photo of boats during dawn

The Meaning of Logotherapy in Psychiatry and Psychotherapy

Presented by: Dr. Cvijeta Pahljina (1943 – 2022), Psychiatrist, at The Future of Logotherapy Congress, Vienna, 2016.

Translated by: Maria Marshall, Ottawa Institute of Logotherapy, 2023.

Recorded by: Yulianna Sagdieva, Director of the Institute for Logotherapy in Central Asia, 2016.

Published with permission from: Barbara Pahljina (daughter of the presenter).

In 1982, the Croatian translation of “Yes to Life In Spite of Everything” was published. In this book, Frankl expressed the view that the essence of a human being is spirit. Frankl stated that human beings always “stand on the ground with their forehead raised toward the sky.” This means that we are oriented toward values.  In this book, he gives a poignant illustration of the human potential for choosing between what is good and what is evil. As a psychiatrist and philosopher, he acknowledged the givens of life. His idea is that the spiritual dimension is an active and dynamic resource that finds expression through our being.

In this presentation, I would like to address the topic of what logotherapy means to the psychiatrist and the psychotherapist and what it means concretely, in my life. As a therapist, I want to work with to build trust and mobilize people’s inner strength with a vision to counteract despair and to break the chain of aggression. I want to work toward mobilizing the community in a sense of the ethos that “the world is not healthy, but healable” (Frankl) and that with small steps we can reach our goals and make progress. In this quest, everything is related and intertwined: values, conscience, freedom, responsibility, meaning, what we hold as worthwhile. I want to illustrate how I translate this into practice.

First, I want to talk about the question of who comes into psychiatric practice, and what kind of people I would be likely to meet? It is people with anxieties, people with psychoses, somatic complaints, addictions, dementia, or people who show symptoms of the ills of society. The emphasis here and the key point is that they are not patients, but people. I use individual or group psychotherapy with a logotherapy orientation to treat them.

The most important guideline is that we heal not only with medications and psychotherapeutic methods, but most importantly, with our own person. In the first place, psychiatrists and psychotherapists should love the people who come to seek their help. They should make them feel welcome. When one feels this love, one radiates it. Everything else that I feel or think should be put away, while I am ready to listen to the clients when they come. Clients expect that whatever they bring to me can be handled. Ideally, that we can handle everything together. One needs emotional stability for this kind of work. Inner calm. Trust that there is a solution. That client already has an intuition for the solution.

What we can offer is our time, care, and the best of ourselves. They entrust us their burdens and we seek to understand these from their position and as we look for solutions. We must be able to grasp life from their point of view, and live life with them.

People are not chemical test tubes in which many elements can be mixed and the wanted results will crystallize. They are not animals on which experiments can be done. There are biological causes that can be influenced with psychopharmacology. There are disturbances in the neurotransmitters of the nervous system. There are psychological causes that are exogenic and can be influenced by psychotherapy. But the person as a spiritual being needs the presence of another person who can understand their pain and look for meaningful solutions. Someone who believes in them that they can find a meaningful solution. Someone who helps them and believes in them. Someone who can differentiate fate from the area of freedom and in the free area acknowledge accomplishments. People develop trust in psychiatrists who welcome them, want to help them, and support them.  Trust is essential for further advancement.

As I mentioned earlier, in psychiatric practice, we face a whole palette of difficulties. What can one expect from logotherapy in all these cases. What meaning does the logotherapeutic approach bring? What is specific about it?

We are familiar with the imago hominis [image of the human being] of Frankl, the schema of freedom or fate. This applies to all the cases. As do the concepts of meaning, self-distancing and self-transcendence. Methods, such as modification of attitudes, de-reflection and paradoxical intention can be used. What is always different is the uniqueness of the person and the uniqueness of their situation. The Psychiatric creed: The person never loses their dignity. This is very specific to logotherapy and differentiates it from other psychotherapeutic orientations.

Individual Intervention

First example: A 45-year-old man, locksmith, married, father or two children, ages 14 and 7 years old. The dilemma is whether to orient him toward reality and to insist on it or not. Diagnosis: schizophrenia. First dialogue after he is discharged home, using the Socratic Dialogue.

Psychiatrist: “You say you have seen the Virgin Mary in the middle of the night?”

He: “Yes, she stood over a burning bush in my garden and said to me that I need to run to a priest who lives 25 kilometers away from my house and there I will receive a rosary. I ran, the priest received me, and he gave me a rosary.”

Me: “How did you end up in psychiatric care?”

He: “I did not want to go home, and I was scared because people were following me for a week on the street and photographed me. I don’t know why. Then, the priest had the idea to phone 911 and an ambulance was sent out, so they took me to the hospital.”

Me: “So, If the priest had not phoned 911, would that have been better or not?”

He: “I am grateful to the priest because at that time he saved me from this horrible anxiety.”

Me: “You were in the hospital for three months and you have been at home now 14 days. What is happening with the anxiety?”

He: “Everything is quiet now and no one is following me.”

Me: “What do you think now, were these real people who were following you, or it was part of the illness?”

He: “In the hospital the doctors explained to me that the hallucinations were psychotic, and I had paranoid delusions, and they gave me medication after which the thoughts went away.”

Me: “Can you accept that these thoughts were part of an illness?”

He: “Yes.”

Me: “How about the Virgin Mary and the rosary?”

He: “I did not see her after that. She was so kind and compassionate. I will never forget that. I think that it was the real Virgin Mary and not my illness.”

At home he had specific antipsychotic medications and in two years he had two additional episodes with paranoid delusions and hallucinations. He regained a good stability in his relationship and regularly came to appointments once a month. Since the illness affected his cognitive functioning, he couldn’t continue to work. Currently, he lives at home, and his wife works. They have a family with two children. This works out well with the children. They have a small farm where he is active. His father-in-law also had schizophrenia and he is making sure that he takes his medications as he should. A few years later, I had another Socratic dialogue with him to shed more light on his values that are his guiding principles.

Me: “How do you think about your life, are you satisfied with it, or would you have wanted it to be something different?”

He: “Thanks God, I am healthy. I have a good family. Despite the diagnosis I feel good, I would not want to change anything.”

Me: […There is an affirmation of his life as worthwhile despite the illness. This is an example of the defiant power of the human spirit. He is thankful for his life despite the illness.]

Me: “You received treatment. Looking back, could this treatment have some meaning?”

He: “I could not help the anxieties I was experiencing. That was beyond me. But after the treatment I am at home, my wife is working, and I can help my family more than before.”

Me: […He understands the difference between fate and freedom. I noticed that he developed mild Parkinson’s symptoms because of the medications. However, he insisted that despite the hospitalization, the medications, the Parkinson’s symptoms, his life was worthwhile and good as it was. He said this out of love for his wife, for his children, for his father-in-law whom he is helping. And he was grateful. Even a client with schizophrenia is capable of self-transcendence. He could experience meaning despite his illness.]

Question for the practitioner:

Should a psychiatrist question the client’s beliefs?

Here psychiatrists are questioned in their humanity. The client was convinced that the apparition of the Virgin Mary was real. The main point for psychiatrists to consider is that every person is more than their illness and they are capable of self-transcendence despite difficulties.

Second example: A 28-year-old hairdresser, a lady who was brought to see me by her mother after having been hospitalized at a psychiatric hospital. They were shocked when they the diagnosis of hebephrenic schizophrenia was communicated to them.  Her mother was a director of a bank. She was diagnosed with terminal cancer, and she was given only a few months to live. She wanted me to follow-up the treatment of her daughter. The daughter was beset by anxieties, she showed disorganized speech and abnormal speech content. She experienced hallucinations with depressive and manic mood. The father died in an accident when she was 3 years old. The older sister was a doctor who worked nearby. The mother wanted to leave the house to the daughter after her death. She hoped that with some psychiatric help, her functioning could improve to the point that the eldest daughter could care for her. After the death the mother, the client came to my office, and in a suspiring clear voice she said: “When I was a little girl, I asked Jesus to send me an illness so I can save the world. I have been in the hospital for a long time.” She begged me to say the “Our Father” together. We joined hands and we prayed the “Our Father” together. It was unexpected. Then, she sank into her confused speech. Sometime later, she met someone at the hospital who had schizophrenia for ten years. He lived with his parents. They went for walks together. Two times a week they baked pancakes together. He loved her despite her illness.

Questions for the practitioner:

What are the boundaries between mystical and spiritual experiences and psychotic illness? Was the early experience with Jesus an early childhood symptom of schizophrenia that was not diagnosed at that time? How should a psychiatrist react in such a situation?

Although the psychiatrist may not want to question something that the client holds so dear, the psychiatrist must ask about the implications of the experience because it is clearly something very significant. She showed the willingness to “save the world” through her illness. That was her attitude towards her illness. At that point one can stop questioning this religious experience any further.

Third example: A 45-year-old woman, divorced, who has a daughter and two grandchildren 5 and 7-years-old. She lives alone in an apartment in a  small city. Her diagnose was Schizoaffective psychosis. [This is a mixed psychoses with manic-depressive episodes and schizophrenia.] She was a policewoman. When she was 27, she saw the opportunity to steal money, which she reportedly did. There were internal investigations. The whole year of investigations left her very exhausted. She was married with a policeman from the same police station, and they had a 2-year-old daughter. The man had an affair with another woman and left her. She decided to move with her daughter to another town where she continued to work as a police officer. She had an emotional and financial crisis. A short time after, she started to experience obsessional ideas that she was being followed. She imagined that the police were going to storm her house and that she would end up in prison. In remission when she felt better, we had this conversation.

Me: “If you had the chance now, would you steal or not?”

She: “Of course not.”

Me: “What can you do now to get out of this problem?

She: “I am still in a financial crisis, I cannot acknowledge the investigation, I could not live with the ridicule of my colleagues.”

Me: “What else can you do then? This is in the area of fate now because it happened in the past. What can you do now to make this good again? When you cannot make it up to the right person, can one make it up to someone else? Can you think of something?”

She: “I am thinking about visiting an old man who lives alone and helping him.” 

After her release, she visited this old man and took care of him. She readily assumed this task out of her free will. With time, they became good friends and he sometimes helped to watch her daughter while she had some other work to do. She got a new job in a new place, working as saleslady at a kiosk. For seven years she was in good remission. Then, the old man died, and her grief precipitated a depressive episode. Although medications and psychotherapy helped, she had to be admitted to the hospital because of the depression. She wanted to commit suicide and took an overdose. Her 15-year-old daughter was there with her. In the next couple of years, she had depressive and manic episodes, and she was between lighter depression and suicides attempts and lighter manic episodes. She saw me regularly. Five years ago, her mother passed away. Her father developed Alzheimer’s disease died in a nursing home. Her sister developed depression and committed suicide. She lived through these difficult experiences. She grieved for her sister. Currently, she is in a stable condition, and she lives in her home. Next door to her lives her daughter. She is divorced and has two children. She goes for walks with them from time to time and she has a cat that she loves. She reads the newspaper, she writes cards, and writes poems. The symptoms of depression are the hardest. The suicidal thoughts ease up when she thinks about her grandchildren and her cat.

Questions for the practitioner: 

How can the client deal with the responsibility of a past crime?

One needs to evaluate what it is that she was doing at that time and how her actions are different now from those actions, since she is doing something good for the community. She developed a new attitude toward life because of her grandchildren and this change was not easy to make because of her health condition. It was a self-transcendental choice. She could find meaning and she found the steps to make life livable.

Can it be that guilt feelings are still leading to conflicts?

In this case one should find ways to restore her balance. For a practicing Catholic, seeking out spiritual guidance, reconciliation, and making amends can be considered. From the psychiatric point of view, it is important to emphasize connections with people, such as social workers, family, organizations, to remain active in society. The key is to do something from the heart and to live for someone. “Often it is through the ruins, that one can see the stars” (Frankl).

These were three different people with seemingly similar diagnosis, but as we said, unique persons in unique situations.

Group Intervention

In psychiatric treatment, we need to take into consideration the manifestations of dysfunctions in society. As we mentioned earlier, the premise is that “society is not healthy, but healable” (Frankl). For example, in Croatia, a significant proportion of young people live alone and avoid making commitments. This stems from not being mature enough to face adult responsibilities and seeking refuge in isolation from society. Then at the age of forty, realizing that opportunities have been missed and the time for establishing a family is faint, they develop depression and require mental health care. We can treat these people in de-reflection groups where everyone shares the same problem. There is a similarity between the experience of these people and the fairy-tale of the “Sleeping Beauty.” We can use this story to animate a discussion where everyone plays a role.

[For those of you who are not familiar with this fairy tale, it is about a 15-year-old girl who lives sheltered in her parents’ castle until one day wanders into a remote room of the castle where she accidentally pricks her finger and falls to asleep for one hundred years. A thick bush of thorns surrounds the castle. A young prince hears about the story of a princess asleep there and cuts though the bushes that turn into roses. She kisses the princess who wakes up from her sleep and the two live happily ever after.]

The knight who saves the princess comes through the thorns of the bushes surrounding the castle and all the bushes turn into roses. This illustrates that with hard work and goal orientation, the obstacles in life can fall away.

It is difficult to change society but when we do not shy away from our freedom and responsibility, we can creatively use our resources and the results can be very interesting: Volunteering, reading, hikes. The psychiatrist can lead these groups and help individuals in the groups to set meaningful goals.

In conclusion, “What is the meaning of logotherapy for the practitioner?”  We can answer this question by recognizing the spiritual dimension of the person and their unconditional dignity. It is a privilege in life to be able to help to someone.

calm body of lake between mountains

Logotherapy and Existential Analysis for Burnout and Moral Injury

Viktor Frankl’s Logotherapy and Existential Analysis (LTEA) can be helpful to prevent burnout as well as to manage the effects of moral injury. Burnout and moral injury are two different entities. Burnout refers to exhaustion from excessive work. Moral injury is the consequence of values transgressions.

Ottawa Institute of Logotherapy, 2020

Burnout is a phenomenon that occurs at the workplace. LTEA, with its focus on the search for meaning, can be useful in its prevention. When people have a sense of meaning and purpose, they can take care of themselves better, and participate in meaningful activities where they actualize values in their lives.

Logotherapy and Existential Analysis for Moral Injury
Ottawa Institute of Logotherapy, 2021

Moral injury refers to values transgressions. It can occur in the process of work, or everyday life, when there is a betrayal of one’s personal values by someone else or through one’s own failures. To come to terms with values transgressions it is important that a person recognizes their values and how they are in search of meaning.

In LTEA, search for meaning refers to the actualization of personal values. Values are guiding principles, but if they are not lived, one cannot find meaning in life. Therefore, it is important to recognize what are our personal values and if they are in alignment with universal values.  Examples of universal values are human rights and the dignity of the person. When one actualizes values in harmony with universal values as their guiding principles, one finds meaning in life. In the case of moral injury, there is a sense of meaninglessness. The sense of meaninglessness can lead to symptoms such as disappointment, anxiety, and distress. These symptoms are the manifestation that the person is experiencing a lack of such values. The symptoms in themselves are not pathological, but if not managed, they can lead to serious consequences, such as depression, or posttraumatic stress disorder.

LTEA, in the first place, looks at areas of freedom and how a person can respond to a situation. It explores emotions related to values. After identifying the values, a person can decide, out of their freedom of will, what is the best course of action. In certain situations, it is to reaffirm those values, those personal and universal values that a person has, and lives accordingly, or choose a different path, or acknowledge that someone else has trespassed those values. In this way, LTEA can be a helpful complement to other therapeutic modalities like cognitive behavior therapy (CBT). The issue with CBT is that we try to reappraise cognitions or look at reality from different perspectives, but in the case of moral injury, the reality is that there has been a values transgression.  As we acknowledge this reality, we recognize the emotions in relation to our values and in doing so, we search for meaning in suffering.

On the other hand, with burnout, what we are trying to do is to increase the resiliency of the person. Resiliency means that people can face life’s challenges and they don’t become broken or sick in the face of those challenges.  They can step back through self-distancing from the situation and respond according to their values. In many cases, when there is exhaustion from work, it is important that the person takes care of themselves, that they replenish their energies so they can be effective in their work.  In other situations, they can analyze what kind of work they are doing and if it is meaningful to them. Sometimes there are repetitive tasks, or monotonous work that is not meaningful, and the person loses their own sense of humanity. When we reconnect with our values, we start to see possibilities within that work environment where we can live our values: In connecting with coworkers, contributing to society, or how we face different challenges.

Burnout and moral injury if left untreated can lead to mental health problems. LTEA offers an approach that can improve life satisfaction and resiliency.

On March 23-24, 2023, Professor Edward Marshall is offering a two-day workshop at the Royal Ottawa Mental Health Centre that will focus specifically on the methods and applications of Viktor Frankl’s Logotherapy and Existential Analysis. This event is tailored toward health professionals and students who would like to deepen their knowledge and understanding of the uses of this modality in their clinical practice. Registration Page.

grand canyon

The Concept of Logotherapy in 1925

Translated by Maria Marshall, PhD, RP

Fundamentals of Medical Psychology: Psychodiagnostics and Psychotherapy in Everyday Practice (1925)

Dr. med. Heinz Fendel, Specialist of Internal Medicine and Nervous Disorders

Hoechst, Frankfurt on the Main River, Germany

Publisher: Urban & Schwarzenberg

Berlin Friedrichstrasse 106 B / Vienna I Mahlerstrasse 4

Chapter 20: Logotherapy

The main medium of every psychotherapy is the spoken word. It is therefore obvious that the verbal message, aside from its activating principles, can be by itself a method. As Dubois emphasized when he stated: “the only weapon of the doctor—when one leaves aside the power of suggestion or hypnosis–is clear understanding, a gift, to communicate facts to the patient clearly, and free from false assumptions.” It is notable that such healing influence on the soul that can be transmitted merely through word based on reason (Logos), requires certain characteristics of the patient and the doctor: It comes into play in the case of certain patients, who have a refined psyche and experience structure. It requires from the doctor the highest mastery of verbal capacity, style, and content, to express such welled up realities. Constating the initially unrecognized complaints, doubts and objections of the patient, exploring deeper to bring out the correcting counter arguments based on their own presenting observations and declarations, that leads to an appreciation of the absurdum of the illogical conception of illness, is the great art, that confronts us in Dubois’ work. To whomever this process “seems really primitive” (Heyer), must not yet have fully appreciated the finest possibilities of psychological healing. Certainly, just like in the case of other forms of psychotherapy, the formal, suggestive, affective, and irrational elements are also at work, however, from simply a methodological point of view, it is an art to be able to utilize this tool.

As much as the content of the logotherapeutic intervention matters, it is also important and difficult to arrive to what is right and to avoid what is wrong. As a principle, the rule not to harm, ranks higher than the bid to use. Kretchmer says: “Whoever has not hurt their patients psychologically is already a good psychotherapist.” Who among us doctors can boast with such “never?”

Specifically, doctors have the duty not to reveal an unfavorable diagnosis, when that has no vital significance to the patient, further, to avoid any communications with the patient that can lead to overexaggerated and erroneous conclusions. How often these rules are disrespected! Especially those who are charged with the care and healing of accident victims. There, through quite unbelievable and construed connections between the harm and subjective difficulties, the dynamics of accident neurosis is brought into motion. For sick notes, literally, and therapeutic measures are much more convenient and “gratifying,” than the clarification of the real (psychogenic) nature of suffering. Since the latter often requires great self-denial. Whoever is only interested in their name and in their practice can never become a true psychotherapist.

Psychotherapeutic activity stands in strict opposition to the anti-psychotherapeutic “goal-directed neglectfulness” (Bruns). To the point that one could speak directly of a “methodical neglect-therapy.” As Dubois explains: “In a case of aphonia that lasted already for six months, I intentionally engaged in a negative suggestion procedure, because I did not only simply ignore the aphonia, but I did not concern myself about it at all. The patient had a host of neurotic disturbances: sleeplessness, diarrhea, pain in the legs. During the first visit, she complained with a toneless voice: ‘Doctor, I can still not talk!’ I still said nothing in response and instead started to ask her about all her other symptoms. I wanted her to forget about her suffering from the aphasia. This went so well that after two days, she started to talk with a loud voice.”

In other cases, and now we arrive to the actual theme of this chapter, it is absolutely necessary to take a detailed look at the patient’s complaints in order to empathize with their condition and even the most subtle aspects of it, whilst, nevertheless, steadfast holding on to the psychological nature of their disturbance. Only from this base one can build the required trust in the words of the doctor.

The methodical principle of restoring sanity comes with clarification. We shall say to the patient: “You are wrong about yourself. Your consideration and judgement are based on false premises. Let’s establish what is clear,” which Dubois put into these words:

“The human machine is so complicated that each and every day we could constate a disturbance somewhere. In can be a gastric disturbance, an undefined pain, heart palpitations, a fleeting neuralgia. But out of full trust in our good health, we forgo this trivia. The hypochondriac, however, paves the path to illness, just from the mere thought.”

What is the best advice so that hypochondriac thoughts do not materialize? Humor (good cheer) and confidence have been proven by science to lead to healthy patterns that support wellbeing and break the chain of harmful patterns. Away with self-tormenting ruminations. These ruminations themselves become the cause.

Pascal’s words: “Man is just a pipe, weakest in nature, but a thinking pipe,” can have two layers: It is possible for us to remedy our weaknesses through knowledge, prudence, and care. However, it is also possible for us through hyper-reflection and through hypochondriacal brooding to exaggerate shortcomings and disturbances to such extent that they arise from nothing. It is an advantage to these latter types of people who have a tendency for such rumination to be thinking beings.

Think about it! Not the reality, not the absolute givens, what may be so serious, but the mental mediation of the absolutes is the greater source of suffering. One fears the hereditary, transmissible, or other sources of illness. Attempt to think about these things in a philosophical manner! What do we know about reality and its relation to us? We have found a couple of categorical formulas that should reveal to us something about the absolute. However, those who have reverence understand that we have not the slightest idea if we can really understand.

“Everything to which much consideration is given, becomes thinkable,” said Nietzsche. To them, everything becomes possible, because they think about it a lot. They judge too swiftly. Whoever makes him or herself the subject of gruesome self-criticism must come across insufficiency and limitation.

Look at it another way! Others can do much less to you than you to yourself. But they worry less, and they have fewer inhibitions.

They have already proved to themselves that they can cope well with real misfortune and adversity. You can conclude from this to your advantage that for you, only intellectual mediation is at the stake.

You will reply: “I do not think about the illness, I am not just imagining something, it is the illness that finds me too often, surprises me and ambushes me at every turn, without my slightest wish or defense against it; I only think and hope for my recovery and wellbeing.”

Alas, you are wrong. Even while you are ignoring the symptoms and try not to think about them, you fear them unconsciously. You may not believe the power of these unconscious thoughts that can overtake our entire ego and have a more direct connection to our bodily organs than those thoughts that we have conscious awareness of. As you are hoping for recovery, the thought of not being healthy is already there, and unconsciously you may be already doubting if you will be healthy.

Visualize your childhood. How effortlessly and naturally everything flew. As soon as you went to bed, you feel into deep sleep. You did not think at all about sleep when you went to bed. You would have been just as ready to remain awake. This is how children fall asleep automatically, without any wish or prohibition to do so. What do you do now? You think about sleep maybe during the day already and calculate the chances of not getting enough sleep. Surely, you do this at the time of going to bed. Sleep is important to you. You interpret it in terms of your health and ability to function. You overrate this function quite a lot. Each time you think about sleep, and long for it, and fear sleeplessness, you whisk it away. On the other hand:  if you did not care so much about sleep and while lying sleeplessly in bed you could say to yourself: “I am resting, even if I am not asleep,” with a peaceful mind, calm images would arise—and you would fall asleep.

Or: Our you are in the grip of anxiety. But not the anxiety, but the anxiety from the anxiety, is what is causing the most anxiety and suffering.

So, you suffer, without intending to, without knowing, that it is almost entirely suffering because of your thoughts, anticipation, and worries. On the other hand, the fact that you suffer should be a ground for trust and for comfort. Because the fact of suffering, anxiety, need, and the feeling of insufficiency, are the proof that with sound thinking and critique you can overcome these phenomena. You know that in the case of serious mental disorders this is not the case, and these feelings are taken for granted.

For the time being, while you have direct encounter with such feelings as weakness, excitement, lack of restraint, you must know that you have the capacity to achieve your final goal. You will get there. In Nietzsche’s words, “Everything important happens anyway.” Do not mistakenly overestimate the disadvantages of such nervousness. Von Speyr has expressed it directly: “Only the neurasthenic achieves something.” Keep in mind that this nervosity is the sign of a high sensitivity that is also the prerequisite of achievements and enjoyment, that other people may not have access to.

All in all, you will have a calmer life and greater life enjoyment if you manage to master the challenging art of whenever possible to look away from yourself, reach out to your environment, nurture your relationship with yourself, value and compare yourself against you, spend less time in self-reflection and self-mirroring to others than to genuinely seek to live for others and to think of others.

Humanity lost paradise in the moment when human beings became concerned about themselves. They can regain it in the moment when they can re-dedicate themselves again to things and people in their environment with original naivety and with the joy of unlimited self-giving.

We must learn and re-learn to gaze upon the objective instead of the subjective. Since all sorts of difficulties stem from circumstantial thinking that are just the products of themselves. If one takes things as out there, without reference to us, without relevance to our need and plans, they lose their sting against us. One learns to identify tangential thinking.

Specifically, one gets fulfilled in fulfilling others, with the freedom to look into the eyes of the objectively given facts, and take them for what they are, instead of drawing personal connections that result in self-depreciating and judgmental thoughts that weight the soul down. So, let us beware of overvalued ideas, complexes, and all other forms of painful manifestations of mental mediation.

We do not need to act with suspicion. Always establish the objectivity of the facts first. Whether it is ambiguous telephone conversations or messages, not to let these right away alter one’s inner landscape. There is the possibility for a goal-directed evaluation of the content and managing of the experience.

Caveat! The proposed objective look at the experience is not for the sake of eventually disclosing an inherent self-interest as means to an end, but rather for a finer understanding of the invaluable asset of the acquisition of finer and more refined psychological knowledge, according to which unwanted and automatic, unconscious impulses are more likely to take advantage of disorganized thought processes.

Objectivity should therefore aid to ward off the inner experiences that mentally take over to the detriment of mental and bodily functioning.

The art of objectivity –with respect to observing the ideas—is not realism or materialism, but rather a subjectivism; to the end that this subjectivism could lead to a richer and stronger development of the subject, after he or she had learned how to overcome hypochondriacal limitations and unrealistic connections.

In this regard, you can understand the doctor’s clarifications with respect to the entirely unnecessary, obsessional, and harmful conclusions of thinking. Dubois already illuminated the logical failures of nervousness! Think about what this means! The nervous person uses their mental powers to artistically make themselves sick!

They feel limited in their surroundings, in their families. This stems from a unique perception of reality, a wrong conclusion. The closest to them in fact, is who gives them motivation to work and a goal. This shows you the helplessness and the indifference that they fall into when they distance themselves from those close to them.

Their exhaustion and tension are the consequence of something conscious or unconscious mentally mediated feelings of displeasure, not an actual bodily exhaustion.  Any young woman can confirm this who will feel fresh and poised to go for a walk after an entire night of dancing, while another feels miserable and tired after an uninspiring company the night before.

Their heart palpitations, as unexpected and as unbelievable, are directly related to their unconscious expectations. Why would these manifest exactly while lying down when the heart is required to make the least effort? Because in the absence of divertissement and other thought contents, these hypochondriacal ideas freely step in. Strong associations build up between going to bed, climbing the stairs, and chasing the tram, and the unconscious expectation of heart palpitations that are quite automatically enacted. If they had once experienced coming late in the theatre or the concert, climbed the stairs, rushed in, and stumbled unexpectedly into the middle of a captivating performance, the heart palpitations were not noticed then because the affective excitement left no space for attention to the heart.

Dubois explained the key to the reason of feeling unwell to a lady suffering from the strongest heartaches the following way: “I suppose you have paid a lot of attention to both circumstances, and as a rule, in your case, they occur together. But please, for once try to put an end to this fateful shortcut between cause and effect! As long as you are convinced that they will occur together and you expect to see heartaches show up at the end of your period, they will really occur. Ignore the observation, as logical as it may be, and hold on to the idea: I am young, strong and healthy. I do not suffer from heart problems, no organic reasons for heart disease can be found, and from a simple nervous suffering, it is impossible that I can die! Then the anxiety will disappear, your heart will stop beating wildly, and you will sleep like a child.”

Their sadness, upset, and their anxiety is not without a ground, since it is unleashed by earlier traumatic memories or thoughts which may reoccur as a result of the chemical state of their personality, but this is exactly the time when they should sit down with themselves and have a dialogue with themselves until this content is made indifferent, and they are over it, and the phase is ended. Digestive problems, even pains and vomiting—as long as there is no evidence of medical reasons—are not the best to treat with dieting. First of all because the unconscious anchoring of the symptoms of illness may persist without patient’s slightest awareness and lock the symptoms into a pattern. Second, because of the loss of energy can lead to physical illness.

The derivation and the propagation of such and similar unhelpful thought processes is the task of logotherapy to tackle. After understanding the symptom, and the individual situation of each patient, we appeal to their individual capacities to take an intellectual and moral stand. “There is something praiseworthy in each and every person: they may be intelligent, reasonable, or have a depth of feeling and heart. Even religious feelings can come handy to mentally uphold the sick” (Dubois).

The goal of therapy is to influence the disposition of the psyche. In this task, everything can be helpful that is at its disposal for comfort and healing that is a renewable daily resource: The art through which we can influence our mental wellbeing (Dasein) , that allows us to be mindful of the uplifting knowledge that we are members and partakers of a spiritual world, ever living, that no death can destroy, and able to overcome time and brokenness—this knowledge given to humanity through religion. Dejerines’ assertion according to which the religious person cannot become nervous or hysterical sure sounds very enthusiastic, and it contains a grain of truth because in it lies, in a sense, living psychotherapy. Eucken said: “In the struggle for a spiritual self-preservation that one is driven to religion.” Nietzsche adds: “Religion and religious significance brings sunshine to plagued human beings and makes their very sight to themselves bearable, refreshed, refined, and capable of making the most of their suffering to even sanctifying and just ends.”

The innate desire of every human being to believe in something more than the self, comes back with vengeance when it has been for a long time suppressed. It fills the resulting vacuum with artificial blockades, jams, absurdities, and pointlessness. In the case of those suffering from neurasthenia, this leads to a cacophony and discord. The so-called religious people live not only more satisfied and happier lives in their huts and in poverty, but they also live with less conflicts and carefree lives in the palaces of riches.

Therefore, “even those who do not regret the appearance of religious illusions in today’s cultural world, admit that they offer to those bound by them the strongest protection against the danger of neurosis, as long as they have strength.” (Freud in “Mass Psychology and Ego Analysis”).

Carried by the Spirit

“Carried by the Spirit: Our Hearts Sing”

Discerning Meaning during the COVID-19 Pandemic

Edited by Maria Marshall and Edward Marshall

Published through the Ottawa Institute of Logotherapy

New book available on Amazon

September 2, 2020 Paperback; September 3, 2020 Kindle

Contributors from around the world recorded their experiential observations and reflections on how the principles of Viktor E. Frankl’s Logotherapy and Existential Analysis (LTEA), a meaning-centered psychotherapy, can activate the resources of the human spirit to increase resilience and alleviate existential suffering while facing the consequences of the COVID-19 pandemic.

The writing process blossomed into an expression of selfless giving and self transcendence. Words of wisdom, courage and solace emerged in response to suffering. Healing words sprang forth in response to the wounds of humanity. A circle of care from person to person overarched our world to respond to the COVID-19 pandemic with care and compassion.

The book includes an original article from 1935, authored by Dr. Viktor E. Frankl (1905-1997), which is published for the first time in the English translation with permission from the Viktor Frankl Archives in Vienna. This edifying instance offers a unique insight into Dr. Frankl’s work. His humanity and closeness to his patients offers a legacy that enriches our understanding of what it means to be a loving human being.

The editors gratefully acknowledge the support of Prof. Dr. Franz Vesely and Dr. Gabrielle Vesely-Frankl at the Viktor Frankl Archives and the Viktor Frankl Estate, Vienna, who granted permission to include an original article written by Prof. Dr. Viktor Emil Frankl in 1935. We are thankful for their acquaintance and friendship.

We wish to thank all our colleagues for the gift of their presence and caring. Especially our contributors: Dr. Teria Shantall, Rabbi Dr. Reuven P. Bulka, C. M., Dr. Tamas Ungar, Valquiria Gonҫalves de Oliveira and Dr. Eugenio Ferri, Dr. Meba Alphonse Kanda, Prof. Dr. Rachel B. Asagba, Matti Ameli, Mar Ortiz, Prof. Dr. Daniele Bruzzone, Dr. José Martínez-Romero Gandos, Prof. Rev. Andrzej Jastrzebski, Prof. Rev. Wladimir Porreca, Dr. Adriana Sosa Terradas, Dr. Robert Hutzell and Vicki Hutzell, Sharon Jones, Dr. Cynthia Wimberly, Dr. Willem Maas, Prof. Dr. Svetlana Shtukareva, Panayiota Ryall, Erika Dunkelberg, Rev. Zoltán Nyúl, David E. White, Sladjana Milošević, Mónica Montes de Solares, Elena Osipova, Sabine Indinger, Blanca Ramirez Gonzales, Prof. Dr. Vladimira Velički, and Miro Raguž.

This book was written in solidarity with those who suffer from the global impact of the COVID-19 pandemic.

All proceeds from the sale of this book will be donated to a United Nations fund aiding refugees and displaced persons.