SOURCE_DOCUMENTS/journal_024_1.txt

115 
The International Forum for Logotherapy, 2001, 24, 1-9. 
HOW TO FIND MEANING AND PURPOSE IN LIFE FOR THE THIRD MILLENNIUM 
James C. Crumbaugh and Rosemary Henrion 
Logoanalysis was originated by the first author, who used special exercises for each step in therapy. 2 Logoanalysis exercises can be found in previous books;2·4 many new exercises are in a new book 

under preparation by the current authors. The book under preparation also offers the psychotherapist or counselor a new approach and new procedures that can be adapted to many treatment situations and which are discussed below. 
The Rogerian-Q 
The Rogerian-Q is a new approach that uses Carl Rogers' Nondirective or client-centered modality. We have modified Rogers' "reflection of feelings" by a technique of questions rather than positive statements, and we have combined it with the Socratic Dialogue. In essence this means that you listen with empathy and reflect to the clients your understanding of what was said -except that, whereas Rogers would make a positive statement, we cast it in the form of a question as to whether we were right. This draws the client into interaction with the therapist more than positive statements that require only a grunt of acceptance. It also leads more readily into the Socratic Dialogue. The latter involves leading the client through your apparent ignorance to create one of the usual rationalizations. Then you zap this rationalization with a question which can be answered only by an inconsistent statement or by admission of error in the defense used. The important point here is the client's conscious awareness of the rationalization and its failure. 
1 
The sting of this failure is removed by the Crurnbaugh-Henrion ecce homo technique, which builds up the client's self-esteem and selfacceptance as a means of strengthening the ego. 3 In the ecce homo technique, the Rogerian-Q is used instead of positive statements. For example, instead of saying "I see that you are gaining self-confidence," the question is asked, "Isn't it apparent to you that you are gaining selfconfidence-wouldn't [what you have just said or done] show this?" Getting clients to express signs of self-esteem or self-confidence often is more effective than telling them that you or somebody else sees this. 
Herein lies the basic approach to the use of the Socratic Dialogue in the present context: Socrates led his adversaries to trip themselves by innocent, non-hostile questions. These questions followed from his having drawn them out through playing the recessive role by asking them for clarification of their statements as if they were teaching him. When the time was ripe he would zap them with a question to which the answer was obvious from their previous statements, and which would require them to answer as he wanted, or to admit having drawn a false conclusion. 
At this point why not try out the Rogerian-Q technique by getting a peer to play the client with a problem? Do that before reading further ... 
. . . Now having practiced it, don't you feel more secure in eliciting the desired response from your client? No? Have you practiced it enough to be sure? Aren't you by the simple process of participating in this dialogue gaining more self-confidence than you had in the beginning? Perhaps? Doesn't "perhaps" show a gain because it is more than you started with? No? Do you have any proof that you are not gaining anything? No? Isn't that because you can never prove a universal negative? Right? So now don't we agree that you might be gaining something after all? MightPerhaps? Isn't that good-on the positive side? For the sake of the discussion? Okay? So we agree on something now, and you'll suspend judgement until we have more data? Great!! Oops-We mean, isn't that great? 
There is one caveat in the use of questions rather than positive statements. Recent research indicates that questions may not work well with involuntary clients (prisoners and others who may be evaluated against their will). 1 Such clients tend to reject questions, but to accept positive statements. The latter represent authority, whereas the former are interpreted as "wimpy." 
2 
A Thumbnail Sketch of Logoanalysis 
In order to orient you better to our methods, we will now present a thumbnail sketch of logoanalysis. From this you could, if you wish, try out our modality, in part or in whole, along with your usual techniques. We present here a minimum of theory, since we aim here only at actual practice and a primary focus on "everyday people" who have emotional problems. But psychotherapists can use our methods in treatment of many neuroses, as we have done. The methods are not designed for use with psychotics, although we have had some success in combining modified forms with procedures for psychotic patients whose psychosis was in remission. (Even though these latter patients did not feel fully responsible, they did feel that the logoanalysis program offered them something from which they could benefit.) 
We always begin by taking a case history that is not remarkably different from the forms in wide current use. Then we evaluate the current "therapeutic condition" of the individual. That is, what are the special needs of this person at this time? If the needs indicate that psychotherapy should be provided, we discuss this and offer the therapy (or suggest referrals). If the individual seems to need only counseling in handling typical everyday emotional problems we first evaluate any degree of depression and any form of grief involved -this needs to be alleviated before treatment begins. Before we enter any actual therapy, we insist that the client go for a medical examination by a professional qualified to evaluate any medical needs. 
Following the introductory procedure in dealing with depression and grief, we proceed with the steps which we believe to have been most effective over our years of experience. Exact application of these steps is not chiseled in stone; we believe as Frankl did that the ingenuity of the individual therapist or counselor is of paramount importance in effective results. Therefore we will sketch below in rather broad outline the steps we use. But to see how they fit our concept of logoanalysis we will first note the general principles of this modality. 
The Basic Axiom: The Will to Meaning 
The basic axiom of both logotherapy and logoanalysis is: the fundamental need of humankind beyond the primary biological needs is what Frankl called the Will to Meaning. This is the universal (although most often unconscious) striving to make meaning of the sum total of conscious experience; to find an interpretation of it all which will give one a feeling of having a place in life that makes it worthwhile and reveals 
3 
that this individual counts (that it makes a difference that this individual lived at all). Most people have from time-to-time half-conscious questions: Who am I? Why am I? What am I? Why am I here? What is the meaning of life in the first place? And finally: Why is there something instead of nothing at all? Our axiom takes a strong position that everyone has a meaning that counts. If we can just discover that meaning in relation to these questions we will know that we count. The therapist or counselor helps the client to discover it. 
The Basic Method: Dereflection 
The basic method in both logotherapy and logoanalysis is Dereflection: reflecting attention away from the failures and inadequacies and deficiencies of the individual and toward remaining assets in which meaning can exist. These assets always do exist but are usually hidden by the emotional reaction to the immediate problem. They are hidden until the individual can transcend to the human spirit level. These assets are capitalized upon to clarify meaning and purpose in life in spite of the negative factors. 
The Basic Technique: Socratic Dialogue 
The basic technique in applying Dereflection is the Socratic Dialogue. Both logotherapy and logoanalysis use Socrates' method of aggressive questioning in pursuing point-by-point every subtle but firm and dogged question. This was not done harshly but with the sincere attempt to understand adversaries. Therefore Socrates would ask them to explain how he might support their position if he adopted it himself and were challenged on the various points that could be raised. The opponents would take the bait and eagerly expand the argument. But at each point Socrates would ask how the position could be supported if he adopted it himself and were challenged on the point. Gradually he would allow them to paint themselves into a corner and force them to admit that there was at least something on the other side. 
It should be noted that in our application of the Socratic method clients are not to be thought of as adversaries, but rather as people to be helped to find the truth. In order to do this it is necessary to elicit vulnerable areas in their thinking. When they see that their position requires modification we are there to help them. 
4 
The Basic Motivational Method: Attitudinal Value 
The basic motivational method in both logotherapy and logoanalysis is the Attitudinal Value: the value involved in taking a positive rather than a negative attitude toward a situation which, while deplorable, is unchangeable. There are two basic attitudes we can take in such a situation: positive or negative. The negative causes us to be washed out immediately, for it offers no defense. The positive is more difficult, but it gives us a chance in even the worst of circumstances. It causes us to examine whatever assets we have in spite of the situation. We may say at first that we have no assets, but this is never actually true. We may have to depend on someone else to help us see them, but they are there. Logoanalysis is a plan to help us explore these and to see how we can use them in spite of our situational handicaps. 
Two illustrations of the Attitudinal Value were presented (though not under this name) in a lighter vein by Reverend Scott Carter, Pastor of Leggett Memorial Methodist Church in Biloxi, Mississippi: 
First illustration. This story has been sometimes attributed to Henry Ford. Whoever did tell it first made a very fundamental psychological point. Two men were contemplating an outrageously difficult task for which they were equally qualified. One said, "I absolutely cannot possibly do that-it is absolutely unreasonable." The other said, "I absolutely can do that-it is unreasonable, but I can do it." Both were entirely correct. 
Second illustration. A well-digger returned at night to the partially dug well to retrieve a tool he had forgotten and left at the bottom. He let himself down by a rope into the twelve-foot depth, picked up the tool, and started to climb out. The rope broke at the top mooring, however, and he had no other way out of the oldfashioned, several-foot diameter depth; therefore he sat down in the edge of the soft muddy bottom and waited for the dawn when, hopefully, he could get someone to hear his cries for help. 
Half an hour later another man came along. But he did not see the well in the dark and fell into it. The soft mud at the bottom cushioned his fall, and he was not badly hurt, but he could not climb out. He did not see the first man at the edge of the depth; and being a religious man, he began to pray loudly: "Help me, Lord! You know I can't get out of here. This is like a grave, and I am terrified! There is no way I could climb out!" 
The well digger silently arose behind him and placed his hand on the man's shoulder. "You are absolutely correct, Sir. There is no way that you can get out of here." 
But he did. 
5 
When we are under pressure we may either give up or expend extra strength. We are naturally tempted to quit trying unless we can see a reason to strive (a purpose or meaning). Here the counselor enters: to help us to see this reason to strive, to explore our assets which we have overlooked in the heat of emotional stress generated by the problem, to see how we can take the high rather than the low road as we are made aware of our assets, and to view the glimmer of hope in overlooked avenues in spite of the problem (in fact, more than a glimmer as we look carefully at our assets). 
The Basic Task: Exploring Personally Important Values which will Make Goals Attractive 
When clients are ready to get down to the nitty-gritty of going after these new goals, they are then guided in exploration of their personally important values which will make these goals attractive. In logoanalysis this can be done by use of the MILE form (the Meaning in Life Evaluation form.)4 It is not a formal psychological scale, but a series of check-lists of the major values which we have found over many years to cover the psychological needs that people normally have. The MILE form helps order these values so as to objectify how they operate in the individual. The MILE form reveals the major specific values that underlie one's emotional structure or psychodynamics. These are explored with the client, who then makes a list of all possible specific goals which could fulfill each value. 
Procedures for Obtaining Cooperation 
Our procedures in obtaining cooperation in doing each exercise follow this basic pattern: Once the client gets into the actual exploration of specific goals as possible avenues in fulfilling given basic values, our procedures take the form of a series of inspirational devices used with most of the exercises. In the book in preparation by the present authors all chapters end with one or more exercises, and the inspirational devices are designed to motivate clients by drawing them continually back to PRESS ON. 
6 
PRESS ON 
NOTHING IN THE WORLD CAN TAKE THE PLACE OF PERSISTENCE. TALENT WILL NOT; NOTHING IN THE WORLD IS MORE COMMON THAN UNSUCCESSFUL MEN WITH TALENT. GENIUS WILL NOT; UNREWARDED GENIUS IS ALMOST A PROVERB. EDUCATION WILL NOT; THE WORLD IS FULL OF EDUCATED DERELICTS. PERSISTENCE AND DETERMINATION ALONE ARE ALL POWERFUL. Author unknown  

Each inspirational device is presented with the assurance that help is continually at hand if needed. Usually one device per session can be achieved, but clients are to work at their own pace. Remember that the Rogerian-Q technique is used throughout. 
Here are the devices in the order of presentation to the client: 
POP-1: Persistence Occasions Praise 
We start by explaining how this slogan is to be used in persisting with the first selected goal. At each step clients take that shows even a little positive promise they are to congratulate themselves and to make notes of the occasion to present at the next counseling session. When the progress is presented at the session, the professional and peers heartily praise them further. But, what if the step fails and shows only negative promise? Then clients are referred to the device FORE. 
FORE: Failure Only Raises Effort 
If only negative promise is made toward the first selected goal, comments such as the following are made: "Hey, who said you should never fail? The person who never fails has never really tried anything. You know the old aphorism, 'If at first you don't succeed, try try again!"' Of course, if you encounter too much resistance, it is best to go on to another goal, at least for the present. If necessary, simply find a related goal for which you know success will come. Then you can go on to PED. 
PED: Praise Evokes Determination 
We note even slight successes here and go ahead with another simple goal which the client will successfully achieve, and praise that. If necessary, return to FORE. Here, as with any step, it may be necessary to return to an earlier one before going on. 
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DEP: Determination Evidences Purpose 
When determination is finally evident in any goal, no matter how simple, the goal will relate to some meaning and purpose that, in turn, relates to some value. Here the counselor praises the client for showing the determination necessary to approach the goal, and explore for the purpose and value related to this goal. 
PEP: Purpose Enables Performance 
Evidence of purpose will be accompanied by performance of some degree, and most likely the performance will be goal-oriented toward a purpose based on one of the individual's highly rated values (in the MILE form). This is noted by the counselor's questions with praise for performance relating to an expressed need. (Remember that in Rogerian-Q positive praise is expressed by questions that ask the client if this performance doesn't clearly show a success that is worthy of praise. If the response is no, question whether the counselor's feeling to the contrary is not obvious.) 
POP-2: Performance Ordains Power 
In questions that confirm the client's performance as showing a degree of mastery or power it is important to ask if a degree of feeling of increased power over the problem has been felt. If not, question whether the counselor's feeling that the client has gained some power has been noted by the client. Further questions should delve into the client's feelings to show evidence from performance that increased ego strength and control over the presenting problem has occurred. 
PADAAP: Persistence And Determination Are All Powerful 
This takes us back to PRESS ON. Each of our devices is a step in fulfillment of this PRESS ON paragraph. As the client reaches PADAAP the fulfillment of the objectives of logoanalysis is approached. The completion is determined by evaluation of the client's response to the presenting problem-when a client has shown adequate handling of this problem discharge is at hand. But usually it is necessary to work through at least several of the device sequences relating to several of the values revealed in the MILE form. 
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PON: Press On Now 
This is the exhortation that is left with the client for the daily repetition of a copy of PRESS ON. It is a good idea to write the devices consecutively on a 3x5 card and give them to the client to check off each one as it is reached. A new card will be needed for each new goal the client chooses. 
PON 
Again we would note that you may find all or only a sliver of these devices palatable in your particular practice. And you may create many improvements (to which we are always open). So add your creative genius to our initial efforts and let's see with what we come up. 
PON!! 
JAMES C. CRUMUMBAUGH, Ph.D. [140 Balmoral Avenue, Biloxi, Mississippi 39531 USA], Clinical Psychologist, is senior author of the Purpose-in-Life (PIL) test and author of several books. He is a Diplomate in psychotherapy with the American Board of Psychological Specialties, and he is a Diplomata and Fellow of the Viktor Frankl Institute of Logotherapy in the USA. 
ROSEMARY HENRION, M.S.N., M.Ed., R.N. [19 Wen Mar Avenue, Pass Christian, Mississippi 39571 USA], Mental Health Professional, has authored publications on /ogotherapy and has presented many education courses on /ogotherapy. She is a Dip/ornate of the Viktor Frankl Institute of Logotherapy in the USA and a long time member of the International Board of Directors of the Viktor Frankl Institute of Logotherapy. 
References 
1. 
Brodsky, S. L., & Lichtenstein, 8. (1999). Don't ask questions: A psychotherapeutic strategy for the treatment of involuntary clients. American Journal of Psychotherapy, 53, 215-220. 

2. 
Crumbaugh, J.C. (1973). Everything to gain. Chicago: Nelson Hall. 

3. 
Crumbaugh, J.C., & Henrion, R. (1994). The Ecce Homo technique: A special case of dereflection. The International Forum for Logotherapy, 12, 1-7. 

4. 
Crumbaugh, J. C., Wood, W. M., & Crumbaugh, W. C. (1980). Logotherapy: New help for problem drinkers. Chicago: Nelson Hall. 


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The International Forum for Logotherapy, 2001, 24, 10-12. 
A HOMEOPATH LOOKS AT SOMATIC MANIFESTATION OF NOOGENIC NEUROSES 
lrmeli Sjolie 
Logotherapy is used by many professionals (teachers, counselors, ministers, sociologists, etc.) who have never seen a medical textbook and are not familiar with the human body --how it is constructed (anatomy), how it functions (physiology}, and what happens when it stops functioning as it should (pathology). On the other hand, many physically oriented therapists have become very popular (homeopaths, acupuncturists, dieticians, osteopaths, etc.), and these therapists are not familiar with the noetic dimension of the human being. I wish to make the connection between the noetic and the somatic dimensions clear for both these groups so that they can help their patients better. 
As a homeopath myself, it is interesting to look at logotherapy's view of the human being and to understand that we exist not only in the psychic and somatic dimensions but also in the spiritual one. In the noetic dimension, conflicts can arise leading to frustration and even noogenic neuroses. Many patients somaticize their noogenic neuroses, presenting a great variety of physical symptoms. 
Somaticizing symptoms is a way the organism has of finding a new homeostasis and surviving with the neurosis. A skin rash, therefore, might be connected to a noogenic neurosis. Treating it with cortisone ointment may make it disappear, but it will not cure the cause. The organism may develop a new symptom until the underlying cause is eliminated. 
The present paper aims to make therapists more aware of the fact that the origin of a physical symptom may be in the noetic dimension. In such cases, unless the "maintaining cause" is removed, no permanent cure can be achieved. I also wish to make logotherapists, who are highly concerned with the spiritual dimension, aware that a physical complaint of the patient may be connected to the conflict they are treating. 

10 
The Human Being as Viewed by Homeopathy 
Homeopathy is a "holistic therapy" teaching that human beings function on the mental, emotional, and physical levels simultaneously. It teaches that a dynamic "life energy" called "dynamis" flows continually through the individual, regulating all functions. As long as dynamis functions well the person is healthy. However, trauma can bring dynamis out of balance, and sickness arises. Homeopathy always treats the whole person, trying to find a "constitutional remedy." 
Homeopathy was developed by a German Physician, Samuel Hahnemann, M.D. (1756-1843). He rediscovered an old medical truth "like cures like" or, in Latin, "sir.1ilia similibus curentur" which means that the symptoms a substance causes in healthy individuals, the same substance cures in the sick! The name HOMEOPATHY comes from the Greek: homeo = like and pathos = suffering. It is a principle exactly opposite the one conventional western medicine uses. For example, in diarrhea homeopathy gives a remedy that causes diarrhea in a healthy person, but conventional medicine gives a medication to stop it. 
Hahnemann spent his life developing homeopathy, proving remedies, and writing about the symptoms they caused in the provers. These facts are collected in books called Materia Medica. He also listed all possible symptoms and which remedies presented these symptoms. These books are called Repertories. 
In those days many medicines were extremely toxic, like mercury for example. He decided therefore to dilute his own, and to his amazement they worked very well. This process is called "potentising," diluting and shaking over and over. 
In short, the homeopath interviews the patient to determine all symptoms, finds the remedy that presents the same symptom picture, and prescribes it to the patient. The homeopath uses the following rules: like cures like, remedies are proven by healthy individuals, only one remedy is given at a time, and the potency is chosen individually. 
Logotherapy and Homeopathy 
Logotherapy adds to homeopathy the noetic dimension and the understanding of it, helping the homeopath by explaining that the maintaining cause might be in the noetic dimension. I should say logotherapy brings to light the spiritual dimension which, I believe, in homeopathy is insinuated but not so clearly stated. 
When we compare what Hahneman said in his definition of health and what Frankl said about the lack of meaning in a person's life, we can 
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see that they are saying the same thing, but in reversed ways. Hahneman said "health is freedom to fulfill our higher mission here in life." Consequently, sickness is limitation of freedom. When our freedom is limited by pain, negative feelings, obsessions, fears, anxiety, etc., it is much more difficult for us to fulfill our mission, meaning, or purpose. Frankl said "lack of meaning in life leads slowly to sickness." 
Somatic Manifestations of Noogenic Neuroses 
We can say that noogenic neuroses are the final fight of the individual against the total existential vacuum. They are the struggle against isolation, suicide, and death. If life has no meaning, then pleasure, material goods, or social gratification cannot fill it! 
Energy that was meant to be used in fulfilling the higher mission in life is transformed into an incredible anxiety. This is expressed in varied forms, many times somatic symptoms. 
Some general somatic symptoms: 
Chronic fatigue, tremors, stammering, perspiration, insomnia, and weight loss. In the respiratory system there can be asthma. In the digestive system there can be nausea, vomiting, gases, diarrhea, constipation. In the urinary system there can be frequent urination, cystitis without bacteria, and enuresis. In the reproductive system there can be frigidity, impotence, and dysmenorrhea. In the circulatory system there can be palpitations, arrhythmias, and hypertension. On the skin there can be excemias, urticarias, rashes, and itching. 
Logotherapy helps the patient to find meaning and to execute necessary changes. Here homeopathy complements logotherapy very nicely, since after the right remedy in administered it gives the patient energy to make necessary changes in life. 
IRMELI SJOLIE, B.Sc., Dipl. Homeopath [Laivurinkatu 39 A1, 00150 Helsinki, Finland] is a recent Dip/ornate of the Viktor Frankl Institute of Logotherapy. She is the principle teacher of Homeopathy at Kairon, the Finnish Institute for Natural Medicine. 
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The International Forum for Logotherapy, 2001, 24, 13-15. 
HEALING AND GROWING AS A LOGOTHERAPIST 
Florence Ernzen 
There is an expanding interest in therapies that draw on the resources of the human spirit as a resource for healing. Logotherapy has as its foundation the acknowledgment of the "treasure chest" of the spirit as a resource individuals draw on for health. How do logotherapists refresh their own spirit so they continue to grow and develop? Dr. Elisabeth Lukas tells us if we do not live logotherapy, we cannot do logotherapy. Dr. Paul Welter reminds us to continue our search for meaning or we will be empty. With these thoughts in mind, letters were sent to many logotherapists asking them to consider the thoughts of Dr. Lukas and Dr. Welter, and they were invited to respond to three questions: 
• 
Are there some spiritual and/or physical exercises that you incorporate into your day that influence your professional practice? 

• 
Who are the authors you to turn to for inspiration? How have they influenced you? 

• 
How have your students, colleagues, and clients helped you to continue to heal and grow? 


Logotherapists responded in many different forms-letters, telephone calls, and e-mail. These responses were presented at the Twelfth World Congress of Logotherapy in Dallas, Texas. The responses of these therapists reaffirm the thoughts of Lukas and Welter. Successful logotherapists take time through exercise and reflection to restore their own spirits. They turn to many authors for inspiration and insight. They recognize the great gifts of their clients and they celebrate these gifts. The attached table presents a summary of the comments submitted. Readers may wish to consider their own reflections on the questions. 
Florence Ernzen, MSW (46461 Arboretum Circle, Plymouth, Ml 48170 USA; e-mail PFERNZEN@mediaone.net] is a Dip/ornate in Logotherapy. 
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..... 
~ 








How Clients & Colleague~ Exercises 
How They lnnuenced You
Authors for Inspiration
Name Spiritual or Physical Helped You to Grow 
----~------·-~-----f-· Rosemary llenrion. RN 
. Inspiration. incorporated 
. ldcnt1IY areas for Diplomate in Logotherapy 
• Philosophers. Inspirational and values 
persona I growth ! . Literature 
meditative exercise . Bible . Approach is therapeutic 
for clients & therapist
• 
Courageous role models 

• 
History: civic & militaf) 


Jacqueline Liguzinski, • Inspiration 
. Children range of ACSW 
• Rowing machine • Albert Camus experience• Courage• Reflection & meditation • Frankl • Ability to rncne in and. Focus on good thoughts 
• 
Abraham Lincoln 


out of feelings. Joy of moment 
• 
Music 

Robert HutzelL Ph.D. 
"Cigar Time .. 
• Philosophical view of 
• Challenging questions Diplomate in Logotherapy 
• Frankl
• 
life 
• Daily opportunities for meditation 
• Contemplation & 
• Authors and Journal 
• Inspiration meaning fulfillmentarticles • A ffirrnat ion• Reframe Issues 
Patricia Haines, Ph.D. 
• Wonderful abilit~ to tell . Courage• Walking • James Yoder 
Diplomate in Logotherapy a story 
• Tramcendencc books 
. Read daily meditation • Robert Frost • Courage & inspiration Spiritual truths 
• AA meetings Sharing
I :
• Painting I 0 Validation 
... 
01 
'liame  Spiritual or Ph~sic11I Exercises  Authors ror Inspiration  How The~ lnnuenced You  How Clients & Colleagues Helped You to Grow  
'vL,nha Sta,ro,. ACSW Diplomatc in l.llgotherap;  . Dail; exercise • 5:30 a.m. in gym. Hour in the silence  • •. •  Jon Kabat-Zinn Thich Nhat Hahn Sog)al Rimpoche Andrew Harve)  • Inspiration • Changed life • Influenced practice  . Choice in the moment • Overcoming • Courage  
Inge Van Pelt. MD  • Earl) morning  •  Dietrich Bonhoeffer  • Strength  A,,e•  
Diplornak m l.ogotherap)  mindfulness cxeruscs Yoga. Sc-ripture reading  • • • •  Viktor Frankl Poetry Dr. Suess American Indian wisdom  • Jo; • E.xcitement • Freedom  • Increased understanding • Joy  
Jim I.anti. Ph.D. [)iplomatc in Logotherap)  • Fishing • Writing Poetry • Jesus prayer  • •  Poetry Frankl  . Honor the meanings and meaning potential  
Paul Welter. Ph.D.  . Walking Intercessory  .  Pau I T ourn ier  • Help  . Expand the view  
Diplomatc in Logothcrap)  prayer • Scripture reading • Break fast and prayer group • 25 years. Meditation  • • • • • •  CS Lewis Henry Nouwen Frankl E. Lukas George MacDonald Ellis Peters  • Inspiration • Direction • Understanding the larger world  • Discovery of strengths and weaknesses  
krry Long. Ph.D.  • Daily ph}sical exercise  •  V. Frankl  • Lessons  • Instruction  
Oiplomate in l.og.otherap)  • Meditation • Prayer  • • •  R. Bach Ernest Hemingway Deepak Chopra  • New under;tanding  • Open hean & mind  
f·lisabeth Lukas. Ph.D. Director. South German Institute of Logothcrapy  . 10 minutes of silence . 30 minutes of piano. I hour walking  •  Many authors  . Clients give more than I have given to them  

The International Forum for Logotherapy, 2001, 24, 16-19. 
LANGUAGE AND SELF-DISTANCING 
William M. Harris 
The hospital where I work used to have a very special diabetes unit. There people who had diabetes went to school for four days to learn how to manage their disease. It was an excellent program which combined individualized training by specialists in a wide variety of fields including nutrition, nursing, stress management, and foot care. I even had a small part in the program by sharing a few ideas about accessing religious support systems. 
The program had a full time psychologist who taught classes. She also had individual counseling sessions with each of the patients and their families. The program suffered a severe blow when the psychologist resigned. As hospital chaplain, I was asked to fill in for the unit psychologist for a few weeks until a new psychologist could be found. 
I had not been working with the Diabetes Training Program very long when I observed that patients reacted differently to one nurse than they did to the two others. Shelly (all names are fictitious) was actually a little reticent around other people, yet the patients responded much better to her. They seemed to pay much more attention to what she said. It took me a couple of weeks to figure out why. 
The other nurses told patients, "You are a diabetic." Shelly always said, "You have diabetes." It was a very subtle difference, but it seemed to make a significant difference to the patients. 
Apparently I was the only person to notice this difference in language. So I proposed that we try an informal experiment. Everyone on the unit would tell a patient that they were a diabetic on the first two weeks of the month. Then everyone would use the language of "having diabetes" on the last two weeks. It was very difficult for our staff to break old habits and speak the "right way" for the time of the month. 
Compliance is one of the greatest problems in treating people who have diabetes. Patients and their families may know what to do to control their disease, but all too often they begin to chafe at the restrictions of diet and inconvenience of scheduling. Before long they are eating things they shouldn't, doing things that harm themselves, and not paying attention to the details of managing their disease. This 

16 
noncompliance may eventually lead to a series of diabetic crises. These crises may include untimely visits to the emergency room, deterioration of various organ systems, pain, unwanted surgeries, and significant disruption of family life. 
The new psychologist came on board during the second month of the experiment. She quickly began a follow-up process to evaluate patient compliance in a more disciplined way. The results were impressive to the staff. It was not long before the unit Director issued orders that everyone on the unit was to be careful of the language they used. A person could have "diabetes" or a "diabetic problem", but no person was ever to be called a "diabetic." There were a few staff grumbles about political correctness, but we noted that the patients were becoming much more effective at keeping compliant with their prescribed medical routines. 
This experience happened long before I ever began learning about logotherapy. Frankl teaches that self-distancing is useful for symptom control. 1 P-57 It is essential, for instance, in the use of paradoxical intention. A person cannot laugh at themselves (i.e., have perspective about themselves) if they cannot see a difference between their self and their symptoms. 
What I learned from this little "experiment" is that the language we use is very important in whether patients see themselves as distinct from their disease. Yet we professionals often use a disease to describe a person. I remember a time when a nurse might speak of "the gall bladder in room 23." I am grateful that this type of talk is very rare in that profession today. Yet still we say that a certain person "is a diabetic." We call a young man "a schizophrenic." The old woman is "an arthritic." 
Use of Labeling 
Certain behavioral health practitioners, especially family systems therapists, have fiercely fought the "labeling" of people. They have done battle with those who assert that it is necessary to have a diagnosis in order to treat a person. It is not possible to responsibly treat a person's disease without a diagnosis of what you are treating. Yet the argument rightly claims that diagnosis (sometimes) is used to label people. This labeling is dehumanizing and unfair. 
Labeling occurs when a person is described as being their disease. Diagnosis occurs when you describe the illness that a person has. It's a very subtle difference but it makes a huge difference in how a patient is perceived and treated. A person is never a "COPDer," but some people do have Chronic Obstructive Pulmonary Disease. 
Health care professionals run the risk of unprofessional behavior when they lapse into sloppy use of language. When we call a young man who has a paralysis of the legs a "paralytic" we run the risk of inducing an 
17 
iatrogenic perception of his condition. This may lead him to stronger denial of his condition and greater resistance to learning what he needs to know to cope effectively with life. 
In my experience, labeling is most likely to occur when a person has an illness that is either chronic or affects many dimensions of life. This is the reason that we are particularly likely to use labeling with people who have severe and persistent mental disorders. But no human being is a schizophrenic. Some people, however, do suffer from a brain disease called schizophrenia. 
People who have serious psychiatric disorders typically develop low self-esteem. This self-perception is often a severe barrier in treatment. The person often struggles with even wanting to fight the disorder because "I'm not worth it." Mental health practitioners work hard to help people who suffer mental illness to overcome this barrier of low selfesteem. 
When a person is described as their disease, several things happen. Their self-esteem suffers. They may surrender to the disease and quit trying. Or they become more resistant to treatment because they do not want to see themselves as being a disease. Some of the very first empirical research in pastoral care was done with people who had cancer. 3 It was observed that women who say, "I have a cancer in my breast" were more likely to survive than those who said, "I have breast cancer." The former group was using language that separated themselves from their disease, while the latter was accepting that their disease was already a part of them. 
Lukas suggests that clients can be led to separate themselves from their symptoms by Socratic dialogue or by the Appealing Technique.2 Proper use of language to describe a disease process is an attempt to get clients to think about the disease from the outside so they do not identify with the disease. 
An Exception to the Principle 
I have come to believe that there is only one exception to this principle that a person should never be called by his or her disease or disorder. This exception is for those who suffer from substance abuse. For a long time I was troubled that people addicted to alcohol were being taught to say, "I am Joe. I am an alcoholic." I was concerned that this was debilitating language that emphasized incapacity rather than pointing a person toward health. 
Dishonesty, especially self-delusion, is so much a part of substance abuse. Recovery is virtually impossible if the client does not face the reality of substance misuse, of allowing this misuse to hurt others, and of harm done to self from misuse. Furthermore, recovery requires a 
18 
recognition that the client's problems cannot be blamed on other people or circumstances. 
Self-deception is a very common and crucial problem in the treatment of substance abusers. The abuser's behavior must be lovingly yet bluntly confronted. Anything else is likely to be heard as giving permission for the addict to make excuses for his or her behavior. The language "I am an alcoholic" or "I am an addict" contains the bluntness needed to confront the addict's tendency toward self-deception. 
I believe the treatment of substance abuse is the only exception to the general rule. Logotherapists are particularly sensitive to the importance of self-distancing as a useful part of helping people help themselves. The language we use regarding our clients plays an important part in our ability to help people self-distance from their symptoms. 
WILLIAM M. HARRIS, D.Min. [309 Main, Willard, Missouri 65781 USA; KAODGK@aol.com] works full time as a chaplain at Cox Health Systems in Springfield, Missouri. He has recently become a Dip/ornate in logotherapy. 
References 
1. Frankl, V. (1978). The unheard cry for meaning: Psychotherapy and humanism. NY: Simon & Schuster. 
2. 
Lukas, E. (1979). The four steps of logotherapy. In J. Fabry, R. Bulka, & W. Sahakian, (Eds.), Logotherapy in action (pp. 95-103). NY: Jason Aronson. 

3. 
When I first began studying pastoral care some 35 years ago, this series of studies done in the 1920s and 1930s was frequently quoted by my teachers. They were quoted then to cite a shift in pastoral care from the strict use of theological resources to the admission of the empirical study to inform pastoral care giving. Unfortunately, I have been unable to find the original studies to give proper credit to the authors. 


19 
The International Forum for Logotherapy, 2001, 24, 20-24. 
SAYING "THANK YOU": ON THE ROLE OF GRATITUDE IN LOGOTHERAPY 
Stefan E. Schulenberg 
One way that a person may derive meaning is through the expression of gratitude. Although gratitude has been noted to be an important aspect of logotherapy,1 little has been written about the concept in the logotherapy literature. The article below highlights areas of gratitude that are especially important for logotherapists, drawing from my personal and professional experience. 

A Personal Experience with Gratitude 
While working toward a Bachelor of Science degree in Psychology, I enrolled in a Psychology and Law course. Throughout the course, one instructor in particular demonstrated a consistent enthusiasm and was an excellent teacher overall. She inspired me to learn more about the field. She encouraged me to volunteer as a research assistant for a project geared toward assisting under-served individuals and families who had been negatively influenced by violence. While working on this project, I began applying to doctoral programs in clinical psychology. She provided advice and feedback during this process. Her assistance was invaluable. Not long after, she died from an illness. 
My former instructor left an indelible impression on my career. The research experiences that she encouraged me to pursue validated my goal to become a psychologist. Through her belief in my potential to become a mental health professional, she inspired me to strive constantly to learn more. By observing her work ethic and her enthusiasm, I learned a great deal about how to make the most of the life that I have been given. Yet, I felt an inner tension because I never had the opportunity to say "thank you." She never knew that I was accepted into a doctoral program. I never had the opportunity to tell her what this acceptance meant to me. 
Over the next few years, as I went through my graduate studies, I was aware that I wanted to do something to show my appreciation for my former instructor's impact on my career, but I was never quite sure how to go about it. My Master's thesis was very challenging, taking much time 
20 
and energy to complete. However, I felt a strong sense of purpose and reward because I dedicated my thesis to the memory of my former instructor. 
I presented my thesis at a psychology conference. By coincidence, the day of my presentation was the day before the written comprehensive exams began in the department of my graduate program. These exams lasted four days, and covered every major area of psychology we students had studied. Driving home late from the airport the night before exams, I was physically and emotionally exhausted from months of preparing, as well as from my recent travelling. Although I felt prepared, I did not know how I was going to find the energy to successfully complete the exams. I recalled the confidence that my former instructor had in my ability. I decided to dedicate my performance on these exams to honor her memory. This dedication provided me with energy that carried me through the four days of testing. 
I had dedicated two endeavors to my instructor's memory. Still, the gratitude I felt was not sufficiently expressed somehow. 
Shortly thereafter, I presented a psychology and law paper at a meeting in New York. While going for a walk one evening, I came across a spot overlooking Long Island Sound. It looked as though someone had broken open a tube of dark blue paint, smeared it across the sky, and the paint had not yet dried. I could hear the waves lapping against the shore, and there was a gentle breeze. I do not know how long I stood there, thinking. I felt a connection to my former instructor because the meeting was directly related to our mutual professional interests. The scene overlooking Long Island Sound afforded me the opportunity to say what I needed to say. I quietly said, "thank you." 
The Role of Gratitude in Logotherapy 
It has been written that logotherapy should be tested through living.7 Logotherapy is not only a philosophy and a form of psychotherapy, it is a way for a person to live a meaningful life. My personal experiences, described above, are one illustration of how logotherapy may be lived. 
The implication for logotherapists is that, in certain instances, it is important to assist clients with deriving meaning through the expression of gratitude. The expression of gratitude can afford clients valuable opportunities to seize meanings of the moment, solidifying their sense of purpose in life. 
Gratitude can also be a way to achieve transcendence. When a person demonstrates heart-felt gratitude, he or she moves beyond selforientation to focusing on those around them. Being able to demonstrate gratitude affords a person the opportunity to create, to experience, and to maintain healthy attitudes. 
21 
It may be important for logotherapists to help clients identify feelings of gratitude, not only in cases of overcoming the tragic triad of suffering, guilt, and death, but also in cases where clients have difficulty being responsible to themselves and to the larger society. For instance, gratitude may be a useful technique with clients diagnosed with oppositional defiant disorders, conduct disorders, or antisocial personality disorders. 
In some circumstances, gratitude may need to be taught, particularly when a client is struggling with the identification of gratitude and how that gratitude should best be expressed. In cases where the person who is the focus of gratitude cannot be thanked, as is the case with death, the expression of gratitude may be frustrated, complicating the grieving process. In these instances, it may be necessary to foster a change of attitudes to help clients focus on what they can do to express their feelings of gratitude. 
Gratitude: A Fourth Pathway to Meaning? 
The question has been posed by Coetzer as to whether gratitude is a fourth way to discover meaning, the other three being creations, experiences, and attitudes.8 Coetzer's article is important and has been 
13
discussed elsewhere in the logotherapy literature.9· 
One view as to whether gratitude, in and of itself, is a fourth pathway to meaning can be taken from the definition of gratitude. "Gratitude is an emotional state and an attitude toward life that is a source of human strength in enhancing one's personal and relational well-being." 6• P-55 Thus, gratitude may be viewed as an attitude. Therefore, it is indeed a pathway to meaning, although not a separate category of meaning in and of itself. 
As an attitude, gratitude effects the other two categories of meaning: experiences and creations. For example, the gratitude that I felt for the advice of my instructor assisted me in completing my Master's thesis, as well as in maintaining the positive attitude that helped guide me through written comprehensive exams. Moreover, the expression of gratitude by uttering the words "thank you" allowed me to derive a greater sense of personal meaning from the experience of my environment. 
Future Research on Gratitude and Logotherapy 
Gratitude is not a heavily investigated concept in the general psychological literature. For instance, it does not have its own entry in a recent dictionary of psychology.4 However, the interested reader should 
11
be aware that there are some contemporary investigations available.6· The time may be right for systematic research to be conducted in the area of gratitude and logotherapy. 
22 
Gratitude is an important construct, but how does one assess it? An examination of the PsyclNFO computerized database, and a review of a 
3
compendium of instruments for clinical practice,2· failed to reveal any gratitude assessment measures. Indeed, there does not seem to be a gratitude measure available in the research literature (R. A. Emmons, personal communication, June 22, 2000). However, a trait measure of gratitude is currently being developed by R. A. Emmons and M. E. McCullough (R. A. Emmons, personal communication, June 22, 2000). At the time of this writing, the best way to assess client gratitude is through careful probing by the therapist. 
Once a gratitude measure is available, and has been validated for clinical use, it could be administered in an assessment battery with clients who present with meaning-related issues. Measures such as the Purpose-in-Life test (PIL},5 the Life Purrose Questionnaire (LPQ}, 10 and the Meaning In Suffering Test (MIST)1 may be positively and strongly correlated with gratitude. That is, the more gratitude that one expresses, the greater the sense of personal meaning, and vice versa. This hypothesis needs to be empirically examined, and could readily be tested through research designs involving the administration of a gratitude measure with measures of personal meaning. 
Certainly, the role of gratitude in logotherapy is an important area to be researched, particularly because the potential benefit to clients is so great. Graduate students may find that a topic in this area of empirical inquiry would serve as an important contribution to logotherapy. Such contributions to the literature could readily be made through one's thesis or dissertation research. For those researchers in the field who are interested in this area, there are enough potential empirical endeavors with regard to validating a gratitude measure and/or testing gratitude's relationship to other meaning-related constructs to support a program of research. 
STEFAN SCHULENBERG [Department of Psychology, University of South Dakota, 414 E. Clark Street, Vermillion, South Dakota 57069 USA] is a Doctoral Candidate in the Ph.D. Program in Clinical Psychology at the University of South Dakota. He received the Master of Arts degree in Clinical Psychology from the University of South Dakota in December, 1998 and is attending a Psychology Internship at the William S. Hall Psychiatric Institute in Columbia, South Carolina. He received the Associates credential in logotherapy through the Viktor Frankl Institute in October of 2000. 
23 
References 
1. Coetzer, P. H. (1992). Gratefulness: A highway to meaning? The International Forum for Logotherapy, 15, 104-107. 
2. Corcoran, K., & Fischer, J. (2000). Measures for clinical practice: A sourcebook-Vol. 1. Couples, families, and children (3rd ed.). NY: Free Press. 
3. 
Corcoran, K., & Fischer, J. (2000). Measures for clinical practice: A sourcebook-Vol. 2. Adults (3rd ed.). NY: Free Press. 

4. 
Corsini, R. J. (1999). The dictionary of psychology. Philadelphia, PA: Brunner/Maze!. 

5. 
Crumbaugh, J. C., & Maholick, L. T. (1964). An experimental study in existentialism: The psychometric approach to Frankl's concept of noogenic neurosis. Journal of Clinical Psychology, 20, 200-207. 

6. 
Emmons, R. A., & Crumpler, C. A. (2000). Gratitude as a human strength: Appraising the evidence. Journal of Social and Clinical Psychology, 19, 56-69. 

7. 
Fabry, J. B., Bulka, R. P., & Sahakian, W. S. (Eds.). (1995). Finding meaning in life: Logotherapy. Northvale, NJ: Jason Aronson. 

8. 
Frankl, V. E. (1985). Man's search for meaning (rev. ed.). NY: Washington Square Press. 


9. Guttmann, D. (1996). Logotherapy for the helping professional: Meaningful social work. NY: Springer Publishing Company. 
10. 
Hablas, R., & Hutzel!, R. R. (1982). The Life Purpose Questionnaire: An alternative to the Purpose-in-Life test for geriatric, neuropsychiatric patients. In S. A. Wawrytko (Ed.), Analecta Frankliana (pp. 211-215). Berkeley CA: Strawberry Hill. 

11. 
McCullough, M. E., Kilpatrick, S. D., Emmons, R. A., & Larson, 


D.B. (in press). Gratitude as moral affect. Psychological Bulletin. 
12. 
Starck, P. (1983). Patients' perceptions of the meaning of suffering. The International Forum for Logotherapy, 6, 110-116. 

13. 
Welter, P. R. (1995). Logotherapy-lntennediate ''.A": Franklian psychology and logotherapy. The Viktor Frankl Institute of Logotherapy, Box 15211, Abilene, TX 79698-5211). 


24 
The International Forum for Logotherapy, 2001, 24, 25-29. 
SCHOOL AVOIDANCE AND LOGOTHERAPY IN JAPAN 
Shunsuke Kanahara 
In Japan, there are more than 130,000 elementary and junior high school students who are not attending their schools, in spite of the fact that school-attendance is mandatory for this generation.3 These students do not have any physical diseases, but may have some psychological or social problems. (Students who are not going to school due to physical diseases are excluded from the above number.) The problems they may have include: truancy, laziness, conduct disorders, phobias, vulnerability, poor skills in human relations, and dysfunctional families. 2 
After several weeks, students with school-avoidance may start showing a tendency to withdraw at home.2 They prefer playing computer games or surfing the Internet rather than doing something else outside. They are awake at night, and go to bed in the morning or afternoon. Their opportunities to communicate with other individuals become extremely limited and they may begin to exhibit signs of depression. Some of them become violent toward their family members and/or develop eating disorders, such as anorexia nervosa. School-avoidance along with the above symptoms can continue for years, even after the students exceed the school age or become adults.6 
Many investigations have been carried out regarding schoolavoidance.2 Doctors, teachers, psychologists, sociologists, and parents' organizations have participated in the investigations. So far, there is no concrete method for dealing with the problem. The technique of not reacting negatively regarding school-avoidance, based on an idea from client-centered therapy, has been employed to treat school-avoiding students.7 The reason why this method has been used may be because client-centered therapy is one of the most prevalent therapies in Japan.9 As a result, very few students are able to go back to school, and the number of students who are not going to school has been increasing every year. 3 
25 
The Application of Logotherapy 
The application of logotherapy in school settings has been suggested. Examples include: modifying students' classroom attitudes, 1 settling destructive behavior,4 improving respect and responsibility, 5 and utilizing logotherapy for teacher-training.8 These reports explain that focusing on self-discovery, choice, uniqueness, responsibility, and self-transcendence is significant in intervention with problematic students. 
When school-avoidance results from a feeling of meaninglessness with regard to school, logotherapy can be an appropriate assistance for the problem. In this paper, I will present the outcome of Socratic dialogue in the case of three students who were refusing school attendance. I did the following interventions as a school counselor. 
Naomi's Case 
Naomi (assumed name), a 15-year-old female, had avoided going to junior high school for more than two years. She had psychosomatic symptoms such as nausea and fatigue. These symptoms made her prefer staying at home all day, because she became worse when she was outside. After being rejected several times by both Naomi and her mother, I obtained permission to meet her at her home. In addition to general conversation and assessment, I explained to Naomi how important it was to go to school, as well as going out of the home, studying, being with friends who belong to the same generation, and so forth. She was not interested at this point. Therefore, I advised her that she should go outside, at least, because it was important for her to do something, whether or not she liked it. She did not pay any attention to what I said, but her mother agreed with me. During the conversation, I noticed that Naomi was very attached to her mother and that the mother was hoping to get Naomi to go to school. I asked Naomi how much she loved her mother. She replied that she loved her mother and hoped to buy a house for her. I explained to Naomi that although she was unwilling to go to school, her mother wanted her to and would be happier if Naomi would go to school rather than buying a house. In conclusion, I suggested that she try to go to school for her mother. Then Naomi began thinking, and agreed with my offer of discussing some plans that could enable her to go to school. She still showed unwillingness, however, but from that day on, she started going outside (e.g., taking a walk, going shopping) with her mother and/or me. A couple of months later, she became able to go to school. 
26 

At school, she could not enter her classroom. She stayed in the school nurse's room every time. She graduated from her junior high school before long, and became a high school student (even if students do not have enough days of attendance, they can usually graduate from a junior high school). In high school, she was able to enter her own classroom with no hesitation. This lasted for approximately two months. She was happy in making her mother happy. Then, she started avoiding school again. This was because she felt isolated in the classroom. She and I are currently talking about a new plan that will enable her go to school in the near future. 
Ken's Case 
Ken (assumed name) was a 14-year-old male junior high school student. He was transferred to his current school because of his parents' moving to a new city. At first, he made every effort to fit into the new school; he attended school every day, had lots of conversations with his classmates, and even tried to participate in the student council's activities. Then he suddenly stopped attending school. After two weeks of his absence, I was informed that he had not been coming to school. When I visited him, he told me that he was a victim of his parents' moving. He had tried to overcome the situation, but this was just tiring and not successful. At home, he was more relaxed, because he did not need to try hard. At the next visitation, I told him that he had better try once again, that it may be tiring and may not be successful, but trying itself would be meaningful for him. Then, I asked him what he wanted to be in the future. He answered that he would like to be a high school student. I asked what he needed to do in order to be a high school student. He answered that he needed to study. I further asked him where he could study most effectively. He answered that it might be at his junior high school. These conversations did not modify his school-avoiding behavior immediately. I kept visiting him once a week, and kept having similar conversations. 
One day, he called and asked me to come to his home. Soon after I arrived, he explained that he wanted to go to high school. The problem was that his parents were not wealthy and it would be difficult for him to go to a private high school. He needed to go to a public high school. In his area, public high schools are more difficult to enter than private high schools. Consequently, he realized that he needed to go back to his junior high school and study. The following Monday he 
27 
began to execute his plan. Almost a half year has passed, and he has never been absent from his school. 
Taro and His Mother's Case 
Taro (assumed name) was a 9-year-old male elementary school student. His mother brought him to my office. According to the mother, Taro had been afraid of school, shaking and crying there. He had not gone to school for almost one semester. She also said that he did not seem to be growing up emotionally. She continued, with tears, that this was all her fault. She had pampered him, so that he could not behave like other students at school. She considered herself a bad mother; she felt gloomy about seeing Taro's teachers because they must regard her a bad mother. I asked her what made her think that she was a bad mother. She said that she had read several books on school-avoidance and the books had concluded that mothers were responsible for school-avoidance. I responded that I was not sure about that idea. She insisted that her discipline had been inappropriate and this made her son not able to go to school regularly. Then, I asked her whether or not there were as many school-avoiding students today as when she was a child. She answered no. I further asked if she believed that there were significantly many more "good" mothers (who made many more children go to school) when she was a child. She answered no again. I agreed with her and said that the number of school-avoiding students were increasing recently, but not because of the increasing number of bad mothers, rather because of other reasons. Then, I suggested to her that if she was a bad mother, she would not be here to see me; this was a sign of a good mother. She, as a good mother, would find the way, with me, to allow Taro to go to school every day. It seemed that my comments encouraged her. She smiled, still with tears, and said that it was good to talk to a person who did not blame her; she could feel more positive. 
My intervention with Taro was simple. After persuading him, I had him go to school along with his mother and asked the mother to stay at school till classes were over. As a result, Taro's days of attendance increased. Although he tends to be absent from school once every week or two, he has recently been able to go to school by himself without being afraid. 
Conclusion 
The efficacy of Socratic dialogue for students who were refusing to go to school in Japan was demonstrated. In the first case, self
28 
transcendence was encouraged; in the second case, the student made his own choice after seeing the meaning for him; in the last case, the mother's self-discovery allowed her to more positively influence the son's school-avoiding tendency. My logotherapeutic interventions were not intended to curtail the students' freedom nor to manipulate them. My intention was to let them turn from "freedom from something" (i.e., not going to school) to "freedom toward something" which is more meaningful and can make the students' experiences more self-fulfilling. 
SHUNSUKE KANAHARA, Ed.D., is a university Lecturer of Psychology and a School Counselor in elementary and junior high schools in Nagasaki, Japan. He learned logotherapy from Joseph B. Fabry. 
References 
1. 
Hirsch, B. Z. (1995). The application of logotherapy in education. The International Forum for Logotherapy, 18, 32-36. 

2. 
lnamura, H. (1997). The study of school-avoidance. Japan: Sinyo-sya. 

3. 
Japanese Ministry of Education (2000). The prompt report of the results of national school inquiry. Japan: The Ministry of Education. 

4. 
Macaruso, M. C. (1995). Treating emotionally disturbed children. In J. B. Fabry, R. P. Bulka, & W. S. Sahakian (Eds.), Finding meaning in life: Logotherapy (pp. 225-227). Northvale, NJ: Jason Aronson. 

5. 
Rice, G. E. (2000). An optimistic stance toward disruptive behavior. The International Forum for Logotherapy, 23, 30-39. 


6. 
Saito, T. (2000). Social withdrawal: Unfinished puberty. Japan: PHP Sinsyo. 

7. 
Tominaga, Y. (1997). School-avoidance: Parents' concern and children's anxiety. Japan: Chikuma-Shobo. 


8. Wirth, A G. (1995). New directions in schools. In J. B. Fabry, 
R. P. Bulka, & W. S. Sahakian (Eds.), Finding meaning in life: Logotherapy (pp. 230-238). Northvale, NJ: Jason Aronson. 
9. Yorifuji, K. (1995). School-refusal. Japan: Jinbun-Shoin. 
29 
The International Forum for Logotherapy, 2001, 24, 30-34. 
NOODYNAMISMS OF VALUE DEFICIENCIES Roberto Rodrigues 
This paper presents an overview of the findings of a project conducted during a seven year period in Brazil. The purpose was to investigate people who have not actualized their spiritual values and who present to a clinical psychotherapeutic practice. Systematizing the findings as specific clinical entities became the focus for this work. The systematization of identified entities (referred to here as Noodynamisms of Value Deficiencies) resulted in a nosology for people who have not actualized their values. This also revealed important opportunities for the actions of professionals who deal with human suffering. 
One hundred patients were chosen from cases in which psychiatric and/or psychotherapeutic attention had been given. Each case involved at least three months duration with one or more sessions per week resulting in 12 to 24 therapeutic hours. 
Review of Theory Underlying the Project 
Since Scheler,7 value entities have been seen as neither relative nor formal but as transcendent essences that have material content. They are perceived by intuition (or spiritual thought-attributes) that are located in the human dimension called Noetic (that which is specifically human) or spiritual. Scheler postulated a spiritual nucleus in which authentic value recognition originates to fill the human life.3 Humans struggle throughout their lifetime to actualize specific values such as love, justice, ethics, creativity, faith, truth, and logical principles. Such values are concrete, contingent, and real reasons for human life.2 This orientation provides the basis to postulate "Noodynamisms of Value Deficiencies" as clinical entities that manifest themselves through psychic sufferings observed by the psychotherapist.6 
The phenomenological method of Jaspers4 is the procedure used to examine the Noodynamisms of Value Deficiencies. Through this method, it is possible to capture both phenomena (spiritual and empirical) as the client is hampered by obstacles in the social, biological, and psychological areas of life. This method points to the human totality (soma, psyche, noetic) without denying dimensional limitations.5 The assumption provides a view of the human being as a spiritual subject and 

30 
also as an empirical object for study that can serve as a basis for a classification system leading to a systematization of Noodynamisms of Value Deficiencies. 
Clinical observation in psychotherapeutic practice that observes all human dimensions and considers the essential values to be actualized as a primary motivation of life can lead to: an understanding of how the Will to Meaning serves as a primary motive; and how a 'Will" creates tension rather than homeostasis. With this orientation, it is possible to unveil Noodynamisms of Value Deficiencies as clinical entities that can be observed through symptoms of frustration of value actualization (i.e., resentment, dissatisfaction, sensation of emptiness, and unhappiness). These symptoms can develop over months or years without obvious disturbance of active, normal life. However, the symptoms may become more pronounced as frustration increases. The extreme intent to actualize either specific or nonspecific values may shift to continuous tension or conflict resulting in prostration, tiredness, and depression that can be manifest as psychopathology, including tragic behaviors such as suicide, homicide, addiction, or delinquency. 
Franklian1 and Schelerian8 value categories lead us to a value nosology different from traditional psychiatric nosology. The traditional psychiatric nosology could be inappropriate as it focuses strictly on illnesses while deficiencies in value actualization are no more than dissatisfactions with life (i.e., a kind of sadness that does not necessarily reach psychopathological proportions). 
Findings of the Brazilian Project 
The existence of clinical entities that have a correlation with deficiency, difficulty, or lack of value actualization was found through this investigation. These entities may be evidenced in psychological manifestations. They are the result of a person's suffering from the struggle to actualize values when there is continuous opposition from one or more barriers. 
Such clinical entities may be systematized in function by the specificity of the value or values that are predominantly unactualized. Given these data, a nosology for psychological phenomena of people who have not actualized their spiritual values can be created. The nosology resulting from my seven-year investigation in Brazil is presented below. 
31 
SYSTEMATIZATION OF NOODYNAMISMS OF VALUE DEFICIENCIES 
NOODYNAMISMS OF SPECIFIC VALUE DEFICIENCIES 
A. IN THE SPIRITUAL ACTS OF LOVE (NLVD) 
1. 
Noodynamism of Conjugal Love Value Deficiency 

2. 
Noodynamism of Pre-conjugal Love Value Deficiency 

3. 
Noodynamism of Social Love Value Deficiency 

4. 
Noodynamism of Familial Love Value Deficiency 


8. IN THE SPIRITUAL ACTS OF CREATIVITY WORK (NCVD) 
1. 
Noodynamism of Theoretical Creativity Value Deficiency 

2. 
Noodynamism of Esthetical Creativity Value Deficiency 

3. 
Noodynamism of ProfessionalNocational Value Deficiency 


C. IN THE SPIRITUAL ACTS OF ATTITUDE (NAVO) 
1. 
Noodynamism of Attitude Value Deficiency in face of Suffering 

2. 
Noodynamism of Attitude Value Deficiency in face of Guilt 

3. 
Noodynamism of Attitude Value Deficiency in face of Death 

4. 
Noodynamism of Attitude Value Deficiency in face of Sin 


D. IN THE SPIRITUAL ACTS OF FAITH AND CREED (NFVD) 
1. 
Noodynamism of Religious Value Deficiency 

2. 
Noodynamism of Love to God Value Deficiency 

3. 
Noodynamism of Transcendence Value Deficiency (Nihilistic) 


E. IN THE SPIRITUAL ACTS OF MORALITY AND ETHICS (NMVD) 
1. 
Noodynamism of Justice Value Deficiency by Commission 

2. 
Noodynamism of Justice Value Deficiency by Omission 


F. IN THE SPIRITUAL ACTS OF SENSIBLE LIFE (NSVD) 
1. 
Noodynamism of Erotic-Sex Value Deficiency 

2. 
Noodynamism of Love of Oneself Value Deficiency 

3. 
Noodynamism of Useful Work Value Deficiency 

4. 
Noodynamism of Utility and Possessions Value Deficiency 


NOODYNAMISMS OF NONSPECIFIC VALUE DEFICIENCIES (NNVD) 
32 
Implications of the Findings for Practice 
With the identification and systematization of Noodynamisms of Value Deficiencies, it is possible to strategically work toward the prevention of dangerous and risky psychopathology and acute crises in those patients who suffer from deficiencies in value actualization. Prevention may be accomplished with groups or individuals. It is not always necessary that psychiatrists or psychologists provide psychotherapy to these individuals. Counselors, social workers, religious people, and educators can detect value deficiencies and lead the sufferer toward value awareness and actualization when necessary. 
Logotherapy is a value seeking procedure whose therapeutic applications base themselves on actualization of values in the spiritual dimension. It postulates that the existential vacuum and noogenic neurosis are difficulties whose causes are deficiencies in finding meaning or failure to actualize values. To this end, logotherapy is especially recommended as a modality for helping individuals who suffer from deficiencies in value actualization. 
Additional Conclusions from the Project 
Analysis of the data of this project also showed that numerous patients who come to a psychiatric and/or psychotherapeutic office manifest signs of deficiencies in value actualization. Additionally, persons whose stages of life present the maximum searching for value actualization are those in whom most value deficiencies emerge. 
Systematization of the value deficiencies, taking patient's suffering not as psychological symptoms but as specific categories of value entities, provides a nosologic utility. However, it is recommended that further research, within the theory and practice of logotherapeutic and existential analysis, be conducted to validate the nosological system presented in this paper. 
ROBERTO RODRIGUEZ, M.D., Ph.D. [Ave lcarai 74 Cristal, Porto Alegre RS 90810-000, Brazil] is a Psychiatrist and Psychologist and a Diplomate in logotherapy. Currently he is Professor of Mental Health in the PostGraduate Program at the Lutheran University of Brazil. He is also President of the Viktor Frankl Association of Logotherapy, South of Brazil, Curitiba. 
33 
References 
1. 
Frankl, V. E. (1987). Em busca de sentido. Um psic6/ogo num campo de concentra<;ao. Porto Alegre: Editoras Sulina/Sinodal. 

2. 
Linares Herrera, A. (1949). Elementos para una critica de la filosofia de los valores. Madrid: Institute Luis Vives de Filosofia. 


3. Llambias de Azevedo, J. (1966). Max Scheler. Exposici6n sistematica y evolutiva de su. Filosofia com algunas criticas y anticrirticas. Buenos Aires: Editorial Nova. 
4. 
Martin-Santos, L. Dilthey (1955). Jaspers y la comprensi6n de/ enfermo mental. Madrid: Editorial Paz Montalvo. 

5. 
Paunero, E. (1977). Metafisica de la persona. Buenos Aires: Editorial Plus Ultra. 

6. 
Rodrigues, R. (1999). Tras una vida sin sentido. Buenos Aires: Editorial Almagesto. 

7. 
Scheler, M. (1984). El puesto de/ hombre en el cosmos. Buenos Aires: Editorial Losada. 

8. 
Scheler, M. (1941). Etica. Nuevo ensayo de fundamentaci6n de un personalismo etico. (El formalismo en la etica y la etica material de los valores). Madrid: Revista de Occidente. 


34 
The International Forum for Logotherapy, 2001, 24, 35-50. 
VIKTOR AND ELLY FRANKL: DEFYING THE DANUBE 
Haddon Klingberg, Jr. 
[Editors Note: This article is an adaptation of a chapter from Professor Klingberg's biography of the Frankls titled: When Life Calls Out to Us: The Love and Lifework of Viktor and Elly Frankl. The book is scheduled for publication October 16 of this year by Doubleday, New York, and is approximately 350 pages, plus 20 photographs and 2 maps. The publisher anticipates translations and publication in several languages. The selected chapter from which our article is adapted focuses on the meeting of Viktor and Eleonore Frankl in 1946. 
This article has been published in The International Journal of Logotherapy and Existential Analysis (initially named Journal des ViktorFrank/-lnstituts), and it has been published in Joernaal/Journal Viktor Frankl -Stigting van Suid-Afrikal-Foundation of South Africa. Given that both of these journals are not readily available to most of our Forum readers, and given that the publication date for the book from which the article originates is approaching, it was felt that publication of the article in the Forum would be of assistance to our readers. Permission to print the article here has been granted by the author as well as by both of the journal editors.] 
Introduction and Background 
On the wall of my study hangs a large map of Vienna and its environs. Fifteen colored indicator pins mark the key places to which the lives of Drs. Viktor and Elly Frankl are anchored. One can see that the Danube River-still beautiful in a way, but not blue-enters Vienna from the north, making its way through the city in a southeasterly direction. The effect is to cut off the smaller northeastern regions of Vienna from the city center. Of course the city is united now by a series of modern and heavily traveled bridges. 
On "the other side" of the Danube, east of the city proper, there are three pins in the map. They indicate the birth house and childhood home of Elly Schwindt in Kaiserm0hlen; and, a short walk from there, the home of her Aunt Mitzi on the banks of the Old Danube, now an offshoot, where Elly swam and played as a girl. The third pin is at the mostly Catholic Kagran Cemetery where the Schwindt family plot is identified by its gravestone. 
35 
On "the main side" of the river twelve pins denote the home of Gabriel and Elsa Frankl where Viktor was born to them on Sunday, March 26, 1905; the places of his university and medical training; the public school building where the Frankl family reported for deportation to the concentration camps in 1942; and the Aspang Station from which their train left for the Theresienstadt camp. After barely surviving three other camps (Auschwitz; then Kaufering and Turkheim in the Dachau system in Bavaria), Viktor's life after 1945 is again traceable in Vienna-mainly in the Ninth District, where the university clinics and hospitals remain even today. A pin stakes out the Poliklinik Hospital where Professor Frankl was chief of neurology for twentyfive years. In its lecture hall he held forth for locals and international visitors across the years. The second pin placed on Mariannengasse signifies the flat where Viktor and Elly lived and worked together from 1946 until his death. Far to the south of District Nine, and on the same side of the Danube, a solitary pin marks the spot in the Jewish section of Central Cemetery where Viktor's remains were buried in a simple and silent Jewish rite in September 1997. 
The wall map in my study, together with books and papers, photographs and electronic paraphernalia, all cradle the Frankl story. Viktor and Elly, beginning in 1993, were themselves the sources of the massive base of information about them: well over a hundred hours of recorded conversations; more than 1,100 color slides, many of which reproduce their own photographs and documents; interviews with over thirty other persons associated with them over the years; etc. 
When invited to write this article, I decided to adapt one chapter from my biography-in-process as a glimpse into the personal lives of the Frankls. This is the first glimpse of its kind, since throughout his career Viktor was seldom autobiographical. So obsessed was he with self-transcendence that he was impatient with efforts at self-actualization and intolerant of self-indulgence, particularly in himself. Not long before his death there was published Viktor Frankl Recollections, 1 a brief series of anecdotes (with photographs) which he had written decades earlier for his family. Upon revising it for publication near the end of his life, and only at the urging of his editor, Viktor added a brief section about his immediate family. 
Professor Frankl typically disguised autobiographical material by using a literary device: he told personal stories using the third person. I initially heard first-person versions of various anecdotes in our interviews. But any reader conversant with Frankl's writings may discover first-person renditions of familiar incidents in Viktor Frankl Recollections.2 In his public life he generally refrained from self-disclosure. 
Thus my research and writing project is unique. Never before, according to the Frankls themselves, had they spoken so freely and fully about intimate details of their lives. I am convinced that Viktor's earlier resistance to autobiography gave way when Elly was included. That is, when I pursued her story as well as his, when the focus was actually their story as partnershipthen he threw himself into the project eagerly. How we three enjoyed our long 
36 
sessions together, typically running overtime, always looking forward to the next! 
Perhaps, during the last years when Viktor was keenly aware that his time was almost gone, he found in re-gathering and integrating memories another way of finishing his work. After Viktor's death I listened to the recording of our last session together. I was surprised when I heard him say these words as we were parting: "That's it. Now the whole story has been sedimented, as it were." 
Further, I am certain that Viktor's earnest involvement in our endeavor was his way of ensuring that the significance of Elly in his love, life, and work, would finally be made known. 
Just a few weeks after Viktor's death I returned to Vienna to see Elly and to continue my work. Their flat, just as Elly said and as I experienced, was hauntingly quiet and unnatural. The wellspring of its energy was gone. Elly and I talked for hours. She described the manner of Viktor's death, and we pondered its meaning for us all, and especially for her. 
In this article I describe not the end, but how Viktor and Elly met in 1946. He was to live fifty-one years more-"quite an encore" as a friend put it. He and Elly were inseparable. They were even called "the Siamese twins of District Nine." She was to him spouse, lover, assistant, chief consultant and collaborator, and unmistakably his dearest friend. How many photographs I have seen of the two of them smiling and clowning, with their arms hanging around each other's shoulders. Here then is the simple beginning of their love, which became so prolific in its influence. 
The Return to Vienna 
Viktor Frankl was liberated from the Turkheim camp April 24, 1945. He spent a few months working in T0rkheim and, when the borders reopened, he returned from Munich to Vienna in a truck transport, arriving at Rathausplatz 
15th
August . This began what was, of course, a pivotal period for his resettlement, both personally and professionally. He immediately tackled the reconstruction and expansion of Artz/iche See/sarge (The Doctor and the Soul) followed by Ein Psycholog erlebt das Konzentrations/ager (Man's Search for Meaning). Indeed, these books were the task by which he transcended himself and his circumstances in the absence of his loved ones. His father, mother, brother, and wife of only a year all had perished in the Nazi camps. Of the former Viennese Jewish community of 180,000, only about six thousand remained after Hitler due to emigration, expulsion, and extermination. 
Viktor found a couple of old friends, and they helped him find a place to live and a hospital position. After that first burst of writing, in February 1946 and at the age of forty, Frankl was appointed head of the neurology department at the Poliklinik, a small hospital for people of the city, including its poor. Like the rest of Viennese society, the medical community was layered in ranks and appellations, and as department chief Frankl's title was 
37 
"Primarius." For him to be addressed as "Herr Primarius Dr." was not unusual, and the title of "Professor" had not yet been added. 
In the shattered city, people were starved in mind as well as in body and Artzliche Seelsorge, one of the first two books published in Austria after World War II, sold out at once. In its 200 pages Frankl addressed directly the most insistent questions of the day: what to make of suffering, of life such as it was and why to go on living it. 
Most of the workers at the Poliklinik, however, were unaware of the book and its author-though word was passing among aides and nurses ("sisters" in Vienna medical facilities) that the new chief of neurology was a demanding and intimidating man. But as an able and energetic psychiatrist, surely he would become successful, even prominent. There was a severe shortage of men after the war due mainly to casualties, and many of those who did return from battle were disabled and destitute. This physician would be quite a catch in this society impoverished by war and where rearing children and being provided for by a good man was a young woman's prevailing fancy. 
The Girl from Across the Danube 
On the other side of the surging Danube, in the time between the Great Wars, Elly Schwindt was born on Friday, November 6, 1925. Her first cries were heard in the little family flat at Schuttaustrasse 64-in the wooded Kaiserm0hlen, so lush and green in summer, its waters a paradise for swimmers and for ice skaters in their seasons. There, in a predominantly Catholic working class area seemingly outside the city, Elly grew up. 
With the coming of World War 11, Nazi forces conscripted able-bodied personnel of all sorts. As a teenager Elly avoided being drafted as an antiaircraft gunner by engaging in an officially sanctioned alternative service. At seventeen she became a volunteer worker in the Poliklinik dental department. By March 1946, even without formal training, she had become so competent an operating room assistant that the oral surgeons requested her. Elly was self-reliant and light-hearted, and looked quite the surgical aide in her starched white gown with the bulging side pockets. She wore the only footwear she owned, a pair of gigantic "admiral's boots" made for soldiers. Every day during wartime she trudged in those boots four and a half miles each way between her home and her job. 
Elly had been forced by war to work hard, to bear uncertainty, to survive. Still she was only twenty, half the age of Primarius Dr. Frankl, and from a very different background. She was no longer a child and not yet a woman, though hardship had its maturing effects beyond her years. Still she loved her swimming, her close and loyal family, her fun-loving friends and the prospect of life with them beyond war. She was free-spirited, and at the time she did not share that prevailing fancy for finding a husband. 
The Rendezvous 
The occasion for the first meeting of Primarius Viktor Frankl and aide Elly Schwindt was nothing unusual in a hospital. To call the encounter a 
38 
"rendezvous" is to suggest that it had been arranged in advance, but no one at the time suspected that it was contrived in any way. It is only in retrospect that we call it a rendezvous because of its consequences-not just for the two, but for people around the world. Only in the end does prolepsis allow us to acknowledge the hand of fate or Providence in what appeared to be a routine encounter between medical personnel. 
When on that April day in 1946 they met for the first time, Elly had been working at the Poliklinik for nearly three years and Primarius Frankl for approximately two months. He had just turned forty-one. 
Even in a small hospital and over a period of ten weeks, it is not surprising that Primarius Frankl and Elly Schwindt had not met. Neurology and dentistry were not closely allied. In the medical pecking order, Frankl-as both psychiatrist and department chief-was far above the youth who had become an aide only recently and under wartime conditions. He knew nothing of her. 
Elly, however, was forewarned about the tough new Primarius of Neurology in a direct way. On this particular morning in the dental department, an acute jaw surgery was completed but no bed was available to the patient for recuperation. The staff wondered together if there might be a spare bed in neurology. It seemed a good possibility, but at first no one was willing to deal with Frankl, that brusque new psychiatrist. 
It was a day unremarkable at the hospital and, at least until now, for Frankl and for Elly. The lack of one bed in the dental department was a routine crisis, since departments often cooperated to accommodate patients from other sections. Unlike the bigger hospitals, the Poliklinik generally enjoyed a family feeling among staff. 
While others wrangled about approaching Frankl, Elly, though she did not know the Primarius, spoke up: "I'll talk to him. I'll find him right now and ask if we can use a bed in his department." 
"Well, it's your neck, not ours," Elly's colleagues agreed. 
Off she went, paying no mind to their fears. At this moment Frankl was leading his medical rounds, absorbed in interactions with his colleagues as they moved along. Elly tracked them down, passing through a corridor on a semi-subterranean level of the hospital where footsteps and chatter bounced into cacophony off the high ceiling and the hard sterile surfaces. There she approached the group in a natural manner and interrupted its obvious leader. 
"Herr Primarius, excuse me. I am from the dental department and we have no bed for a patient just out of surgery. Is it possible to use a bed in your department for two or three days, four at the most?" 
He looked at her intensely and faltered. His associates stood by deferentially. For a moment it seemed that he had missed Elly's question, and the situation struck her as odd. She thought: "He is strange, maybe a little crazy even. Not like his reputation. What is wrong with him anyway?" 
Rounds had come to a halt, but Frankl finally collected himself and replied agreeably: "Yes, of course. I'll arrange for the bed immediately." "Thank you, Herr Primarius, very much." 
39 
Elly turned and climbed the three flights of stairs to her department, there announcing: "The bed is available and the patient can be moved to neurology at once." 
"What? Frankl approved the bed? Did he yell at you? What did you say to him? Was he angry about it?" 
"Not at all," Elly said. "I met him on rounds and asked for the bed. He said he would arrange it right away. He was rather friendly about it. Quite a nice guy actually." 
"Are we talking about the same doctor?" 
What Elly had not heard, after she left the small group to complete their rounds, was that Primarius Frankl had turned to Walter Schober, his first assistant, asking: "Did you see those eyes?" 
"Yes, I suppose so. But why do you ask?" Schober had replied. 
Frankl had been entranced by the young woman from dental, and he would later call it "love at first eye-sight." Elly was not struck, though she did think him a pleasant and decent man. 
A couple of days later, perhaps by coincidence, they met just outside the Kassa-the cashier's or business office. There Frankl said to the young aide: "Good to see you again. Look, I have a terrible toothache," pressing on his cheek as if to relieve pain by pressure. 
Elly responded: "But you know you can come up to our department anytime you want to and one of the dentists can take a look at you." 
"But this is no help to me, what you are asking me to do! I also have a terrible fear of dentists-all my life I have been this way. You would have to catch me with a lasso and drag me upstairs! That is the only way. Otherwise there is no possibility to get me there." 
After chatting a bit more, they parted. Elly enjoyed the encounter and was amused. But she felt no romantic spark. 
A couple of days later, Elly playfully fashioned a lasso from unrolled gauze bandage. She took it down to the bottom floor, where the Primarius had his office. Upon entering she lifted the lasso into the air, swinging it back and forth in front of Frankl. She beckoned as if to put the noose around his neck. 
"Okay, okay, nurse. I'll come with you," he yielded. 
They climbed the three flights of stairs to the dental department, and on the way he made the first of his admissions to trickery. Playful deception was a skill Viktor had already refined, and here he confessed: "Elly, I must tell you now that I never had a toothache at all and I am not afraid of dentists! I just needed an excuse to see you again." 
Elly was delighted-with both the disclosure and the hoax itself. 
They entered the vast oral surgery, a room lined with operating stations. The dental chairs were arranged in a row, as in a large hair salon. The two found a corner in which to sit and they talked good-naturedly for quite a spell. Viktor ventured an invitation. 
"You see, I live just down the block-my place is here in Mariannengasse. Why don't you come home with me for a visit? In my room I 
40 
have something that will certainly interest you. I have killed the most poisonous snake in all of Austria. Actually I killed it with an ice pick and decapitated it with an ax, then brought it back from the mountains in my rucksack. Now I have preserved it in formaldehyde and have it in a jar. Wouldn't you like to see it?" 
Elly thought, "This is funny! But why not? It might be quite interesting." So she agreed and after work they walked together down Mariannengasse to number 1, then up to the third floor room where Viktor was living. As she accompanied him into the flat, she encountered many other people who were living there in a most peculiar arrangement due to the war. 
Viktor occupied the large corner room, whose windows were still boarded up from the bombings of the previous year. In this very space he had created his first two books so recently. Elly could not see out of the bay windows at the corner, but she thought the view must be wonderful, overlooking the very old and sprawling General Hospital across Spital Gasse ("clinic drive"), and Mariannengasse below. 
The flat was comprised of several large rooms, though only Viktor's had windows on two sides. The quarters were occupied by an assortment of mostly unrelated people, eighteen in all. Perhaps a third of Vienna's residences had been bombed and these temporarily homeless people had escaped safely from their own ruined dwellings. Here they were, crowded together for shelter and all using one toilet and the same kitchen. Frankl had the responsibility for managing the rental space and did not mix much with the housemates he had inherited. They were not friendly to him and probably resented the physician who, from their perspective, was privileged not only in having work, but his own room and a young girlfriend too. (They were cool toward Elly also.) Viktor never told them about the concentration camps. Why would he? They were preoccupied with their own situation; and besides, they would not have believed that the worst of these cramped conditions seemed to him like Eden. Anyway, with each passing month more of the residents were moving out to new-found housing of their own. 
When Elly entered Viktor's room for the first time there were only the following: a simple single bed under the window on the wall to the east, a small cooking stove on the floor, a large dining table and a cabinet. The owner of the flat, a former Nazi, had taken most of the furnishings with him. 
On the table sat an old typewriter, a gift from Viktor's dear friend Bruno Pittermann. Also on that solitary table was the bottled snake in all of its gory glory. The snake story with which Viktor had lured Elly was true enough, though he admitted later that he had used it only as an excuse to invite her over. Who'd have thought that anyone could be tempted so winsomely by a dead serpent? 
The friendship warmed in the days that followed. Viktor and Elly spent more and more time together. She continued her daily commuting between Kaiserm0hlen and the Poliklinik on electric streetcars now back in service. Viktor knew that she walked the block just below his windows along Spital Gasse early each morning, since she had to be dressed and washed for 
41 
surgery at seven. She always mused about him as she stomped by in her admiral's boots. She was grateful for Viktor's kindness and for the friendship they had found in one another. 
One morning as she glanced upward toward the third-floor flat, she saw hanging from a window opening the lasso she had made. She was enchanted and laughed over this retaliation by noose. Perhaps as Elly smiled on the street below, Viktor was contemplating his renascence since the deathcamps and how Elly had come into his world. Elly, with those beautiful eyes. 
Viktor wondered if Elly discerned the human longings beneath his confident professional crust. Might she come to comprehend his determination to live without revenge-thus to be free to do for others what is uplifting, encouraging, helpful? Most of all, would she ever find it in her vibrant young heart to love him? 
Perhaps he feared that the stirrings in his own heart and the commotion in his mind would come to nothing. What if thinking too much and writing too long would send him spinning out into some intellectual void, into obsessions and pessimistic suspicions? Was he to be hounded by his own restless nature, and driven by some destiny, to be alone, with no one to stay alongside for the whole journey? 
Elly, using her hospital lunch breaks, walked almost daily all the way to the small Jewish hospital on Malzgasse in Leopoldstadt (the formerly Jewish district where Viktor was born) to pick up sacks of food for him. Foodstuffs were provided there to the few Jews still in the city-in a sense they were privileged in this. Generally provisions were hard to come by, even for those with means, and a Christian family as poor as Elly's struggled from meal to meal to have something on the table. 
One day upon entering Viktor's room, Elly saw that he had been sipping cough syrup again from bottles left by a former tenant of the flat. Sometimes he did this when he craved something sweet. She chided him but he shrugged and defended his ingestion: "Calories are calories." (These words he had said repeatedly in the deathcamps, to himself and to others. As a physician in conditions of starvation he had known that in saliva and phlegm there are a few calories, to be conserved by swallowing. He had practiced this himself and encouraged his prison comrades to swallow theirs.) 
No one treated him the way Elly did. Most kept a distance from him out of deference or apprehension. She spoke to him honestly. She liked him very much, and he loved her. Since her early interest in him was not romantic, she made no effort to impress him. Thus he was even more impressed. 
Elly felt for Viktor, though. She even pitied him sitting there in his one shabby jacket-the one issued to him from the storeroom at the Turkheim camp on his release. It was the "sport coat" he wore with his only necktie, the one that had been laden with lice eggs when he left the camp. On his small feet Viktor was wearing his only shoes, made for a girl. 
Elly cared for Viktor as friend and took pleasure in him as companion. Before long he was speaking his heart to her with ease, and she was speaking hers to him. She noticed with what careful, feeling words he painted 
42 
portraits of his godly parents. Elly could hardly believe other things she heard from Viktor: the conditions in the concentration camps; what he himself had suffered and witnessed; the monstrous manner of the deaths of his father and mother. Her heart went out to him even as she became more fascinated with him. He was old enough to be her father, but she thought him handsome and esteemed his maturity and wisdom. They shared many values and outlooks, and we know that doing so is a crucial factor in enduring relationships. 
Viktor told Elly about his first days back in Vienna, less than a year earlier, and particularly how he had looked up his old colleague and friend, Dr. Paul Polak. Finally, in Paul's home (where Frau Polak, his widow, has continued to live since his death in 1980), Viktor opened up about the deaths of his parents, his brother Walter, his wife Tilly, bursting into tears. Turning to the apartment balcony and facing outward toward the gardens below, Viktor sobbed as he choked out the following words: 
"Paul, I must tell you-and I know that, if anyone can, you will understand me. When all this happens to someone, when a person is tested in such a way, there must be some point to it, some meaning in it. I have a feeling, which is all but impossible to describe, that there is a task waiting for me, that something is now expected of me. I sense that I am destined for something." 
Elly also learned from Viktor how improbable his survival had been and how, in his dreams as in his waking hours, obstinate questions dogged him. For what purpose had he been spared so undeservingly? For what cause did some mysterious grace offer to him the life denied to most prisoners, even to selfless victims far more virtuous than he? What could he possibly do to justify in some measure the time he was being granted? 
Elly, naive and trusting at the time, had no notion of what these questions would come to mean for her, how in their wake her life would change forever. All she knew was that she began to love Viktor in his struggle, and because of it. 
By her listening and by her spontaneous responses, she became to him a kind of angel unaware. He became ever more hopeful and open. She was charmed by his quick wit. Marveling most at the absence of bitterness and vengeance in him, she would remember always that this is what stirred her first affection for him. Increasingly she welcomed the persistent, simple expressions of his wishful devotion to her. 
In their early courtship, while Elly was still living with her family, she was involved in an accident on the ReichsbrUcke-the large bridge over the Danube River which Elly crossed each day on her commute. She was midbridge when a drunk driver crashed his automobile into the streetcar in which she was riding just behind its operator. There were very few motor cars in Vienna at the time, but the driver in this case was a son of one of the city's wealthiest citizens. In the crash, three automobile passengers were killed and Elly was thrown against the streetcar interior. She had no visible injuries, but she did not feel right and returned to her family. At home Elly became more aware of pain in her head and of an inability to grasp things with her hands. 
43 
Thinking she would be better off near the Poliklinik and Viktor, in the evening she took a streetcar back to Mariannengasse. By this time she was carrying a key to Viktor's flat where she admitted herself quietly. Viktor was asleep and, while she was arranging a makeshift bed for herself on the floor, she passed out. Nearer to dawn she awoke and arose, and for the first time Viktor became aware of her presence in the doorway. 
From his bed he asked: "What are you doing? What has happened that you are here?" 
"I have been here for hours," Elly replied. "I was in an accident yesterday and I came here last evening, but I think I have been unconscious for a long time." 
Viktor was concerned and got dressed immediately. They walked together down the street where he admitted her to Poliklinik neurology for observation. (Viktor would later describe this as "moving Elly from the apartment to the department") She was given a bed-second from the right on entering-in a room with five other female patients. Next to Elly were ladies who had already become acquainted with one another as ward patients do. Soon they included Elly in conversations, having no inkling of her relationship to Primarius Frankl. Before Frankl and his associates were due on rounds, the ladies in the room began fussing with their hair and layering their faces with lipstick and rouge. As this expectant preparation was underway, one of the ladies spoke to the others as if making a newsworthy announcement. 
"Do you know why I am in here in the hospital?" 
Elly guessed aloud: "Not exactly, but because you are ill of course." 
"No," the patient said as she continued to preen herself. "I am here because I want to marry Viktor Frankl." 
Elly said nothing, but internally she was laughing over the absurdity of the moment. She thought how much she and Viktor would enjoy this incident later on! 
When the physicians arrived on their rounds, Frankl had with him no other than Professor Dr. Otto Potzl (1877-1962), his great mentor and a wellknown neurologist from Prague now practicing and teaching in Vienna. The VIP attention to Elly by two doctors must have made quite an impression on the ladies. It was difficult for Viktor to be objective about Elly's condition, so he brought in Potzl for the finest neurological consultation he could arrange. Elly had suffered dizzy spells following the accident and for a longer time was dropping things occasionally. Eventually she regained her ability to grasp and hold, and in a few weeks she was back to work with no enduring effects of her injury. 
Eventually Elly moved from her family home in Kaisermuhlen into Viktor's flat. Their marriage had to wait for official Red Cross certification of Tilly's death at Bergen-Belsen, which arrived in July 1947. Within a day or two, Viktor and Elly walked to the district's administrative offices on Wahringer Strasse, where they were married in the simplest of civil ceremonies. At the 
44 
time Elly was four months pregnant and Gabriele, their only child, was born that December. 
The Rendezvous Remembered 
During long and recent consultations I had with Viktor and Elly, they sometimes elaborated on stories in later sessions. For example, they clarified that Viktor had hung the lasso from his window above Spital Gasse day after day where Elly could see it each morning. Viktor often injected a joke into the flow of conversation, always with some connection to the topic of the moment. Here he interrupted to tell the following. 
"An Austrian soldier in the First World War was in a little Jewish town in Poland and needed a repair on his watch. So he went to a shop where watches were on display in the window. He entered and asked the proprietor about service for his watch. 
'"But I am no watchmaker,' the shopkeeper replied. 
'"So then what is your profession?' the soldier asked. 
"'I do circumcisions on little boys, here in the back room.' 
"The puzzled soldier asked: Then why do you have all those watches hanging in your window?' "The shopkeeper: 'What else should I be hanging up in my window?"' Immediately Viktor made the application by adding this line: "So if not the 
lasso, what else should I have been hanging out the window?!" 
After the laughter, Elly proceeded: "So here we were, in this very room. Right there on the table was that snake in a bottle. I think it was here that our first mutual interest started." 
"In snakes," Viktor quipped. "It was the snake that attracted her. Who eise?" 
Elly smiled: "Ya, ya. And when Viktor opened the little cabinet and-oh my goodness-it was dirty and looked terrible. It was full of old bottles of whiskies and cough medicines and so on." 
Viktor: "I gave the whiskey to others and kept the cough syrup for myself. I liked it. Sometimes I would use it to take the edge off of my hunger." 
Elly: "But inside that cabinet was a mess. The bottles were dirty and stuck to the shelf. Only some paper and a pencil, maybe a book-everything in this little cabinet was dirty and sticky. I thought it was terrible." 
Viktor: "Everything I owned was in this room, and most of it in that small cabinet." 
Elly returned to nourishment: "My family was so poor, and I was so hungry. You have no idea how hungry I was! Sometimes we had nothing to eat. If we had some lard to spread on a crust of bread we were happy beyond words. In my childhood I had never tasted butter. I will never forget the first time I tasted butter; I must have been twelve or thirteen years old. My goodness, it was wonderful. Helly [a best friend] and I had found it in my aunt's cold cellar. We opened it and, oh, it smelled wonderful. After stealing a little taste, we wrapped it carefully again." 
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Viktor: "It smelled even better than paid-for butter! Elly, you never have told me about this." 
"When I brought food to Viktor from the Jewish hospital, I was too timid to say to him: 'Look, I'm hungry. Can I have something to eat too?' He didn't even think I might be hungry, and I was so shy about it. When he was eating I hoped that something would be left for me, but I never told him. When he finished we put the food there, on the coal furnace. When I was leaving he would pull the doors closed, and then I would stuff the leftovers into my mouth and gobble them down as I walked out." 
Viktor: "I didn't know that she was hungry! I found it out only later. I would have given her anything. The food was even more than I needed. So when Elly left she would eat the remnants as I was settling down for my afternoon nap." 
'Don [my familiar name] to Elly: "Just like you had stolen apples when you were a hungry little girl." 
Elly: "Because I was too silly to ask him! I brought food to him for weeks and yes-I was stealing the leftovers." 
Viktor: "After all, calories are calories." 
When I appealed to Viktor and Elly to say more about their early poverty, he again referred to his one old jacket and necktie from the TOrkheim camp. Then, with a sudden and insistent emotion, Viktor said: "But you see, I felt very rich." 
No words were spoken as that claim settled on us. Then Elly affirmed it: "We were so happy. We had almost nothing, but you have no idea how happy we were." 
Many times I heard the Frankls repeat these assertions. They were blissfully happy in the postwar years, having the pitiful clothing they wore on their bodies and little more. We talked about how peculiar such happiness sounds in more affluent places and times. I told the Frankls about the visit of a young physician to a lunchroom where my parents worked. I was only a boy at the time, but I remember it distinctly. 
On the wall of the dining area there was a painting of an old man at a crude table, spectacles and book laid down for his repast. His hands were folded in a prayer of thanksgiving alongside a simple crust of bread and bowl of soup. The young physician looked at the picture and cracked quite sincerely: "Now who could be thankful for an existence like that?" 
"Exactly," Viktor and Elly chimed in. "People today cannot understand how happy we were with almost nothing!" 
On another occasion, Viktor and Elly towed me around the city to see this and that. During the last taxi ride of the day they were enthusiastic about our last stop: the Poliklinik. Viktor paid the driver for the afternoon, since we would be walking home from there. With a camera still strapped to one hand and microphone in the other, I followed the vigorous Frankls into the front entrance, past the Poliklinik doorman to whom Viktor explained our mission. 
"Okay, fine, Herr Professor. Please go in as you wish." 
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Elly assured me that the interior of the building had changed little in fifty years. Down into the semi-subterranean level we went, to the very spot where they had met for the first time. Even the tiled floor was the same. I was surprised when Viktor and Elly began spontaneously to reenact their first meeting. I halted them while I readied my gear for photos and audio recording. Then camera. Action. 
There I was, witnessing as two mature people-88 and 68 years of ageacted out on the very spot, using the same sentences, their first encounter nearly fifty years earlier. 
"Herr Primarius, excuse me. I am from the dental department and we have no bed . . . "-the opening of a conversation upon which the future turned. What is now called in psychology a "flashbulb memory" had been blitzed into their brains lastingly and in exquisite detail because of its significance for them. 
On an occasion a few weeks after Viktor's death, Elly and I were sitting together at his desk. She shared with me a treasure that she had discovered only the evening before among papers Viktor had saved since 1945. On flimsy blue paper, now yellow with age at its fringes, she had written one sentence to him. Both the note paper and the envelope bore Elly Schwindt's initials, "E.S." On the envelope the penned words: "Herrn Primarius Dr. V. Frankl." And on the inside, written in her own hand: 
28.IV.46 Nicht Mitleid sondern Liebe ist's. Elly In English: 28 April 46 It is not sympathy but love. Elly 
Elly was surprised, upon reading her words again after fifty-one years, that she had written them so soon after she had met Viktor-in the same month. While she never "fell for" Viktor as he did for her, it was not very long after their meeting that their friendship evolved into a mutual romance. 
As Elly was fitting to words her memories of those wonderful days, I mused aloud on what that little note must have meant to Viktor when he read it the first time. How he must have thrilled to think that, after all, she had found it in her vibrant young heart to love him. He kept the little note "throughout decades," as he would have said. 
All Elly said in response was, "I don't know." And her eyes welled up. 
In Viktor's absence that day, which seemed so discordant, she also placed in front of me on the desk a 1946 first edition of Artzliche See/sorge. Inside on the title page Viktor had inscribed the book to her: 
"Wer das Tiefste gedacht, liebt das Lebendigste" (Holderlin) In Erinnerung an den Stadtpark am 6. Mai .46 VEFrankl 
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The second line is transparent: "On our first visit to the Stadtpark on the 6th of May 46." But the translation of H0lderlin's poetic line is difficult. Viktor, in one of our earlier conversations, had offered this rough translation: "Who thinks most deeply loves what is most lively." He explained further the sense that he took from it: "The one who is caught deep in his own thoughts is the one who is drawn most to what is full of life, to the most spontaneous expressions of our human experience." 
I pressed further to understand why the H0lderlin line was so meaningful in their journey. Viktor hesitated, so Elly responded first. 
"Without me he would get lost in his own world, in his own thoughts. I am down-to-earth, and he needs this. If I died today, in about three days he would die also-he would be so lost by himself." 
Viktor simply grinned a boyish grin and calmly added: "I would be codying." Then he seemed quite pleased when Elly and I laughed at the manner in which he expressed his agreement with her. 
Viktor used often the H0lderlin line, even in his last year, when he talked about Elly and what she was to him. And the date of his Stadtpark inscription indicates that Viktor first penned the line to Elly within a month of their meeting. And only one week after he had received Elly's little note, "It is not sympathy but love." 
Conclusion 
Very soon after they met, Viktor was certain that Elly was what he was not, and that he needed her. She offset his tendency to obsess. His spirits lifted when he was with her and he said over and over through the passing years that he relished her refreshing naivete and candor, her naturalness above all. He told me that no one can understand how much she meant to him, and that she sacrificed more in the cause of logotherapy than he ever did, and because of her love for him. 
For us who still live, there is an unforgettable picture of two poor but happy people strolling down Alser Strasse on a summer Sunday afternoon in 1946. Viktor, a thin, short, intense Jewish psychiatrist, highly educated, and wearing on his small feet his only shoes, fashioned for a girl. Alongside him a sweetheart half his age, with no advanced education, and from a Catholic family across the Danube. Elly is wearing the only footwear she owns: big black admiral's boots, built for a man. Arm-in-arm they go down the busy boulevard, so glad to be alive. He parades proudly in his one pair of white undershorts worn as his outer garment, the front of which she had sewn closed for him. 
They have almost nothing. Except for their fidelity to one another. And great fun being together. And memories of their loving families, thoughts about their friends. He carries a passionate sense of duty to the global human family and its oneness, and she an unequivocal devotion to him. They strut down Alser Strasse as if there were nothing more anyone could expect or ask. 
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One day when I was with Viktor and Elly I told them that I had visited their family burial plots in Central Cemetery on the main side of the Danube and Kagran Cemetery "on the other side." We all knew that religious convention would never allow Viktor and Elly to be buried in the same place as Jew and Christian. Then I pointed out that the Danube would flow between them in death as it had in birth. 
Viktor's response: "Who cares if we cannot be buried side-by-side? It doesn't matter a damn! What matters is that we have loved each other and worked together all these years. This can never be taken away!" 
There again was that defiant spirit which defined Viktor Frankl in his living, suffering, working, loving, dying. He took what was offered to him and made the most of it. He accepted what the world imposed, even its evil, and faced it down. He challenged us by word and deed to devote ourselves to persons other than ourselves and to causes greater than ourselves. He called us high-to human responsibility and reconciliation. And he practiced that same high calling to the last conscious moment of his life. 
In his final parting, Viktor left to us what he called a great honor: to help wherever and however we can. To answer responsibly, no matter what the circumstances, as life calls out to us. To do everything we can to make the world a better place. And he wanted us to know, by his loving union with Elly across half a century, that we can only do so together. That, in a manner of speaking, no one defies the Danube alone. 3 
HADDON KLINGBERG, Jr., Ph.D. [North Park University, 3225 West Foster Avenue, Chicago, Illinois 60625 USA] is a Clinical Psychologist and Professor of Psychology. His acquaintance with the Frankls dates back to 1962-63 when he attended Frankf's "Wednesday Lectures" at the Vienna Policlinic. 
1 Viktor Frankl Recollections: An Autobiography, Plenum Press, 1997, whose English text I edited at his request; it is a Joseph and Judith Fabry translation of the German Was nicht in meinen BDchern steht, Quintessenz, 1995. 
2 For one example, Frankl told the story of a prisoner at Auschwitz who urged his young wife to grant sexual favors to Nazi SS men who might demand such, if by so doing she could save her own life; in this way the husband forgave his wife in advance of such a circumstance (see The Will to Meaning, Meridian, 1988, p. 64). In another context Frankl told the same story autobiographically; that is, he identified himself as the prisoner-husband who frees his prisoner-wife Tilly from her obligation of sexual faithfulness to him in case of, and in advance of, a life-threatening situation (see Viktor Frankl Recollections: An Autobiography, Plenum Press, 1997, p. 90).
3 I hope that I may be forgiven for neglecting until this endnote other people of enormous significance for Viktor. It is because this article is limited 
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to a single biographical chapter. But readers should know what family meant to him. Whenever Viktor spoke of his own parents it was almost in a sacred way, and the manner of their deaths in the concentration camps he described as "a blow to the face of any theodicy." Following the Holocaust, in time and in addition to his dear Elly, he also loved and was loved by his daughter and son-in-law, Gaby and Franz; by his grandson Alexander; by his granddaughter Katja and her husband Klaus. Each was close to Viktor in unique ways and on them all he depended; his own human defects-of which he was aware and about which he was open-simply blended with theirs. So from Elly and from each of them he drew aspects of his strength and hope, and this was even more vividly evident to me as his eyesight and health deteriorated in his last years. The full story lends new meaning to my line: "No one defies the Danube alone." Other wellsprings for Viktor across his lifespan were an array of mentors and friends and, more privately, his obstinate sense of a mysterious Providence-though he would always defend, and be most amiable toward, anyone who preferred to call it "fate." 
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ISSN '0190-3379 · IFODL 24(1)1-64(2001)