Trancript of the Article by Dr. Chritopher Wurm, published with his permission. Originally published in: Wurm, C. S. (1992). Logotherapy in palliative care. Hospress, 6(1), 34-39.
By Dr. Christopher S. E. Wurm
Family Practice Unit, University of Adelaide
General Practice Teaching Unit, Modbury Hospital
Behavioural Medicine Clinic, Flinders Medical Centre, Bedford Park, South Australia
Logotherapy in Palliative Care
By Dr. Christopher S. E. Wurm
Family Practice Unit, University of Adelaide
General Practice Teaching Unit, Modbury Hospital
Behavioural Medicine Clinic, Flinders Medical Centre, Bedford Park, South Australia
Logotherapy and its Foundations
Logotherapy is an approach to counseling developed by Professor Viktor E. Frankl, Auschwitz survivor and subsequently Professor of Neurology and Psychiatry at the University of Vienna. It incorporates important themes from existentialist philosophy to arrive at a more comprehensive understanding of humanity and to offer comport in the face of human suffering. The word Logotherapy is derived from the Greek Logos, for meaning or spirit.
Logotherapy is not a substitute for other counseling approaches as much as an adjunct or extension. It is compatible with many other methods including Rogerian Counselling, Psychodynamic Psychotherapy, Cognitive Behaviour Therapy and Family Therapy, differing significantly in its focus on the issues of meaning and purpose in life. While recognizing the importance of biological, psychological and social processes, logotherapy deals with phenomena which are uniquely human. Frankl refers to the “noetic” or spiritual” dimension to explain the specifically human phenomena of the will, individual responsibility, conscience, self-transcendence and the will to meaning.
Following on as it does from Freud’s Psychoanalysis and Adler’s Individual Psychology, Logotherapy has been called the Third Viennese School of Psychotherapy. But where Freudian psychoanalysis is centered on the pleasure principle (or the will to pleasure) and Adlerian psychology on striving for superiority (or the will to power), logotherapy focuses on the meaning of human existence as well as on man’s search for such a meaning. According to Frankl this striving to find a meaning in one’s life is the prime motivation force in man.
The Search for Meaning in the Face of Death
So, if Logotherapy is about meaning, how do people find meaning specially when they are terminally ill? In Frankl’s words, life can be made meaningful in a threefold way: first through what we give to life in terms of our creative works; second by what we take from the world in terms of our experiencing values; and third, though the stand we take toward a fate we no longer can change or the like. (1)
Although illness may interfere with a person’s ability to work or pursue their commitment to
a cause and may also stop them from finding meaning through their experience of nature, or art or within a relationship. The blocking of these paths to meaning does not prevent them from looking for an attitude which enables them to confront the situation. To quote Frankl again “The possibility of realizing what I call attitudinal values – by the very attitude with which we face our suffering is there to the very last moment. Now we can understand the wisdom of Goethe when he said, ‘There is no condition which cannot be ennobled either by a deed or by suffering.’… And what about death? – Does it not completely cancel the meaning of our life? By no means. As the end belongs to the story, so death belongs to life. If life is meaningful then it is so whether it is long or short.” (2).
Elsewhere he writes “Logotherapy, keeping in mind the essential transitions of human existence, is not pessimistic but rather, optimistic. To express this point figuratively, we might say the pessimist resembles a man who observes with fear and sadness that a wall calendar, from which he daily tears a sheet, grows thinner with each passing day. On the other hand, the person who attacks the problems of life actively is like a man who removes each successive leaf from his calendar and files it neatly and carefully away with its predecessor, after first having jotted down a few diary notes on the back. He can reflect with pride and joy on all the richness set down in these notes, on all the life he has already lived in the fullest. What will it matter to him if the if he notices he is growing old? Has he any reason to envy the young people who he sees, or be nostalgic over his own lost youth? What reason has he to envy a young person? For the possibilities that a young person has, the future which is in store for him? ‘No, thank you’ he will think. ‘Instead of possibilities, I have realities in my past, not only the reality of work done, and of love loved, but of sufferings bravely suffered. These sufferings are even the things of which I am most proud, though these are things that cannot inspire envy.” (3)
Logotherapy in the Hospice Setting
Writing about counselling the terminally ill and Austrian logotherapists and academic theologian, Dr. Franz Schmatz, referred to the need to recognise the individuality and uniqueness of each patient and to see them as having multiple potentialities. (4) Thus, he says it is necessary to accept the person as a whole and to take them seriously, paying attention to their freedom, responsibility and competence, viewing them not as needing supervision but as an individual to accompany. An extension of this approach is that effective counselling should open up possibilities, not close them off as tends to happen if patients are not accorded the chance to make their own decisions about meaning, and exercise the responsibility that comes with human freedom. This may in itself be a painful process, but one which can lead to personal growth., whereas the repression of realistic fear of dying can diminish the person’s quality of life.
In discussing life and death and the meaning of human existence, questions often arise which are outside the scope of logotherapy and Frankl cautions against losing sight of the distinctions between psychotherapy and religion. (5)
The Needs of Caregivers
Families, volunteers involved in hospice and palliative care want their own lives to be meaningful as well. Family members are affected by the unavoidable suffering of bereavement and will also need to implement attitudinal values to deal with the loss. This also applies to volunteers and professionals in the area, although it is only when there is no scope for creative or experiential values that attitudinal values come into play.
A Czechoslovakian logotherapist, Stanislav Kratochil, refers to parallel and pyramidal value systems. (6) In a parallel system the person places equal importance on a range of ways of deriving meaning as opposed to pyramidal system where one form of meaning is given considerable priority, and others rank lower and lower on the pyramid. Certainly, most people find that this helps to maintain balance between different areas in their life, but there are also obviously very good reasons why some values are more important to individuals than others.
The late Edith Weisskopf-Joelson spoke of the need for a balance when she said “The logotherapeutic notion that experiencing can be as valuable as achieving is therapeutic because it compensates for our one-sided emphasis on the external world of achievement at the expense of the internal world of experience.” (7)
In conclusion, I would say that working in Palliative Care requires us to be aware of the importance of meaning and purpose, not only in the lives of our patients and their families but also in our own lives.
(This paper is based on a talk to the Association’s General Interest Branch on Monday, 24th February 1992.)
References
- Frankl, V.E. (1967). Psychotherapy and Existentialism. New York: Touchstone. (p.15)
- Ibid, (p. 28).
- Frankl, V.E. (1984). Man’s Search for Meaning. New York: Touchstone. (pp. 24 -5)
- Schmatz, F. (1988). “Die Bedeutsamkeit der Logotherapie für den seelsorglichen Sterbebeistand.” In Längle, A. (Ed.), Entscheidungen zum Sein. Munich: Piper. (pp. 66 – 78).
- Frankl, V.E. (1967). (p. 32).
- Lukas, E. (1984). Meaningful Living. Berkeley, CA: Institute of Logotherapy Press. (pp. 6 – 8).
- Frankl, V.E. (1981). Die Sinnfrage in der Psychotherapie. Munich: Piper. (p. 61).
Further Reading
- Frankl, V.E. (1967). Psychotherapy and Existentialism. Simon and Schuster, New York.
- van Duerzen-Smith, E. (1988). Existential Counselling in Practice. Sage Publications, London.
- Frankl, V.E. (1984). Man’s Search for Meaning. Simon and Schuster, New York.
- Frankl, V.E. (1969). The Will to Meaning. New American Library, New York.
- Frankl, V.E. (1978). The Unheard Cry for Meaning. Simon and Schuster, New York.