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.
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?”
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.
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.
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.
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.
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.
The December 2022 issue of the Scientific American features an article by Elisabeth Svoboda on Moral Injury: “Moral Injury is an Invisible Epidemic that Affects Millions.” The article defines Moral Injury as a “specific trauma that arises when people face situations that deeply violate their conscience or threaten their core values.” It presents recent examples from the health care setting, where ethically challenging dilemmas are part of the everyday scenario.
The article reviews literature that first identified Moral Injury in the military setting, to its working definition for everyday life and clinical practice. It provides several examples that require a therapeutic approach that goes beyond traditional cognitive behavioral therapy (CBT), since the distress is genuine and not the product of distorted thinking. The article asserts that Moral Injury is different from Post Traumatic Stress Disorder (PTSD). It does not respond well to conventional trauma treatments, and it requires a more “spiritual approach” that considers the whole of the person.
Proposed models for the treatment of Moral Injury share the emphasis on the search for meaning to overcome its effects. The article reflects on the role of Viktor Frankl’s Logotherapy and Existential Analysis (LTEA) for the management of Moral Injury. This approach “bolsters a clients’ sense of purpose.” It validates the reality of values transgressions, and helps to find meaning in line with core values as guiding principles. LTEA can be applied alone, or as a complement to other treatment modalities currently employed in the treatment of Moral Injury.
The book, “Logotherapy and Existential Analysis for the Management of Moral Injury,” by Edward Marshall and Maria Marshall, published through the Ottawa Institute of Logotherapy in 2021, reviews the history of the conceptualization of Moral Injury, the development of tools for its assessment, and a review of the treatment modalities proposed for its management. In developing the case for the application of LTEA, the book reviews the evidence base of LTEA, and provides practically relevant principles and methods based on LTEA that can be useful for clinicians when treating individuals affected by Moral Injury.
On March 31, 2022, Professor Edward Marshall offered a workshop with over 120 participants on the application of Logotherapy and Existential Analysis for the management of Moral Injury at the Royal Ottawa Mental Health Centre, Canadian Centre of Excellence on PTSD.
Awareness of Moral Injury is increasing as examples locally, and globally amount. Validation for the use of LTEA as an evidence-based method for addressing the symptoms arising from moral injury is a welcome sign that the scientific community embraces LTEA to offer a purposeful and meaningful contribution to the treatment of moral injury, one that puts humanity at the forefront of responding to suffering arising from values transgressions.
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.
Interview with Elisabeth Lukas, PhD, by Stephan Baier (Grandios Magazine, Regensburg, February, 2022). Translated by Maria Marshall, PhD
How does the capacity to trust arise and grow?
In what ways does parenting affect trust?
Can one do well without a basic trust in life’s meaningfulness and a positive mage of the world?
These are the topics of the following interview that was conducted with Dr. Lukas by Stephan Baier at the GRANDIOS Magazine Studios in February 2022.
SB: Trust; what is this concept? The capacity to trust; are we born with it, or do we have to gradually learn it? And finally, is trust like a talent that one can be endowed with more of, or less with, or is it a decision to trust or not to trust. These are the topics that we are going to discuss with Dr. Elisabeth Lukas. Dr. Lukas is one of the most well-known psychotherapists in the German speaking world, and most certainly, the most prominent student of Dr. Viktor Frankl. Viktor Frankl was the father of logotherapy, also known as The Third Viennese School of Psychotherapy.
Dear Dr. Lukas, prior to this interview, you gifted me with this booklet (“Wolken vor der Sonne?” Lukas, 2021), that I would like to cite from, since I found something very interesting here that brings us right to our topic: You write that trusting people live not only longer lives, but they get along more harmoniously with others, and they can tolerate loneliness better than others. Why is this so?
EL: Yes, well, trusting people are of course more sympathetic because when it comes to communication and living together, one gets along easier with someone who is trusting than with someone who is skeptical, and when one meets others with a spark of trust, it is easier to get along right away then if one is met with suspicion. This trust that one grants in advance to the other, perhaps more than what they deserve, motivates the other to do something good in return, not to shatter the expectation. In this way one locks the other in trust that presupposes and expects that something good will happen. Of course, one sometimes pays a price for this, if one gives more trust than what was reasonable, one is going to be disappointed, but one needs to accept this. It is better to let oneself experience a bit of disappointment than to be stuck in a steady climate of skepticism and mistrust.
SL: But how do I become this trusting person?
EL: This question has to do with the basis of trust. You raised the question if one naturally has the tendency for trust, or one has to develop it? In principle, each newborn brings with them the capacity to trust, just as they take their first breath. Even babies are born with this innate tendency to expect help when they are helpless, and we know that human babies are more helpless than any baby animal. They are totally dependent on help. They have to trust that help will come. They only way they can signal if they need help is by crying and then help comes, maybe not right away, but it arrives. And this strengthens the experience that help comes when help is needed.
SL: But is there not a disappointment as well if the parent is not responsive? For example, if a mother responds late but does respond eventually, is it not a rhythmic change from disappointment to trust and from trust to disappointment, this rhythm of back and forth and back and forth between trust and disappointment?
EL: Human babies come into the world with a complex neural system that is incredibly adaptable. First, it makes the connection that help is on the way. That it comes. And learns to observe: Observe lights and shadows, observe movements. Also, to perceive those processes that are going to result in help. For example, they can hear the steps, or when spoken to. They learn to associate words with help. When they are spoken to, help will soon come, they will be comforted. When babies grasp the meaning of the events in the world around them through such associations, they can also wait. Here I would like to highlight a point that I think is important: Subjective sense of time. Subjective time is different from the objective amount of time that may have passed. Subjective perception of time changes in the course of life. For a younger person, the same time feels longer than for someone older. For a 10-year-old, a year is a very long time. For a 60-year-old, a year passes in a blink. For a baby, an hour seems an eternity. When they cry the whole night or days go by before anyone responds to their cries of help, then for the child that affects their trust.
SL: When we experience pain or suffering, time seems to pass much slower than other times.
EL: You are exactly right. For a small child or for baby with a long time of no help and discomfort seems a very long time. Most parents know this and they stay up most of the night and watch their baby and are attentive to their needs. I do not mean to say by this that parents need to be always one hundred percent available and run as soon as their child begins to fuss, there must be some learning on the part of the child as well, of a bit of toleration and waiting for the parent to help. When one has a good communication than one feels integrated in the milieu where one feels safe and protected in the home, one feels at home, and one trusts that help will arrive when it is needed even if it may take for some time to arrive.
SL: The older a child is, the greater the disappointments can get when they understand that the world does not operate according to their wishes. One needs to take this disappointment seriously and learn from it, that the world is not always the way we wish it to be. How can trust grow, despite the disappointments that children and youth need to experience?
EL: A child develops. However, from the beginning, they bring with them a sense of basic trust. This is so deeply engraved in people in all cultures in people from all walks of life and through all concepts and images of God, that there must be behind something or someone that we can trust. I’d like to point out that the fairy tales also do not paint us an ideal world, there are elves, and witches, and dragons, and all sorts of things that occur in them. Yet, what the fairy tales show to us is a clear world. Clear, since there is good and bad. In the stories the good always wins. It always has the final say. People can be saved, changed, and, at the end, the good comes through. This is what reinforces and re-states the notion of basic trust in children. When they grow, they understand of course that the reality is not always like that, the good characters are not always good, the bad characters are not always bad, and between good and bad there are all these ways of in-between, but by that time children have the capacity to distinguish and decide. They can differentiate between their external reality and their inner feeling of trust and security. In the external world, there may be a lot of things that do not match, that do not work, but in their inner reality, there can be something there that wins, that remains. It is otherwise when children from a very early age are subjected to abuse, violence, and aggression, and have experienced grave disappointments, and, as a consequence, they see the world as a hostile and dark world in which the good can not be taken for granted. The negative experiences in this case can stifle a sense of trust that remains hidden inside.
SL: We talked about the positive case, when children feel protected and well taken care of, and parents in such families can also do certain things right and maybe certain things wrong. What can they do to keep trust alive? You gave us one tip, to tell their children stories to reinforce basic trust. What else would you suggest doing?
E.L.: With the example of the fairy tales, I just wanted to illustrate how in the folk tradition there is already a sense of basic trust. In the early years what fosters trust in consistency. This means rules so that children have a routine, and they can tell what is going to happen next. They learn that now it is bath-time, then we are walking for a walk, now it is time to sleep. This works well for the elderly as well; they function better when they have a structure that they are familiar with. Flexibility comes in-between. In the milieu of such structure, children learn to differentiate that certain people have different traits, different behaviors, reactions, but when their own reference person, a person who they trust, act inconsistently, that upsets children. Children can tolerate and learn very well how people have some different ways o reacting or doing things. However, strong emotional outbursts by the same person, or inconsistencies, and inconsistent reactions manifested by their main caregiver are troubling for children. This happens for example if mothers are over-exerted, under extreme stress, or under the influence of drugs and alcohol, where they show instability, lability, and there are outburst of emotion or temper. When the main caregivers have a loss of self-control emotionally, that confuses children because they learn that they can not trust someone if they are friendly because it is not for sure that this friendliness will last and for how long. It makes children fearful and anxious and loose trust.
SL: Caregivers model trust to their children themselves?
EL: There are no perfect families, but we can say that the intact family is the place of the highest feeling of security on earth. The reason of it is that in other places, one is judged according to one’s abilities and contribution. For example, if I have good recommendations as a speaker, I am being sought after. But if I shy away from people and remain in seclusion, no one will think that I am a good speaker. This is not the same in the family. In the family, when it is intact, one feels valued. Regardless of one’s appearance, even if one is unproductive, one is valued for who one is, whether one is young or old, smart, or not so smart, in the family, one is valued because one is part of the family. I know that this is an ideal, but the family is the place of this ideal. What is wanted to express is that in the family, one is valued for one’s personhood and for one’s inherent value. When children experience this, they develop a sense of self-worth, that helps them to face whatever may come their way.
SL: Is this not inherent in every person to want to be loved and accepted for who they are?
EL: Yes, although in the family it is also important to consider the other part of the question. Everyone wants to be loved but one needs to offer love as well to the others. One wants to be understood, but does one understand the other? It must be a two-way process.
SL: When a child does not experience that, then what happens? For most children, they know that they are loved, valued, and accepted. They know that their parent loves them even when they are corrected or scolded. What happens to those who never experience such validation or acceptance? What do they then feel that they can give to the other when they have received little, and how can they then think that the world is still a good place?
EL: This is a fundamental question you are speaking about. One discusses this is psychotherapy a lot, and we need to reach back to one’s view of the human person. The view of the human person influences how one sees oneself and others. It is not true that a person is a “Tabula Rasa” and that everything that a person becomes is because of what their caregiver has written on this board. This is simply not the case. People come even genetically with a lot of influences; we know this thanks to modern research. One brings even psychological tendencies, both positives and negatives, strengths and weaknesses. On top of that one has the influences of the environment, the influence if the parents, influence of media, etc. At any rate, people are not merely the product of their genetic inheritance and the impact of their environment. Frankl always said, there is a third given, and this is the spirit of the person, which is an entire novum. Each person is unique, a new creation.
SL: And here lies our potential, right?
EL: Yes, here lies our potential in spirit, and thus a potential for molding and creating oneself. This is what I wish to emphasize. From the beginning, a young person reacts to their environment and to their circumstances in the way that they develop themselves and use their talents for self-discipline, and for self-development to bring the best out of what a person is capable of becoming. A person can take a stand toward their environment when they give their “yes,” or “no” or when they resist something. In other words, there is a capacity that one has for resistance. This is the case when one may be coming from a very miserable background and one had a misfortune of accumulating negative life experiences, this capacity to develop oneself and change oneself is still there and can be developed. When one distances oneself from such negative influences, quite conscientiously decides to distance oneself from repeating what was mistaken, when one can distance oneself, and one decides “What I do not want” and “This is what I do not want to repeat” that is when Frankl speaks of the defiant power of the human spirit. “I will do it better, and I will do it differently.”
SL: This is a different message, right? If one came to you in psychotherapy and said to you, “I have been totally ruined in my childhood, and for that reason I am unable to go on with my life,” is it that you would have good news for them?
EL: It is a hypothesis that one is “ruined” and comes from being outspoken, but the spiritual person is never “ruined.” They have within themselves the capacity to make everything renewed and different. Also, from the experience of suffering one can develop an advantage of warning. “One knows what not to want, what will not work, and to be even stronger and determined to achieve it. In other words, the new generation does not need to repeat the mistakes of the old generation. They can grow through it and build something new and better. This old sadness may be there and come back at times, but one also has the defiant power of the human spirit through which it is possible to overcome the past and to build something new.
SL: You were talking about basic trust that each person is born with. This can not be destroyed but it can be disturbed. So then if a person seeks your advice who trust has been shaken, what is your advice? How could one correct this?
EL: One question is how I could help someone, as you say, “correct this.” The other question is, how can one help oneself? Two different questions. How would I help a child, for example, shall we start with that?
EL: Children are by nature incredibly robust. Nature built them incredibly strong. When they come into contact with a person who has a positive influence of them, they can easily relax and open up. What one can offer, on the one hand, is caring conversations in which one points out connections. For example, a parent is under extreme stress, or ill. By this, what I mean to say, not to gloss over but to speak frankly and honestly, so they can process what happened. To illustrate connections and links, so that they can understand is helpful. When we understand things, we can process them better and is such way one fosters insight that is age appropriate and possible. The second point I wish the emphasize is the importance of building on children’s strengths. You see, children are capable of becoming very enthusiastic and when one notices and encourages their strengths and talents in the areas it may be in, technical, musical, sports, cooking, dance, arts and crafts, then these activities let them remain enthusiastic while their wounds are healing. They discover that they are good for something, they are good at something, and enjoy their activities, which reinforces the view that there are nice things in the world, not only the bad they experienced. Then they go on with life and grow with more elasticity and this is not an exaggeration, but a very helpful bandage for the wounds to grow with.
SL: For us to go on with our tasks, we need to believe that the world is good place, that for me personally, the world is good place, for me it is meaningful, that there is a meaning to discover. Do we need such a sentiment to be able to keep on living?
EL: I will start with the first part of your question, “do we need to know that the world is a good place” I would like to question this. Our world is not a very good place. It has good sides and bad sides. It is not about if the good in the world needs to outweigh the bad in the world. There is a lot of suffering it the world. There is a lot of grief. Frankl spoke about the tragic triad of grief, death, and pain. We all have sorrows, we all make mistakes, and we will die. Realistically, about whether the world is a good place, I do not know. About the other part of your question, if being has meaning, that is a different question. This has to do with a very deep search in people, a wish to find meaning in everything that there is. This is a quite deep search engraved in the human soul. The question is there is a last or ultimate meaning, despite all the grief and suffering. Basic trust is not at all the belief that at the end, everything will turn out fine. Basic trust is the conviction that there is a higher dimension, beyond our dimension, in which even our suffering can have meaning. It is the question if all the uncertainty of our life can culminate in a final harmony, even if we may not be able to grasp the individual pieces. Dr. Frankl, who was a survivor of the holocaust during the Second World War, explained that the prisoners walked to the gas chambers with their heads held high and a prayer on their lips. The prisoners did not think that God will appear and intervene and save them from the gas chambers. They knew that God will not intervene to stop this great injustice, but they entered the gas chambers with a prayer on their lips. This is basic trust. It remains a mystery why there is so much misery in the world and suffering. Frankl said we need to bow in front of this mystery. And we need to trust that in this higher dimension everything retains its meaning.
SL: Do you think it is easier for religious people to accept that there is such dimension? The reality of God in a higher dimension would be perhaps easier to grasp for someone who is religious.
EL: Frankl offered a very beautiful metaphor to illustrate this. Imagine a scale with two arms, an antique scale, with two wide arms. He said, take one side where one can place the idea that the whole entire reality is a nuisance with no meaning. Everything will be lost, the planets will disappear, the suns will get sucked into a dark hole, everything is nothing and leads to nothing. This is on one side of the scale. One the other side of the scale is the conviction that everything has meaning, beyond even human comprehension. This entails the belief that the reality of creation is more that what is available to us and that the whole of creation expresses the will of God. And Frankl said, with logic and reason one cannot decide for one side or for the other. The two sides weigh the same.
SL: Life would be nicer, if this side weighed more.
EL: Well, yes, but Frankl said that the only way to make one side weight more than the other is to place one’s entire existence on one side or the other. This side will, for this person, personally weigh more than the other. There are simply no statistics that will help with the decision. There are statistics of other kind, however. Two of them can be found in my book. One of them is by Stephen Covey who wrote a bestseller that you may be well familiar with, on the habits of highly effective people. These people who do very well in life, Covey found in his research, believe that there is such an ultimate meaning. They affirm the meaningfulness of life. The other research is by Leonard Sargon who followed a large group of people with longevity and found that many factors played a role, and among genetics and lifestyle, he established that a personal outlook on life also played a role. People who lived very long lives confirmed the meaningfulness of life. It appears that it is more helpful to believe that life is meaningful than it is to think that it offers no meaning, or nihilism.
SL: Can we establish then that those people who see a general meaning in life are more likely to experience their own lives as meaningful?
EL: When everything has meaning than of course every small part must have a meaning. Yes.
SL: When someone opts for the other arm of the scale, how do you help them? When everything seems absurd? Where does one reach then? One sinks into depression, or anxieties, or sadness?
EL: We need to know that everyone needs to make a decision for themselves. We can bring arguments, illustrations, and examples, but at the end the decision lies with every person. But every person can have time when they wrestle with the question. At these times it is very helpful what has been recognised in psychotherapy, a method, or the knowledge of the possibility of taking a “leap of faith.” How can one take a leap of faith? One has the capacity for self-distancing. What do we mean by self-distancing? One can step away from oneself and one can observe oneself from a distance in the present or in the past. One can also place oneself into the future and observe oneself there. One can look at oneself from the position that one is in right now and look in the future; my very best version of myself, for example in the future, and see what that would look like, and step by step advance towards that image that one wishes to become. This is the concept of the “leap of faith” [to advance toward something that is chosen and desirable out of one’s free will, to make that a reality when it is yet only in the future as an ideal].
For example, a person addicted to alcohol. How can she step out of tis habit? She must imagine, “One day, I will be sober, and I will stop drinking.” One can give help, but ultimately, people need to do it by themselves. This “one day” they need to live it as if they were already free. But it is not in the reality. They can set it into the reality step by step. The body is still dependent on alcohol but the “one day” can be already alcohol free. Maybe a day, maybe a week, maybe a month, maybe a year. One day, this can become reality. Or an overly anxious person. How can they break the disturbance? One can help them. But again, there is a point at which they need to do it themselves. They need to go into the depth of the deep of the anxiety and face it. Entering the situation and the moment one dares to face anxiety and realizes that one has strength and freedom that one did not know existed before. He or she may go with trembling knees, and perhaps the second time will be a bit easier than it was the first, and then one can elaborate it in the context of a story such as entering the lion’s den to find out that the “roaring lion” was a in fact a “pussy cat.” The courageous facing of anxiety allows this leap of faith. When I come back to your question about how one can help someone who is experiencing a lack of trust to re-gain that trust, we need to establish that there is nothing that one can do, because one can not force oneself to trust, one can only advise or challenge oneself to live as if one had trust. One leaps into a life of trust and lets oneself be surprised.
I often work with women who have difficulty trusting men because they had a bad experience in a relationship. They may have felt take advantage of, betrayed, used, you name it. Now they have a new man in their lives, and they do not trust this friend. They tell me they have pictures from the previous relationship come to their mind, they fear being taken advantage of, etc. So, I tell them, “But your new friend is of course entirely not guilty of your previous experiences.” The women conclude it themselves that “He does not deserve to be mistrusted,” and “I deserve to get to know a nicer side of life.” At this point then I advise them to take a leap of faith and proceed by being open to the other person with this self who is still experiencing suffering because of the repeating images in the mind, but the “I who I want to be, and can be” in the future. This often works. If there are no further disappointments, the relationship succeeds.
SL: Trust for adults it is a decision-making process then. An adult can decide in their freedom to want to trust and hold fast to this decision. Is this so?
EL: No. To want to trust is not the right word. But to decide to trust is the right word. Decision and trust belong together. This is a pair. When you decide, you must trust. When you trust, you must reach a decision. That is, you would not have to trust if you were always sure that something will work out fine. Thus, always in the uncertainty is that we need to have trust, and in the uncertainty the possibility of a decision is there. When you are applying for a job, you do not know yet if everything will work out fine; when you start a relationship and choose a partner, you do not know if everything will work out fine, and the relationship will be viable. At each point, you need to make a step into the uncertainty, and make a risk and a leap of faith; this is what is basic trust. Trust and decision work together just like uncertainty and taking a risk do. People who lack trust have a hard time deciding. Professor Frankl used a very beautiful expression about trust when he spoke to his American students: One has to act “half sure but who-hearted.” Maybe not sure, but with full trust.
About the subject of will, I like to mention that there are phenomena that cannot be intended. They can not be brought about by will. For example, one cannot intend to intend, one cannot “will” to love; one either loves or not. One cannot want to believe. One can not want to trust. These phenomena have prerequisites, from which they flow. For example, something valuable, brings forth valuing. Something loveable, brings forth to love it. Something believable brings it forth belief. Something trustworthy brings forth trust. So, will is intended toward these prerequisites. This is what we can intend for, to want. We can look for something valuable in the world; something loveable; something credible; something trustworthy. This is what we can want to intend for. This is what we can “will.” We can look in the world to find them; we can seek them out. We can search and find. Whoever searches, finds.
There are a lot of things that are worthwhile in the world. When I find this what is worthwhile, beautiful, and trustworthy, it will automatically elicit my will, and elicit my trust.
SL: How is it with self-esteem?
EL: This is an exciting topic in psychotherapy. Psychotherapy has to do with a lot of people who suffer from their confidence being shaken. Self-confidence has to do with the evaluation of one’s own inner resources. Self-esteem can be too low or over-inflated and neither of these has a good outcome. Either one’s level of performance will be low because of low self-confidence, and one does not develop one’s potentials as much as one could, or one over-estimated one’s capacities and one needs to touch ground at some point. However, self-confidence has another aspect that I would like to address. When one accomplishes what one committed oneself to do, this correlates highly with inner satisfaction and well being. One can plan a lot and accomplish little of those plans. Or one can break one’s promises, change one’s decisions, sabotage oneself from accomplishing the tasks that one set out for oneself, and this will have a negative impact on self-confidence. Imagine the example that one orders some work being done and the handyman says he will be there at such and such time on such and such day. You wait the whole day, but they do not show up. You phone them, agree on a new date and time. The time, comes, and they do not show up, but give you all sorts of excuses. The following time, when they do not show up, you will not take any of the excuses but really get mad at them. This is how people who sabotage themselves or let themselves down feel about themselves. When people sabotage their own plans, the feeling is a sense of failure, or impotence, “I can’t do it,” “I can’t do well anything.” So, in therapy how this plays out is not that we have to persuade people who do not trust themselves to make a leap of faith and convince themselves to accomplish small tasks that they can feel good about. Rather, often we have to advise them to request from themselves as little as possible, and as less demanding as possible, but that little that they then really make a commitment to fulfill, regardless of their feelings, as much as possible, so they can develop a healthy stand.
SL: For healthy self-confidence we have to have a realistic view of ourselves and know what we can do and what we are not so good at, right? For example, if I think that I am a great cook, but experience shows otherwise, I need to adjust the view of my abilities.
EL: Yes, for those who over-value themselves, there can be a series of disappointments, and sometimes they need to learn the hard way. The question is how one can learn from experience and adapt self-experience. For example, it could be a learning process for someone who thought they were a great cook but found out that they are not such a great cook after all, to start with something small, a salad and a simple menu that they can pull off with no difficulty. So, it is important that one does not give up and says, “I can not cook at all,” but make it little by little, step by step, try out this and try out that, and end with the conclusion that “Well, not so bad after all.” I think that the more one can learn from one’s experience about the difference between one’s self-confidence and the requirement of situations, the more one can use this knowledge to one’s advantage. In this sense, even negative experiences can be helpful because they can lead to development and growth.
SL: Do we need to be able to trust ourselves to be able to trust others?
EL: You pose very good questions.
SL: Do I need to have a firm anchor in myself to trust others?
EL: Well, maybe not if you take a leap of faith.
We can not say that only those people who have been loved can love. Maybe one is still able to give a positive attempt and make an effort to be positive towards others and, as a reward, receive self-confirmation. To come out of the difficulty does not require convenient circumstances. But to get back to your question, do we need to trust ourselves to trust others? That is a very good question.
I have spent thousands of hours in therapy with patients and I noticed that the pictures that they formed had something in common. Those who had a more positive self-image, had more likely a more positive relationship with others and a more positive relationship with God. Those who had a negative self-image tended to have more unfavorable interpersonal relationships and an image of God as unforgiving and punishing. So, I could conceptualize it in this way: Imagine that in the course of the life of a person one could unroll a transparent film that is lighter or darker in color. All the experiences in life are projected onto this transparent film. The difficult experiences that get projected to a lighter part of this transparent film can still retain their sparkle. While even nice experiences that are projected onto a dark part of this film, loose from their sparkle somehow.
A man who takes a higher position and projects everything onto a dark film, will think of the downside of the new job: the mishandling, the rivalry, the incompetence, etc. But a man who loses his job, but this experience falls onto a bright film, that man may look at this experience as a good thing: “I will find a better job.” So, it has to do with this “the glass is half-full or half-empty mentality.” This is the background onto which the experience is projected that can differ and determines how it will be interpreted. So, self-confidence, confidence in others and in God can fall on a dark film or a bright film. This is what makes the difference.
SL: Very interesting. This far we have only talked about the positive side of trust. Now I would like to bring up its opposite side, naivity. There is an expression that goes with it, we say someone is “gullible.” Are some people gullible because they trust too easily and too much, and they fall for swindlers and robbers and you name it. How can gullibility be avoided and trust somehow trained?
EL: Even in the fairy tales there is a warning about not to trust everyone. Not to trust evil. But I think that today being overly trusting is not a virtue anymore. The internet is full of deceiving advertisement, the news full of fake news. One needs to learn caution and measure one’s trust. Whom to trust and not to trust, which was you question, and how to prepare for making good decisions, has to do with critical thinking. One needs to form opinions and informed choices based on credible sources. Such choices can be made in conversations, observing different options, perspectives, which is possible in democratic countries. Even in democratic systems there is one challenge with finding space and time to calmly consider options and alternatives. This happens when parents in a family are very stressed than perhaps there is little time for such earnest discussions of different sources and information. Honest discussions with others have great advantages. For example, it has been shown that is schools, violence could be reduced through the introduction of a course on rhetoric. It is important to be able to express oneself and put into words one’s feelings; what one hopes for or what one is bothered by. Round-table discussions in politics can also lead to de-escalation. If one can express one’s inner self better, one gains trustworthiness because of the word. Words can be used for lying as well. One can see if one’s words are consistent with one’s actions and vice versa.
SL: Can we apply this in the society about people’s trust in institutions? It has been reported in sociological studies that the trust in major institutions such as the church, government institutions and agencies has dramatically decreased. Do you find this dangerous?
EL: I find this a pity. “Errare humanum est.” When one is human, one makes mistakes. As long as the responsible individuals are making an effort to correct the mistakes that have led to the decrease of trust, I think that is a good sign. I think in most instances there is a willingness to look critically at making good decisions. The understanding of a problem and capacity to solve it go together. Sometimes the attempt to solve certain problems can bring new problems that were not there before. For example, a new road can pose some inconvenience to the habitants. One arrives to the next problem. So, it is not that politicians, or church persons can not do anything at all well, rather they cannot do everything always well. I think it is these instances that need to be corrected because things have many perspectives. In addition, no one can have the capacity to foresee the future. Sometimes, in hindsight is easy to see and to make a judgement, but in foresight it is hard to always see the full consequences. When protesting, one should consider these facts and try not to just negate people in the position of power.
SL: Who I trust and whom I trust, is it then a personal decision?
EL: One can trust institutions, but not to forget that they are led by individuals. Certain individuals are corrupt. Certain individuals are untrustworthy. To make generalisations and to say “all” politicians, or all theologians, etc. is not helpful because it does not correspond to the truth. One can seek out individuals and examine their credibility on the basis of what they say and what they do. I think that it is all right to let oneself get disappointed at times. We also may have at some point let someone down. It is not always that we may have kept the confidence that was invested in us. Wittingly or unwittingly, there are so many misunderstandings that can happen. It is better to look at individual cases because out of these individuals is that the system is made of. The individual influences the system and the institution is expressed in society that influences the institution.
SL: For the final question: Whom or what do you personally trust?
EL: I think that I am fortunate that my chosen film is bright. Therefore, my self-image, and my image of God, carry a rather bright tone. I have also no fear of disappointments. I think I can deal with them well because I am mild on people. In my profession I worked with thousands of people, and I have seen that we can all have weaknesses. A very nice saying comes to my mind, it was said by an author, whose name I now fail to recall, but it goes like this: We are all angels with one wing. One wing that represents all the good and the beautiful we can do. What makes us grand. We have another wing that is just a small stump, that is not well formed. There is something wrong with it. And so, the author continued, if the angels once decided that they embraced each other, then they could have two wings and they could fly. This is what I trust in: that if we embrace each other, and we are not too hard on each other, and we understand that the other also has a wing that is not perfect and has weaknesses, but if we hold on to each other, we have two healthy and strong wings, and, together, we can fly.
SL: Let’s keep flying together. Thank you very much!
“We are each of us angels with one wing, and we can only fly by embracing one another” (Luciano de Crescenzo, Italian writer 1928-2019).
If I was to arrange my memories with Dr. Elisabeth Lukas in a photo album, the album would span several decades. In this essay, I will draw out my favorite pictures from the album and share them with you.
My first memory reaches back to 1982. There is a beautiful Christmas tree in my grandparents’ home. It is set on a table with glorious decorations and best of all, marzipan candies covered in chocolate and colorful, shiny wrapping paper. It is comfortable to sit under the tree and listen to the conservation of the adults sitting around the dinner table in the kitchen, adjacent to the living room. My father leads the conversation. He talks about Dr. Frankl and Dr. Elisabeth Lukas. He visited Dr. Frankl a few years earlier and is in touch with him about setting up a local telephone hotline for the prevention of suicides. It is the first initiative of this kind in our region. A lot of psychiatrists, psychologists and social workers will collaborate under my father’s guidance. The line will be available twenty-four hours a day, seven days a week, so many volunteers are required who are willing to help. The discussion shifts to Dr. Frankl’s book, “Man’s Search for Meaning” and the second world war. The memories of my grandmother are still vivid from the time when children she used to play with on the street were forcibly taken to unknown locations, neve to be seen again. The memories are fresh for my father as well, since his great grandfather perished in Auschwitz and his father came back alive from the forced labor camps. Everyone is silent for a while. My grandmother wipes tears from the side of her eyes. Then, my grandfather proposes to try my grandmother’s pie.
The second picture is from 1989. It is a chilli but sunny, beautiful, spring morning. My father leaves to work on his bicycle early in the morning to start work at 7:30 a.m. at his hospital. I have some time before I need to leave for school. There is a noise at the door as the flap of the mailbox closes. I run downstairs to empty the contents and retrieve a brown envelope with my father’s name and address on it. It is written with a blue fountain pen and impeccable spelling of our address 16 Vase Stajića, Subotica, Jugoslavien. The sender is Dr. Lukas and her husband, Mr. Gerhard Lukas, at the South German Institute of Logotherapy in Fürstenfeldbruck, Germany. I place the envelope on the living room table, ready for my father to open when he comes home from work. That evening, I see for the first time some images of Dr. Frankl and Dr. Lukas in the Jahresbericht (the Annual Report) of Dr. Lukas’ Institute. I sit in a comfortable armchair covered with grey velvety fabric and spend hours taking in the images.
The third picture is from 1991. There is a war in Yugoslavia. Everyone suspected that war would break out, but no one was really prepared for it. As soon as I arrive home for the summer holiday after my first year of university, my parents send me back to Hungary with the earliest train in the morning. All I can take with me is a backpack. They reassure me that they will join me later that day, when they cross the border in their large van with my six siblings, pretending to go on a holiday. They give me the address where I should go and wait for them. The day seems like an eternity. Finally, late in the evening, they arrive. They made it and got through the border safely. The van is packed to the brim. Even then, there is only one suitcase for each person. Inside mine, I discover the few books by Frankl that my father owns and used to read in the dim light at night, with pen in the hand. The books are heavily used, and the pages somewhat discolored brown, with shorthand side notes, and some exclamation marks. The yearly reports from the South German Institute are there as well, the whole package enveloped into a few T-shirts. This is the only literature that travels with us during the next few weeks while we wait to receive the immigration papers to Canada. The waiting seems unending. We wash our clothes in rivers. We sleep in abandoned parking lots or quiet streets, in the car. Finally, after two months of hope against all the odds, the visas are granted. We book plane tickets for nine persons: two adults and seven children, to Calgary, Alberta. We are off to the “unknown.” The suitcases are boarded onto the plane. They fly with us to this new land.
The fourth picture is from 1997. Nearly ten years have passed since we have been in Canada. The date is September 2. I am in the Counselling Psychology Doctoral Program at the University of Alberta and have just received a list of signatures from committee members who approved that my doctoral research with the title, “The Applications of Viktor E. Frankl’s Logotherapy in Counselling Psychology” can go ahead. Six committee members have approved the proposal and recorded their signatures in black ink. I am beyond words, elated. I have no idea that thousands of kilometres away, on the other side of the ocean, in Vienna, Dr. Viktor E. Frankl passed away on this day. I do not have e-mail and no internet. But I do have Dr. Frankl and Dr. Lukas’ books with me, and that is enough to get me started in my work.
The fifth picture is from the year 2000. I have just finished my Doctoral Dissertation a few months ago. It is November, and I am walking toward the South German Institute of Logotherapy. Dr. Lukas has invited me to be her special student at the South German Institute of Logotherapy. After participating in several presentations that she offered in Canada, the United States and in Germany, today is the day of the final exams. The class time seems to have passed very fast. It was a stellar opportunity to hear Dr. Lukas speak and demonstrate how she applies the principles of logotherapy in practice. As she talks, my attention is all on her. I soak in every word and every movement. I feel that I understand her very well, even though when she askes me if there are any nettles in Canada, I get so embarrassed that I stutter something like: “I do not think so.,” in German. To which Dr. Lukas says that that maybe I live in places where there are no nettles! There is a wonderful book that she hands out as a present to the class, written by one of her former students. It is about “Ortie” a little nettle who grows up to be different from the other plants around her, and must learn that she too has an important place to fill in the world. In this class, I get to know people who become life-long friends and colleagues. Among them are Dr. Alexander Batthyany, in charge of the Viktor Frankl Archives at that time, and the late Dr. Cvijeta Pahljina, a psychiatrist from Croatia, who knew my father. Everyone in the class is very supportive and I quickly forget that speaking German is not effortless. Will I do well on this final exam? I spent the entire night reading through the books again.
The sixth picture is about the final exam in Dr. Lukas’ office. It is the end of November, and Christmas is approaching fast. We are sitting around a large, round, glass table. In the middle is a candle. Dr. Lukas light it, which gives a reassuring sense of comfort and peace. She asks me a few introductory questions and then to describe the qualities of the human spirit. I do know some things, and she adds a few more concepts about the relevance of the resources of this specifically human dimension in health care. We speak about the first and the second Creed in Frankl’s logotherapy, according to which the essence of the person, the spirit can not become ill. It is a healthy core and resource. A person can become ill, but behind the mask of the illness, the spirit is always present. A person may be disturbed, but they can not be destroyed. At the end of the exam, Dr. Lukas does not tell me if I passed or failed, because this is not a pass or fail exam. I find out why. Dr. Lukas trusts me to keep learning and applying logotherapy and she has confidence in me. We walk to the front of her office where all of Frankl’s book and her books are exhibited on shelves. She invites me to indicate, from among all the books that I see on the shelves, the ones that I already have, and which ones I do not have yet. I am hesitant to admit how many books I still do not have, but I want to be honest, so I point to all the beautiful new editions, one more desirable than the other. One by one, Dr. Lukas lifts the books from the shelf and gives these books to me as a present! I have no words for her kindness and no words to describe how I feel. I am now the proud owner of almost each of her available books, and several new editions of Dr. Frankl’s books in German.
My book collection has been growing ever since. This is thanks partially to my husband, Edward, who has the same love for logotherapy as I do. Together, we direct the Ottawa Institute of Logotherapy in Ottawa, Canada. We have five children ad we distribute our time between taking care of the children, seeing patients, research, writing, and teaching logotherapy and related topics. Our connection with the Vienna Institute is fostered through a bond of friendship and collegiality that has endured the past twenty years.
What was Dr. Lukas’s influence on me? More than what one can express in words and write in an essay. I look up to Dr. Lukas as pioneer in presenting and teaching the applications of logotherapy in clinical practice and transmitting the ideas of Dr. Frankl in their purest form. I admire her work ethic and sound judgement. I admire her wisdom and her peaceful manners. I am in awe of the number of books she has written over the years and the knowledge and experience that she has in the areas of logotherapy and existential analysis that is helpful for clinical practice and for everyday living. I like her charming sense of humor and her sophistication. More than any other female psychologist, Dr. Lukas is a role model whose influence I cherish. Despite the distance in miles, Dr. Lukas feels close in spirit.
Nowadays, I am with Dr. Lukas, each time I cite her books, articles, or presentations. She is mentioned and referenced in most all the books that we have ever published through the Ottawa Institute of Logotherapy. Thanks to technology, I can regularly follow her presentations on the television or radio and get notified about her new publications.
With Dr. Lukas, Viktor Frankl’s Logotherapy and Existential Analysis continues to be an invitation to keep learning, reading, thinking, and comprehending, to be able to give and to give generously. Finally, to live, and to live to the fullest.
“Two roads diverged in the wood, and I-I took the one less traveled by, and that has made all the difference”
In “The Will to Meaning,” we find a paragraph where Frankl reports that he has been asked by some of his students about conscience. Specifically, about how Hitler ended up the way he was? He replied that “Hitler would have never become what he did unless he had supressed within himself the voice o conscience.” (Frankl, 2014b:46). He went on to say that “…only an erroneous conscience will demand a person to commit suicide, homicide, or genocide” (Frankl, 2014b:46).
Frankl understood human beings as entities who want to shape their lives in a meaningful way(Lukas, 2000). He made it clear that “Logotherapy is a life-affirming stance” (Frankl, 2014b:46). In the same paragraph, he explained that “…No logotherapist can pretend they know the value and know what makes sense and what does not” (Frankl, 2014: 46). No therapist can impose their values on others. But what they can do is to refer people back to their own conscience to show what is of value and what is meaningful or not.
There is a description of what conscience is in Elisabeth Lukas and Heidi Schőnfeld’s (2019) book entitled “Meaning-centered Psychotherapy.” Conscience has been denoted as the meaning organ, a resource of the human spirit, a specifically human phenomenon, whose function is to intuit, and discern what is meaningful. Meaning is present in a value that stands in relation to a person. In Frankl’s definition, meaning is objective and not subjective (Frankl, 1994). It is subjective only to the extent that it is person, and situation specific. It is an objective reality through which a human being is called every moment and in every instance.
We can be either consciously or unconsciously in search for meaning. The actualization of the value that we intuit is the most meaningful in a particular situation, brings it into the reality, makes it appear in a concrete and visible form this value that we “make our own.” This is the case with creative values, when we put into the word something that was not there before. We literally, co-create. It is evidenced in the case of experiential values, were we take something from the world in relationships with nature, or persons. Attitudinal values represent our inner stand through the defiant power of the human spirit. Meaning is thus actualized in the context of a relationship between a person and a value, in that a person reaches out to a value that he or she intuits, recognizes, and acknowledges as the meaning of the moment.
Conscience has intuitive, aesthetic, and creative capacities. Intuitive refers to the capacity to anticipate outcomes and points to what really matters, a “vision,” of what ought to be. Aesthetics refers to what seems in harmony and flow freely, what “should be.” Creative refers to possibilities, what “could be.” The three aspects of conscience encompass the realms of Intuition (Ethical Conscience); Inspiration (Aesthetic Conscience) and Justice (Moral conscience). These aspects correspond to the aspects of meaning as Truth, Beauty, and Goodness (Marshall & Marshall, 2022). Not every possibility that we can think of or can think of is equally meaningful. In general, what is meaningful to us in a particular moment is what is tailored to our context, our abilities, possibilities, and responsibilities (Batthyány, 2021).
Furthermore, the values that we choose to actualize need to conform to the aspects of meaning: they need to be true, good, and beautiful. At least, we need to aim for the actualization of the best possible alternative in a situation. The best is what reduces the suffering in the world as much as possible, and at least, does not harm the other and does not harm the person. The value that we actualize needs to conform to the “Laws of the Universe” and to the laws of universal values, to be meaningful. Universal values consider the dignity and uniqueness of each person, the value of each life, the dignity of the person. The meaning of the moment must be in harmony with “Ultimate Meaning” (Frankl, 2000). There needs to be a connection and a relationship between the here and now and the eternal, and when this connection is lost, alienation is inevitable (Marshall & Marshall, 2022).
When conscience is ignored, supressed, or repressed, when its voice is not brought to consciousness, or pushed back to the unconscious, one’s actions will not be meaningful. Most likely, they will not be in line with universal values and thus, not in line with harmony in the universe, not in line, in deep spiritual terms, with the “Will of God.”
This can happen when conscience is not formed to conform to the laws of the universe, when the spiritual muscles atrophy, and when a person chooses to turn away from the call to bring out the best that they can, are able to, and are called to, in the world.
The consequence of this alienation is objectification. The person will see their objectives in treating others as means to ends. They can even consider them as replaceable, their value depending on their utility for one’s own self-imposed goals. However, at the root of their actions will be a motivation by primitive instincts and fear, science Basic Trust, a belief in life’s ultimate meaningfulness and value, is compromised.
As the will to meaning remains unheard and frustrated, one may reach to power to enforce one’s ways. Violence, aggression, the blatant disregard for human rights and freedoms, mass murder, can happen when the other is alienated to the point of being objectified, and denigrated to the level of the less than human as one projects one’s own faulty image of the person onto others to justify one’s erroneous and mistaken actions.
When reflection to hear the voice of conscience to discern value is not heard, the loud screams of violence take over. Worse yet, a calculated and cold mastermind can spread suffering and destruction in the world, foreshadowing his or her own demise.
Frankl distinguished between subjective meanings, based on feelings, and objective meaning, that are actualized in the world (Frankl, 1968). He referred to rat experiments that were conducted in California, whereby brain regions of rats were stimulated with LSD, giving them the sensation of instant satisfaction, orgasm, and elation. The rats habituated to the drug very quickly and pressed the lever with increasing frequency, to the point that they cared only for the feeling and rejected actual sexual partners and real food. Frankl explained, that when one resorts to subjective meaning, one by-passes real meaning possibilities in the store because they seek for meaning within themselves, and neglect objective meaning that is waiting as potential to be fulfilled in the world. Once we have actualized the potentiality, we rescued it into the past, where no one can take it away. But the other way it is true: what we did not actualize is lost forever. Within this realm lies our responsibility. No one can always actualize every meaning possibility, but that is part of human reality, of fallibility and vulnerability and does not hinder the actualization of objective meaning, exactly in the face of transitoriness, fallibility, and vulnerability. We have to aim not to pass by transitory potentialities, for once we actualize them, we have rescued them forever (Frankl, 1968).
Only what is meaningful will remain in the world. Only what was courageously suffered, the guilt that was overcome, the consolation that was given, the unavoidable suffering courageously faced, the goodness shared. What is meaningless will remain meaningless and return to meaninglessness, into nothingness, into non-existence.
The basis of existence is self-transcendence (Frankl, 2014a, 2014, 2019). Human beings reach to a value, reach toward a cause to make their own and a person to love, or a difficult situation to handle. Through actualizing creative, experiential or attitudinal values is that they actualize meaning. One of the characteristics of human beings is the ability to make decisions and to be able to reflect on their values and the consequences of their actions. Thus, human beings are free, within their potential freedom as a finite, vulnerable and fallible human being, to “create themselves:” to shape themselves, mold themselves, to re-form themselves. They can make the choice to break an unhealthy habit and to shift from habitual or dysfunctional ways into a new direction. When one embraces meaning, one may travel the path “less travelled.” In other words, it may not be the most convenient, obvious, or easy path. However, one takes this road considering its promise: to conforms to the person in the image and likeness of that which was intended form the beginning—a self-transcendent and meaningful life that shows response-ability, responsiveness, and responsibility toward the self, toward others, toward the environment, toward the world, and the Transcendent.
What one has become, one has become through one’s choices. When one actualizes a wrong possibility, they become that what they chose. A person ordering the murder and killing of others becomes a murderer. A person who steals things from others becomes a thief. A person that does teel the truth becomes a liar, and so on. But they are still a person with the possibility to let meaning imbue their being and per-sonat, sound through their being in the world (Lukas & Schőnfeld, 2021).
The person is conditioned, but not determined. The person retains his or her value. To the last breath, one can bring meaning into the world a flood one’s life with meaning. But for that to happen, one needs to alter course, change heart. Have an honest conversation with oneself in the light of what the rules of the universe demand, what universal human values point to, what one is asked to do. One does not, one can not and one should not invent meaning and create it, because ultimately that is not the truth. It is a self-deception to think that one is leading a meaningful life if one created and fabricated meaning oneself without consulting one’s conscience and acknowledged the truth.
Meaning can not be invented, created, or fabricated. That is where the mistake lies. Conscience is creative because it can help us actualize a value that was intended in the circumstances in ways that it is possible for us to accomplish with our resources that are given and available.
The voice of conscience can be awakened by being present and being with. It cannot be done in isolation, talking to ourselves. It is not just a monologue to oneself, it needs to be in a dialogue with what is meant in an honest encounter in the light of truth, beauty, and goodness.
Quite frankly, “Life is not something, it is the opportunity for something,” Frankl affirmed (Frankl, 2019:50 quoting Hebbel, a German poet 1813-1863).
In a lighthearted way, he remarked, “…I am quite convinced that God knows when someone has made a confusion of Him with oneself…” (Frankl, 1994:284).
Batthyány, A. (2021). La superación de la indiferencia. Overcoming Indifference. Herder & Herder.
Frankl, V. E. (1994). Logotherapie und Existenzanayse. Texte aus sechs Jahrzehnten. München : Quintessenz.
Frankl, V. E. (1968). Subjective and objective meaning. Viktor Frankl Institute Vienna: Videoclip Archives.
Frankl, V. E. (2000). Man’s search for Ultimate Meaning. New York, NY: Perseus.
Frankl, V. E. (2014). Man’s search for meaning. Boston, MA: Beacon Press.
Frankl, V. E. (2014b). The will to meaning. Foundations and Applications of Logotherapy. New York, NY: Penguin/Random House.
Frankl, V. E. (2019). Yes to life in spite of everything. Boston, MA: Beacon Press.
Frost, R. (1993). The road not taken and other poems. Dover Publications.
Lukas, E. (2000). Logotherapy textbook. Toronto: Liberty Press.
Lukas, E. & Schőnfeld, H. (2021). Meaning-centered Psychotherapy. Bamberg: Elisabeth Lukas Archives.
Marshall, M. & Marshall, E. (2022). Viktor E. Frankl’s Logotherapy and Existential Analysis: Theory and Practice. Ottawa: Ottawa Institute of Logotherapy. Peck, S. M. (2002). The road less traveled. New York, NY: Simon and Schuster.
Fear and trust are fundamental human phenomena that exist on a continuum of psychological and physiological states with existential aspects. The dimension of spirit offers a dimension in which fear and trust can dialogue and can be reconciled for harmonious living. Neuroplasticity, based on discernment and reflection, can aid to reinforce values that we want to live for and that are in harmony with universal values. Through the resources of the human spirit, fear can be tamed, and basic trust can be re-gained for a meaning-filled living to avoid despair. Meaning is associated with self-transcendence, resilience, and post-traumatic growth. Meaningful living is related to positive health and mental health outcomes. In the light of these considerations, the journey from fear to trust is that of hope and faith—a living project—that unfolds in the context of Frankl’s three-dimensional view of the person, inspired, and guided by the unconditional trust in ultimate meaning and unconditional faith in ultimate being.
Dr. Viktor E. Frankl, MD, PhD (1905-1997), was a neurologist, psychiatrist, and the founder of Logotherapy and Existential analysis, a meaning-oriented approach to psychotherapy. One his great contribution to medicine was the re-humanization of psychiatry and psychotherapy though a three-dimensional view of the person, in which the body and mind are vulnerable and instruments of the spirit, and where the spirit is a non-material dynamic, and the essence of the person and his or her indestructible core. The articles that are explored in this presentation inform us of the dynamics of the body and the mind as the instruments of the spirit. It is meaningful to understand the processes of our body (1) to be able to appreciate the marvel of creation, (2) to accept and understand how we can best manage our emotions, (3) to gain insight of our area of freedom and fate; and (4) to understand how we can best take care of ourselves to be able to accomplish our mission; and (4) to reach out to others with hope. Thus, our trajectory will cover elements of self-discovery, self-distancing, and self-transcendence.
Therefore, the premise of this exploration is that, although we are conditioned, we are not determined:
In “The Will to Meaning” Frankl asserted that “…human beings are not fully conditioned and determined but they determine themselves whether to give in to these conditions or stand up to them. In other words, human beings are ultimately self-determined” (Frankl, 2014b:122).
The objectives of this research are: (1) to explore the bio-psychological mechanisms underlying fear and trust, (2) examine existential phenomena related to fear and trust, and (3) consider the ways in which meaning-orientation can foster trust to avoid despair.
The sources of the present research are books of Prof. Viktor E. Frankl, MD, PhD. Additional resources were collected from books of logotherapists disseminating Frankl’s work, such as Prof. Elisabeth Lukas, PhD, and several other prominent experts in the field, books by the author on logotherapy and related topics, and research articles in the field of medicine, neurology, psychiatry, psychology, and counseling. The findings are examined in the context of a holistic view of the person as a body, mind, and spirit entity.
Fear is one of our fundamental emotions. Other emotions include anger, disgust, sadness, surprize, and happiness (Gu, et al., 2019).
According to neuroscientific findings, four basic emotions, happiness, fear, sadness, and anger are differentially associated with three core affects: reward (happiness); punishment (sadness); and stress (fear and anger): “…These core affects are analogous to three primary colors (red, yellow, and blue) in that that are combined in various proportions to result in more complex ‘higher order emotions,’ such as love and esthetic emotion” (Gu, et al., 2019).
Often, we tend to categorize these emotions into positives and negatives. We aim for happiness, and maybe even surprize, and wish to avoid fear, disgust, sadness, and anger. This is a natural inclination. However, in excessively doing so, we may overlook the evolutionary value of emotions that serve the preservation of our lives. Realistic fear serves to protect us from danger. Lack of reasonable fear would lead to hotheaded actions. Excessive fear is unproductive because it blocks us down. Thus, the right management of fear ensures that we can use the energy of fear for our advantage.
The Neuropsychology of Fear
Emotions are part of pour psychological processes, closely linked with our physiological functioning. Brain regions involved in the generation and modulation of the fear response are complex and involve the recognition of danger through the hippocampus (the parahyppocampal gyrus), and the activation of the cerebellum-amygdala-cortical pathway. Cortical and sub-cortical regions help to interpret, modulate, and process our perception of fear, and activate our physical response to it (Javanbankht, & Saab, 2017).
It is interesting to note that the perception of fear occurs first unconsciously and then consciously. Within 100 ms after a stimulus is presented, there is an unconscious registering of it, and in about 400 ms it is registered consciously. Processing may take a long time after the event occurred (Williams, 2004).
The sympathetic nervous system is activated in response to the threat (Le Doux and Pine, 2016). At the neuro-physical level, processing fearful stimuli is associated with enhanced skin conductance, increased eye blink frequency, increased pupil dilation, and accelerated heart rate which indicate autonomic arousal to prepare the body to deal with the impending events (Tao, et al. 2021).
Language allows to express the internal feeling to others. It allows us to communicate, to describe and to transmit the emotion after we become aware of it (Junto Institute, 2022). Self-awareness of feelings helps to identify internal experiences and tonalities in relation to thoughts and behaviors.
Figure 2: Junto Institute (2021). Wheeel of Emotions. A colorful illustratetion of nuances and intensities. A conceptual guide.
From neurophysiological studies we also know that intense emotions affect attention and memory. Optimal arousal levels and emotional involvement is associated with greater encoding and retention of information; however, intense stress is counterproductive to rational thinking, complex reasoning, decision making, and problem solving (Sandi & Pinelo-Nava, 2007).
According to the stress theory of Hans Selye, intense stress leads to the fight or flight response. Intense fear may also lead to being blocked and “paralyzed” in the body’s attempts to ward off the fear (Selye, 1973).
In the condition of prolonged toxic stress, that is unbuffered by mediating forces such as a source of safety, security and trust, the body’s resources become increasingly depleted and physical and emotional disorders can result from prolonged and intense states of arousal (Bucci, et al. 2016).
Unreasonable fear, and fear of fear, the anticipatory anxiety related to anxiety disorders has been described by several researchers (Kessler, et al., 2009).
Neuroplasticity and the brain’s remarkable ability to form new connections helps to mediate the effects of stress and fear in the nervous system (Cramer, et al., 2011).
According to a psychological definition, trust is an emotional brain state (Thagard, 2018). It has been described as (1) a complex neural process that binds diverse representations into a semantic pointer that includes emotions; (2) a feeling of confidence and security; (3) an abstract mental attitude toward the proposition that someone is dependable; (4) a belief in the probability that someone will behave a certain way (Thagard, 2018).
The Neuropsychology of Trust:
According to neuroscientific findings, the ventromedial prefrontal cortex and insula, and the amygdala, as well as the dorsomedial prefrontal cortex are involved in the mediation of trust. The structure of these brain regions has been found to be directly influenced by the grey matter volume and amygdala volume as a function of decision making and trust in others (Haas, et al. 2014).
Figure 3: Illustration of trust and distrust in the activation of brain regions involved.
According to the developmental theory of Erik Erikson, one of the main tasks of the early stages of life rom birth to 18 months of age is to develop a secure bond with a loving caregiver for the maintenance of trust. In the absence of a secure connection, there is a fear of abandonment. Erikson believed that children who learn to trust their caregivers in infancy are more likely to have a sense of safety and security in the world. They will form trusting relationships with others in their lives (Graves and Larkin, 2006).
Current research confirms that traumatic events reduce the amount of trust one experiences (Filkukova, et al., 2016, Dahlen, 2010, AFWI, 2019). However, one can learn to develop trust if one faces one’s fears (Hillebrand, 2021). Trust mediates the perception of threat. It alters people’s perception of themselves, and the world around them (Enjolras, et al, 2019; Filkukova, et al., 2016). From am individual to a global scale, reducing fear and enhancing trust has been described as the main precondition for enhancing social concern and peace-making (Wheeler and Booth, 2008).
It is important to note that trust can not be forced, commanded, or demanded because it is a choice to trust someone. One trusts someone with similar values easier than someone with dissimilar values. Here is an area were freedom where will, the ability to make decisions and choice are manifested. While tolerance toward others with dissimilar values is possible, and required for peaceful coexistence, value-impositions run contrary to harmony. Adopting values not in line with universal human values– such as the value of each life, or the dignity of the person–is not meaningful. Meaning is the objective reality of a value standing in relation to each person in their own unique situation that has to be discovered, and discerned through conscience (Frankl, 2014b). Conscience is a “meaning-organ” (Frankl, 2008) that helps to intuit and infer the meaning of the moment, the person, and situation specific meaning, that is related to what is the very best possible option represented by the actualization of a value in harmony with universal values culminating in “the value of values” –Ultimate Meaning (Frankl, 2000).
Fear and Trust in the context of Meaning
Originally, Maslow’s hierarchy of needs outlined five areas of human concern: (1) physiological needs, (2) safety needs, (3) love and belonging, (4) esteem needs, and (5) self-actualization. In 1960, following an exchange with Viktor Frankl, Maslow acknowledged that the main motivation of human behavior is the will to meaning and added it to his hierarchy of needs (Marshall & Marshall, 2022). Thus, while several concerns can be the object of our fear and confidence, it is within a higher and more encompassing dimension of the dimension of the human spirit where we can reconcile our fears and give space to trust.
When conceptualizing of a person as a three-dimensional entity of body, mind, and spirit, it is the spiritual domain where the search for meaning takes place and where there is a healthy tension between a person and the values that they wish to actualize. According to Frankl, body and mind are instruments of the human spirit, through which the spirit expresses itself.
The dimension of body is the reservoir of physical resources. It is a bio-physical organism that ensures our physical functioning and survival (Frankl, 2014b). The mind in Frankl’s theory is used to denote our psychological processes, such as perception, memory, cognition, thinking, and emotions (Frankl, 2014b).
The dimension of the spirit is conceptualized as dimension that is higher and more encompassing than the dimension of the body and mind, not a substance but dynamics, the seat of the will to meaning, the defiant power of the human spirit, conscience, and other healthy resources such as our capacity for self-distancing, self-transcendence, humor, love, gratitude, hope and faith (Marshall & Marshall, 2022). Psycho-physical parallel and psycho-noetic antagonism refers to the fact that while body and mind are vulnerable, spirit is a healthy resource that can not become ill (Frankl, 1994, Marshall & Marshall, 2020).
The implications of the nature of the body, mind and spirit led Frankl to conceptualize his first and second Creed. According to the Psychological Creed, the person can be disturbed but not destroyed; and (2) according to the Psychiatric Creed, behind the mask of disease, the spirit is still intact (Frankl, 1994:86, 96).
Emotions Point to Values:
The arousal of emotions, correlated with inner brain states and paralleled by physiological responses, is like an inner source of energy that informs us about our values, value-system, and value-hierarchy.
For example, we feel sadness about loosing a family member because we loved them. Grief and sadness follow from love and closeness, the experiential values and attitudinal values remain as a bond between us and our loved ones.
We may feel angry if we see someone tosses garbage in the park because we value taking care of nature and care about the good use of resources.
We feel disgusted and repulsed by the cowardly actions of a compulsive liar, because we value truth and justice.
Emotions are like inner signals that tell us when events and actions are in harmony with the values that we perceive through our conscience as what should be, could be, or ought to be.
From a holistic point of view, this inner signal system is something that we have rather than who we are, and it serves an important function to guide our lives, not like instincts and impulses, but as signals that we can choose to act on, we can choose to embrace, or choose our position in response to.
Any signal system is as good as effectively it functions, as much as we pay attention to it, and the way we interpret its meaning wisely. Similarly, to a traffic light, where red means stop, yellow means go and green means go, it would be foolish to ignore our “gut feeling” and speed up when we see the light turning from yellow to red.
From a logotherapeutic point of view, we are in the driver’s seat, not our impulses, emotions, or drives, and there is always a space between a stimulus, and a response. We have an area of inner freedom to decide how to respond to our circumstances: give in to fears or not; develop trust or choose not to develop it. Our mind and heart, the emotional and rational brain work together in discerning what is most meaningful in each situation.
Existential Aspects of Fear
There are phenomenological states that occur when the voice of conscience is ignored, repressed, or suppressed, the will to meaning is blocked, when one does not find meaning to fulfill, or when one’s usual ways of fulfilling meaning in life are no longer possible:
Existential vacuum- is the feeling of inner emptiness, boredom, that results when one does not see meaning is life (Frankl, 2014; 2014b).
Existential frustration-occurs when the will to meaning is blocked.
Existential distress- occurs upon long standing existential frustration and vacuum that can lead to depression and despair, noogenic neurosis (Frankl, 2004).
Existential struggle-occurs in the case of values transgressions (Marshall & Marshall, 2021).
The concept of “Existential Angst” has been widely used by the existentialists to describe a long-standing sense of lack of meaning in life.
The term “existential threat” has been used to refer to a feeling that one’s mere existence in jeopardy (used to refer to a fear of loss of values, loss of selfhood, or identity).
“Existential risk” is defined as “risks that threaten the destruction of humanity’s long-term potential” (Bostrom, 2002).
The Vicious Cycle of Fear of Fear Leading to Desperation
Frankl described that either avoiding or fighting fear increases fear and results in an anticipatory anxiety of fear of fear (Frankl, 2004). The same pattern can occur in groups and societies.
In the case of existential angst, the fear motivation can give rise to individual neurotic patterns: such as depression, aggression, and violence (Frankl, 2014b), especially when the will to meaning is frustrated, which further reinforces the existential angst.
In the case of existential threat, frustration of the will to meaning, can give rise to collective neurotic patterns, such as collectivistic thinking, fanaticism, reductionism, and nihilism, reinforcing the vicious cycle of existential threat and dread.
The common element between existential angst and existential threat is fear. How we respond to fear is therefore crucial in breaking the pattern blocking the will to meaning that leads to despair.
Figure 4: Maria Marshall (2022). Illustrates the vicious cycle of desolation and despair fuelled by fear.
Erik Erikson talked about a fundamental trust that develops in early childhood and which can be easily lost and when one encounters trauma (Cherry, 2019). Frankl’s notion of trust is “…basic trust that is ultimately a belief in life’s meaningfulness which we can choose to embrace. Among other things, it means the awareness of our uniqueness and irreplaceable singularity as well as our value for the world” (Schechner & Zürner, 2011: 151). Basic trust is based on a choice “that life is ultimately meaningful” as opposed to “meaningless.” The loss of this ultimate trust leads to over-dependence on success, happiness, power and feedback about one’s value and the seeking of approval from others, seeking experiences, expectations that create an insatiable uneasiness and restlessness—the existential angst.
The opposite of existential angst is basic trust (Schechner & Zürner, 2011). Basic trust brings about an inner recognition and change of heart and mind to be free from the approval of the world and of others and to be self-determined, free, and responsible in the pursuit of meaning. Basic trust is opposed to “anxiety motivation” and avoidance with “love motivation” and intention toward purposeful goals (Lukas, 2020). Embracing this basic trust implies that we are wanted in the world. We are loved and a precious and irreplaceable part of creation. Inherent to this viewpoint is to appreciate what is good, true, and beautiful and gratitude for the wonders of life and creation. Basic trust can be fostered by: (1) Opening our eyes to possibilities: the ability to do good; the invitation to experience something beautiful and the capacity to transform suffering into something meaningful; (2) By awakening to the wonder and gift of every moment; (3) Through gratitude and kindness; (4) Through formation and personal development; (5) Through nurturing healthy relationships (6) Though a willingness to be open to the wonders of the world and changes in ourselves through gaining new experiences and insights (Schechner & Zürner, 2011).
According to Frankl (2019), an affirmation of life’s meaningfulness, or the possibility of life’s meaningfulness points to the possibility of a world in which every person is awaited and wanted and every person in addressed by life. Thus, in a world in which every person has value and dignity. This trust is the wellspring of hope that is strong enough to attract the energy of fear to use it to boost a person’s determination to jump over his or her own shadows or overcome obstacles and to thus channel the energy of fear into a meaningful action. Fabry (2021) outlined six ways in which basic trust can be furthered through orientation to meaning. He termed them the “signposts to meaning:” (1) uniqueness; (2) choices; (3) self-distancing; (4) self-transcendence; (5) responsibility and (6) response-ability. Attentive Meaning Sensitivity is a competence that can be practiced and enhanced (Marshall & Marshall, 2016).
The Principled Model of the Freedom of Will
Within this framework, and consistent with a thorough review of the literature and neuroscience findings, the authors (Marshall & Marshall, 2017) put forth what they termed the Principled Model of the Freedom of Will (PMFW). This model shows that through a process of reflection, human beings can make decisions about which values to live for (slow process related to cortical brain activity associated with reasoning). These values are then stored in conceptual memory regulated by the cortico-limbo-diencephalic system to guide everyday decisions (fast process involving limbic structures associated with emotions).
Figure 5: Marshall, E. (2017). The Principled Model of the Freedom of Will.
Following the PMFW model, individuals can be helped to gain insight into their values as guiding principles. Individuals can affirm if they wish to live according to these values or choose other values in harmony with universal values.
“Freedom of the will is opposed to destiny. For what we call destiny is that which is essentially exempt from human freedom, that which lies neither within the scope of man’s power nor his responsibility. However, we must never forget that all human freedom is contingent upon destiny to the extent that it can unfold only within destiny and by working upon it” (Frankl, 1986:78).
Aside from many other factors, our brain physiology is part of our destiny because it is part of what has been given and made available to us. However, beyond mere brain functioning or destiny in life, or Providence, gifted each human being with a design that allows to creatively shape themselves to reach their ultimate destination.
Or, as Frankl stated, we may not be free from conditions, but we are free to bring something valuable into the world. Human beings can choose the values they wish to actualize and shape and mold themselves.
Self-Transcendence and Functional Brain Imaging:
A team of psychologists and experts in the field of mindfulness, Kristin Neff, Christopher Germer, Geshe Lobsang, Tenzin Negi, Christopher Willard, Jack Cornfield, Dennis Tirch, Susan Pollak, Paul Gilbert, Deborah Lee, and Laura Silberstein-Tirch with the National Institute for the Behavioral Application of Behavioral Medicine suggest that complementing traditional cognitive approaches with compassion practices is uniquely suited for addressing complex trauma (NICABM, 2019). The researchers differentiate between rumination “a repetitive thinking which focuses on negative internal states, self-perceptions and emotions” is associated with “increased levels of self-attention, personal distress, negative affect and poorer levels of autonomy and social and interpersonal functioning” (Sutton, 2016). They point out that reflection and meditation differ from rumination as their goal is to be open to a variety of experiences. They can involve observing the self-experience with the intention of gaining increased objectivity from different perspectives, angles, views, and contexts. They open access to bring unconscious resources to conscious awareness and open a pathway to strengths and resources. These researchers believe that, on a neurological level, people who engage in compassion are more likely to down regulate the arousal as it changes the tome of their setting from a simply cognitive exercise to being able to see an area of freedom where they can tale a stand toward themselves and events (NICABM, 2019). These psychologists have found that individuals who engage in compassion-oriented practices are able to better address early childhood issues than people who receive only traditional forms of therapy. By activating human compassion through action and relation to oneself and others, these individuals are more likely to experience fewer PTSD symptoms, score lower depression related measures, report lower levels of loneliness and sleep difficulties. They score higher on measures of happiness and sense of purpose. According to these psychologists, compassion is not just about being kind to your self and accepting yourself but being courageous and doing things differently. The core of it is to be able to do things for others. The most important aspect of compassion is the courage to do good to others (NICABM, 2019).
A large study by Yoona Kang and her colleagues (2018) was undertaken as a collaboration between schools of communication, departments of medicine, public health and neuroscience. The study explored whether affirmation and self-transcendent attitudes have the potential of affecting brain and eventually alter behaviour and health outcomes. Two hundred and twenty sedentary adults were randomly selected into two groups. Both group members received regular health programming and reminders about the benefits and advantages of healthy lifestyle, healthy nutrition and regular exercise. Participants in both groups were given a list of values to rank the order from highest to lowest personal significance. The control group was subsequently asked to engage in reflecting about those values which they deemed least significant to them along with everyday activities.
The other group participated in affirmation and compassion meditation. They were invited to reflect on the way they practice and experience their highest personally important values in their everyday lives. Subsequently, they practiced compassion meditation and well wishes in relation to these values and individuals. On the list the highest rated values included family members and connection with a transcendental entity.
Brain areas related to neural activity while performing these tasks were scanned and compared. Participants were also administered a battery of screening instruments related to their mood and health behaviours. Self-transcendence and compassion were found to significantly reduce the likelihood to evaluate the health messages as potentially threatening to the self esteem, even though beneficial (Kang et al, 2018). They predisposed participants for a tendency to openness, lowered defensiveness and valuing the health messages as “valuable to me.” Aside from message receptivity, there was an overall significant difference in mood and health behaviour. Self-directed, negative mood was less in the self-transcendence and compassion group than in the control group. Those who were affirmed showed greater increases in their average moderate/vigorous activity and decrease in sedentary behavior than those in the control group. Self-transcendent tasks stimulated the ventromedial prefrontal cortex associated with positive valuation and reward processing. During subsequent health message exposure, the same regions showed increased activity, indicating that affirmation, the reflection on values is interpreted as rewarding experience and coupled with self-transcendence, has the capacity to affect behavioural change (Kang et al, 2018).
These findings further support the idea that a positive, other focused mindset, characterised by kindness, compassion, gratitude and valuation may contribute to helping people see personally relevant information as valuable to them and they are more likely to engage in positive, healthy behaviours such as self care if they see a personal value and purpose attached to it. An interesting observation during this study was that even those who were asked to think about their values but reflected on lower ranked values showed some improvement in subsequent health related behaviours and showed pre-frontal activation, albeit not as much as the other group. This finding indicates that reflecting on one’s values, even if not followed by self-transcendent mindful and compassionate thinking, can have an affirmative effect (Kang, et al., 2018).
In fMRI images, Kang and her colleagues (2018) found frontal area activation during compassion and affirmation tasks related to self-transcendence and reflection of values that one wants to live for. The same frontal area activation was not found in the control group, who were asked to reflect on everyday activities.
Figure 6: (Kang et al., 2018.) Functional MRI images of the brain areas activated during affirmation, and compassion in comparison with the control group.
Brain Plasticity and Resilience:
Robust studies investigated the effects of early trauma on the developing brain and the effects of toxic stress on health and mental health outcomes in later adulthood (Harvard University, 2019). Brain-plasticity, the brain’s capacity to moderate the impact of trauma, develop new connections, has been observed during critical windows of development and during the life span. Toxic stress paired with a lack of supportive caregiving was linked with deficits in brain areas crucial to executive and control functioning in the social, cognitive, and emotional areas was noted (AFWI, 2019). Teaching internal self-regulation, problem solving, planning and organisation skills, cognitive flexibility, was found helpful to help override automatic responses and prevent reinforcing and transmitting adversity (Marshall & Marshall, 2021).
Miller Karas developed a Community Resiliency model that focuses on self-awareness and self-regulation to (1) track and understand bodily reactions, (2) access inner resources and learn how to evoke them and intensify them; (3) grounding, (4) understanding gestures and spontaneous movements; and (5) shift and stay, whereby one can intentionally recognize and down-regulate intense emotional states to reach an optimal level of physical and psychological arousal. This approach has been extensively used both nationally and internationally by the Trauma Resource Institute. It is appropriate for men, women, and children (Grabbe & Miller- Karas, 2017).
Building resilience skills and engaging in self-transcendent actions following trauma and complex PTSD was related to enhanced sense of meaning in life and post-traumatic growth in veterans. Engaging in meaningful community activities was perceived as qualities of “super-survivors” who not only overcame their trauma but helped others. Helping others, in return, was reported to have had a positive impact on the individual’s recovery following trauma (Southwick & Charney, 2018; Marshall & Marshall, 2021b).
Meaning in Life and Health Outcomes
A study with 1,546 individuals over the age of fifty found that in the presence of medium to severe pre-existing coronary heart disease at the baseline, purpose in life was associated with lower odds of having a myocardial infraction during a two-year follow up (Kim, 2015). A similar study with close to 7000 individuals found that those with higher purpose scores showed reduced likelihood of a cerebrovascular incident in the next four year-period (Kim, 2013). large study by Alimujaing and her colleagues (2019) in close to 7000 adults aged fifty years and over in the United States confirmed that stronger purpose in life was associated with lower all-cause mortality. These results were in line with findings by Koizumi, and his colleagues, according to which strong purpose was associated with 72 percent lower rate of death from stroke, a 44 percent reduction of the rate of chance of dying from a cardiovascular disease and overall 48 percent chance of dying from any cause of death in a population of men over the period of a thirteen year follow up, even if controlled for the effects of controlled stress and cardiovascular predisposing risk factors (Koizumi, et al., 2008).
The work of Patricia Boyle and her colleagues with 1151 elderly individuals at the Rush Alzheimer’s Disease Center (Boyle, et al., 2010) indicated that purpose in life was a protective factor against the development and progression of Alzheimer’s disease. Autopsy results obtained post-mortem confirmed that those individuals who had higher purpose scores have shown less cognitive decline despite the presence of high burdens of Alzheimer related protein accumulation, as measured in the amount of beta-amyloid and tau deposits associated with the disease (Boyle, et al., 2012).
A longitudinal study in the United States by Case and Deaton (2015) found that in a population of 100,000 white men who were followed between 2000 and 2020, there was a dramatic increase of deaths due to suicide, drug and alcohol poisoning, and chronic illness due to drug or alcohol use between 2005 and 2020. They termed these factors as “death due to despair.”
Chen et al. (2020) who investigated “death due to despair” in a sample of 100,000 health care workers in the US, (66,492) females (between 2001 and 2017), and 43,141 males (1988-2014), found that people who had a deep-seated spirituality and religiosity and attended religious service at least once a week had significantly lower rates of death related to suicide or addictions and overdose than those who did not have religious church attendance. Church attendance was positively correlated with psychosocial well-being outcomes, greater purpose in life and social integration.
A review of purpose and health-related studies was conducted by Dr. Adam Kaplin, chief psychiatric consultant to the Johns Hopkins Multiple Sclerosis and Transverse Myelitis centres and Laura Anzaldi (Kaplin & Anzaldi, 2015). Their observation is that research on the role of purpose is a new and upcoming movement in neuroscience. Considering the several side effects of pharmaco-therapy, especially in the areas of psychiatry and clinical neuroscience, these authors believe that “purpose in life should be promoted, as opposed to pill-pushing.” In other words, methods that enhance a sense of purpose and meaningfulness in life are desperately called for to complement current clinical practices.
Several recent studies shed further light on wishes for hastened death in people diagnosed with terminal cancer and the elderly. The following points summarize the findings:
Death wishes [in older adults] can not be explained by mental disorders (Van Wijngaarden, et al, 2021).
The mental health consequences of isolation are disconnection, meaninglessness, anxiety, panic, obsessive-compulsive symptoms, digestive problems, depressive problems, and post-traumatic stress (Rogers, et al., 2020; Pietrabissa & Simpson, 2020) and psychiatric symptoms (Brooks et al., 2020).
The trajectories of death wishes can be varied and fluctuate (Breitbart, 2017; Leigh, et al., 2017).
Active, outspoken, and expressed wishes can subside and vanish over the months or years (Van Wijngaarden, et al., 2021)
Wishes for hastened death are related to external factors such as health, activities, and relationships (Van Wijngaarden, et al, 2021).
Once the desires are firmly established, and in the absence of support, these wishes can be enduring (Wilson, et al., 2007).
Diminished wish for hastened death is linked with a regained sense of meaningfulness and forming connectedness (Breitbart, 2017; Southwick & Southwick, 2020; Van Wijngaarden, et al. 2021).
A ground-breaking study validated with randomised control trials at the Sloan Kettering Cancer Treatment Hospital in New York under the direction of William Breitbart outlined an eight session “Meaning-centered Group Psychotherapy Protocol; MCGP” (Breitbart, and Poppito, 2014a, Breitbart & Masterson, 2016; Breitbart, 2017). The sessions were intended to reduce anxiety, depression and suicidal ideation among patients who have been diagnosed with advanced stages of cancer and to increase their well being and quality of life by helping them find deeper meaning in the midst of battling their disease. They covered topics in eight consecutive sessions:
Concepts and Sources of Meaning.
Identity Before and After the Diagnosis of Cancer Diagnosis.
Historical Sources of Meaning: “Life as a Legacy” that one has been given.
Historical Sources of Meaning: “Life as Legacy” that one lives and will give.
Attitudinal Sources of Meaning: Encountering Life’s Limitations.
Creative Sources of Meaning: Creativity, Courage, and Responsibility.
Experiential Sources of Meaning: Connecting with Life through Love, Beauty, and Humor.
Transitions: Final Group Reflections and Hopes for the Future.
Those who completed the program showed lower scores on depressiveness, anxiety and wish for hastened death. Despite their cancer diagnosis, they reported higher levels of quality of life than people in the control group. The researchers noted that offering physical care is crucial in palliative medicine (Breitbart, 2017). Beyond that “…it is equally important to encourage the spirit by a constant show of love and compassion” (Kissane, and Poppito, 2006: 694), and enhance resilience though meaningful connections (Southwick & Southwick, 2020; Southwick & Charney, 2021).
In several studies, meaning was found to correlate with measures of self-transcendence, resilience, and post-traumatic growth, which are factors associated with psychological well being. Thus, meaning can be conceptualized as creating a bridge between protective factors in the face of adversity and directly contributes to psychological well-being (Russo-Netzer, & Ameli, 2021).
Based on current criteria for evidence-based research, Lewis (2014) summarized the findings of studies to date: (1) A positive correlation exists between meaning and measures of well-being and coping: (2) An inverse correlation exists between meaning and a diagnosis of mental illness; (3) When mental illness does occur, an inverse correlation exists between meaning and symptom severity. Other well-documented findings are: (1) an inverse correlation exists between reasons for living, or purpose in life, and suicidality; (2) an inverse correlation exists between meaning and a diagnosis of substance use disorders; (3) a positive correlation exists between meaning and health. Emerging findings include: (1) meaning in life is positively correlated with occupational functioning; (2) an inverse correlation exists between meaning and criminal or antisocial behavior; (3) meaning in life is positively correlated with social functioning (Lewis, 2014).
The present review of literature corroborates that neuroplasticity, based on discernment and reflection, can aid to reinforce values that we want to live for and that are in harmony with universal values. Through the resources of the human spirit, fear can be tamed, and basic trust can be re-gained for a meaning-filled living. Meaning is associated with self-transcendence, resilience, and post-traumatic growth. These factors are associated with positive health and mental health outcomes.
Viktor Frankl’s Logotherapy and Existential Analysis was formulated at a time when the search for meaning was a crucial preventive and protective factor against despair. It is a values-based approach to psychotherapy and counselling with principles and evidence-based methods (Russo-Netzer & Ameli, 2021; Marshall & Marshall, 2022).
Perhaps only a few people are aware that Frankl was afraid of heights (Marshall & Marshall, 2021). He challenged himself to rock climbing: “Who is stronger. Me or the fear in me?” he used to ask (Frankl, 2008). With the fear he climbed, and he advised is patients to do the same. In brief, to “Take the bull by the horns!” (Lukas, 2000:105) and “Hitch your wagon to a star!” (Lukas, 2011).
However, Frankl did not scale the rocks unaided. He used proper mountain gear and a rope. One of such ropes is exhibited at the Viktor Frankl Museum in Vienna (Marshall & Marshall, 2021). A rope is a symbol of our connectedness to others, to the world, to hope and security and trust. The rope is the symbol of our connection to our ultimate home.
When we learn about logotherapy, we not only learn to help ourselves, but we also learn about a skilful way of guiding people from less difficult to most difficult terrains. The most challenging heights are the ones where we must jump over our shadows and turn the energy of our emotions to propel us to new heights. These heights can not be conquered other than with courage, faith, and trust.
Dr. Frankl affirmed that anchored in Ultimate Trust, we can say “Yes” to life, despite everything. He ended his book, the “Will to Meaning” with what he said that he intended to be “the lesson to learn” from this book (Frankl, 2014b:121):
“…Out of an unconditional trust in ultimate meaning and unconditional faith in ultimate being, Habakkuk chanted this triumphant hymn: ‘Although the fig tree will not blossom, neither shall fruit be in the vines; the labor of the olive shall fail, and the fields shall yield no meat; the flock shall be cut off from the fold, and there shall be no herd in the stalls: Yet I will rejoice in the Lord, I will be joyful in the God of my salvation” (Frankl, 2014b:121).
As Dr. Frankl taught lessons about life by the way he lived his life, and the way he practiced, we must also live what we believe. The “unconditional trust in ultimate meaning and unconditional faith in ultimate being” (Frankl, 2014b:121) can be our motto, our inspiration and hope on our journey from fear to trust. – A living project.
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In addition to crimes against humanity, the irreplaceable cost of the loss of countless lives, the displacement of millions of people, economic downturn, and sending shock waves through the entire human family, the current war in Ukraine rests on a fundamental error and faulty attitudes that lead to a vicious cycle of destruction and self-harm. While the implications of this harm to the self, in addition to others, may not immediately perceptible, its consequences are far reaching and deeper than physical wounds. These are the wounds of the soul. (6) The purpose of this article is to describe the nature attitudes that lead away from meaning and propose and to present possible meaning-centered interventions for altering course.
According to Viktor Frankl, MD, PhD, (1905-1997) an Austrian psychiatrist, a survivor of the Holocaust and the founder of Logotherapy and Existential Analysis, the Third Viennese School of Psychotherapy, the fundamental motivating force for human beings is not the will to pleasure, or the will to power, but the will to meaning. (4) His most well-known book, “Man’s Search for Meaning,” which sold millions of copies around the world, testifies to the endurance and resilience of a human being to find meaning under all circumstances, even the most miserable. LTEA is a meaning-centered and evidence-based approach to psychotherapy that rests on three fundamental assumptions: (1) The Freedom of Will; (2) The Will to Meaning; and (3) Meaning in Life. (1,8)
The first concept, the Freedom of Will, rests on Frankl’s three-dimensional conceptualization of the human being as a body, mind, and spirit entity. In the “Ten Theses on the Person,” Frankl, asserted that the dimension of the spirit is an indelible aspect of human existence that is not a substance but a dynamic.(2) The spirit is the source of the will to meaning, the human capacity for searching for and finding meaning, self-distancing, the capacity to distance oneself from the self and to observe oneself from the outside; self-transcendence, the capacity to reach out toward meaning, and other meta-physical phenomena such as love beyond the physical, gratitude, humor, kindness, forgiveness, hope, and faith. These capacities of the human spirit are, like an inner reservoir, the well spring of resilience, self-transcendence and growth that have a protective effect in crisis prevention and curative effect in crisis intervention. (3)
The first basic tent of logotherapy, Freedom of Will, asserts that humans are not fully subject to their conditions and the circumstances that surround them, but they can, within the limitations of those circumstances, and in view of being a fallible, vulnerable and finite human being, take a stand toward both internal conditions (such as one’s own biological and psychological state, instincts, drives, genetic makeup, thoughts, and emotions) and external circumstances (social factors, the past and what others decide to do). (1) The freedom to take a stand derives from the dimension of the spirit, which in Frankl’s holistic view of the person is conceptualized as the essentially human realm. The spirit is who we really are, over and above the dimension of the body and mind, of what we have. Body and mind are the instruments of the spirit. (1) As spiritual persons humans are infinitely more than reacting organisms, they can choose their stand toward their circumstances and shape themselves and their lives. (2)
The second concept, the Will to Meaning, asserts that, in addition to being free, human beings are free for something, they are free to reach their goals and accomplish purposes. (1) These goals and purposes are present in reaching out for meaning that is present in values that stand in relation to every person in each situation. Realizing meaning is seen as a fundamental motivating force of human behavior. (1) When the Will to Meaning can not reach its target, the feeling is experienced as a nagging feeling, followed by a sense of meaninglessness. (4) There are other forms of existential manifestations of the Will to Meaning being inhibited in its natural dynamics. The term “existential frustration” describes when values that used to be actualized, can no longer be actualized for some reason, and a person feels an inner sense of exasperation. (4) “Existential vacuum” is the feeling of inner emptiness that follows long-standing feelings of existential frustration. (4) “Existential struggle” results from not living up to one’s values or trespassing them. (7) “Existential distress” accompanies existential frustration and existential vacuum characterised by a feeling of despondency. (8) “Existential Angst” has been traditionally used by the existentialist to refer to a sense of meaninglessness (8). “Existential Threat” is used to refer to one’s existence and fundamental values being in jeopardy. The frustration of the will to meaning can lead to the pursuit of avenues that may mimic the effects of finding meaning, such as pleasure, success, or power seeking. (5) It can also result in aggression, addiction, depression, self-harming, and self-defeating behaviors as well as increase the severity of psychological and emotional distress. (1)
LTEA was specifically developed to help people become aware of and to tackle the obstacles that hinder the accomplishment of meaningful goals. (1,4) In LTEA, people are led to areas of freedom where meaning potentials can be found. However, they are not given or offered specific meaning contents because they need to discern and discover these for themselves with help from their conscience and will to meaning. The will to meaning is the strongest ally of the helper because it is that source of vitality and elan that is aimed at detecting realistic meaning possibilities that one can accomplish. (8)
The third principle, Meaning in Life, asserts the belief that life offers purposeful goals worth accomplishing in every situation. (1,4) Meaning is a thought of as a trans-subjective value standing in relation to the person. Thus, meaning is an objective reality that addresses the person, not an invention or figment of imagination or wishful thinking, arising from the soma or mind of the person. (1) Meaning is intuited through conscience and discerned in the dimension of spirit. (2) A person is invited to use their freedom of will and responsibility to make the best of a situation and of themselves. While ultimate meaning is abstract and impossible for humans to fully comprehend, as it is only with faith that one can approach its mystery, the meaning of the moment in harmony with ultimate meaning is a concrete possibility and task that is awaiting each person, linked to their specific circumstances and situation and in a state of change from moment to moment. (5) Thus, instead of finding a general meaning in life, one is invited to keep an open mind and remain flexible to accomplish the call of the moment, and thus shape oneself and one’s life moment to moment and day by day. (1)
There are three therapeutic techniques that form part of the non-specific tool kit of LTEA. These methods have been developed to deal with patterns, tendencies, and attitudes that can block the will to meaning and cause emotional and psychological suffering. Each of these techniques are evidence-based practices. (8)
Paradoxical intention has been used since the early 1930s in the treatment of obsessive and compulsive tendencies, and anxiety. (4, 5, 6) The basic premise of this method is that excessive avoidance of anxiety provoking stimuli can lead to excessive fear. Attempts to ward off this fear can be coupled with fear of fear. Fear of fear leads to a vicious cycle in which self-observation, hyper-vigilance, and hyper-attention, bring about the feared symptom. (4,8) Thus, excessive fighting against, leads to symptom amplification. The way to break the vicious cycle is to create a distance between the self and the fear, face the fear instead of running from it or warding off from it though safety behaviors, identify the trigger of fear, learn how to tolerate fear, and employ humorous formulations to exaggerate it to create even more distance between the spiritual self and the fear, which breaks the vicious cycle and symptom amplification. (1,8)
De-reflection has been used in the case of sleep disturbances, sexual dysfunctions, and anxiety disorders, where the root of symptom amplification had to do with anxious self-observation, anxious rumination, and hyper-intention. (1,5,6) The increased attention and intention, coupled with increased anxiety led to a vicious cycle of hyper-arousal that interfered with spontaneous functioning. Right passivity, though drawing attention away from the physical and emotional self toward areas of freedom and values allowed the spontaneity and natural flow to return. (8)
Modification of Attitudes is focused on identifying and altering attitudes and expectations that block meaning fulfillment. (1,8) Such patterns can be habit forming and alienate a person from being in touch with themselves, with their aspirations and meaning potentials in life, thus alienating them further and further and reinforcing maladaptive a poor choice that are causing suffering to themselves and others. Rather than value impositions, telling people what to do, ordering and commanding them how to alter their maladaptive patterns of behavior, therapists reach to the root of these behaviors in attitudes that are unrealistic, exaggerated, counterproductive, or self-defeating to help them gain new perspectives and outlook that may offer a fresh path to a productive and fulfilled life. The Socratic dialogue is used to challenge old and maladaptive assumptions and to bring up the possibility of re-thinking and re-committing oneself to new ways of seeing and doing that brings meaning into the world. The aim of the Socratic dialogue is to help to re-connect with universal values, and to re-connect with truth, beauty and goodness, aspects of meaning that one can bring into the world. (1,8)
The faulty assumptions underlying the idea of war can be seen in collectivistic thinking, reductionism, and fanaticism. (3) Collectivistic thinking requires to relinquish the individual agency and freedom of the individual to the thinking of the group. (3) In the case of an autocratic style of leadership, individual freedoms and responsibility is required to be relinquished to a central figure.
Reductionism is the idea that complex realities can be understood along lower levels. (3, 5) Such thinking denies the freedom of will of the individual.
Fanaticism is manifested in the elevation of a relative value to the absolute. (3) The danger of fanaticism is an “all or nothing thinking” in which the value on the of a pyramidal system is absolutized, idealised and quasi “worshipped.”
Three vicious cycles are created by the wrong attitudes: (1) “Existential threat,” the one’s values are in jeopardy, are exacerbated by a fanatic attitude in which one value is idealized and absolutized. Fanaticism evokes a feeling of “existential threat,” and the feeling of “Existential threat” reinforces the fanatic zeal to protect this value from being lost. (2) “Existential Angst,” a sense of meaninglessness fostered by reductionistic thinking provokes a fear of fear. The fear of fear reinforces the existential angst. (3) The perception of “existential threat” of the autocratic style evokes “existential angst” and the existential angst reinforces the perceived existential threat.
The will to meaning is temporarily blocked by these three obstacles. Existential frustration surfaces, but the voice of conscience is ignored and continually supressed. In the absence of meaning, the motivation may change to seeking pleasure and appreciation of utility instead of inherent value. Since this path des not lead to meaning, it is frustrated and leas to existential vacuum. In the vacuum aggression, violence, abuse, and harmful behaviors flourish.
In the continued absence of meaning, a will to power may predominate. It reinforces the fanatic zeal, but ultimately, fails to bring a sense of fulfillment and leads to frustration and despair. The consequence is existential despair.
From the perspective of LTEA, without restoring a healthy meaning-orientation, suffering amounts. Pain is inflicted in the self and on others. There are three points of intervention that can help to remove the obstacles from the path of the frustrated will to meaning: (1) breaking the fear of fear through paradoxical intention; (2) modifying the fanatic attitude through the method of modifying attitudes; and (3) re-instating a three-dimensional view of the person in one humanity by de-reflecting from self-interest and considering others. This will fully re-instate the dynamics of the will to meaning.
Paradoxical intention to break the pattern of existential angst and fear of fear can focus on being able to face fear and tolerate it without lashing out and hurting others. It is a normal phenomenon to experience fear of meaninglessness. The fear itself points to the significance of finding meaning. Excessive fear leads to a paralyzed sense of rigidity or attempts to fight the fear by frantic action and acting out. It is a human prerogative to take a distance from oneself, from one’s inner state. It is a human achievement to look fear straight in the face and deal with it, like the bull fighter tackles a bull by its horns. “Take the bull by the horns.” “You are in a unique position like no one else in the history of this world to effect change, and defeat fear by looking not its eyes and defeating it through your resolve to be stronger than it.”
Modification of attitudes can tackle the vicious cycle of fanaticism and the feeling of existential threat. Whenever we idealise a value, and place it on a pedestal, we place it in a position that if it is not possible to achieve, we are risking having no value because we put everything on the line, “we put all our eggs in the same basket.” An idealized value makes us loose sight of the fact that we are not the one wo assign values, but it is life. Rather than placing values, we need to live them. The Socratic Question helps us to reflect on: “Rather than us asking what we an expect from life, we need to ask, what is life asking from us in this moment?”
The third vicious cycle between existential threat and the existential angst that blocks the will to meaning can be alleviated through de-reflection. We think of the future beyond our self-interest. What is it that we want our legacy to remain in the world? According to Albert Einstein, if all the resources that are invested into the war could be put to a good use, the world could be a much better place to live in. Let us imagine and build such a world.
Frankl, a survivor of the Holocaust believed that when the basic need for meaning is ignored, disregarded, and shunned, then even success, power and fame will feel empty and futile. (5) In the absence of meaning, falls into the abyss of despair. In the presence of meaning, however, even a perceived failure can lead to a sense of fulfillment. (5)
He outlined three avenues through which life can be made meaningful. (1) Through creative values, to which category belong everything that we bring into the world through work, and creative activities. (2) Experiential values, though which we can find meaning in what we receive from the world, such as its beauty and the relationships we cultivate; and (3) through attitudinal values, the possibility of facing unavoidable suffering with courage. (4, 5) This latter in the highest form of human accomplishment because it offers the deepest possible meaning until the last breath. The attitudinal values are subdivided into another triad: meaningful attitudes to pain, guilt, and death. (5)
As human beings, we are fallible, vulnerable, and finite. However, our essence is not what is fallible, finite, and vulnerable, but that what is eternal—our essence. Surely, what we have done, cannot be undone. However, the attitude toward pain confronts us with the possibility of taking a stand toward fate. In the case of guilt, one has the chance to take a stand toward oneself. Because of our freedom of will, it is a human prerogative to become guilty of a wrongful act, and it is a human imperative to overcome this guilt, to have a change of heart. (5)
As for the third aspect of the tragic triad, life’s transitoriness, Frankl remarks that we usually see only the partial picture:
“Usually, man only sees the stubble fields of transitoriness and overlooks the full granaries of the past. In the past nothing is irrevocably lost but everything is irrevocably preserved and saved, safely delivered and deposited. Nothing and nobody can deprive us of what we have rescued into the past. What we have done can never be undone. This adds to man’s responsibleness. For in the face of transitoriness of his life, he is responsible for using the past opportunities to actualize potentialities, to realize values, whether creative, experiential, or attitudinal. In other words, man is responsible for what to do, whom to love, and how to suffer. Once has realized a value, he has fulfilled a meaning, he has fulfilled it once and forever” (5:52).
“Man’s Search for Meaning” expresses trust in the realistic optimism that change is possible. Through the freedom of will, a human being is uniquely in the position to shape and to mold him or herself.
“I speak of a tragic optimism, that is, optimism in the face of tragedy and in view of the human potential which at its best allows for: (1) turning suffering into a human achievement and accomplishment; (2) deriving from guilt the opportunity to change oneself for the better; and (3) deriving from life’s transitoriness an incentive to take responsible action” (4: 129-130).
“…O Lord, our Sovereign, how majestic is your name in all the earth!” (Psalm 8)
This is a busy time of the year, and two holidays almost coincide. In the Jewish tradition, Hannukah started at sundown on Sunday, December 2. It lasts eight days until December 5th. Hannukah is one of the most widely observed Jewish holidays, also called the Festival of Lights. It commemorates that in 165 BC, Judas Maccabee and his brothers won a victory over the invading Syrian army. On that occasion, they re-dedicated the Temple in Jerusalem. The oil lamp inside the temple had enough oil for only one day. But the light did not dim, and the oil lasted for eight days until new oil could be made. Hannukah is a joyous, cheerful celebration of re-dedicating oneself. Tikkun Olam means spreading good in the world and being the light of the world.
In the Christian tradition, Advent, the four weeks before Christmas is a time of waiting and preparation. We prepare our hearts and minds for welcoming the Christ Child. Jesus is the “Light of the World.”
In Frankl’s home both Christmas and Hannukah were observed (Klingberg, 2001).
Symbols and metaphors are commonly used in logotherapy to refer from the concrete to the abstract and to capture a meaning that goes beyond the mundane and the ordinary (Lukas, 2020).
In this presentation, we would like to consider some of the most frequent symbols associated with Hannukah and Christmas and illustrate logotherapeutic concepts or principles that can be pondered using these symbols. Symbols and metaphors are used in practice is for clarification and for encouraging the spirit. They usually occur in the context of an authentic “I and Thou” encounter, with the recognition that as therapists or patients, we are pilgrims in our journey of life (Marshall & Marshall, 2022). During the holidays, we profit from the time available for reflection and meditation to offer new insights and to allow meaning to unfold.
The symbols that we chose to reflect on today are those most frequently noticed in our surroundings at this time: (1) The candle, (2) the tree, (3) the presents, and (4) the star. Many of these items have rich symbolism and their existential significance can be explored.
Most of us have a candle in our homes. Whether we saved it from previous years, or we bought a new one for the holidays, our candles are ready to be lit.
The candle’s purpose, its function is to give light and warmth.
If we just kept candle hidden in the drawer, it would not fulfill its purpose.
So, let us take a closer look at our candle and observe what logotherapeutic thoughts may be associated with it. Some of the following ideas were described by Dr. Elisabeth Lukas’ “Candle Meditation,” found in her book, “Alles fugt Sich und erfullt sich,” published in 1994. She used these mediations in group settings:
The candle is composed of wax and has a structure.
Inside the wax is a tiny bit of wick that is visible on the top of the candle. The rest of the wick is invisible, but we know that it is inside.
The wick is the most important part of the candle, because without the wick, the candle would be of not much use. We could not light it, only burn it. (Maybe, that would not be such a good idea).
The candle represents our human reality. Our bodies and mind that are like the wax, fragile. We are fallible, vulnerable, and finite beings.
Much like the wick, our essence is not our bodies, or minds, but rather, what is “inside,” and most hidden from the eye, other than a little bit of what is visible of the wick at the top of the candle, what can be seen.
Spirit is the very essence of our being. Body and mind are only its instruments through which the spirit can express itself. This is similar, to how the wax provides structure and holding place for the wick so it can fulfill its function (Lukas, 1994). The spirit relies on its instruments to accomplish its purpose.
We can say, we have hands, feet, and eyes. With a stretch of the imagination, perhaps we can embrace the statement that we are the feet, the hands, and the eyes through which truth, beauty and goodness can be brought into the world.
St. Theresa of Avila was a Carmelite nun and a mystic. She wrote these beautiful verses so appropriate to the metaphor of the candle:
“Christ has no body but yours,
No hands, no feet on earth but yours,
Yours are the eyes with which he looks
Compassion on this world,
Yours are the feet with which he walks to do good
Yours are the hands with which he blesses the world.
Yours are the hands, yours are the feet,
Yours are the eyes, you are his body.
Christ has no body now but yours,
No hands, no feet on earth but yours,
Yours are the eyes with which he looks
Compassion on this world.
Christ has no body now on earth but yours.”
When we light the candle, it gives light and warmth. This is the purpose of human life. To be a beacon of hope and to shine in the world though one’s actions of caring and kindness.
In the moment we light the candle the candle is no longer wax and wick, it is transformed into purpose and function. The physical energy is transformed into light and heat energy that radiates into the world and that remains in the world.
It is interesting to ponder that the reality of the candle giving light is independent if someone else can see the candle or knows about it. Similarly, our actions of kindness and goodness do not pass away and are independent of who knows about it (Lukas, 1994).
The old candle, the broken candle, a damaged candle, the bruised candle can still be lit, and it can still give light and warmth.
As we contemplate our candle, we may recall Frankl’s words:
“What we radiate into the world, the waves that emanate from our being, that is what will remain of us when our being itself has long since passed away” (Frankl, 2019:45).
The Christmas Tree:
We may buy our tree or observe some that we can see around us on the streets, in the shop windows, or at the city square. A gorgeous, green tree may be erected and decorated in the mall or at the market.
What do we see?
The tree, a symbol of life, spirals toward the sky, ending in a high point symbolizing a climax or destination.
In may places, the branches of the tree bear rich decorations or tiny lights and ornaments. Every decoration is carefully placed. Sometimes, it takes some time to decide where one will place the larger ornaments, where one will place the smaller ones. Where one might hang a dented but highly prized piece, or where the most cherished ornaments will find their place. These decisions can represent the choices we make. The decorations are like the values that stand in relation to us. They shine brightly.
When we finish making our choices, and decide where we will place the ornaments, the lights, or the ribbons, we usually stand back and admire the tree. There it stands in all its glory. The decorations sparkle in the light, and they all rise, pointing up toward the top of the tree. Up high, closer to the tip, are the ornaments representing the higher values or universal values, such as the values of love, value of fidelity, the value of life, the dignity of a person, and so on. These values are under which the lower values are subsumed. The lower branches are closer to us. So are the decorations on them, which represent the values through which we actualize concrete meaning, the meaning of the moment that is within reach.
The tree is beautiful when all the decorations are in harmony with each other. From the concrete to the abstract, from the low to the high, from the meaning of the moment to ultimate meaning, the lights and special ornaments create a harmonious and appealing image of actions reflecting values just as decorations reflect our highest ideals, aspirations, and ideals.
Pierre Teilhard de Chardin, a French Jesuit and theologian once remarked: “…Remain true to yourself but move ever upward toward greater consciousness and greater love! At the summit your will find yourself united with all those who, from every direction, have made the same ascent. For everything that rises must converge.”
Frankl reminds us that our actions are meaningful if they are in harmony with universal values that point to ultimate value and to ultimate meaning (Frankl, 2014).
As we contemplate the beauty of the Christmas tree, we may take a moment to reflect on his words of wisdom:
“It is terrible to know that at every moment, I bear responsibility for the next: that every decision, from the smallest to the largest, is a decision for ‘all eternity;’ that in every moment I can actualize the possibility of the moment, of that particular moment or forfeit it. Every single moment contains thousands of possibilities—and I can only choose one of them to actualize it. But in making the choice, I have condemned all the others and sentenced them to ‘never being,’ and even this is for all eternity! But it is wonderful to know that the future—my own future and with it the future of the things and the people around me—is somehow, albeit to a very small extent, dependent on our decision in every moment. Everything I realize through them, or ‘bring into the world,’ as we have said, I save into reality thus protect from transience” (Frankl, 2014:106).
How do we decorate our tree, which values do we pace higher or lower? The choice is sometimes not easy to make. It may take some prayerful reflection to decide well.
Several ideas of presents that we want to buy, or wrap may be going through our minds. Those of us who are really organized, already have some items ready and hidden, somewhere were little eyes and hands can not touch them, so they are a surprise.
Presents represent our acts of kindness and good deeds, the warmth, and the love we share. Yet, while we have not given them, they are only possibilities. When we give them is the moment when they accomplish their purpose and bring smile to the face of someone.
As we contemplate presents, the ones we may give and those we may receive, we contemplate the gift of love and being loved.
Earlier, when we talked about the example of the candle, we talked about the uniqueness of each person and the value which is related to the community and serving the community, serving others. This is love that we give.
There is also a second path, says Frankl other than doing, and that exists in being, in being appreciated for who one is, which is a more passive way. This is lovethat we are given.
“This is a more or less passive path, without any stiving, without any doing—“without doing anything for it”—in being loved, what someone otherwise had to strive for in his activity or employment now seems to fall into his or her lap; on this path of being loved we achieve what we would normally have to fight for and though our performance, but without needing to earn them: indeed one cannot force love; love is not a reward but a blessing. On the path of love a person thus receives by “grace” the things that he or she would have to strive for to obtain through action: the realization of both his or her uniqueness and individuality. For it is the nature of love that makes us see our loved one in their uniqueness and individuality” (Frankl, 2019:75-76).
Thus, as we contemplate presents, the presents that may want to give and the presents we may receive, we can ponder love. The mystery oflove is that can not be demanded or commanded but it is an act of grace.
As the hustle and bustle of preparation is nearing, let us recall the greatest gifts that God gave. Let us prepare fitting gifts in our hearts:
“Lord make me an instrument of your peace.
Where there is hatred, let me sow love,
Where there is injury, pardon;
Where there is doubt, faith;
Where there is despair, hope;
Where there is darkness, light;
And where id sadness, joy.”
O Divine Master, grant that I may
Not so much seek
To be consoled as to console,
To be understood as to understand,
To be loved, as to love.
For it is in giving that we receive.
It is in pardoning that we are pardoned,
And it is in dying that we are born
To eternal life.” (Prayer reflecting the spirituality of St. Francis of Assisi)
The final symbol that I would like to ponder in relation to logotherapy is that of the Star of David and the Star of the Nativity. Christmas time in all traditions is a celebration of hope and good will. This hope and good will is fulfilled in our relationship with the Transcendent and the Divine who is not distant and far away but with us on our journey though the desert until we reach the Promised Land.
Perhaps these words are ever more significant today, during the suffering that we experience due to the COVID-19 pandemic than ever before.
Two millennia ago, in the small town of Bethlehem, Jesus was born. According to the Gospel of Luke 2:8-16:
“In that region there were shepherds living in the fields, keeping watch over their flock by night. Then an angel of the Lord stood before them, and the glory of the Lord shone around them, and they were terrified. But the angel said to them, ‘Do not be afraid; for see-I am bringing you good news of great joy for all the people” ‘to you is born this day in the city of David a Saviour, who is the Messiah, the Lord. This will be a sign for you: you will find a child wrapped in bands of cloth and lying in a manger. And suddenly there was with the angel a multitude of the heavenly Host, praising God and saying, Glory to God in the highest heaven, and on earth peace among those whom he favours!
When the angels had left them and gone into heaven, the shepherds said to one another: “Let us go now to Bethlehem and see this thing that has taken place, which the Lord has made known to us.”
So, they went with haste and found Mary and Joseph and the child lying in the manger.”
And at the time when Jesus was born, there was a star that marked the place of the manger, which led the wise men on their journey to Bethlehem:
“In the time of King Herod, after Jesus was born in Bethlehem, wise men from the East came to Jerusalem, asking, “Where is the child who has been born the King of the Jews?’ For we observed his star at its rising and we have come to pay him homage” (Matthew, 2:1-2).
And following the star they found the baby and thy paid homage to him.
The star of Bethlehem heralded his birth. The angels sang. And on this holy night, God, yet again, confirmed his never-ending covenant.
God is all mighty, God is all knowing, God is all powerful. In comparison, we are weak, vulnerable, time limited and fragile. Like a speck of dust on the face of the earth. But God does not abandon his people. He has chosen an appointed time in history to manifest himself in relation to us, in a way that we could possibly relate to him most in a personal way.
As we spoke of our finiteness, vulnerability, and fallibility, so we must also speak of suffering, and we must note the concept of the Tragic Triad of pain, guilt, and death that Frankl mentions in Man’s Search for Meaning (2014:129). Pain belongs to our vulnerability, death to our finality and mortality, and guilt to our fallibility.
Suffering uniquely colors our lives and represents an opportunity for expressing our individuality and uniqueness in not only how we experience it, but how we respond to it. Through creative, attitudinal, and experiential values, Frankl described the avenues through which suffering can be turned into a human achievement. The highest challenge, and the highest form of human achievement possible is to find meaning and to live meaning in suffering.
In Frankl’s words, “…In some ways suffering ceases to be suffering at the moment it finds a meaning, such as the meaning of a sacrifice” (Frankl, 2014).
Tragic optimism (and by optimum Frankl meant “the best”), humanity at its best, in the face of tragedy is manifested in the human potential that (1) allows for turning suffering into a human accomplishment; (2) deriving from guilt the opportunity to change oneself for the better; and (3) deriving from life’s transitoriness an incentive to take responsible action” (Frankl, 2019:130).
As we ponder the Star of David, composed of two inverted triangles juxtaposed one on the other, and the star of the Nativity, let us remember that as our suffering is unique although shared with all humanity, the meaning-call that lies in it is also unique that we leave with all humanity.
At Christmas time, let us open our ears, hearts and minds to a call that transcends time and space, and which resonates on our inner selves: “We are wonderfully designed, eternally loved, and awaited!”
To close with Frankl’s thoughts:
“It is only in the image and likeness of God that we understand ourselves (Frankl, 1951).
“It is only to the extent to which we transcend ourselves that we actualize meaning” (Frankl, 1972).
Frankl, V. E. (1951). Logos und Existenz. Vienna, Austria: Amandus Verlag.
Frankl, V. E. (1972). Der Wille zum Sinn. Vienna: Huber.
Frankl, V. E. (2014). Man’s search for meaning. Boston, MA: Beacon Press, Boston.
Frankl, V. E. (2019). Yes to life in spite of everything. Boston, MA: Beacon Press.
Lukas, E. (1994). Alles fught sich und erfullt sich. Stuttgart: Quell.
Lukas, E. (2020). Living Logotherapy. Logotherapy Principles and Methods. Bamberg: Elisabeth Lukas Archives.
Klingberg, H. Jr. (2001). When life calls out to us. The love and life of Viktor and Elly Frankl. New York, NY: Doubleday.
Marshall, M. & Marshall, E. (2012). Logotherapy Revisited. Ottawa, ON: Ottawa Institute of Logotherapy.
Marshall, M. & Marshall, E. (2022). Viktor E. Frankl’s Logotherapy and Existential Analysis. Currently in press. Ottawa, ON: Ottawa Institute of Logotherapy.
Bible references are based on the Holy Bible, NRSV (1989). Division of Christian Education of the National Council of Churches of Christ in the United States of America.
Quotations by Teilhard de Chardin, Theresa of Avila, and the poem attributed to St. Francis and are in the public domain.
*This presentation was prepared for the Christmas series of AMES, Alianza Mundial para Encuentros con Sentido, and presented virtually on December 2, 2021.
The COVID-19 pandemic brought Moral Injury (MI) to the forefront of clinical attention and research. This multi-dimensional syndrome has been first described in the military context and is now understood to affect people in other occupations such as health care, business, education, law enforcement, the legal profession, disaster relief, international aid, social justice, as well as other areas of social and occupational functioning. Moral injury occurs when deeply held beliefs, ethical and moral principles have been trespassed. The violation of universal values and personal principles can be committed by oneself or by others. Witnessing potentially morally injurious events gives rise to guilt, shame, remorse, anger, disgust, feelings of betrayal, spiritual struggles and disorientation, loss of meaning, and despair. The secondary symptoms of moral injury may include anxiety, depression, and post traumatic stress. The symptoms of moral injury can vary in intensity and can present from mild to severe, seriously impairing functioning. Moral injury is not considered a mental illness but a syndrome that warrants clinical attention.
Employing a phenomenological hermeneutic method of systematically reviewing pertinent texts, the present study explores the lived experience of moral injury in relation to assessment and treatment methods currently available. Conceptually, research indicates that self care, moral resilience, and social support are linked with factors such as resiliency, post-traumatic growth, and self-transcendence. These factors are correlated with meaning, a key factor in wellness following existential frustration and distress. Thus, a holistic body, mind and spirit approach to the assessment and response to moral injury is warranted.
Viktor E. Frankl’s Logotherapy and Existential Analysis (LTEA) is an evidence-based meaning-centered approach to psychotherapy and counselling that has been successfully applied in the treatment of conditions involving existential issues. The present research examines the contribution of LTEA to the conceptual understanding of moral injury and to its related symptomatology. It details the application of LTEA principles and structured meaning-centered interventions in responding to moral injury. The applications are illustrated with examples that help to position this method into a holistic framework promoting re-connection, renewal, and health.