Logotherapy

Discovering meaning

According to Frankl, "We can discover this meaning in life in three different ways: (1) by creating a work or doing a deed; (2) by experiencing something or encountering someone; and (3) by the attitude we take toward unavoidable suffering" and that "everything can be taken from a man but one thing: the last of the human freedoms – to choose one's attitude in any given set of circumstances".^[2] On the meaning of suffering, Frankl gives the following example:

"Once, an elderly general practitioner consulted me because of his severe depression. He could not overcome the loss of his wife who had died two years before and whom he had loved above all else. Now how could I help him? What should I tell him? I refrained from telling him anything, but instead confronted him with a question, "What would have happened, Doctor, if you had died first, and your wife would have had to survive without you?:" "Oh," he said, "for her this would have been terrible; how she would have suffered!" Whereupon I replied, "You see, Doctor, such a suffering has been spared her, and it is you who have spared her this suffering; but now, you have to pay for it by surviving and mourning her." He said no word but shook my hand and calmly left the office.^{[2]:178–179}

Frankl emphasized that realizing the value of suffering is meaningful only when the first two creative possibilities are not available (for example, in a concentration camp) and only when such suffering is inevitable – he was not proposing that people suffer unnecessarily.^[12]:115

Overcoming anxiety

By recognizing the purpose of our circumstances, one can master anxiety. Anecdotes about this use of logotherapy are given by New York Times writer Tim Sanders, who explained how he uses its concept to relieve the stress of fellow airline travelers by asking them the purpose of their journey. When he does this, no matter how miserable they are, their whole demeanor changes, and they remain happy throughout the flight.^[15] Overall, Frankl believed that the anxious individual does not understand that his anxiety is the result of dealing with a sense of “unfulfilled responsibility” and ultimately a lack of meaning.^[16]

Treatment of neurosis

Frankl cites two neurotic pathogens: hyper-intention, a forced intention toward some end which makes that end unattainable; and hyper-reflection, an excessive attention to oneself which stifles attempts to avoid the neurosis to which one thinks oneself predisposed. Frankl identified anticipatory anxiety, a fear of a given outcome which makes that outcome more likely. To relieve the anticipatory anxiety and treat the resulting neuroses, logotherapy offers paradoxical intention, wherein the patient intends to do the opposite of their hyper-intended goal.

A person, then, who fears (i.e. experiences anticipatory anxiety over) not getting a good night's sleep may try too hard (that is, hyper-intend) to fall asleep, and this would hinder their ability to do so. A logotherapist would recommend, then, that the person go to bed and intentionally try not to fall asleep. This would relieve the anticipatory anxiety which kept the person awake in the first place, thus allowing them to fall asleep in an acceptable amount of time.^[2]

Depression

Viktor Frankl believed depression occurred at the psychological, physiological, and spiritual levels.^[16] At the psychological level, he believed that feelings of inadequacy stem from undertaking tasks beyond our abilities. At the physiological level, he recognized a “vital low”, which he defined as a “diminishment of physical energy”.^[16] Finally, Frankl believed that at the spiritual level, the depressed man faces tension between who he actually is in relation to what he should be. Frankl refers to this as the gaping abyss.^[12]:202[16] Finally Frankl suggests that if goals seem unreachable, an individual loses a sense of future and thus meaning resulting in depression.^[16] Thus logotherapy aims “to change the patient’s attitude toward their disease as well as toward their life as a task”.^[12]:200

Obsessive-compulsive disorder

Frankl believed that those suffering from obsessive-compulsive disorder lack the sense of completion that most other individuals possess.^[16] Instead of fighting the tendencies to repeat thoughts or actions, or focusing on changing the individual symptoms of the disease, the therapist should focus on “transform[ing] the neurotic’s attitude toward their neurosis”.^[12]:185 Therefore, it is important to recognize that the patient is “not responsible for his obsessional ideas”, but that “he is certainly responsible for his attitude toward these ideas”.^[12]:188 Frankl suggested that it is important for the patient to recognize his inclinations toward perfection as fate, and therefore, must learn to accept some degrees of uncertainty.^[16] Ultimately, following the premise of logotherapy, the patient must eventually ignore his obsessional thoughts and find meaning in his life despite such thoughts.^[12]

Schizophrenia

Though logotherapy wasn’t intended to deal with severe disorders, Frankl believed that logotherapy could benefit even those suffering from schizophrenia.^[16] He recognized the roots of schizophrenia in physiological dysfunction.^[16] In this dysfunction, the person with schizophrenia “experiences himself as an object” rather than as a subject.^[12]:208 Frankl suggested that a person with schizophrenia could be helped by logotherapy by first being taught to ignore voices and to end persistent self-observation.^[16] Then, during this same period, the person with schizophrenia must be led toward meaningful activity, as “even for the schizophrenic there remains that residue of freedom toward fate and toward the disease which man always possesses, no matter how ill he may be, in all situations and at every moment of life, to the very last”.^[12]:216

Terminally ill patients

In 1977, Terry Zuehlke and John Watkins conducted a study analyzing the effectiveness of logotherapy in treating terminally ill patients. The study’s design used 20 male Veterans Administration volunteers who were randomly assigned to one of two possible treatments – (1) group that received 8-45 minute sessions over a 2 week period and (2) group used as control that received delayed treatment. Each group was tested on 5 scales – the MMPI K Scale, MMPI L Scale, Death Anxiety Scale, Brief Psychiatric Rating Scale, and the Purpose of Life Test. The results showed an overall significant difference between the control and treatment groups. While the univariate analyses showed that there were significant group differences in 3/5 of the dependent measures. These results confirm the idea that terminally ill patients can benefit from logotherapy in coping with death.^[17]

Authoritarianism

In 1969 Rollo May argued that logotherapy is, in essence, authoritarian. He suggested that Frankl’s therapy presents a plain solution to all of life’s problems, an assertion that would seem to undermine the complexity of human life itself. May contended that if a patient could not find his own meaning, Frankl would provide a goal for his patient. In effect, this would negate the patient’s personal responsibility, thus “diminish[ing] the patient as a person”.^[18] Frankl explicitly replied to May’s arguments through a written dialogue, sparked by Rabbi Reuven Bulka’s article “Is Logotherapy Authoritarian?”.^[19] Frankl responded that he combined the prescription of medication, if necessary, with logotherapy, to deal with the person's psychological and emotional reaction to the illness, and highlighted areas of freedom and responsibility, where the person is free to search and to find meaning.^[20]

Religiousness

Critical views of the life of logotherapy's founder and his work assume that Frankl's religious background and experience of suffering guided his conception of meaning within the boundaries of the person^[21] and therefore that logotherapy is founded on Viktor Frankl's worldview.^[22]

Frankl openly spoke and wrote on religion and psychiatry, throughout his life, and specifically in his last book, Man’s Search for Ultimate Meaning (1997). He asserted that every person has a spiritual unconscious, independently of religious views or beliefs, yet Frankl's conception of the spiritual unconscious does not necessarily entail religiosity. In Frankl's words: “It is true, Logotherapy, deals with the Logos; it deals with Meaning. Specifically, I see Logotherapy in helping others to see meaning in life. But we cannot “give” meaning to the life of others. And if this is true of meaning per se, how much does it hold for Ultimate Meaning?”^[23] The American Psychiatric Association awarded Viktor Frankl the 1985 Oskar Pfister Award (for important contributions to religion and psychiatry).^[23]

Origins

On Frankl's doctrine that one must instill meaning in the events in ones life, that work and suffering to find meaning, will ultimately lead to fulfillment and happiness. In 1982 the highly cited scholar and holocaust analyst Lawrence L. Langer, who while also critical of Frankl's distortions on the true experience of those at Auschwitz,^[24] and Frankl's amoral focus on "meaning" that could just as equally be applied to Nazis "finding meaning in making the world free from Jews",^[25] Langer would go on to write: "If this [logotherapy] doctrine had been more succinctly worded, the Nazis might have substituted it for the cruel mockery of Arbeit Macht Frei [the sign chosen to be placed over the entry to Auschwitz]".^[26]

A biographer of Frankl would later remark on the penetrating insight of Langer's reading of Frankl's holocaust testimony, with Langer's criticism published in 1982 before ther biographer's research, the former had thus drawn the controversial parallels, or accommodations in ideology without the knowledge that Victor Frankl was an advocate/"embraced"^[27] the key ideas of the Nazi psychotherapy movement ("will and responsibility"^[28]) as a form of therapy in the late 1930s. When at that time Frankl would submit a paper and contributed to the Göring institute in Vienna 1937 and again in early 1938 connecting the logotherapy focus on "world-view" to the "work of some of the leading Nazi psychotherapists",^[29] both at a time before Austria was annexed by Nazi Germany in 1938.^[30][31]

The origins of logotherapy, as described by Frankl, were therefore a major issue of continuity that Biographer Pytell argues were potentially problematic for Frankl because he had laid out the main elements of logotherapy while working for/contributing to the Nazi-affiliated Göring Institute. Principally Frankl's 1937 paper, that was published by the institute.^[32] This association, as a source of controversy, that logotherapy was palatable to National Socialism is the reason Pytell suggests, Frankl took two different stances on how the concentration-camp experience affected the course of his psychotherapy theory. Namely, that within the original English edition of Frankl's most well known book, Man's Search for Meaning, the suggestion is made and still largely held that logotherapy was itself derived from his camp experience, with the claim as it appears in the original edition, that this form of psychotherapy was "not concocted in the philosopher's armchair nor at the analyst's couch; it took shape in the hard school of air-raid shelters and bomb craters; in concentration camps and prisoner of war camps." Frankl's statements however to this effect would be deleted from later editions, though in the 1963 edition, a similar statement again appeared on the back of the book jacket of Man's Search for Meaning. Frankl over the years would switch between the claim that logotherapy took shape in the camps to the claim that the camps merely justified his already preconceived theories, as the definitive word on the matter, in 1977 Frankl himself began to clarify the controversy stating "People think I came out of Auschwitz with a brand-new psychotherapy. This is not the case."^[33]