated by ambivalence. The Other and Responsibility For all of the three participants, a significant theme concerns responsibility and a sense of guilt toward other people. This theme is not adequately accounted for through the phenomena of existential guilt and anxiety, which predominantly concern the students’ relationships with themselves, albeit tend to forget their relationships with the concrete other. Simon feels guilt toward his coach and teammates, and Maria’s bad conscience concerns her grandparents, who will not be around forever. Jonas’s sense of responsibility and guilty conscience toward his little brother, however, appear even more dominating, which is why I focus on his experiences. Several times while talking to Jonas I thought that he was experiencing a bad conscience about something of which he is not responsible, namely the well-being of his little brother. If however we are respectful of Jonas’s experiences, we may elucidate from them how his relationship to his little brother places his own autonomy into question and thereby discloses J. Meier: Necessary Suffering? - Investigating Existential Suffering in Youth Qualitative Studies 6(1), pp. 116-141 ©2021 133 a more fundamental notion of responsibility. Such notion seems similar to the moral phenomenologist Emanuel Levinas’s (1969) account of, how the “face of the other” puts forward a demand that precedes our own freedom: “The will is free to assume this responsibility in whatever sense it likes; it is not free to refuse this responsibility itself; it is not free to ignore the meaningful world into which the face of the Other has introduced it” (pp. 218–219). To be a self signifies not being able to escape the responsibility that the face of the Other introduces. In this sense, responsibility is not something we choose for ourselves. Instead, it is the unwilled and unchosen condition of our very being. When Jonas’s brother knocks on his door, Jonas senses a responsibility even though he is not responsible in any formal meaning of the term. In these situations, responsibility seem to emerge from the particular encounter, where Jonas is subject to the unwilled address of his brother. This becomes particular evident when Jonas experiences a return of bad conscience even though he has “justified himself”. This indicates that Jonas is not himself in autonomous mastery over his sense of obligation to his brother. Thus, his obligations can suddenly intrude into his life even against his will and justification. To Levinas, such experiences embody that our relation to the Other is actually primary to ourselves. It is the relation to the Other that constitutes our being-in-the-world14 (Levinas, 1981). As Judith Butler (2005) has expounded Levinas’s account of subjectivity: “the ‘I’ first comes into being as a ‘me’ through being acted upon by an other, and this primary impingement is already and from the start an ethical interpellation” (p. 89). A self comes into being by the address of the other, which precedes any formation of the self.15 There is not first an autonomous self that secondarily chooses its obligations. Instead the “ought” of the Other constitutes who one “is”. The Other makes a source of Jonas’ suffering. He feels unable to fulfill the demand that the face of his little brother raises, and he blames himself for “not being good enough.” Jonas’s experiences seem to disclose that he is bounded to obligations that precedes his own free choice and by which he inevitably suffers. 14 Levinas criticized Heidegger for neglegting “the Other” in that he privileges ontology over ethics. The aim here is neither to discuss nor synthetize their theoretical positions, but to apply them to analyze central sources of existential suffering, which I do not consider mutually exclusive. 15 Levinas (1984) substitutes the relationship between ethics and ontology. J. Meier: Necessary Suffering? - Investigating Existential Suffering in Youth Qualitative Studies 6(1), pp. 116-141 ©2021 134 Through the analysis, I have suggested that the participants’ experiences can be regarded as normative implications of existence. However, the ontological and ontic level of existence is connected in complex and ambiguous ways, and one cannot draw a linear relation between them. It is therefore a vital methodological challenge to identify valid and trustworthy connections between these two levels of existence. The aim of the analysis has not been to capture all complexities but to make probable that there is a relation at all, and thereby why suffering clings to existence. I believe no methodological devotion (Curt, 1994; Janesick, 1994, p. 215) can decide whether this have succeeded or not. The best indication might be the degree of existential resonance experienced by the reader, or what Max van Manen (1990, p. 27) described as the evoking of a “phenomenological nod” of recognition. The Normativity of Suffering It might appear evident that Simon, Maria, and Jonas struggle with and suffer from various matters in their everyday lives. More controversial it seems to suggest that such suffering should be regarded as an existential necessity. Therefore, in this final section, I put forward two critical concerns. First, I point to the risk of naturalizing young people’s suffering by framing it as a necessity. That is, should we not always be against suffering? Secondly, I respond to the problem of evaluating the experiences of one’s participants. What about the participants’ own voices? By framing suffering as a necessity, there is a risk of naturalizing what is not natural. Thus, what if the young people’s distress is not primary one of existential necessity but rather of social pathology, which ought to be criticized and changed for the better? If we follow such thesis, we would interpret the participants’ experiences quite differently. The distress accompanied by Simon’s choice, for instance, could be contextualized with regard to the “tyranny of choice” in late capitalism (Salecl, 2011) or the pervasive obligation to act as an autonomous individual (Rose, 1998, p. 100). Likewise, Maria’s nagging feeling of “not being able” might be understood as a symptom of the omnipresent cultural injunction to realize endless possibilities, which leaves people suffering from inadequacy (e.g., Baumann, 2007; Ehrenberg, 2016; Petersen, 2016). And Jonas’s troubled sense of responsibility toward his little brother could be conceived as related to the way contemporary individualism represses the importance of social bonds and render people nondependent and self-sufficient individuals (Scheff, 1994, p. 15). I think, there is much importance in such culturally sensitive J. Meier: Necessary Suffering? - Investigating Existential Suffering in Youth Qualitative Studies 6(1), pp. 116-141 ©2021 135 interpretations of young people’s suffering. However, these interpretations do not contradict as much as complement the existential account given through this paper. For instance, the contemporary cultural demand of realizing endless possibilities becomes a source of suffering only because humans are beings of finitude who are not able to realize everything. In addition, a cultural-critical perspective toward young people’s suffering is also valuable to go beyond a solely diagnostic and pathological understanding of suffering. However, although there is a strong critical potential in viewing suffering as a matter of societal pathologies, I believe such a clear-cut perspective is itself in danger of reducing all kinds of experienced suffering to an evil that ought to be criticized and changed. Charles Taylor (1989) has described his reservation against what he termed the “cardinal mistake of believing that a good must be invalid if it leads to suffering or destruction” (p. 519). To incorporate the demand of a good in one’s life, Taylor argues, can be “crushing” and “the source of much suffering” (p. 81). In ways not unlike to Taylor’s view, I have aimed to disclose, that there is a suffering in youth, which seems closely related to emerging existential goods such as freedom, choice, and responsibility. Second, we might ask if it is reasonable from a third-person perspective to evaluate other people’s suffering as a necessity. What about the participants’ own voices and accounts? Thus, according to Amedeo Giorgi (2006, p. 14) psychological research should be able to encompass the values of the research participants but it should not itself value the participants’ experiences. From that perspective, the analysis in this paper might at first glance appear problematic. The aim, however, has not been to evaluate the particular experiences of the participants. Rather, the purpose is to demonstrate how their concrete experiences relate to fundamental conditions of existence from which suffering necessary springs. Whether or not the participants’ particular distress is one of necessity remains an open issue. More profoundly, I find the paper’s overall argument in a way consistent with the participants’ own evaluations: “Maria: Sometimes you may think that there was a reason to have a bad conscience about it, where other times it might be a little exaggerated, where it might not have meant anything anyway”. “Jonas: I think I’m trying to sort out and think about whether it’s really worth having a bad conscience about”. J. Meier: Necessary Suffering? - Investigating Existential Suffering in Youth Qualitative Studies 6(1), pp. 116-141 ©2021 136 Maria expresses how she tries to determine whether she has a reason to suffer from a bad conscience. Similarly, Jonas describes his attempt to decide whether something is worth having a bad conscience about. As formulated by Iris Marion Young (1990, p. 5) “normative reflection arises from hearing a cry of suffering or distress, or feeling distress oneself”. Maria’s and Jonas’s normative reflections which arise from their experiences of bad conscience seem to suggest that there is distress in their lives that they themselves tend to affirm or approve of. Based on their statements what appears to be key is, whether or not they find good or worthy reasons to suffer (from a bad conscience). Maria’s and Jonas’s concerns thereby embody what Peter Goldie (2004, p. 43) has named “reason-responsiveness”. That is, they do not relate indifferently but respond differently depending on the reasons related to their suffering. This, I think, corresponds to a commonsense experience for most people. Simply put, people intuitively tend to distinguish between legitimate and illegitimate forms of suffering all depending on the reasons of their suffering16. Of course, this is not a straightforward business to settle, and it might be one of the most demanding life tasks to determine what is worth suffering for. However, on a more general level, the phenomenon of approved suffering suggests that there is a normativity inherent to people’s experiences of suffering. Human beings do not only strive to reduce pain and maximize pleasures, but live and suffer intentionally according to significant matters of their lives. Accordingly, we ought to be much more attentive to different kinds of suffering, as well as the normativity of people’s suffering. It requires varied accounts and discourses of suffering that enable us to criticize social-induced suffering, treat pathological suffering as well as encompass the suffering that inevitably clings to existential conditions and goods. 16 For instance, people in grief tend to turn down a hypothetical pill that could make their suffering go away (Kofod, 2016, p. 236). J. Meier: Necessary Suffering? - Investigating Existential Suffering in Youth Qualitative Studies 6(1), pp. 116-141 ©2021 137 References Aginam, O. (2002). International law and communicable diseases. Bulletin of the World Health Organization, 80, 946-951. Aho, K. (2019). Contexts of Suffering: A Heideggerian Approach to Psychopathology. Rowman & Littlefield International. Bojesen, L. B., & Lindhardt, J. (1979). Samvittigheden. Berlingske leksikon bibliotek. Bauman, Z. (2007). Consuming life. Polity, Cambridge. Bech, et al. (2001). The sensitivity and specificity of the Major Depression Inventory, using the Present State Examination as the index of diagnostic validity. 66 J Affect Disord 159-164. Bellah, R. N., Madsen, R., Sullivan, W., Swidler, A., & Tipton, S. M. (1985). Habits of the heart: middle America observed. London: Hutchinson. Brinkmann, S. (2014). Languages of suffering. Theory & Psychology, 24(5), 630-648. Brinkmann, S. (2016). Diagnostic cultures: A cultural approach to the pathologization of modern life. Routledge. Butler, J. P. (2005). Giving an account of oneself. Fordham Univ Press. Cooper, M. (2011). Eksistentielle terapier. Dansk Psykologisk Forlag. Crawford, R. (1980). Healthism and the medicalization of everyday life. International journal of health services, 10(3), 365-388. Critchley, S. (2007). Infinitely Demanding: Ethics of Commitment. Politics of Resistance. Verso. Critchley, S., & Cederström, C. (2010). How to Stop Living and Start Worrying: Conversations with Carl Cederstrm. Polity. Curt, B. C. (1994). Textuality and tectonics: Troubling social and psychological science. Buckingham: Open University Press. Davies, J. (2012). The importance of suffering: The value and meaning of emotional discontent. Routledge. Due, P., Diderichsen, F., Meilstrup, C., Nordentoft, M., Obel, C., Sandbæk, A., & Nielsen, A. T. (2014). Børn og unges mentale helbred: forekomst af psykiske symptomer og lidelser og mulige forebyggelsesindsatser. Eckersley, R. (2011a). A new narrative of young people's health and well-being. Journal of youth studies, 14(5), 627-638. J. Meier: Necessary Suffering? - Investigating Existential Suffering in Youth Qualitative Studies 6(1), pp. 116-141 ©2021 138 Eckersley, R. (2011b). Troubled youth: an island of misery in an ocean of happiness, or the tip of an iceberg of suffering?. Early intervention in psychiatry, 5, 6-11. Ehrenberg, A. (2016). The weariness of the self: Diagnosing the history of depression in the contemporary age. McGill-Queen's Press-MQUP. Ehrenreich, B. (2010). Smile or die: How positive thinking fooled America and the world. Granta books. Fernandez, A. V. (2018). Beyond the Ontological Difference: Heidegger, Binswanger, and the Future of Existential Analysis. Finlay, L. (2009). Debating phenomenological research methods. Phenomenology & Practice, 3 (1), 6-25. Galvin, K., & Todres, L. (2013). Caring and well-being: A lifeworld approach. Routledge. Garmy, P., Clausson, E. K., Berg, A., Steen Carlsson, K., & Jakobsson, U. (2019). Evaluation of a school-based cognitive–behavioral depression prevention program. Scandinavian journal of public health, 47(2), 182-189. Giorgi, A. (2006). Facts, values and the psychology of the human person. Indo-Pacific journal of phenomenology, 6, 1-17. Gjernes, M. F. (2020). Diskurser om livsmestring: En kritisk analyse av hvordan livsmestring konstrueres som emne i skolen (Master's thesis, The University of Bergen). Goldie, P. (2004). On personality. London, UK: Routledge. Greco, M. (2004). The politics of indeterminacy and the right to health. Theory, Culture & Society, 21(6), 1-22. Grøn, A. (2008). The concept of anxiety in Søren Kierkegaard. Mercer University Press. Görlich, A., Pless, M., Katznelson, N., & Graversen, L. (2019). Ny udsathed i ungdomslivet: 11 forskere om den stigende mistrivsel blandt unge. Halling, S., & Nill, J. D. (1989). Demystifying psychopathology understanding disturbed persons. In Existential-phenomenological perspectives in psychology. Springer, Boston, MA. Halling, S. (2008). Intimacy, transcendence, and psychology: Closeness and openness in everyday life. New York: Palgrave Macmillan. Heidegger, M. (2010). Being and Time. Suny Press. Horwitz, A. V. (2011). Creating an age of depression: the social construction and consequences of the major depression diagnosis. Society and Mental Health, 1(1), 41-54. Horwitz, A. V., & Wakefield, J. C. (2005). The age of depression. Public interest, (158), 39. J. Meier: Necessary Suffering? - Investigating Existential Suffering in Youth Qualitative Studies 6(1), pp. 116-141 ©2021 139 Horwitz, A. V., & Wakefield, J. C. (2007). The loss of sadness: How psychiatry transformed normal sorrow into depressive disorder. Oxford University Press. Howard, J. J. (2014). Conscience in moral life: rethinking how our convictions structure self and society. Rowman & Littlefield. Janesick, V. J. (1994). The dance of qualitative research design: Metaphor, methodolatry, and meaning. In N. K. Denzin & Y. S. Lincoln (Eds.), Handbook of qualitative research (pp. 209–219). Thousand Oaks, CA: Sage. Jackson, P. (1968). Life in classrooms New York. Holt Rinehart Winston. Jensen, H. A. R., Davidsen, M., Ekholm, O., & Christensen, A. I. (2018). Danskernes sundhed- Den nationale sundhedsprofil 2017. Joseph, F., & Reynolds, J. (2014). Existentialism, Phenomenology and Philosophical Method. The Bloomsbury Companion to Existentialism. Bloomsbury Publishing Joseph, F., Reynolds, J., & Woodward, A. (2014). Introduction. The Bloomsbury Companion to Existentialism. Bloomsbury Publishing. Kaufmann, W. (2016). Existentialism from Dostoevsky to Sartre. Pickle Partners Publishing. Kierkegaard, S. (2014). The concept of anxiety: A simple psychologically oriented deliberation in view of the dogmatic problem of hereditary sin. Liveright Publishing Corporation. Kierkegaard, S. (2013). Kierkegaard's Writings, XIX, Volume 19: Sickness Unto Death: A Christian Psychological Exposition for Upbuilding and Awakening. Princeton University Press. Kleinman, A. (2008). Rethinking psychiatry. Simon and Schuster. Kofod, E.H. (2016). Sorg som grænsediagnose. In S. Brinkmann & A. Petersen (Ed). Diagnoser: perspektiver, kritik og diskussion. Klim. Køster, A. & Fernandez (in press). Investigating Modes of Being in the World: An Introduction to Phenomenologically Grounded Qualitative Research. Lane, C. (2008). Shyness: How normal behavior became a sickness. Yale University Press. Levinas, E. (1969). Totality and Infinity: an Essay on Exteriority. Pittsburgh: Duquesne University Press. Levinas, E. (1981). Otherwise than being or beyond essence. Springer Science & Business Media. Levinas, E. (1984). Ethics as First Philosophy.ǁ 1984. Hand, 75-87. Macquarrie, J. (1972). Existentialism. Hammondsworth. J. Meier: Necessary Suffering? - Investigating Existential Suffering in Youth Qualitative Studies 6(1), pp. 116-141 ©2021 140 Madsen, O. J. (2018). Generasjon prestasjon: hva er det som feiler oss?. Madsen, O. J. (2017). «Hvordan har dere det egentlig?» Som man spør, får man svar. Samtiden, 125(03), 40-45. Orr, J. (2006). Panic diaries: a genealogy of panic disorder. Duke University Press. Ottosen, M. H., Andreasen, A. G., Dahl, K.M., Hestbæk, A., Lausten, M., Rayce, S. B. (2018). Børn og unge i Danmark – velfærd og trivsel 2018. Det nationale Forsknings- og Analysecenter for velfærd. Packer, M. J. (2011). The science of qualitative research. Cambridge University Press. Pisinger, V., Thorsted, A., Jezek, A. H., Jørgensen, A., Christensen, A. I., & Thygesen, L. C. (2019). UNG19 - Sundhed og trivsel på gymnasiale uddannelser 2019. Statens Institut for Folkesundhed Petersen, A. (2016). Præstationssamfundet. Hans Reitzels Forlag. Richardson, F. C., Rogers, A., & McCarroll, J. (1998). Toward a dialogical self. American Behavioral Scientist, 41(4), 496-515. Rose, N. (1998). Inventing our selves: Psychology, power, and personhood. Cambridge University Press. Rose, N. (2019). Our psychiatric future. Polity press. Rose, N. (2006). Disorders without borders? The expanding scope of psychiatric practice. BioSocieties, 1(4), 465-484. Salecl, R. (2011). The tyranny of choice. Profile Books. Scheff, T. J. (1994). Microsociology: Discourse, emotion, and social structure. University of Chicago Press. Shweder, R. A., Much, N. C., Mahapatra, M., & Park, L. (1997). The “big three” of morality (autonomy, community, divinity) and the “big three” explanations of suffering. Morality and health, 119, 119-169. Szasz, T. S. (1961). The uses of naming and the origin of the myth of mental illness. American Psychologist, 16(2), 59. Taylor, C. (1989). Sources of the self: The making of the modern identity. Harvard University Press. Taylor, C. (1992). The ethics of authenticity. Harvard University Press. Thomsen, S.U. (2011) Shaken Mirror: Poems. Gyldendal. J. Meier: Necessary Suffering? - Investigating Existential Suffering in Youth Qualitative Studies 6(1), pp. 116-141 ©2021 141 Twenge, J. M., Cooper, A. B., Joiner, T. E., Duffy, M. E., & Binau, S. G. (2019). Age, period, and cohort trends in mood disorder indicators and suicide-related outcomes in a nationally representative dataset, 2005–2017. Journal of abnormal psychology, 128(3), 185. van den Berg, J. H. (1972). A different existence: Principles of phenomenological psychopathology. van Deurzen, E., Längle, A., Schneider, K. J., Tantam, D., & Du Plock, S. (2019). The Wiley World Handbook of Existential Therapy. E. Craig (Ed.). Wiley Blackwell. van Manen, M. (1990). Researching Lived Experience: Human Science for an Action Sensitive Pedagogy. Althouse Press, Ontario. van Manen, M. (2017). Phenomenology in its original sense. Qualitative Health Research, 27(6), 810-825. Welz, C. (2008). Keeping the secret of subjectivity: Kierkegaard and Levinas on Conscience, Love and the Limits of Self-understanding In Despite Oneself: Subjectivity and its Secret in Kierkegaard and Levinas. Welz, C., & Verstrynge, K. (Ed.). Turnshare Ltd.- Publisher. Young, I. M. (1990) Justice and the Politics of Difference. Princeton: Princeton University Press. Žižek, S. (2001). The fragile absolute: or, why is the Christian legacy worth fighting for?. Verso. About the Author Joachim Meier is a Ph.D.-student at Aarhus University, Department of Psychology. His research project focuses on young people’s experiences of bad conscience in order to understand the existential concerns and normative order of their lives. He has broad theoretical interests in existential philosophy and psychology, the study of subjectivity, and morality.